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Fortunately there is a substantial international literature that deals with this point, and it is to this literature that we turn now. 8 For a concise examination of the social determinants of health, see Wilkinson, R. 12 We note, for example, how following the 1989 National Aboriginal Health Strategy in Australia, there was a powerful emphasis in national public policy on the need for better infrastructure – especially improved housing, water quality and sanitation – as the way to make progress in Aboriginal health, almost to the detriment of the provision of health services at all. The work of Thomas Mc Keown in the 1970s and more recently, substantial evidence of the importance of the social determinants of health, have critically challenged the ‘common-sense’ idea that improved population health is simply the result of better health care. This is of course was very different to the intent of the Strategy. For example, in his highly influential book, Development as Freedom, Amartya Sen suggests that increases in life expectancy in 20th century Britain were particularly strong in those periods marked by a strong emphasis on social sharing, and the public provision of health care and nutritional support. "The contribution of medical care to mortality decline: Mc Keown revisited." J Clin Epidemiol 49(11): 1207-13, Nolte, E.
Omran’s model has attracted the attention of demographers [7–9], medical anthropologists [10,11], economists , and public health policy workers [13–15].
To date it has received scant attention from epidemiologists, however .
The first transition occurred with the shift to agriculture about 10,000 YBP, resulting in a pattern of infectious and nutritional diseases still evident today.
In the last two centuries, some populations have undergone a second transition, characterized by a decline in infectious disease and rise in degenerative disease.
Thirty years on, most workers in the field would agree in broad terms with Mc Keown’s hypothesis.
Nevertheless, his theory has been refined and updated, and most theories advanced in recent years see the provision of health care as at least a part of the explanation for better health. This review explores the evidence both domestically and internationally as to whether access to high quality primary health care is essential to enhancing Indigenous health status.Page last updated: June 2008 To the common sense view, the proposition that better health is the result of better health care – more spending on health systems, more health care workers, more advanced drugs and treatments – is unarguable.It is simply assumed to be true, and a considerable amount of public and political discourse in Australia is based on the more-or-less uncritical adoption of this view.However, there have been serious challenges to this apparently obvious assumption.He even rejected any significant role for public health measures such as improved hygiene and sanitation, again because they only became effective after the decline in mortality was well underway.At the time of their first publication, Mc Keown’s theories flew in the face of accepted wisdom which saw scientific advance and better medicine as the principal drivers of better health.Mc Keown’s argument was based on the fact that between roughly 18, the greatest decreases in mortality and advances in life expectancy for particular diseases occurred before the introduction of improved medical treatments for those conditions.Mc Keown argued that these advances were actually the result of better nutrition associated with rising living standards.Top of page Accordingly, there is now a general consensus that health care systems’ contribution to population health is far from negligible. The epidemiological transition model describes the changing relationship between humans and their diseases.