Population health in Europe: how much is attributable to health care?

Does health care save lives? Commentators such as McKeown and Illich, writing in the 1960s, argued that it contributed very little to population health, and might even be harmful. However, they were writing about a period when health care had relatively little to offer compared to today. More recent reviews of the contribution of health care to health have led to a consensus that McKeown was correct to the extent that 'curative medical measures played little role in mortality decline prior to mid-20th century'. But the rapidly changing scope and nature of health care means it cannot be assumed that this is still the case. Thus, several writers have described often quite substantial improvements in death rates from conditions for which effective interventions have been introduced. Yet the debate continues, with some arguing that health care is making an increasingly important impact on overall levels of health while others contend that it is in the realm of broader policies, such as education, transport and housing that we should look to for future advances in health. Inevitably, this is to a considerable extent a false dichotomy. Both are important. But how much does health care contribute to population health?