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21st century determinants of health and wellbeing: a new challenge for health promotion

We are at a turning point in health policy: the nature of 21st century health, changes in society and technology call for a radical change of mindset and a reorganization of how we govern health in the 21st century. Health has moved up in the political agenda in countries, in development policies and in global agreements precisely because of its relevance to the economy, political ideology and legitimacy and to the expectations of citizens. It is of a highly symbolic nature: it concerns definitions of the common good and the role of the state, markets and individuals, as well as the interests of many stake holders. Is health and wellbeing something that we collectively strive to pursue (1) in a world of globalisation and individualisation? New thinking is emerging in part because of and in part in spite of the economic crisis facing many high-income countries. Our way of life has not delivered what it promised. As inequalities increase, the health debate changes: the medical and technical development dimension of public health is increasingly overlaid by a debate on the social, political and economic factors that determine health. George Rosen (1910–1977) had initially defined these two major strands of public health and one can use them to analyse how the health debate changes over time: in the 19th and early 20th century the focus of public health was mainly national, social and political. I would suggest that in the course of the 20th century it moved to being national, medical and technical, and then in the late 20th and very early 21st century to being global, economic and technical. Today the focus is increasingly global, social and political – powered by developments in information technology that were not at our disposal even 10 years ago. Health promotion is challenged to link three big debates to the health agenda: wellbeing, sustainability and social investment. Key debate: wellbeing and sustainability