Improving the health of the population is the defining goal of
health systems; health system performance should therefore be
viewed primarily from the perspective of how health systems manage
to improve the overall average level of population health and
reduce inequalities in health (25). This implies that health systems
aim both at improving the health of the population in general and at
achieving greater gains in the health status of those who have been
in poorer health. It is important to recognize that both the overall
level of health and equity in health result from the interaction of
other social systems and determinants of health that lie outside the
health system (26), such as those related to living and working conditions:
agriculture and food production, education, the working environment,
unemployment, water and sanitation, health care services,
and housing (27).