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Health may be defined as a state of balance in our body, mind and soul. When this balance is disturbed, so is our health. However, the balance in our health is fundamentally related to the balance in our society. Imbalances in our societies, particularly of a socioeconomic nature, would naturally affect our inner balance and health. Hence, this book argues that imbalances in the distribution of socioeconomic resources have led to inequities in health both within and between nations. It systematically explores the roots of inequalities in markets as the dominant distributive mechanisms in advanced capitalist economies to show their inherent biases against the poor and less powerful. It also describes the various social protections that have been put in place in the post-war era to protect the vulnerable among us, and documents how such protections have been rolled back with the rise of neoliberalism, especially after the recent financial crisis. It calls for social medicine, both in the sense of understanding health as the outcome of social conditions, and as the necessity of a collective approach for addressing health inequities through a social polity, as it contains the costs and sustains the healthcare systems.

Jalil Safaei Department of Economics, University of Northern British Columbia, Prince George, BC, CanadaBackground: There is a vast body of literature on deliberative, participative, or engaged democracy. In the area of health care there is a rapidly expanding literature on deliberative democracy as embodied in various notions of public engagement, shared decision-making (SDM), patient-centered care, and patient/care provider autonomy over the past few decades. It is useful to review such literature to get a sense of the challenges and prospects of introducing deliberative democracy in health care.Objective: This paper reviews the key literature on deliberative democracy and SDM in health care settings with a focus on identifying the main challenges of promoting this approach in health care, and recognizing its progress so far for mapping out its future prospects in the context of advanced countries.Method: Several databases were searched to identify the literature pertinent to the subject of this study. A total of 56 key studies in English were identified and reviewed carefully for indications and evidence of challenges and/or promising avenues of promoting deliberative democracy in health care.Results: Time pressure, lack of financial motivation, entrenched professional interests, informational imbalance, practical feasibility, cost, diversity of decisions, and contextual factors are noted as the main challenges. As for the prospects, greater clarity on conception of public engagement and policy objectives, real commitment of the authorities to public input, documenting evidence of the effectiveness of public involvement, development of patient decision supports, training of health professionals in SDM, and use of multiple and flexible methods of engagement leadership suited to specific contexts are the main findings in the reviewed literature.Conclusion: Seeking deliberative democracy in health care is both challenging and rewarding. The challenges have been more or less identified. However, its prospects are potentially significant. Such prospects are more likely to materialize if deliberative democracy is pursued more systematically in the broader sociopolitical domains.Keywords: citizen juries, patient engagement, shared decision-making, decision aids, public participation

Background: The social and economic woes that have inflicted many countries around the world are testimony to the inadequacy of current institutional makeup of societies where individualism and market forces by and large have taken the leading role in directing societies' choices and resources. Problems of inequities in health and wealth, the widening gaps between the rich and the poor, employment insecurities, the growing social exclusion of the marginalized, and the looming environmental concerns are acute as ever. At the same time, the progressive social forces and the counter-balancing capacity of governments are being undermined by the prevailing neo-liberal forces. This sobering state of affairs can only lead to more problems and a growing frustration on the part of those who seek alternatives to the status quo, which have actually produced better results in certain countries. Objective: This study takes the position that the involvement of democratic collective institutions (e.g., local organizations and governments at all levels) in setting societal priorities and directing resources towards achieving those priorities would avoid or mitigate many of the socioeconomic problems facing us today. It aims to show that comprehensive social policy could prevent the emergence of such problems and contain the problems that remain, effectively working as a social vaccine. Methods: The study uses macroeconomic panel data and socioeconomic indicators from OECD countries to empirically examine the relationships between indicators of social wellbeing on the one hand, and measures of social policy on the other, while controlling for relevant macroeconomic covariates. Results: The empirical results indicate that better population health outcomes are consistently associated with stronger social policies, including social spending on health and non-health services. Also, they show lower poverty rate is associated with higher social spending. Lower crime rate is also associated with higher social spending, but it is strongly country-specific. Conclusion: Although improving social wellbeing and social protection are morally justified in their own right, the evidence presented in this study suggests that even a purely rational view concerned with the societal costs and benefits of public policy should find social policy an effective tool or vaccine against population ill-health, poverty, and crime.