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Closing the gap: Policy into practice on social determinants of health

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Policy into Practice on Social Determinants of Health
Discussion Paper

Department of Ethics, Equity, Trade and Human Rights - WHO
World Health Organization – September 2011

Available online as PDF [56p.] at:

World Conference on Social Determinants of Health
Rio de Janeiro on 19-21 October 2011

Conference Program:

“………..In the time it takes to read this discussion paper, hundreds of people will die needlessly as a result of health inequities – unfair and avoidable or remediable differences in health outcomes between different population groups. Health inequities cause unnecessary suffering and result from adverse social conditions and failing public policies. These inequities are sentinels of the same factors that undermine development, environmental sustainability, the well-being of societies, and societies' capacity to provide fair opportunities for all. Health inequities are a problem for all countries and reflect not only differences in income and wealth, but also differences in opportunity on the basis of factors such as ethnicity and racism, class, gender, education, disability, sexual orientation, and geographical location. These differences have profound consequences and represent the impact of what we know as social determinants of health.

Yet health inequities, by definition, are not inevitable. Millions of people need not die of preventable causes each year. in 2008, the WHO commission on social Determinants of Health compiled recommendations to create an extensive prescription of what is required to “close the gap” through action on social determinants across all sectors of society. after considering the commission’s report at the 2009 World Health assembly, Member states resolved to put these recommendations into practice, adopting resolution 62.14, "reducing health inequities through action on the social determinants of health."

“…..This discussion paper aims to inform the proceedings and contribute to fulfilling the purpose of the World conference, as mandated by resolution 62.14: to share experiences on how to address the challenges posed by health inequities and to mobilize commitment to the urgent implementation of feasible actions on social determinants in all countries. The paper does not provide a blueprint, but instead lays out the key components that all countries need to integrate in their own context in implementing a social determinants approach.
The discussions at the World conference will further consider these themes and show how, in all contexts, it is possible to put policy into practice on social determinants of health to improve health, reduce health inequities, and promote development. ……….” Dr Marie-Paule Kieny, assistant Director-General innovation, information, evidence and research WHO

Discussion paper - Content

Executive Summary


Conceptual Basis and Rationale for Action on Social Determinants

Political Considerations for implementing Action on Social Determinants

  • Progress, obstacles, and the effect of crises
  • Principles and requisites for action

1. Governance to tackle the root causes of health inequities: Implementing action on Social Determinants of Health

  • Building good governance for action on social determinants
  • implementing intersectoral action

2. Promoting Participation: Community Leadership for Action on Social Determinants

  • creating the conditions for participation
  • Brokering participation and ensuring representativeness
  • Facilitating the role of civil society

3. The Role of the Health Sector, including Public Health Programmes, in Reducing Health Inequities

  • executing the health sector‘s role in governance for social determinants
  • reorienting health care services and public health programmes to reduce inequities
  • institutionalizing equity in health systems governance

4. Global Action on Social Determinants: Aligning Priorities and Stakeholders

  • aligning global stakeholders
  • aligning global priorities

5. Monitoring Progress: Measurement and Analysis to Inform Policies and Build Accountability on Social Determinants

  • identifying sources and collecting data
  • Disaggregating data
  • selecting indicators and targets
  • Moving forward despite unavailability of systematic data
  • Disseminating information on health inequities and social determinants to inform action
  • integrating data into policy processes
  • assessing the health and equity impacts of different policy options

Conclusion: Urgent Steps



Closing the gap: policy into practice on social determinants of health: Discussion paper for the World conference on social Determinants of Health was produced under the overall direction of rüdiger Krech (Director). The principal writer and editor was Kumanan rasanathan. Funding to assist in the preparation and production of this discussion paper was received from the Government of Brazil.

Significant contributions in the form of text, fi gures, and boxes were provided by carmen amela Heras, ilona Kickbusch, Bernardo Kliksberg, Taru Koivisto, Jennifer Lee, rene Loewenson, Belinda Loring, Miranda MacPherson, Michael Marmot, Don Matheson, Lorena ruano, Victoria saint, Jeanette Vega, and David Woodward.
Key inputs and peer review for drafts of the discussion paper were provided by the advisory Group, the organizing committee and WHo regional Focal Points for the World conference on social Determinants of Health. The members of these groups included silvio albuquerque, carmen amela Heras, Mohammed assai, eduardo Barbosa, anjana Bhushan, Jane Billings, Paulo Buss, nils Daulaire, Maria Luisa escorel, Kira Fortune, Luiz a. c. Galvão, suvajee Good, ilona Kickbusch, Bernardo Kliksberg, Taru Koivisto, rüdiger Krech, Michael Marmot, alvaro Matida, Malebona Precious Matsoso, abdi Momin, Davison Munodawafa, Jai narain, Luiz odorico, rômulo Paes de sousa, alberto Pellegrini, Felix rigoli, carlos santos-Burgoa, Tone Torgersen, agis Tsouros, eugenio Villar Montesinos, susan Watts, and erio Ziglio. Valuable comments, suggestions, criticisms, and assistance were also received from Daniel albrecht, Francisco armada, alanna armitage, Jim Ball, Leopold Blanc, ashley Bloomfi eld, Ludo Bok, Josiane Bonnefoy, Matthias Braubach, Danny Broderick, chris Brown, Kevin Buckett, andrew cassels, Genevieve chedeville-Murray, Maggie Davies, Barbara de Zalduondo, Marama ellis, sharon Friel, Michelle Funk, Peter Goldblatt, Volker Hann, Patrick Kadama, rania Kawar, Meri Koivusalo, Theodora Koller, Jacob Kumaresan, ronald Labonté, eero Lahtinen, Pierre Legoff, Michael Lennon, Margot Lettner, Bridget Lloyd, Knut Lönnroth, Brian Lutz, Peter Mamacos, nanoot Mathurapote, Hooman Momen, Davide Mosca, carles Muntaner, Benjamin nganda, Monireh obbadi, eeva ollila, Jeffrey o'Malley, cyril Pervilhac, Maravand Pinto, sandy Pitcher, amit Prasad, Mario raviglione, Marilyn rice, Katja rohrer,
Ana Lucia Ruggiero, Xenia scheil-adlung, Gerard schmets, Ted schrecker, Claudio schuftan, Hani serag, alaka singh, anand sivasankara Kurup, Zsofi a szilagyi, Martin Tobias, Peter Tugwell, nicole Valentine, Vivian Welch, Deborah Wildgoose, carmel Williams, Holly Wong, ilcheong Yi, and Hongwen Zhao.

Source: PAHO/WHO

Last Updated ( Monday, 26 September 2011 21:51 )  

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