Governments are often urged to take steps to improve the health of their citizens. But there is controversy about how best to achieve that goal. Popular opinion calls for more investment in medical care and the promotion of behaviors associated with good health. However, across the developed countries on which we focus here, variations in the health of the population do not correspond closely to national levels of spending on medical care, and there remain many uncertainties about how governments can best promote healthy behavior. Expanding access to health care offers greater promise, but, as many chapters in this book note, health care is only the tip of the iceberg of population health.

The objective of this chapter is to extend our understanding of how governments affect population health. We develop a distinctive perspective on this topic that suggests governments do so by creating or eroding social resources when they make public policy. Our analysis turns on a contention at the heart of this volume, namely, that the structure of social relations in which people are embedded conditions their health. In social epidemiology, there is substantial evidence to support this claim but continuing controversy about which aspects of social relations impinge on health and through which causal mechanisms this occurs. We shed light on these issues by proposing a model linking social relations to health and then use that model to identify the dimensions of social relations most likely to impinge on health.