THE MARKET IS A STRANGE CREATURE - FAMILY MEDICINE MEETING THE CHALLENGES OF THE CHANGING POLITICAL AND SOCIOECONOMIC STRUCTURE

The market is a Strange creature: Family medicine meeting the challeng es of the changing political and socioeconomic structures. Family Prac tice 1995; 12: 394-401. This paper examines the extent to which family medicine is prepared to face today's political and socioeconomic tren ds. A modest assumption is that most countries will avoid the threats of food and energy crisis, environmental disasters, social collapse an d even wars. Given that privilege, family medicine is faced with recen t trends of market liberalism throughout the world, giving rise to new perspectives of economic prosperity, as well as widening gaps between the rich and affluent, and a growing number of unemployed, poor, and 'marginalized'. The recent UN World Summit for Social Development in C openhagen highlighted the fact that poverty and long-term unemployment is becoming a permanent problem even in the rich world. The distincti on between rich and poor countries might be better understood as widen ing gaps between rich and poor people in both kinds of countries. The challenge to family medicine will be twofold: 1) To develop a broader understanding of the associations between social risk factors on a pop ulation level, and its clinical expressions in individual patients in terms of illness, sick role behaviour and manifest disease, as well as potentials for constructive coping; 2) To contribute to a universally available primary health care, meeting the needs also of those who ar e not in the best position to pay. We are reminded of the classic 1971 Lancet paper by Julian Tudor Hart on ''The inverse care law'',(1) imp lying that ''the availability of good medical care tends to vary inver sely with the need for it in the population served''. In a world plagu ed with unforeseen discontinuities, general practice will need to main tain its core of 'personal doctoring'. Meeting people at the primary c are level provides unique opportunities of being sensitive and respons ive also to unexpected changes in society, and in some areas even maki ng contributions to the directions of change.