Article révisé par les pairs
Résumé : In 2024, the Lancet Commission on Investing in Health proposed targeting investment in 15 priority conditions through 19 modularinterventions to improve global health by 2050. While pragmatic, this approach may not fully capture the complex-adaptive nature ofhealth and health systems, nor their social, economic and political determinants. In an iterative, interpretive analysis, proposed global healthinvestment frameworks were mapped against complexity, systems thinking and health epistemology frameworks; five thematic areas wereidentified for further development: (i) health as emergent from interdependent, social-biological systems; (ii) the non-biomedical determinantsdriving inequities; (iii) health systems' adaptive requirements; (iv) epistemic injustices that marginalize non-Western perspectives; and (v) theneed for context-sensitive, community-led implementation of health measures. Recent major disruptions to international aid financing,while challenging, present a unique opportunity to redesign health investment on more sustainable and locally grounded foundations,where national governments deliberately invest in the social determinants of health as direct health improvement strategies rather thanmerely as adjacent social policy. To seize this opportunity, we propose five guiding principles for policy-makers: (i)community co-productionof interventions; (ii) adaptive governance structures; (iii) complex systems literacy in workforce training to navigate interdependenciesand uncertainty; (iv) cross-sectoral partnerships to address determinants of health; and (v) context-sensitive metrics that incorporatecommunity engagement to support learning within health systems. These are not optional enhancements to existing approaches; theyare the foundations without which any health investment strategy will continue to treat the symptoms of inequity rather than its causes.

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