Chapter_30(S)-01
INFOGRAPHIC: The main determinants of health.
Health is not just determined by 'disease' but, according to the World Health Organization (WHO), a complete state of physical, mental and spiritual well-being. In recent years, the predominant view—that individuals are the primary agents of their health—is being challenged to encompass the more (realistic) 'rainbow' model of the social determinants of health that include societal changes governing circumstances and behaviour. (Adapted from, Dahlgren, G., and M. Whitehead (2007). Policies and strategies to Promote Social Equity in Health:Background document to WHO – Strategy paper for Europe. Stockholm Institute for Future Studies; 2007:14.). (French version).

— Abstract

The twentieth century witnessed a number of transitions in health, including longer life expectancy and changing burden of disease. Yet it also resulted in persistent inequalities in health outcomes within and between countries. Underpinning this result is a tension between different ways of valuing health: as a consumable product, an investment, or as a right. Over time, there were distinct waves in thinking on the linkage between health and development: from a tropical health era focused on diseases endemic to developing countries; to an international era of efforts to control population, improve nutrition, and immunize children. The current global era targets the burden of disease, maternal health, and tackles new pathogens. Looking forward, concerns for equity and security are driving a systemic view of health, particularly on financing (prepaying to avoid catastrophic out of pocket expenses) and governance (with a shift of power from international organizations to non-state actors).

- Download this Chapter -

— Suggested Readings

Chen, Lincoln C., Tim G. Evans, and Richard A. Cash (1999). “Health as a Global Public Good,” in I. Kaul, I. Grunberg, and M. A. Stern (eds), Global Public Goods: International Cooperation in the 21st century. Oxford: Oxford University Press, 284–304.

De Savigny, Don. (2008). Fixing health systems. Ottawa: International Development Research Centre.

Frenk, Julio. (2010). “The Global Health System: Strengthening National Health Systems as the Next Step for Global Progress,” PLoS Medicine, 7(1).

Hernández Bello, Amparo, and Carmen Rico. (2011). Protección social en salud en América Latina y el Caribe: investigación y políticas. Bogotá, D.C.: Editorial Pontificia Universidad Javeriana. (Résumé en français disponible ici)

Levine, Ruth and What Works Working Group (2007). Case Studies in Global Health: Millions Saved. Sudbury, MA: Jones & Bartlett. [PDF 2MB]

Weil, David N. (2015) "A Review of Angus Deaton's The Great Escape: Health, Wealth and the Origins of Inequality" Journal of Economic Literature 53(1): 102-114. [PDF  487 KB]

Omran, A. R. (1971), “The Epidemiological Transition: A Theory of the Epidemiology of Population Change,” The Milbank Memorial Fund Quarterly, 49(4): 509–38. [PDF 474KB]

WHO (2010). The World Health Report—Health Systems Financing: The Path to Universal Health Coverage. Geneva: World Health Organization.

World Bank (1993). World Development Report 1993: Investing in Health. New York: Oxford University Press. [PDF 1.3MB]