One - The healthy society

Summary

It is something of a cliché that just as we as individuals are born into a ready- made society, so this same society is, in many fundamental respects, a product of prior societal forms. How best to interpret the past has given rise to a discrete area of study known as ‘hermeneutics’. Are we to understand past societies in terms of the frames of reference of those inhabiting them at the time? Or deploying the frames of reference available to us in the present? Or can we as historians or social scientists develop frames of reference that somehow transcend these past– present divides? What is unquestionable is the omnipresent requirement that these hermeneutic quandaries and the sensitivity and restraints they demand are understood and factored into historical- social enquiries. As will become clear, what we might call ‘health problems’ have inevitably varied by time and by place. Less resistant to capture are variations in life expectancy: after all, all humans are born, live their lives, and then die. The problems with data on life expectancy hinge on their paucity and validity. It is only relatively recently that data, globally and by continent and nation state, have become available, permitting comparative analyses; but even these data sets admit of variation due to interand intranational differences in data collection and processing.

Box 1.1 offers a summary of historically evolving types of society. What this does is help position and facilitate analyses of social order and change and their ramifications for population health and health care. But two qualifications are necessary. First, the whole business of ‘periodising’ history is problematic and can easily mislead the unwary: there is always a mix of continuity and change. I have used the phrase ‘pendulum paradox’ to allude to this issue. It tends to be sociologists who look for and trade on the patterning of events and want to theorise about social order and social change. Historians on the other hand prefer to focus on events and sequences of events. When the pendulum swings towards sociology, critiques typically emphasise the complexity of events; and when it swings towards history, critiques complain of an unnecessary curtailment of explanatory ambition.