chapter  3
20 Pages


In the earlier chapters it has been argued that many of the policies and practices of our health systems continue to perpetuate reductionist views of how health is maintained; they pursue the analogy of bodies as machines which, if they break down, can be fixed by the use of ever more expensive and complicated medical technology (supplemented by some individual responsibility for personal behaviour). However, there have always been powerful arguments that would suggest that this partial view of the phenomenon of health creates a distortion of perception and practice. There have always been voices, in most cultures, which draw attention to the centrality of environment, milieu, context, to the notion of health. Among the most cogent of these more recent arguments in western society (we shall turn to other cultures later) are those to be found in the body of knowledge that we can describe as the ‘social determinants of health’ literature, providing striking fresh evidence of the fact that health and illness are linked, inextricably, to the social, cultural, economic and emotional environments of individuals and communities. Health is not just situated in the environment: it must be seen as the very interaction between the self/ community and the environment.