Health inequities are complex social and policy problems that require action from multiple levels of government and numerous sectors. We have been analyzing the comprehensive national strategies developed in many countries and regional bodies, including the European Union, to reduce persistent health inequities, to assess key lessons learned and to identify implications for Toronto and Ontario. One key finding is that strategies at the national level–although crucial for providing resources, leadership, and strategic direction–are insufficient in themselves for addressing the health inequities most relevant to local communities and individuals. Even the most comprehensive and effective national strategies need to be adapted and implemented locally and regionally. At the same time, the absence of a formal national equity strategy has not prevented leading cities and regions from developing strategies or action plans that address elements of social determinants of health and/or tackle health inequities within their local population.