Two approaches have coexisted for centuries in global thinking on healthy societies: social determinants and rights-based approaches and biomedical/pathogenic approaches, with global positions and policies presenting a dominant view that masks significant diversity in thinking about healthy societies in different regions.

When biomedical approaches were imposed in India, Latin America and East and Southern Africa, they undermined local cultural understandings of health, and in all three regions stimulated rights-based, social determinants and social medicine approaches to confront the alienation and health inequities generated by colonialism and globalisation.

Advancing ideas into policy depends on growing social, scientific and policy networks and calls for spaces to debate contesting ideas, investment in a more equitable circulation of ideas between regions in framing global approaches, and transdisciplinary, reflexive and participatory ways of building knowledge that are embedded in and learn from action.

In responding to threats posed to health by climate change, the damage to ecosystems and pandemics, how we think and act on healthy societies and how far the choices are understood and made beyond elites and states within society itself can lead us to significantly different futures.


Rene Loewenson (email:, Eugenio Villar, Rama Baru and Robert Marten


Loewenson R, Villar E, Baru R, et al Engaging globally with how to achieve healthy societies: insights from India, Latin America and East and Southern Africa BMJ Global Health 2021;6:e005257.

BMJ Global Health
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Engaging Globally With How To Achieve Healthy Societies: Insights From India, Latin America and East and Southern Africa


The way healthy societies are conceptualised shapes efforts to achieve them. This paper explores the features and drivers of frameworks for healthy societies that had wide or sustained policy influence post-1978 at global level and as purposively selected southern regions, in India, Latin America and East and Southern Africa. A thematic analysis of 150 online documents identified paradigms and themes. The findings were discussed with expertise from the regions covered to review and validate the findings.

Globally, comprehensive primary healthcare, whole-of-government and rights-based approaches have focused on social determinants and social agency to improve health as a basis for development. Biomedical, selective and disease-focused technology-driven approaches have, however, generally dominated, positioning health improvements as a result of macroeconomic growth. Traditional approaches in the three southern regions previously mentioned integrated reciprocity and harmony with nature. They were suppressed by biomedical, allopathic models during colonialism and by postcolonial neoliberal economic reforms promoting selective, biomedical interventions for highest-burden diseases, with weak investment in public health. In all three regions, holistic, sociocultural models and claims over natural resources re-emerged. In the 2000s, economic, ecological, pandemic crises and social inequality have intensified alliances and demand to address global, commercial processes undermining healthy societies, with widening differences between ‘planetary health’, integrating ecosystems and collective interests, and the coercive controls and protectionism in technology-driven and biosecurity-driven approaches.

The trajectories point to a need for ideas and practice on healthy societies to tackle systemic determinants of inequities within and across countries, including to reclaim suppressed cultures; to build transdisciplinary, reflexive and participatory forms of knowledge that are embedded in and learn from action; and to invest in a more equitable circulation of ideas between regions in framing global ideas. Today’s threats raise a critical moment of choice on which ideas dominate, not only for health but also for survival.

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