Monday, March 10, 2008

[EQ] Constructing the evidence base on the social determinants of health: A guide

Constructing the evidence base on the social determinants of health: A guide

 

Josiane Bonnefoy, Antony Morgan, Michael P. Kelly, Jennifer Butt, Vivian Bergman With Peter Tugwell, Vivian Robinson, Mark Exworthy, Johan Mackenbach, Jennie Popay, Catherine Pope, Thelma Narayan, Landon Myer, Sarah Simpson, Tanja Houweling, Liliana Jadue

The Measurement and Evidence Knowledge Network (MEKN) of the WHO Commission on Social Determinants of Health

November 2007

 

Available online as PDF file [337p.] at: http://whqlibdoc.who.int/hq/2007/a91145.pdf

 

“……This guide is designed for practitioners interested in developing and implementing policies and programmes to tackle the social determinants of health inequities. It sets out state of the art recommendations on how best to measure the social determinants of health and the most effective ways of constructing an evidence base which provides the basis for translating evidence into political action…

 

The guide is divided into two parts:

I Issues and principles

II Tools and techniques...”

 

Table of contents

 Introduction

PART I - ISSUES AND PRINCIPLES

1 The challenge of measurement and evidence about the social determinants of health

1.1 Conceptual and theoretical issues

1.2 Eight principles for developing the evidence base

1.3 Conclusion

2 Taking an evidence based approach

2.1 Lessons from evidence based medicine

2.2 Applying the evidence based approach to the social determinants of health

2.3 Building an integrated evidence base for the social determinants of health

2.4 ‘Equity proofing’

2.5 Illustrative case studies

3 Gaps and gradients

3.1 The pioneering work of Antonovsky and Victora

3.2 Health gaps

3.3 Health gradients

3.4 Shape of health gradients

3.5 Illustrative case study

3.6 Remainder of this guide

PART II - TOOLS AND TECHNIQUES

4 Framework for policy development, implementation, monitoring and evaluation

5 Getting social determinants on the policy agenda – understanding the policymaking process

5.1 Introduction

5.2 Understanding policy-making

5.3 SDH and the policy-making process

5.4 Policy-making in context

5.5 Models to inform policy-making

5.6 Conclusions

5.7 Illustrative case studies

CONSTRUCTING THE EVIDENCE BASE ON THE SOCIAL DETERMINANTS OF HEALTH: A GUIDE

6 Getting social determinants on the policy agenda – making the case for change

7 Getting social determinants on the policy agenda – equity proofing

7.1 Equity filter/ lens

7.2 Equity audits/ health equity audits

7.3 Equity-effectiveness loop

7.4 Equity gauge

7.5 Equity-focused health impact assessment

7.6 Conclusion

7.7 Illustrative case studies

7.8 Specific tools

8 Generating evidence for policy and practice

8.1 Status of the evidence base on the social determinants of health

8.2 Getting the questions right

8.3 Achieving methodological diversity

8.4 Assessing the quality of the diverse evidence base

8.5 Conclusion

8.6 Illustrative case studies

8.7 Related reading

8.8 Specific tools

9 Evidence synthesis and action

9.1 Synthesizing complex and diverse data

9.2 Producing guidance for action

9.3 Illustrative case studies

9.4 Related reading

9.5 Specific tools

10 Effective implementation and evaluation

10.1 Health equity auditing, needs assessment and impact assessment

10.2 Organizational development and change management

10.3 Readiness for intersectoral action

10.4 Effective ways of involving local communities

10.5 Evaluation

10.6 Illustrative case studies

10.7 Related reading

10.8 Specific tools

CONSTRUCTING THE EVIDENCE BASE ON THE SOCIAL DETERMINANTS OF HEALTH: A GUIDE

11 Learning from practice

12 Monitoring

12.1 Introduction

12.2 Use of data to monitor health inequities

12.3 Sources of health data

12.4 Issues in interpreting key equity stratifiers

12.5 Special issues in low and middle income countries

12.6 Special issues in high income countries

12.7 Improvements in monitoring systems

12.8 Illustrative case studies

12.9 Related reading

13 Further issues for consideration

13.1 Attribution of effects and outcomes

13.2 The challenge of policy

13.3 Hierarchies of evidence

13.4 Equity: relative or absolute?

13.5 Where further research and development is required

14 Conclusion

14.1 Social structure and the operation of the determinants of health inequities

14.2 Towards a causal hypothesis

14.3 A plea for action

15 References


Appendix I – Illustrative case studies

 

Case study 1: United Kingdom – Using evidence to inform health policy: the Acheson Inquiry

Case study 2: Brazil, Peru and United Republic of Tanzania – Failure to equity proof interventions for children in low and middle income countries

Case study 3: Bolivia – Evaluating Bolivia’s Social Investment Fund

Case study 4: Brazil – Use of survey data to determine and refine state-wide policies and programmes; persistent inequities between rich and poor

Case study 5: Canada – A decade of children’s policies based on evidence (1990-2001)

Case study 6: Mexico – Use of evidence to reform national health system

Case study 7: Thailand – Introduction of universal health coverage

Case study 8: Various countries – Linking research and evidence to policy-making

Case study 9: Thailand – Use of locally-defined health determinants to push for change, Mun River dam

Case study 10: Brazil and Chile – Use of national conferences to bring together policy and evidence

Case study 11: Uganda – Community-based monitoring and evaluation of Poverty Action Fund

Case study 12: Various countries – Synthesis of qualitative studies of effectiveness of tuberculosis treatment

Case study 13: Various countries – Synthesis of different types of evidence to assess the impact of school feeding

Case study 14: United Kingdom – Development of evidence based guidance

Case study 15: Slovenia – Health impact assessment of agriculture, food and nutrition policies.

Case study 16: United Kingdom – Health impact assessment of a housing estate regeneration project

Case study 17: Mexico – Use of monitoring and evaluation to continuously improve the Oportunidades programme

Case study 18: Sweden – Use of evidence to develop the intersectoral National Public Health Strategy and the challenges of monitoring its implementation

Case study 19: Bangladesh – Evaluating the Food for Education programme using existing data sources

Case study 20: Kenya – Impact of grassroots involvement in gathering data on successful introduction of change

Case study 21: The Netherlands – Introduction of a multi-level surveillance system for monitoring health inequalities

Appendix II – Low and middle income countries by income group, equity and health indicators, and data sources

Appendix III – Content of standard surveys

Appendix IV – Recommendations from MEKN final report

Appendix V – List of abbreviations.

 

 

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