‘Closing the Health Equity Gap: Policy options and opportunities for action’

ForewordHealth inequities are unfair, avoidable and remediable differences in health status between countries and between different groups of people within the same country. Health inequities are attracting increasing attention on national and global policy agendas. Despite this, few countries have been able systematically to reduce them. WHO convened the Commission on Social Determinants of Health in 2005 to survey the available worldwide evidence on health inequities and, most importantly, to look at the evidence for policy options that could reverse the trend of increasing inequities.

The result has been a three-year process involving hundreds of people from all over the world and producing over 100 publications − nothing less than the most comprehensive review ever undertaken of global health inequities and measures to address them. The Commission conclusively shows how health inequities are not natural phenomena but rather the result of policy failure. They are thus avoidable by improving policy choices.

The final report of the Commission, released in August 2008, provides a cogent diagnosis of the problem and an admirable survey of the range of policy interventions required. Necessarily, however, the report could not include  more than a fraction of the material collected and produced by the various work streams of the Commission. This report is explicitly aimed at policy-makers and others interested in acting on the social determinants of health in order to help them navigate the vast amount of work produced. It draws from the extensive work of the nine knowledge networks set up by WHO to generate evidence for the Commission.

Essentially, it brings together a series of policy briefs, each roughly corresponding to a knowledge network and a specific social determinant of health, which together form an overall policy brief on options for policy-makers to act on the social determinants of health. This monograph first considers the essential role of the health sector in reducing inequities, and then discusses how the health sector can work with other sectors that are also vital to this task. It is thus designed for both health-sector policy-makers and those in other sectors. This document should be seen as an input to the policy dialogue on how to implement the recommendations of the Commission both globally and within individual country contexts. As the Director-General of WHO has noted, when we think about the Commission’s findings we must confront the paradox that, while health has risen to prominence on the international development agenda, within most countries health matters are often afforded lower priority than the concerns of other sectors.

The World Health Assembly in May 2009 provided a strong mandate to work together in this area, through its resolution on reducing health inequities through action on the social determinants of health. The Rio Political Declaration on Social Determinants of Health in October 2011 endorsed by the World Health Assembly in May 2012 further strengthens this mandate. We hope that these policy briefs clearly show how the work of the Commission can be applied by policy-makers now to accelerate the difficult but important journey to achieving health equity in a generation.

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