ABSTRACT
One of the striking features of the improved prosperity of countries since the industrial revolution has been the improvement of the health and well-being of populations (McKeown 1976; Fogel 1994; Frank and Mustard 1994). Dramatic as this improvement has been, the factors involved in determining the improved health status of populations have not been well understood. Some have championed improvements in medical care as the major factor in improving the health of populations while others have argued that it is better public health measures in the form of vaccination and better water systems. Important as all of these factors are, there is growing recognition that much of the improved health status following the industrial revolution was the result of prosperity and the associated social and economic changes. A society’s understanding of the determinants of health has an important influence on the strategies it uses to sustain and improve the health of its population. A dominant view in developed societies today is that the main cause of premature death is cancer and heart disease and that medical science will provide cures and strategies for prevention (Mackenbach 1993). Another view that is gradually gaining prominence is that the principal influences on the health and well-being of individuals and populations are the social environment, lack of social support, poor education, poor work conditions, and stagnant economies (Marmot 1986; Evans et al. 1994).
