And so governments have to decide which programs will best reward the investment of tax dollars (Merkhofer 1987).
One of the most controversial areas of public policy involves health care for that part of the population least able to pay for their own care. Socioeconomic status has been identified as a powerful factor in one's health (Bloomberg, Meyers and Braverman 1994). The more health problems that those citizens at the lower end of the socioeconomic spectrum have, the greater the tax burden will be on the rest of the citizenry.
However, while the politics of money should play a significant part in the development of social policy, there is also the idea of social justice to consider. Social justice takes on many definitions, depending on the political leanings of the definer, but the general idea involves the creation of a sense of fairness or equality of opportunity to members at all socioeconomic levels of a society (Jordan 1998; Marshal, Swift, and Roberts 2002). Under the Thatcher administration, inequalities in access to quality health care began to widen in British society (Wagstaff, Paci, and van Doorslaer 1991). When Prime Minister Blair took office, one of his first moves was to establish improved access to health care as a top priority.
There are at least three schools of thought as to how to engineer social change. The "laissez-faire" line of thinking - which basically involves allowing society to shake itself into the desired state - might argue that education alone would awaken the British public to the plight of the poor, particularly with regard to health care. The transition in the health habits of the Indian state of Kerala, between 1961 and 1974, could serve as a strong example for the laissez-faire viewpoint. Over that period of time, the birth rate fell from 39 to 26.5, while levels of literacy, life expectancy, female education, and age of marriage became the highest in all of India (Ratcliffe 1978). The cause of this change is not massive social expenditure for contraceptives, not an infrastructure of free clinics, but simply public education about the benefits of family planning, and about the importance of equitable distribution of opportunities (Ratcliffe 1978).
Near the other end of the spectrum stand the Social Democrats, who believe that social justice can be achieved, if government planners can only find the right level of taxation to put into place sufficient programs and infrastructure. The natural sympathy that rightly extends to those who need medical treatment that goes beyond what they can afford has made social justice one of the central ethical principles of public health nursing. Programs that do not ultimately result in a change of behavior, however, are only short-term solutions that will not change societal patterns over time (Drevdahl, Kneipp, Canales, and Dorcy 2001). Also, programs that do not accurately address the factors that connect socioeconomic status and health will, ultimately, waste taxpayers' money and will solve nothing (Marmot and Feeney, 1997).
The New Labour way of thinking sits somewhere, at least in its own mind, between the