Should social scientists, in their professional capacity, help to formulate political ideologies, policies and programmes? Or should they – and can they – preserve a professional neutrality? I begin by exploring these familiar questions and conclude that social scientists are as entitled as the next man to debate social problems, but should bear in mind that there is no authoritative solution to most of them.

Efforts to eliminate poverty as a major domestic problem in the United States have a long history. The attack was significantly heightened in 1964 with the passage of the Economic Opportunity Act, the statute designed as the foundation of the so-called war on poverty. In the succeeding years which have encompassed two national Administrations, one Democratic and the other Republican, a variety of means have been brought to bear on the problem. Public-assistance expenditures have spiralled upward and substantial amounts of money and manpower have been funnelled into preexisting and new programmes to increase total employment, improve housing, provide more and better health care, equalize opportunities and outcomes across ethnic and racial groupings, and bring legal justice, safety and security to those who have heretofore lacked the financial means for full enjoyment of these values. Still other anti-poverty programmes are under active consideration, most notably President Nixon's proposal to put an income floor under every American household.

Social policy and taxation have commonly been regarded in Britain as quite separate aspects of government policy. Changes in taxation appear to be decided largely independently of the aims of social policy, and reforms of the social security system are often proposed with no regard to their fiscal consequences. Despite the fact that Chancellors of the Exchequer have recently arrogated the right to announce increases in National Insurance benefits, there is little evidence of co-ordination between the Treasury and the Department of Health and Social Security over income maintenance. Yet there is clearly a close relationship between these two arms of government policy, and it is important that any proposal for reform should consider taxation and social policy in conjunction.

Even in Western industrialized countries which have for several decades spent around 5 per cent of their Gross National Product on health care, interest in planning for health is recent. In countries like the United States, with what is sometimes described as a pluralist system, this is scarcely surprising. When the United States is described more bluntly, as it was for example by Walter Reuther, the incompatibility of planning with the general pattern of delivery is clear: ‘What we have, in fact, is a disorganized, disjointed, antiquated, obsolete, non-system of health care.’ But even in the United Kingdom with the framework for planning provided by the National Health Service, observers have been struck by the failure to develop an adequate planning mechanism in twenty years. This view has not been confined to foreign observers nor to British commentators outside the medical establishment.