The causes of poor health are complex. A society's understanding of the determinants of health has an important influence on the stratagies it uses to maintain and improve the health of its population (Mustard 1996). Examining determinants of health from the perspective of social, economic and cultural circumstances is necessary to assist understanding the variations in the health of modern populations. .
Historically interventions aimed at improving the health of populations have met with limited success At the end of the Second World war advancements in medical science, such as the mass production of penicillin to treat infectious diseases, led to an impact on policy making and most notably the provision of free medical services through the NHS and the welfare state within the UK."It is understandable, given this background, that the provision of universally available medical care was seen as a vital part of policy for improving health standards throughout society "(Blane et al,1996, p2) .
It was expected that these developments would narrow social class differences in health but figures relating to standardised mortality ratios for social classes showed that these differences were actually widening rather than narrowing. The implication of this was that social class differences in mortality were not predominantly related to the health impact of the varying situations in which people lived. .
Explanations for why mortality differences were relatively unaffected were sought. One explanation developed was "The behavioural approach to the prevention of degenerative diseases" (Blane et al ,1996, pg5). The behavioural approach focused attention on individual choices, that led to health damaging behaviour. A number of studies were undertaken to examine health improvement that could be attributed to changing individuals" behaviours with disappointing results.
It is against this background that increased interest in other health determinants developed.