In ancient societies collective action regarding the health of populations was reserved for promoting the comfort of elites. Despite the expansion of public actions in many societies to try and preserve the health of both rich and poor, inequalities in health belligerently persist both within and between industrial and non-industrial societies in the late twentieth century. Since the 1980s, as public health practice increasingly focused on the responsibilities of individuals, so the contract of health between governments and their citizens in advanced industrial societies began to change. Shifts in the modern—or postmodern—social contract of health have been contextualized within a re-evaluation of the role of social welfare in industrial and industrializing societies. Managed care has improved access to care for those who remained previously un- or under-insured, increased the use of primary and preventive care, raised efforts to measure the quality of care and reduced the incentives to over-treat which were exacerbated by fee-for-service methods.