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The value of this interesting study is somewhat reduced by the overtly political comments in many chapters. Had the politics been confined to an introductory preface, readers could have concentrated better on the substantial arguments of various authors that growing social inequalities in today's world exacerbate health inequalities and reduce the quality of life for poorer people, especially in developing countries. The sustained and telling criticisms of the health policies of the WHO, Unicef, World Bank and IMF merit examination.
Some of the best health chapters are: 7, where two Mexican professors of social medicine analyse critically the World Bank's approach to investing in health, arguing that the Bank sees this as a realm for privatisation and capital accumulation rather than controlled state expenditure; 10, where Debabar Banerji, professor of social medicine in New Delhi, offers a powerful global review of international and national health policies and deficiencies in many countries, including the unreasonably homogenised approaches to immunisation, AIDS and tuberculosis, and the heavy handed Malthusian family planning policies in India and China; and 12, on the proposed switch of Medicare funding in the US to the voucher system, offering a balanced critique of the arguments.
Most of the authors ignore the problem that in democratic societies the voters ultimately decide how much taxation they will accept for health and other services. In conversations with leading WHO figures in the mid-1980s, this reviewer was told of the yawning financial abyss that faced every health system, with limitless demands and a limited tax base.
Rather than seeing the injustice of inequalities as deliberate capitalist ploys, attention should be given to new systems that can ensure greater equity. Chapter 15, by Richard Wilkinson, a research professor in the UK, offers one solution—that greater economic and industrial democracy could lead to a fairer allocation of resources.