Mckeown Thesis Summary

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Health service providers and policy makers have had to deal with two common reactions to this challenge.

On the one hand, all too often the reaction is to acknowledge the importance of these ‘upstream’ factors that so powerfully influence health, but then consign them to the background, as issues that are too hard to address and outside the responsibility of the health system. Investing in Prevention and Public Health in Northern Australia.

Mc Keown’s argument was based on the fact that between roughly 18, the greatest decreases in mortality and advances in life expectancy for particular diseases occurred before the introduction of improved medical treatments for those conditions.

Mc Keown argued that these advances were actually the result of better nutrition associated with rising living standards.

Thirty years on, most workers in the field would agree in broad terms with Mc Keown’s hypothesis.

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Nevertheless, his theory has been refined and updated, and most theories advanced in recent years see the provision of health care as at least a part of the explanation for better 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. 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.While explanations of illness cast in terms of exposure to certain individual risk-factors (for example viruses, bacteria, smoking, alcohol misuse, or being overweight) are a powerful way of understanding disease and illness, considerable evidence has now emerged that in addition to these individual causes lie other deeper causative factors.These are, of course, the social determinants of health.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.Omran’s model has attracted the attention of demographers [7–9], medical anthropologists [10,11], economists [12], and public health policy workers [13–15].To date it has received scant attention from epidemiologists, however [16].


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