The social study of medicine used to be inhibited by the awe which doctors inspired in lay people. Doctors would conduct their esoteric debates among themselves, confident that the leading issues were purely technical in nature. During the past generation, however, the caring professions have become less confident of their prescriptions, and correspondingly willing to discuss their concerns with a wider public. Meanwhile the soaring cost of medical services has provoked wider debate about health policies, and closer attention to the costs and benefits of programmes. The community as a whole now funds services which most individual patients cannot afford.

The new openness is especially marked in those regions roughly described as the ‘third world’, newly emancipated from colonial administrations. Colonial governments discouraged public debate on social policies generally, and consumers of those policies lacked a forum for canvassing their needs. Independence created forums for debate, and continuing poverty and low standards of living promoted discussion of the relative merits of health programmes as against education, or agricultural extension, or any other element of ‘development’. These discussions have also been internationalised, to match the international implications of any single country's health hazards. The present AIDS epidemic and the remarkable revival of malaria are only the most visible of many concerns which agitate researchers, practitioners and planners throughout the world.