We live in a time of spectacular opportunity for health. By 2011, life expectancy exceeded 80 years in 26 countries. But with life expectancy below 55 years in another 17 countries, there are also spectacular levels of deprivation. Opportunities for health have grown, but so too have inequalities in access to those opportunities.
WHO's 2008 Commission on Social Determinants of Health attributed health inequalities to “structural conditions that together fashion the way societies are organised—poor social policies and programmes, unfair economic arrangements and bad politics”. The Commission proposed as one pillar of the response to build the power and ability people have to make choices about health inputs and to use these choices towards health. Amartya Sen has similarly identified health outcomes as being a product of different dimensions of functioning and of agency. Whilst health professionals are fairly certain of their role in a biomedical approach to improving health, there is less certain knowledge about whether and how to intervene in unequal power relations or to build people's agency to achieve wellbeing. Yet as Rudolf Virchow once wrote “all disease has two causes, one pathological and the other political”.