Chapter 1: Introduction
Health policy is collective action. It is action undertaken by a group of people because doing nothing does not bring about the kind of society in which they wish to live. Richard Titmuss said it all: ‘Social policy is about social purposes and choices between them’ (Titmuss, 1974: 131). Social policy has ‘no meaning at all if it is considered to be neutral in terms of values’ (Titmuss, 1974: 27). Ideology is on the x-axis. Belief is on the y-axis. Stranded in between, there is thee and me. That is how health policy is made in a liberal democracy that is built upon economic exchange but upon the common identity as well. Richard Titmuss had public policy in his blood. Adam Smith did not. Adam Smith was in favour of pecuniary self-interest, rational choice and the invisible hand of supply and demand. The consumer and the shopper, he said, could be relied upon to produce the well-being of nations. The discrete individual knows where the shoe pinches. The gain-seeking salesman knows whom he has to satisfy in order to live well: ‘By pursuing his own interest he frequently promotes that of the society more effectually than when he really intends to promote it. I have never known much good done by those who affected to trade for the public good’ (Smith, 1961 : I, 448). Adam Smith looked to goal-orientated exchange to maximise people’s well-being, self-perceived.