The market is a strange creature: family medicine meeting the challenges of the changing political and socioeconomic structure.

Abstract

This paper examines the extent to which family medicine is prepared to face today's political and socioeconomic trends. A modest assumption is that most countries will avoid the threats of food and energy crisis, environmental disasters, social collapse and even wars. Given that privilege, family medicine is faced with recent 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 Copenhagen highlighted the fact that poverty and long-term unemployment is becoming a permanent problem even in the rich world. The distinction between rich and poor countries might be better understood as widening 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 population 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 are 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", implying that "the availability of good medical care tends to vary inversely with the need for it in the population served". In a world plagued with unforeseen discontinuities, general practice will need to maintain its core of 'personal doctoring'. Meeting people at the primary care level provides unique opportunities of being sensitive and responsive also to unexpected changes in society, and in some areas even making contributions to the directions of change.