THIS ISSUE ON HEALTH AND SOCIAL JUSTICE contains a selection of papers that were originally presented at a conference convened by the Royal Institute for Inter-Faith Studies in October of 2002. These papers reveal that the growing global public health crisis is an index of broader political and social crises and argue strongly for a social and political understanding of health, rejecting tendencies to isolate health in the individual body—the medicalization of health and illness.

While suffering is an integral part of the human condition, its distribution between and within societies is uneven. Injury, disease, frailty and longevity vary across social categories and are differentially distributed in all societies. Indeed, the distribution of illness and suffering can be the result of a deliberate policy of discrimination. Rune Flikke, in “Public Health and the Development of Racial Segregation in South Africa,” looks at the relationship between disease and social inequality in that country. Using an historical and anthropological approach, he explores the origins of social segregation in South Africa in the way that colonial medical discourses pathologized African culture as a source of disease.

The growing vulnerability of millions of People to the suffering caused by disease and violence is a measure of the crisis of the State in protecting and caring for citizens. Governments have been withdrawing from their commitment to public health either because they can no longer afford to invest the sums required or because International Monetary Fund (IMF) requirements for economic structural reform compel them to privatize.

Jihad Makhoul’s Study of poverty and health in postwar Lebanon reveals the state’s failure to provide basic health care for all of its citizens. She argues that the magnitude of deficiencies in the public health system is obscured by an absence of basic social statistics and bureaucratic monitoring systems. The consequence is that the nature of social inequality and its relationship to poverty also remain concealed. Information is the essential starting point for the establishment of public health needs. If Lebanon’s public health system was chronically deficient in meeting basic health needs before the civil war (1975-1990), then it is even worse in the postwar context.

The increased vulnerability of People to disease and illness has been exacerbated by the economic requirements of IMF structural adjustment policies. In post-colonial Africa, IMF policies have forced large cutbacks in health spending, which have led to the dismantling of public health institutions and large-scale unemployment among nurses and doctors. The HIV/AIDS epidemic in African states is itself a measure of the fragility of public health systems. In post-Communist Russia, IMF poliCies have been accompanied by a rapid increase in premature death rates among adults and epidemics of tuberculosis and sexually transmitted diseases within certain social categories. In his contribution, Craig Janes provides an account of the impact of the dismantling of the Soviet health care system and rapid privatization in post-Socialist Mongolia, where the development of a private primary care model has left doctors unable to treat the most common ailments. Janes argues that the ultimate effect of these policies is to “produce poor medicine for poor people.”

Not only is public health in crisis globally, but the paradigms and methods of modern medicine more often compound than alleviate the problem. Modern medicine and Other healing professions, such as psychology, medicalize suffering as illness in the body.

The political power of medical discourse emphasized by Flikke in the colonial context continues today through the process of medicalization or the increasing dominance of the professional medical model in determining the meaning and treatment of illness and suffering. In their essay, “Medicalization in Arab Society and Beyond,” Eugene Gallagher and Kristi Yingling argue that medicalization is “a dominating, macrosocial current in modern society, akin to urbanization, industrialization and rationalization.” By examining the impact of the medicalization of health care in Arab societies in relation to reproductive risks and consanguinity and the treatment of infantile diarrhoea, they reveal some of medicalization’s repercussions for personal identities and traditional values. Another dimension of medicalization that they touch upon is the influential pharmaceutical industry, which supplies the drugs used to manage all sorts of conditions,

The power of the professional discourse of medicalization has also become evident in the ways in which intervention and humanitarian assistance are provided in conflict settings. The widespread social condition of trauma in societies after violence has become increasingly medicalized and individualized as Posttraumatic Stress Disorder (PTSD). Healing has come to be conceived as reshaping the self through medical, pharmacological, or psychological techniques or reshaping the social relationships in which the self is sustained. In his article, “Collective Trauma, Psychiatric Morbidity and the Epidemiology of Dubious Knowledge,” Allan Young argues that, because PTSD’s symptomology is highly variable and because it has been conceptualized as individual, transgenerational and collective, it is better understood as a syndrome rather than a disorder. Importantly, PTSD has a moral dimenSion since the sufferer is seen as a victim—as having a psychological condition imposed exogenously.

The significance of health as a focus for social recovery and reconciliation in post-conflict situations is addressed in a case-study on postconflict Kosovo. In “International and Local Discourses on the Public Mental Health Crisis in Postwar Kosova,” Stevan Weine, Ferid Agani and Ralph Cintron look at the question of the effectiveness of international intervention in alleviating trauma and suffering. They argue that discourses on the relief of trauma and the protection of human rights do not adequately address local social, cultural and political contexts to allow greater participation by families and communities in ameliorating suffering and mental illness.

In “Psychosocial and Mental Health Principles for Use in Times of Armed Conflict and Natural Disaster,” Joop de Jong also explores the efficacy of international intervention and the scale of health problems in complex humanitarian and political emergencies.” Much like Weine and colleagues, he argues for a community-based approach to public mental health, while offering a flexible preventative and curative model for application in a wide variety of local contexts.

Beyond the question regarding the most suitable paradigms and technologies for healing lies a more general one on the selective nature of intervention. Healing is not only a matter of technique, but of ethical perception as well. Suffering is not only unevenly distributed, it is differentially and selectively recognized. William Connolly (1999) points out that the threshold of moral vision must often be adjusted in order for human suffering to be recognized. The extent to which human suffering is either ignored or denied is a measure of the ethical crisis of our global age. Discourses on health and suffering are thus inextricably tied up With the exercise of political power, as well as perceptions of social justice. If, as Veena Das (1999) argues, theodicy—the meaning of human suffering—has been made a bureaucratic and political issue, rather than a religious one, then the failure of governments to address the public health crisis (and increased social suffering) will undermine their legitimacy. In my own paper, entitled “Healing and Justice after Atrocity: Challenging Impunity,” I argue that the failure to address the victims of political violence is a failure to recognize the importance of truth and justice for social healing, that is, for the social rehabilitation of fractured societies. The ongoing human rights movements to confront the issue of the ‘disappeared’ after transitions to democracy demonstrate that justice and reconciliation are fundamentally about moral reconnection and recognition.