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The re-publication of this remarkable book could not be more timely. As America considers strategies to follow in health development, The Hidden Health Care System reminds us that achieving and maintaining health calls for strengthening the often unrecognized resource in health care — non-professional resources that people depend on. These “mediating structures” are complementary to the formal system of medical care. They are a vital component of the health care system. A must-read for health professionals and policy makers, this book will change the way US health care is planned and implemented.

Nora Ellen Groce, PhD, Leonard Cheshire Chair
Department of Epidemiology and Public Health University College London

Einstein’s definition of great scholarship is meant to invoke imagination. Levin and Idler do precisely that. Hence their pioneering work strongly merits reissue, given the continuing urgency of the same topic. Every field of science has a natural history phase. Considering that the first issue of The Hidden Health Care System was published in 1981, this reissue documents how ahead of the times and how pioneering this work was! Levin and Idler’s work fits the evolving social model of health. Today’s model of health is deeply committed to a social model without betraying the fundaments of biology, and looks to advances in medical care to take a broader systems view. Enrico Fermi (1953) urged us to think of nature in terms of complex math. Levin and Idler remind us that our health care model is likewise complex, and hidden, though self-evident.

Berton H. Kaplan, PhD.. ABMR
Department of Epidemiology UNC School of Public Health

Levin and Idler’s, The Hidden Health Care System is in many ways even more important for academics, policymakers, health care providers and communities to understand today than it was when first written in 1981. Its re-release is timely in the face of all that prefaced the focus and passage of a health care reform bill almost 30 years later. Health care costs, gaps in access, and unsustainable ‘state’ run programs have reached zeniths heretofore never conceived. This reality when coupled with empirical data pointing to ‘health care’ as representing but a fraction of what can be attributable to one’s health, should guide how policymakers attack these runaway problems. Perhaps more time, money and effort should be paid to the ‘nonhealth care’ aspects of health. Understanding and optimizing ‘hidden’ mediating structures of health may be where proportional efforts should lie.
         The book explains through the use of classic studies what is meant by the ‘mediating structure’, and why medical science can only take us so far. The authors chose a few such structures to discuss in more detail. Families, religion and communities are mediating structures used as exemplars in the book to illustrate the construct. A new preface acknowledges the boom in technology not widely in play when the book was first written. However, the ideas hold and may be important in the new socialization that virtual networks provide.
           The authors offer that mediating structures must be instrumental as well as expressive in order to help the person in ill health in any meaningful way. In other words, the family, religion or community must move from ‘admiring the problem’ of the individual to actually assisting in achieving the improved outcome. It is explained that while the former task is oriented to the individual the latter is moreso ‘to the larger society’. The book illustrates how this connection of structure and society has been lost over the last centuries, leaving our health care in the hands of strangers. Indigenous societies show how connection is important in the total or holistic health of the person, the community and beyond.
          The authors noted that the terms, ‘Health’ and ‘Medical’ care were confused decades ago. These terms remain at the root of a current debate for example, whether the ‘Health Care Home’ or ‘Medical Home’ is more appropriate. They offer some health policy tips on what should be taken into consideration regarding non-professional, lay, and informal health provision i.e., the bulk of all provision of health care. And, the importance of these structures has become more significant as we move more towards a nation of chronic diseases as our primary health concern.

 Margaret P. Moss, PhD, JD, RN, FAAN 
2008-2009 RWJF (Robert Wood Johnson Foundation) Health Policy Fellow