People in More Equal Countries Enjoy Better Health: What Should Clinicians Do?

I.When citizens of a country succeed in making incomes more equal, the health of nearly everyone improves. Clinicians interested in being part of movements for greater income equality have two roles,as a citizen and as a professional. In the second role, they may ask whether professions themselves have at times opposed greater income equality. If so, how could professions be changed? These are old questions, still new. II. I will answer these questions by making four arguments. 1) A key obstacle to achieving greater income equality is a small corporate class. They persuade the majority to consent to extreme inequality. 2) Many professions, including medicine and psychology, inadvertently help in this persuasive effort. 3) However, clinicians in several traditions, such as social medicine, liberation psychology and democratic psychiatry, have helped to reform professions and democratize health care systems. These actions have supported broader movements toward greater equality. 4) One can think about a strategy for a more democratic health care system in two steps. First, consider the most feasible type of change, reform of an existing structure or creation of a new structure, such as a cooperative, beside the old., Second, imagine the system as an irregular pentagon. At the points of the pentagon are theories about illness, clinical practice, institutional structure, laws and groups of patients and different professions, such as nurses and doctors. Robert Castel suggests that changing the relations among these points is essential. This is a good starting point for a discussion.