Congress report - European Health Forum Gastein

Plenary Session I + II
improvements in the environment (e.g. the introduction of sanitation measures), living
conditions (e.g. better housing and nutrition), and other factors related to social and
economic development (e.g. increased family income). Medical breakthroughs, such as the
availability of vaccination and immunization, came after the Second World War, by which
time the major drop in mortality rates had already occurred (35).
In developed countries, the receding pandemics of infection during the 18th and 19th centuries
were attributable more as a response to social, economic and environmental changes than to
medical breakthroughs (34). The latter were few and came too gradually and too late to be
responsible for the changes in health and disease patterns. The policy implications of all this
are still largely overlooked. There is no doubt that the explanation for this reduction in
mortality is strongly linked to improvements in living and working conditions brought about
by social and economic development (14,33,34,35,41,43,79).
To argue that falls in death rates and the decline of pandemics in the last two centuries have
been primarily related to changes in the environment, in the nutritional status of the
population, in the supply of clean water, in the effective disposal of excreta, rather than to a
specific medical intervention is not to downplay the role of the medical profession in
achieving these successes. In many cases it was physicians who saw the relationships
between nutrition, water supply, sanitation, poverty and illness and forced the authorities to
take action (46,47). Health professions have played, and continue to have, an important role
to play in changing disease patterns. What is important to recognize is that the actions to
control or eradicate diseases are often social, economic or environmental interventions.
2.2 Evidence from the Present
Turning to the present, a number of recent studies focus specifically on the issue of social
and economic development as key categories of health determinants
(8,9,13,31,35,48,53,54,56). Several studies point out that the early signs of deterioration in
the health status of populations are, in general, determined by changes in their social,
economic and environmental conditions (see for example: 23,48,50,56,57,58).
At national level, there is a demonstrable relationship between economic performance,
income distribution, and health status, which has significant implications for social and
economic policy-making. The higher a country’s average income per capita and the more
equal its income distribution, the greater the likelihood of longer and healthier lives for its
population (61,64). Maternal and child health patterns often reflect general economic trends.
For example, child and infant mortality rates have been found to be sensitive to economic
hardship. Studies in developing countries have shown that a 10% increase in income per
capita corresponds to a 3.5% fall in child mortality rates (57). According to the World Bank,
this estimate reflects the total impact of income on health. It includes efforts working directly
through income (e.g. food consumption), as well as indirectly through factors that are
themselves mainly determined by income (e.g. access to safe water and sanitation,
availability of health care, etc.).
There is now overwhelming evidence that much of contemporary illnesses and death (and
thus the potential for the promotion of the health of the population) are rooted in the
prevailing type of economic development and linked to social factors (8,9,11,12,13,30,48,53).
In general, if economic development goes hand in hand with decreasing social inequalities, is
environmentally friendly and strengthens social capital, it will have positive impact on a wide
range of social and health indicators. In both developed and developing countries the
number of people in poverty is an especially important reason for differences (inequalities) in
health. In every society the income and status of women exact a powerful influence on
population health. Especially in the poorest countries, policies that accelerate family income
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