de Kadt E
Soc Sci Med. 1982;16(6):741-52. doi: 10.1016/0277-9536(82)90465-8.
As in any area of socio-economic reality, ideological interpretations influence our understanding of matters to health and health policy. Ideologies simplify and fudge issues. Yet ideologies, social movements and social research relate to each other in complex ways, and there are also innovative and creative aspects to this relationship. After a brief general discussion of ideologies, the paper examines the significant insights gained from analysing the role of ideologies (dominant, radical and subordinate) in class societies: much of this is relevant, by analogy, to the field of health. Various explanations of health and ill-health are then discussed. While capitalist socio-economic organization has undoubtedly had negative health effects, capitalist societies are neither as uniform nor as unreformable as Marxist analysis (and ideology) suggests. Similarly, there is exaggeration in Illich's description of the ills of industrialism. Yet his concept of the medicalization of health helps to understand how the dominant conception of medicine and ideologies dominant among health professionals interact to create institutions--also in wider areas of health planning--that express the power of physicians and benefit elites. These effects are particularly acute in capitalist societies. As for the problems and achievements in health of so-called socialist countries, these are frequently presented through rose-coloured spectacles, thereby hindering a realistic assessment of alternative policies for moving towards Health for All by the Year 2000, WHO's current organizing make-shift and contradiction, especially with regard to the ideas of 'political will' and 'community participation'. The paper ends with a discussion of the latter concept. In practice this may mean little more than co-option and contribution, or it may give people a genuine chance to influence what deeply affects them. It does not help to erase such fundamental differences by the ideological language of international compromise.
如同在社会经济现实的任何领域一样，意识形态解释会影响我们对健康问题和卫生政策的理解。意识形态会简化并模糊问题。然而，意识形态、社会运动和社会研究之间以复杂的方式相互关联，而且这种关系也存在创新和创造性的方面。在对意识形态进行简要的一般性讨论之后，本文考察了通过分析阶级社会中意识形态（主导、激进和从属）的作用而获得的重要见解：通过类推，其中许多见解与健康领域相关。随后讨论了对健康与不健康的各种解释。虽然资本主义社会经济组织无疑对健康产生了负面影响，但资本主义社会并不像马克思主义分析（及意识形态）所表明的那样统一或不可改革。同样，伊利奇对工业化弊病的描述也存在夸张之处。然而，他的健康医学化概念有助于理解医学的主导观念与卫生专业人员中占主导地位的意识形态如何相互作用，从而创建出在更广泛的卫生规划领域中体现医生权力并使精英受益的机构。这些影响在资本主义社会中尤为严重。至于所谓社会主义国家在健康方面的问题和成就，人们常常戴着有色眼镜看待，从而阻碍了对实现2000年人人健康的替代政策进行现实评估，而这正是世界卫生组织当前的临时组织架构和矛盾所在，尤其是在“政治意愿”和“社区参与”等理念方面。本文最后讨论了后一个概念。在实践中，这可能仅仅意味着被吸纳和做出贡献，或者可能给人们一个真正影响深刻影响他们事物的机会。用国际妥协的意识形态语言来消除这种根本差异并无益处。
