Social Science and Public Policy

Richard Freeman

backpublications - prevention in health policy

Recursive politics: prevention, modernity and social systems

The aim of this paper is to connect the recent interest in prevention to recent developments in social theory. It begins by recovering some of prevention's essential features from the realm of common sense, showing that what is taken to be the common sense of prevention is emblematic of modernity. For prevention is built on scientific understandings of cause and effect and the possibility of prediction; on a capacity for controlled intervention by government in social life; on a universal value base; on the authority of professional expertise; on rational, calculating, individual social subjects. As this order develops and changes, many of its constituent elements begin to be threatened by social processes which it has itself set in train. Prevention is affected by (and implicated in) these changes, too. But far from being eclipsed by them it becomes more prominent. Drawing on systems theory, the paper argues that prevention meets the essential purpose of boundary maintenance by which the functioning of social systems is sustained. For reasons both external and internal to welfare agencies, including an increased burden of social risk and increasing organisational complexity, this need to mark and maintain system boundaries is ever more pressing. At the same time, at least part of the problem of the fragility of boundaries is attributable to attempts to maintain them. It is for this reason that preventive policy making can be described as recursive, or self-propelling.

Publication Type: journal paper      Source: Children and Society 13 (4) 232-241
Date: 1999       Link:

Prevention as a problem of modernity: the example of HIV and AIDS
Scott, S and Freeman, R

Publication Type: chapter in book      Source: Gabe, J (ed) Medicine, Health and Risk. Sociological Approaches, Sociology of Health and Illness Monograph Series, Oxford: Blackwell
Date: 1995

Prevention and government: health policy making in the United Kingdom and Germany

The gap between rhetoric and reality in health policy making for disease prevention services is well recognized. I do not try once more to close the gap, but rather argue that the rhetoric of prevention is politically significant. Beginning with an account of prevailing explanations of prevention in policy making, I explore the idea that prevention has a pervasive legitimacy in health politics. This affords opportunities for instrumental policy making by government. To this end, I concentrate on the relationship between disease prevention and health care delivery, discussing in detail the association between prevention and health care reform. My arguments are based on case studies of policy making in Germany and the United Kingdom. I discuss implications for understanding the core interests of government, physicians, and users with respect to prevention in health policy making. The concluding section offers comparative commentary on the role of disease prevention in health sector restructuring.

Publication Type: journal paper      Source: Journal of Health Politics, Policy and Law 20 (3) 745-765
Date: 1995       Link:


Prevention in health policy in the Federal Republic of Germany

The comparative study of what tend to be regarded as marginal questions of health policy, such as prevention, is developing slowly. This case study covers important developments in preventive policy making in the Federal Republic of Germany in the period 1968-1990. The paper is intended both as a descriptive summary of institutional arrangements for prevention in health and as a preliminary analytical essay. It considers the evolving positional interests of federal and state governments, the public health service, the sickness insurance funds and the medical profession. It looks in detail at constitutional conflict over prevention at the end of the 1960s, at the progressivism of health policy conceptions of the early 1970s, at the liberal conservatism which characterised the 1980s and at the place of prevention in health care reform legislation. It refers to responses to HIV and AIDS and comments on the extent to which the circumstances of preventive policy making in health have changed with unification. The paper concludes by discussing the importance of the German case in developing ideas about the role played by prevention in health politics.

Publication Type: journal paper      Source: Policy and Politics 22 (1) 3-16
Date: 1994       Link:


Prevention in health policy in the United Kingdom and the NHS
Allsop, J and Freeman, R

Publication Type: chapter in book      Source: Mills, M (ed) Prevention, Health and British Politics, Aldershot: Avebury
Date: 1993


The idea of prevention: a critical review

Publication Type: chapter in book      Source: Scott, S J, Williams, G H, Platt, S D and Thomas H A (eds) Private Risks and Public Dangers, Aldershot: Avebury
Date: 1992