ABSTRACT
In this final chapter, we wish to draw together some of our contentions and conclusions and suggest, tentatively, how the understanding of medicine and health may be advanced. Throughout the book, when considering disease, medicine, health care and health itself, we pointed to the role of the social fabric. The natures and effects of all these phenomena are, therefore, shaped and influenced by their containing societies. This is not to suggest that their impacts or effects on such factors are precisely the same for all individuals and groups within those societies. Other factors-environment, work, class, culture, personality — intervene to predispose individuals and groups in specific ways. Health inequalities and differential ecological association between disease and group are but two examples of the influence of such factors. Nor should we suggest that health, medicine and health care are simply reflexes of the social order. We cannot determine the conception of health or the nature of the health care system simply by looking at the nature of societal development. Predisposing factors do not operate uniformly, nor always in the same direction. Once formulated, conceptions of health and health care delivery systems have their own impacts on the social order. There is thus no unique logic of industrial development and the intended consequences of health care provision may produce some unintended effects. Individuals and groups, for example, do not simply accept their fate; or, more accurately, they do not acquiesce for ever. They learn from their own experiences — from their own health status and own accessibility to health care resources. Their experience, therefore, contains within itself an immanent critique, not only of everyday life but also of the institutions and structures that shape that life.
