Abstract
This research examines the impact of cultural components and social justice on health policy in Iran after the Islamic Revolution. The main research question is how the cultural components and social justice concepts explored in the theories of Douglas and Walzer have influenced health policy in post-revolutionary Iran. The central hypothesis posits that cultural components, including Islamic values and concepts of social justice, have directly contributed to the formation of health policies aimed at achieving equitable access and improving the health conditions of marginalized groups. The findings suggest that health policies in Iran after the revolution, influenced by Islamic culture and principles of social justice, have focused on improving access to healthcare services in deprived areas and expanding health infrastructure. Rural health networks and the Health Transformation Plan, as examples of policies based on social justice, have made significant achievements in reducing health inequalities. However, regional and class-based disparities remain major challenges. The research method is qualitative, utilizing a documentary and library-based analysis approach.
Keywords: Justice, Culture, Health, Iran, Revolution, Insurance
Introduction
Public health, as a key pillar of sustainable development and social well-being, has long been a central concern for policymakers and researchers. In Iran, following the 1979 Islamic Revolution, health policy has been profoundly shaped by cultural, social, and economic transformations. Cultural factors—encompassing values, beliefs, and social attitudes—play a decisive role in shaping the provision and accessibility of healthcare services. In a society with deep Islamic and cultural roots like Iran, these factors often serve as a foundation for health policy formulation. Equally important, social justice emphasizes equitable access to healthcare for all segments of society, recognizing that social and economic inequalities directly affect service quality and availability. In light of recent reforms, such as the Health Transformation Plan and the establishment of national healthcare networks, this study examines how cultural factors and social justice influence post-revolution health policymaking in Iran, aiming to identify challenges, opportunities, and pathways toward a more equitable and effective healthcare system.
Materials & Methods
This study examines the evolution of health policies in Iran post-Islamic Revolution, focusing on the structural transformations, programs implemented, and challenges faced in the healthcare sector. The research utilizes a mixed-methods approach, integrating quantitative data from reports and statistical analyses with qualitative data from scholarly articles, policy documents, and expert opinions. The materials include publications from the Ministry of Health, WHO reports, and academic sources, which provide both descriptive and analytical insights into the impacts of these policies. The methods used involve a historical and comparative analysis of the healthcare system in Iran, assessing the effects of key policies such as the establishment of health networks, the family physician program, and the development of telemedicine services. Additionally, the study investigates how the economic challenges and international sanctions have shaped healthcare access and quality.
Discussion & Results
Post-revolutionary Iran witnessed significant transformations in its healthcare system, marked by an emphasis on expanding access to health services, especially in rural and underserved areas. One of the main structural changes was the establishment of a nationwide healthcare network in 1984, based on the WHO's Primary Health Care model. This network helped significantly increase the coverage of primary healthcare services in remote areas, which became one of the most successful health policies in the country. By 2020, over 5,000 rural health centers were operational, serving around 22 million people. Despite its successes, the network faced challenges related to the quality of services, including shortages of medical professionals and adequate equipment, particularly in remote areas (Hamidzadeh et al., 2019).
Another critical policy, the Family Physician Program, was launched in 2015 to provide primary healthcare in rural and underserved areas. By 2020, approximately 75% of the population was covered by this program. While this program has been hailed as a key element in improving healthcare accessibility, it has faced structural and operational challenges, including a shortage of trained personnel, delayed payments for physicians, and a lack of efficient monitoring systems (Behzadifar et al., 2019). The quality of care has been compromised in some cases, particularly in remote regions where healthcare professionals are scarce.
The use of modern technologies, such as telemedicine, has been an important development in Iran's healthcare policy, especially in light of the COVID-19 pandemic. The introduction of online medical consultations and health applications has provided remote access to healthcare for many, particularly in underserved areas. Reports indicate that about 30% of patients utilized these services during the pandemic, reflecting a notable success (World Health Organization, 2021).
The study also highlights the impact of the economic challenges and international sanctions on Iran's healthcare system. Sanctions have led to shortages in medical supplies and equipment, further exacerbating the difficulties in providing quality healthcare. The reduction in health budgets, due to the decline in oil revenues, has directly affected the provision of services, particularly in poorer areas. Furthermore, the increasing costs of treatment, especially for chronic conditions, have restricted access to healthcare for low-income populations (Mohammadbeigi, 2013).
In addition to these structural changes, the Ministry of Health has placed significant emphasis on human resource training, particularly in rural areas. Educational programs for nurses and healthcare workers have led to a 30% reduction in medical errors and improved patient satisfaction (World Health Organization, 2018). However, challenges remain, particularly in ensuring the equitable distribution of skilled healthcare workers across the country.
Significant improvements in public health have been observed, such as the reduction in infant mortality rates and an increase in life expectancy. The infant mortality rate decreased from around 50 deaths per 1,000 live births in 1980 to approximately 10 per 1,000 in 2020. These improvements are attributed to the expansion of healthcare services, maternal and child health programs, and vaccination campaigns. Iran’s vaccination program, in particular, has achieved high coverage, with over 95% of infants receiving full vaccinations, significantly reducing the incidence of infectious diseases (Ministry of Health, 2020).
Moreover, life expectancy in Iran has risen from about 55 years in 1979 to 77 years in 2021, reflecting the overall improvements in healthcare services, nutrition, and living standards (World Health Organization, 2020). However, disparities still exist in healthcare access, particularly between urban and rural areas, and significant gaps remain in terms of healthcare infrastructure and trained professionals in less developed regions.
Conclusion
In conclusion, the post-Islamic Revolution healthcare policies in Iran have made significant strides toward expanding healthcare access and improving public health outcomes, particularly in rural and marginalized areas. The establishment of the health network, the family physician program, and the integration of modern technologies like telemedicine have been central to these efforts. Despite these achievements, challenges such as insufficient healthcare resources, particularly in remote areas, shortages of medical professionals, and the adverse effects of international sanctions continue to impede the full realization of equitable healthcare for all.
The study underscores the importance of justice in health policy, particularly in terms of equitable access to healthcare services, which has been a central tenet of Iran’s health policies post-revolution. However, regional and socio-economic disparities remain a significant challenge, necessitating ongoing efforts to improve the quality of healthcare and ensure its distribution across all regions of the country. Additionally, the economic sanctions and budgetary constraints have impacted the healthcare system's ability to maintain its service quality, particularly in areas requiring specialized medical care and advanced medical equipment.
Finally, the research highlights the relevance of cultural values and social norms, especially Islamic principles, in shaping health policies in Iran. The emphasis on social justice and cultural compatibility in policy-making has influenced both the design and implementation of health interventions. The future success of Iran’s health system will depend on addressing these systemic challenges while continuing to emphasize equity and access in the face of evolving economic and geopolitical obstacles.