The decades after the Second World War – the liminal space between violent transnational chaos and the establishment of new global order – were rich in opportunities to shape future society (Middleton, 2000; Skidelsky, 2009). Between national processes of reconstruction and the international reconfiguration of rule-bearing institutions, new models of growth and health emerged, powered on one hand by industrialising production and mass consumption, and on the other by national health systems operationalised through proliferating systems of epidemiological surveillance, fuelled by a miraculous expansion in curative capabilities and a newly minted biomedical vision of the individual and the body.

Conceptually conjoined, these models settled into a deep popular sedimentary conviction, and commensurate political promise, that increase was the natural human condition, whether measured in dollars or life-years – an endless vista of life and wealth mediated by mass commercialisation and underpinned by technological innovation (Blasco-Fontecilla, 2014). That conviction has come under increasing strain in recent decades, both in the increasingly evident limitations of the biomedical model for public health and the increasingly urgent environmental limits to our appetite for growth.

The limits to growth

The trajectory of health system development in almost all low-and middleincome countries in the post-war period broadly followed the contours of the developed world's biomedical model – allocating the lion's share of resources to managing individual and disease, with often little more than residual attention to the social and economic factors which generate illness as societies develop and grow (Miranda et al, 2008; Samb et al, 2010; Yusuf et al, 2015; Asante et al, 2016; Gmeinder et al, 2017; Xu et al, 2018; Wendimagegn and Bezuidenhout, 2019). There is no question that curative care is a powerful expression of social progress and a vital dimension of human health. But it is inefficient and costly. Economic growth and technological development have equipped the biomedical model with increasingly sophisticated – and expensive – technological and pharmaceutical capabilities ill-adapted to preventively dealing with escalating global epidemics of chronic disease creeping quietly through the arteries of modernising societies.