Representations used for health planning: naivety and crisis in the concepts and methods

This article supports the theory that one of the causes underlying the crisis in the health services in the crisis in the concepts and methods used. Examples from a Third-World country (Congo) and from an industrialized country (France) are given in which problems of the same nature are met. Epidemiology is of little use in defining health action save in the case of accurately-identified diseases for which efficient technical means are available. Detailed epidemiological data is of no use in establishing priorities for larger-scale action, since operational and political criteria are beyond its scope as a discipline. The infra-medical magma which constitutes the bulk of health problems has to be tackled from a point of view broader than the purely medical, since a great number of risk factors must be acted upon. Relations between different administrations and different professions founder on linguistic and power conflicts. Some of the administrative criteria recommended for the organization of the medical side of health care are neither practised nor practicable, since they take no account of the functional logic of such systems, particularly the balance of power between interest groups.