Mckeown Thesis Summary

Mckeown Thesis Summary-77
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.

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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.

His controversial hypothesis helped revolutionise how the health of populations was viewed.

In the last fifteen years or so, a whole new theory and field of research has grown up that, like Mc Keown’s hypothesis, locates the major factors determining the health of populations outside the health care system, but which goes much further in exploring and documenting these factors.

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.

It has also been convincingly argued that medicine, as well as having a greater direct effect than Mc Keown’s analysis gave credit for, also had an indirect beneficial effect on population health.

Alternatively, while neither Mc Keown nor the researchers and theorists on the social determinants of health claim that health care has no effect on the health of populations, there have been times when their implicit or explicit critiques of the ‘medical model’ have led some to abandon the belief that the health system has any effect on the health of populations at all. (2005) The health status of Indigenous and non-Indigenous Australians, Discussion Paper No. UK Australia Seminar: Federalism, Financing and Public Health.

Top of page While neither of these reactions may be very useful or strategic, the question remains about the extent to which health services contribute to population health. Social Determinants of Health: the Solid Facts, World Health Organization Regional Office for Europe. Social determinants of Health: The Solid Facts, 2nd edition, Marmot, M and Wilkinson, R (eds.), International Centre for Health and Safety, Denmark. 486, Centre for Economic Policy Research, ANU, Canberra, and their estimate that income, employment status and education accounted for between one-third and one-half of the gap in health status between Indigenous and non-Indigenous Australia. Canberra, The Nuffield Trust and Australian Government.

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.


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