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Introduction
What are the conditions most conducive to good health? Conversely, what are the conditions that are most likely to lead to or perpetuate ill health? These questions have vexed researchers for many years, with adherents to particular theories seeking out evidence that appears to support of their own preferred explanation and ignoring evidence that conflicts.
Some researchers argue that income distribution and other related ‘social’ factors are at the heart of the problem. They assume that income inequality is directly and causally responsible for much of the world’s disease burden.
Other researchers argue that the availability of government provided health services is the fundamental issue. For them, the presumption is that the governments of poor countries must be given supplemental resources in order to improve their provision of health services.
There are also those who point out the strong relationship between levels of economic development and the health of the population. But the direction of causation is disputed: a spate of publications has recently promoted the idea that the provision of health services is a pre-requisite of economic growth – rather than the other way around.
Others question the validity of both the ‘social determinants’ argument and the assumption that increasing public spending on health is the most effective means of improving health and wealth. It could be that policies which seek to redistribute wealth in the name of improving health may actually be counterproductive — jeopardising wealth creation and thereby keeping people both poor and ill.
This paper analyses existing literature and elucidates the real determinants of health. It is divided into four parts. Part one looks at the relationship between health and wealth, and evaluates the claim that a massive increase in public health investments in poor countries will result in improved health and economic development. Part two considers the role of markets and their underlying institutions – especially property rights, enforceable contracts, the rule of law – in providing a framework for
economic development and enabling people to address the diseases of poverty.
Part three examines the supposed link between income inequality and ill health, and questions to what extent the two are linked. This is followed by an examination of the impact of globalisation on health, in the context that this process is often accompanied by rising international income inequality. The final section takes a critical look at the so-called “social determinants of health”, and suggests some ways market-based policies can improve social and health conditions.
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