It has been argued that political democracy in nation-states is dependent upon certain levels of social and economic development. Some authors (Lipset and Cutright) argue that a particular complex of social and economic requisites appears necessary for the institutionalization and maintenance of democracy. Others (Lerner and Pye) suggest that national political development of any form is predicated upon the development of a system of communications sufficiently sophisticated to overcome the parochialism of traditional society. Still others (Almond and Verba) find social factors such as education crucial for the development of those attitudes deemed adequate for active citizens of democratic polities.By definition, political democracy in nationstates requires some minimal level of citizen participation in decision making. Historically the most effective method of institutionalizing such participation is through some form of representative government. This mechanism permits groups of citizens with common preferences to support representatives who will, in turn, attempt to schedule those preferences for decision by the government. Groups of representatives will form coalitions in an attempt to insure that their common preferences will be enacted into public policy. Because preferences in society are likely to vary in direction and intensity, the successful implementation of political democracy imposes two requirements. One, communication of preferences among competing groups, must be widespread. If they are not, it will be difficult for groups with shared preferences to combine their resources such that “majority” preferences can be successfully implemented. Indeed at a more basic level, communication is necessary for the identification and articulation of common preferences. Second, groups within the citizenry holding competing preferences must be socialized into the procedural norms of the system. Most important is the acceptance of the norms of compliance so that groups which “lose” on any given issue (enactment of a preference set) do not withdraw from the decision system or opt to overthrow it. In short, two primary conditions for the maintenance of any system of political democracy are, (1) communication among members of the political system and, (2) socialization into the “rules of the game.”
This paper presents a critical reaction to the Surgeon General's recent report and recommendations on American health. Entitled Healthy People, the report has been described as providing impetus for a "second public health revolution." Our analysis leaves us less than enthusiastic. We first summarize the Report, noting its heavy emphasis on lifestyle. We then compare its tenets with those of the nineteenth century public health revolution. The Report recognizes social and economic conditions as significant factors in determining health but fails to incorporate this recognition in its policy recommendations. Instead, it places the burden of its recommendations on the reform of individual behavior. We explain this focus in terms of the continued centrality of the ideology of individualism and its collective counterpart, social and political pluralism. We then examine the ways in which these ideologies act on the Report and we suggest why the proposals they shape are unlikely to be successful.
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