The relationship between average income and health: why do some countries exceed expectations?

Since infectious diseases in developing countries continue to be widespread they are a cause of both health problems and mortality. Controlling them should be the first step in improving health, but how to effectively do this remains unclear. If income is the cause of health gains, then policies should target growth. But if income is not the cause then deliberate action aimed at health improvements should be the focus of policies. We find that that the arguments for income as the cause of health are weak and we find no relationship between inequality and health differences between countries. When testing the impact of key social services like education, sanitation and water we find a very weak relationship. But that can easily be explained by interaction mechanism. The case study of Costa Rica shows that the structural changes made in its health care system are an important factor in explaining health gains. These changes were mainly targeted at the ability of the health care system to provide good quality care for all, which included actively reaching out to the underprivileged sections of society. We conclude that income inequality is not a cause of poor health but health care inequality is. Political determination played an important role in the structural changes made and it is doubtful that these changes could have been made without the consistent long term political determination. We can conclude that deliberate actions does cause health gains but requires significant political power.