For debate--Does health care save lives?

The contribution of health care to the health of a population has long been controversial. In the 1970s, McKeown and Illich argued that health care had made little contribution to population health and may actually be damaging it. There is, however, a growing body of evidence that health care now has a demonstrable effect on health at a population level, albeit subject to certain methodological limitations that affect the precision of the estimates of scale. In particular, there is emerging evidence that reduced access to high quality medical care may contribute to the east-west gap in mortality in Europe and to social inequalities in mortality in some industrialised countries. These findings apply both to overall measures of mortality amenable to medical care as well as to death rates in particular age groups and from particular conditions, where the association between policy and outcome tends to be clearer. These findings have implications for those who seek to promote health at population or individual level. Primarily, there needs to be a stronger link between public health and health care, with those in public health recognising that health care can make a difference and those in health care recognising the right of public health to challenge what they do.