The health systems agenda: Prospects for the diagonal approach

Julio Frenk, Octavio Gómez-Dantés, Felicia M. Knaul

Research output: Chapter in Book/Report/Conference proceedingChapter

3 Scopus citations


The increasing pluralism that has populated the global health landscape, coupled with the accountability pressure represented by the Millennium Development Goals, has fueled a renewed concern for health systems. There is consensus on the idea that agreed goals will only be met and health outcomes improved if health systems are strengthened. However, there is less agreement on how to strengthen such systems. The recent attention to health systems has also reignited the debate on some of the dichotomies that have persisted for decades in the global health field: prevention versus treatment, primary versus specialized care, vertical versus horizontal strategies, and social determinants of health versus health services. This chapter has two aims: to provide a conceptual basis to advance our understanding of health systems and to help settle the disputes between vertical and horizontal approaches to improving health through the construction of a “diagonal” perspective. Its central message is that in order to meet the challenges of the present century we need to offer comprehensive responses and move beyond false dichotomies towards integration. The first part of the chapter is devoted to a discussion of the meaning of health systems. The chapter then revisits the debate around vertical and horizontal approaches to healthcare and discusses the main features of the diagonal approach and exemplifies the use of this approach by addressing the issue of child mortality in Mexico. The chapter concludes with a reflection of the strengths and potential limits of the diagonal perspective.

Original languageEnglish (US)
Title of host publicationThe Handbook of Global Health Policy
Number of pages15
ISBN (Electronic)9781118509623
ISBN (Print)9780470674192
StatePublished - Apr 14 2014
Externally publishedYes


  • Health system
  • Mexican health reform

ASJC Scopus subject areas

  • Social Sciences(all)


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