The essay explores the broad outlines of the main barriers/enablers to health policy and management in the prevailing biomedical model from the late 19th century to the present. Based on this analysis, it proposes the modernisation of political leadership and multisectoral integration as key determinants of a resilient, holistic and equitable health system for the 21st century. The methodological process was based on the review and critical analysis of the relevant literature on the topic and the author's experience. We conclude with a call for reflection on the need for a clear understanding of these elements for a new vision of health policy and management.