Introduction

When comparisons of different health outcomes are carried out, there is still often an assumption that the reasons for those differences must be due to the performance of the health services in those countries. Politicians and policymakers debate league tables of health outcomes as if the results are entirely dependent on what goes on in healthcare services, and plans are put in place to attempt to address what have been identified on problem areas (Greener, 2016). However, it may often be the case that the health outcomes differences between different countries may be due to factors outside of the direct control of healthcare services.

Healthcare services are undoubtedly important, and the book will explore how they are funded, and what the money is spent on, in Chapters 3 and 4. But however important healthcare is, our health depends on a range of other factors that fall outside the remit or control of healthcare organisations and institutions (Schrecker and Bambra, 2015).

In respect of our own lives, we are fully aware that health services are not the only, or perhaps even the most important, factors in determining our health. Whether we can access health services (or not) when we are ill or injured is clearly important. This will be especially the case where people have a serious injury or life-threatening illness, but is also the case for the millions of people with long-term health problems that may require medications or medical devices, as in the case of diabetes or asthma.

At the same time, there are a range of factors which are likely to affect our health, but which generally fall outside of the control or remit of most health services. These factors are often referred to as the ‘social determinants’ of health, and go from those that might come most quickly to mind, such as the levels of smoking and drinking, and other activities we have come to associate with poor health outcomes, as well as education levels and the quality of housing available. However, there may also be much larger social factors, such as levels of inequality, which those taking a more large-scale, social determinants approach suggest are extremely important.