Two years ago, a former Australian prime minister said of a politician from the opposite side of politics “he’s all tip and no iceberg”. Unfortunately, much the same can be said of national and international health policy. This is despite compelling arguments and evidence presented by the Commission on the Social Determinants of Health (CSDH)1 in favour of looking below the surface for solutions to improve health. Typically, responses to diseases and health problems are knee jerk and concerned with ameliorating immediate and visible causes. This is well illustrated by health sector budgets, which are generally vastly in favour of hospitals and treatment services to the detriment of disease prevention and health promotion.

The “all tip and no iceberg” approach is illustrated by two examples. The first is that of suicide. Most responses to high comparative rates of suicide treat depression as a strong risk factor. It is rare for responses to be based on the question why some societies or communities have higher rates than others. When Canadian researchers Chandler and Lalonde2 asked such a question in relation to …