ABSTRACT
Health is fundamental to the human experience. It is a precondition for most of the activities that we defi ne as human: our culture, economy, child-raising, laughter, sex, work, freedom of choice, the affi rmation of our rights — all are in some way dependent on the health of the individual and their community. Health is also an outcome of the human experience: humans work to create and use resources that result in health and wellbeing, such as food, education or leisure. Positive endeavours lead to greater social capital, success and even positions of social dominance. This then increases overall wellbeing and life expectancy for both individuals and communities. However, this same principle also leads to poor health outcomes. In situations where freedoms are denied, education not provided, work not done or environments in which violence, inequity and exclusion are common, there are often signifi cant negative effects on health. The health status of populations can, therefore, serve as an indicator of the levels of equality, trust and wellbeing in a community, just as it can provide evidence of the levels of direct and indirect violence, inequity and the abuse of the environment. Using this approach means that health becomes a lot more than just a product of medicine — it becomes an outcome of the effects of these social and environmental ‘determinants’ of health. For health and development workers, this represents a paradigm shift in thinking: to improve health, we need to
challenge the underlying injustices and social conditions which lead to poor health outcomes. It also means that health extends far beyond the responsibility of the professional health worker — it requires active and critical citizenship.
