POLITICAL ISSUES IN HEALTH 61 a political system which continues to encourage a country to be ruled by an oligarchy or whether it actively promotes a change in the social system which enables the masses particularly the underprivileged and the underserved, to actively participate and to have their say in the affairs of their country. Under a political system which sustains the status quo—which perpetuates c*n oligarchy—alternative systems are formulated either to find more effective approaches to serve the ruling oligarchy or, much worse, to provide an aura of legitimacy to an obviously unjust social system by arousing false hopes among the underprivileged and the underserved. Development of super specialities to provide services which are mostly accessible to the privileged classes can be cited as an instance of an alternative health care system within a political framework which perpetuates an oligarchy. Establishment in poor countries of Rotary Club supported cancer hospitals, setting up of units for cardiothoracic surgery, neurosurgery and other such super specialities and the opening of elaborate intensive care units, form the medical care components of alternatives under such^political systems. Campaigns for cancer control, development of genetic counselling services and control of noise pollution are examples of the preventive services component of such alternatives. Imposition of compulsory sterilisation on the weaker sections of the population, without making available to them even the most elementary health care services and economic security provides another facet of an alternative within this political framework. Efforts to cover up such an obviously unjust and inequitous distribution of community health resources in poor countries by projecting manifestly unreplicable measures as miracle solutions of the health problems of the masses in these countries form an even more pernicious category of alternatives within political systems that arc dominated by an oligarchy. Work by a highly respected clinician to develop ^voluntary" health services in a peri-urban population of a few thousands with the help of heavy State subsidy, heavily subsidised health insurance schemes to cover some villages and State subsidised health cooperatives to cover the medical needs of the ^middle" classes are instances of this categoiyof ^alternatives."2 In recent years a number of Christian missionary institutions, which have extended their ^charitable" medical work from the hospital to the community, have been projected with the help of a well orchestrated propaganda campaign as alternative health care systems8. Here, again, adequate consideration has not been given to their replicability in the rural population at large. In their eagerness to find alternatives within the existing political framework, unwittingly or otherwise, research weikers have lost sight of a most glaring sociological characteristic of rural populations of the poorer countries—the acute stratification of such populations into a