Mckeown Thesis Summary

Mckeown Thesis Summary-53
It is simply assumed to be true, and a considerable amount of public and political discourse in Australia is based on the more-or-less uncritical adoption of this view.However, there have been serious challenges to this apparently obvious assumption.

It is simply assumed to be true, and a considerable amount of public and political discourse in Australia is based on the more-or-less uncritical adoption of this view.However, there have been serious challenges to this apparently obvious assumption.

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.

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.

He even rejected any significant role for public health measures such as improved hygiene and sanitation, again because they only became effective after the decline in mortality was well underway.

At the time of their first publication, Mc Keown’s theories flew in the face of accepted wisdom which saw scientific advance and better medicine as the principal drivers of better health.

Originally published in 1976, Professor Thomas Mc Keown’s influential book The role of medicine – dream, mirage or nemesis?

put forward a formidable and convincing argument to the effect that health care itself made only a minor contribution to the massive improvements in population health between the mid-nineteenth and mid-twentieth century in the developed world.

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.

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