Wednesday, April 25, 2012

[EQ] Improving Equity in Health by Addressing Social Determinants

Improving Equity in Health by Addressing Social Determinants

Edited by:

The Commission on Social Determinants of Health Knowledge Networks

Jennifer H Lee and Ritu Sadana

World Health Organization, Geneva – 2011

Available online PDF [319p.] - [1.5 MB] at:

This recently published book highlights actions to improve health equity based on findings from the nine global Knowledge Networks that were established during the WHO Commission on Social Determinants of Health. 

Their task was to synthesize existing evidence and identify effective and appropriate actions to improve health equity in nine thematic areas:
- globalization;
- gender;
- social exclusion;
- early child development;
- urban settings;
- employment conditions;
- health systems;
- public health programs; and
- measurement and evidence. 

The evidence reinforces the fundamental impact of social determinants on health outcomes and in creating health inequities. 

“… the Commission was designed to marshal this existing knowledge about what can be done to promote health equity and by so doing to focus global attention on the challenges of achieving greater health equity within and between countries.” 

“Across the knowledge networks, there are common actions that were identified as key to reducing inequities in health related to social determinants: increase universal access to public education, establish a minimum living wage, improve social protection, and reduce discrimination based on gender, race, ethnicity, etc.”

“A rigorous understanding of the distribution of health outcomes and opportunities across socioeconomic groups is an essential tool for policy-makers to appropriately and effectively tailor interventions that address patterns of health inequity.”

“Effective action to address the social determinants of health requires us all to rethink dominant understandings of the way in which population health is improved and health inequities reduced.”

The chapters communicate that in order to address the underlying causes of health inequities, multiple and sustained action across sectors are required and provide recommendations for doing so. 


“……The report by the Commission on Social Determinants of Health represents a watershed moment in public health. It marks the first systematic and truly comprehensive attempt to draw together data and evidence on social determinants that is pluralistic and diverse methodologically, empirically and theoretically. It is a rallying cry for political action in support of the action against those elements which do so much damage to human health, and it is an important signpost for action political and scientific…..

……Recently, WHO convened a global conference in Rio de Janeiro, Brazil to build support for the implementation of action on social determinants of health. The conference provided a global platform for dialogue on how to implement the recommendations from the Commission's report on all socioeconomic groups and at rate of improvement that increases at each step down the socioeconomic ladder.


….. At the conclusion of the conference, 125 participating Member States adopted the Rio Political Declaration on Social Determinants of Health pledging to work towards reducing health inequities by taking action across five core areas related to the evidence synthesized across this book:

1) Adopt better governance for health and development;
2) Promote participation in policy-making and implementation;
4) Strengthen global governance and collaboration; and  
5) Monitor progress and increase accountability (WHO, 2011).

……The evidence compels action and the momentum generated by the Rio Declaration confirms that it is imperative for all to act to reduce health inequities…”




1. Strengthening efforts to improve health equity
    Ritu Sadana, Sarah Simpson, Jennie Popay, Daniel Albrecht, Ahmad Reza Hosseinpoor and Tord Kjellstrom

2. Globalization: the global marketplace and social determinants of health
Ted Schrecker and Ronald Labonté

3. Gender inequity in health

     Gita Sen and Piroska Östlin

4. Social exclusion and health inequalities: definitions, policies and actions
Jennie Popay, Sarah Escorel, Mario Hernández, Heidi B. Johnston, Jane Mathieson and Laetitia Rispel


5. Early child development: a powerful equalizer
    Arjumand Siddiqi, Emily Hertzman, Lori G. Irwin and Clyde Hertzman

6. Urban settings: our cities, our health, our future
   Jostacio Lapitan, Jennifer H. Lee and Tord Kjellstrom

7. Employment and working conditions as health determinants
    Joan Benach and Carles Muntaner with the EMCONET

8. Challenging inequity through health systems
    Lucy Gilson, Jane Doherty and Rene Loewenson

9. Reducing health inequities through public health programmes
Erik Blas and Anand Sivasankara Kurup

10. Measuring the social determinants of health: theoretical and empirical challenges

                       Josiane Bonnefoy, Antony Morgan, Emma Doohan, Jennie Popay, Johan Mackenbach and Michael P. Kelly

11. The way forward: acting on the evidence and filling knowledge gaps
       Jennifer H. Lee and Ritu Sadana


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