The article analyzes briefly the effect of a hierarchical structure of the health team on patient and community health outcomes. It then assesses the role of the total school system in nonsocialist underdeveloped and developed countries in reproducing this hierarchical structure. First, the school's selecting/channeling process determines who will or will not ascend to various levels in the health hierarchy, by means of (a) the differential allocation of educational resources by social class, race, and sex, and (b) evaluative instruments containing systematic invalidities which select specific groups over others. Second, the socialization process of the schools by means of the structure of human relationships (democratic/authoritarian, competitive/cooperative, creative/alienating) inculcates specific attitudes and behaviors “appropriate” to the specific hierarchical level attained. The article then analyzes the determinants of school structure, suggesting that educational and health care outcomes, while often not serving the public interest, do in fact serve the interests of those whose economic resources and power enable them to determine the structure and function of the schools. The school structure thus serves to maintain and reproduce the hierarchical organization of the health work place which in turn is determined by the economic and political structure. Finally, the article discusses the role of the health intellectual in the critique and formulation of educational and health policy.
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