Social determinants, political contexts and civil society action: a historical perspective on the Commission on Social Determinants of Health.

ISSUES ADDRESSED To evaluate opportunities for action on social determinants of health (SDH) requires a historical perspective. Plans for addressing SDH should be developed with an awareness of past similar efforts and factors that contributed to their success or failure. METHODS Review of published historical literature on analysis and action on SDH, in particular from the Latin American social medicine movement. RESULTS In the period since World War II, global public health has oscillated between a social vision of health and a more individualistic, technological and medicalised model. Action on SDH was central to comprehensive primary health care as promulgated at the 1978 Alma-Ata conference and championed by the movement for 'Health for All by the Year 2000'. Subsequently, commitment to addressing SDH declined under the impact of restrictive interpretations of 'selective primary health care' and the pressure of neo-liberal economic and health policies. CONCLUSIONS Through its critique of politically naive medical and public health approaches and of neo-liberal ideology, the Latin American social medicine tradition offers important lessons for today's efforts to advance action on SDH. Key lessons concern: (1) the model of praxis, consciously uniting reflection and action for political change; and (2) the importance of civil society and community participation in action on SDH.