The World Health Organization’s Commission on the Social Determinants of Health (SDoH) has sparked broad interest in tackling persistent and widening health inequities by addressing the social and economic inequality, precarious employment, poverty, inadequate housing, social exclusion and other fundamental factors that underlie these health inequities. This month, the WHO is sponsoring a global conference on how to implement the Commission’s recommendations.
The big challenge in advancing health equity has been translating these analyses into actionable policy alternatives (others are building the broad community and political mobilization needed to force the necessary major policy changes and finding popular and effective messages and framing of social determinants and health equity – we will blog further on these issues.)
Social determinants are complex and fundamental change across many inter-connected sectors will be key. But ultimately, significant and sustained change in the determinants of health will require equally significant shifts in state policy and comprehensive and multi-faceted government programs and investments; and part if this is ensuring that policy solutions are aligned with the structural incentives that drive government policy and action.
Another ongoing conundrum of making progress on the social determinants is that the issue is so large that it sometimes seems impossible to know where to start. Our Submission to the WHO reflected this and argued that action must be comprehensive and connected, but that getting started is the most important thing. We argued that the WHO should drive action in four key areas:
- Governance: how efforts to address social determinants can be more comprehensive, connected, collaborative, integrated, aligned, deep, long-term, and grounded;
- Role of the Health Sector: how the health sector can build equity into its priority-setting and service planning;
- Promoting Participation and Community Leadership: how communities can be empowered to take greater leadership in addressing the social determinants using mechanisms like comprehensive community initiatives;
- Monitoring Progress: how do we know when policies are making a difference?
We also made a Submisison to the Pan-American Health Organization (PAHO/WHO), who are preparing a regional position paper for the conference. PAHO asked for three recommendations to government regarding the social determinants of health. We argued that the top three priorities are:
- Each national government should commit to reducing income inequality by 10 percent by 2020;
- Each national, sub-national, and local government or planning authority should develop and implement comprehensive strategies to reduce health inequities; and
- Each government, as part of its comprehensive health equity strategy, should systemically invest in the foundations of more healthy and equitable communities.
In both submissions, the overarching theme is that policy-makers need to take a more comprehensive and integrated approach to addressing health inequities that reflects the interconnected and interdependent nature of the social determinants of health. A simple policy framework will never work for all situations – adapting responses to local conditions is important.
We’ll continue to post on the WHO conference as it unfolds.