1 Social Determinants of Health

2 Overarching Recommendations 1.Improve Daily Living Conditions (21 Recs) CH5 Equity for the start CH6 Healthy places healthy people CH7 Fair employment and decent work CH8 Social protection across the life course CH9 Universal health care 2. Tackle the Inequitable Distribution (27 Recs) CH10 Health equity in all policies, systems and programmes CH11 Fair financing CH12 Market responsibility CH13 Gender equity CH14 Political empowerment – inclusion and voice CH15 Good global governance 3. Understand the Problem and Assess the Impact of Action (8 Recs) CH16 SDH: Monitoring, research and training CH17 Global movement

3 CH10 Health equity in all policies, systems and programmes Health equity: greater than the health sector Building a coherent approach to health equity: –Health equity as a marker of societal progress –Policy coherence: win-win policy solutions, adapting to the context Action within the health sector: –Skills & capacity, financial support, institutional strengthening –The health sector as a catalyst beyond government

4 CH10 Health equity in all policies, systems and programmes Recommendations 10.1 Parliament and equivalent oversight bodies adopt a goal of improving HE through action on SDH as a measure of government performance 10.2 National government establish a whole-of-government mechanism that is accountable to parliament, chaired at the highest political level possible 10.3 The monitoring of SD and HE indicators be institutionalized and HE impact assessment of all government policies, including finance, be used 10.4 The health sector expands its policy and programmes in P&P and health care to include a SDH approach, with leadership from the MOH 10.5 WHO support the development of knowledge and capabilities of national MOH to work within SDH framework, and to provide a stewardship role in supporting SD approach across government

5 CH11 Fair financing Recommendations 11.1 Donors, multilateral agencies and Member States build and strengthen national capacity for progressive taxation 11.2 New national and global public finance mechanisms be developed, including special health taxes and global tax options 11.3 Donor countries honour existing commitments by increasing aid to 0.7% of GDP, expand coordinate aid use through SDH framework 11.4 International finance institutions ensure transparent terms and conditions for inter borrowing and lending, to help avoid future unsustainable debt 11.5 National and local govt and civil society establish a cross-govt mechanism to allocate budget to action on SDH 11.6 Public resources be equitably allocated and monitored btw regions and social groups

6 CH12 Market Responsibility Recommendations 12.1 WHO institutionalizes HE impact assessment, globally and nationally, of major global, regional and bilateral economic agreements 12.2 Government policy-setting bodies ensure and strengthen representation of public health in domestic and international economic policy negotiations 12.3 National govt strengthen public sector leadership in the provision of essential health-related goods/services and the control of health-damaging commodities

7 CH13 Gender Equity Recommendations 13.1 Legislation: Govt create and enforce legislation that promotes gender equity and makes discrimination on the basis of sex illegal 13.2 Gender mainstreaming: Govt and international institution set up within the central adm and provide adequate and long-term funding for a gender equity unit that is mandated to analyze and to act on the gender equity implications of policies Women’s economic contribution in national accounts: e.g. household work, care work, voluntary work 13.4 Education and training: to invest in expanding girls’ and women’s capabilities through investment in formal and vocational education and training 13.5 Economic participation: to support women in their economic roles – guaranteeing pay-equity by law, equal opportunity for employment, family-friendly policies 13.6 Sexual and reproductive health and rights: universal coverage

8 CH14 Political empowerment – inclusion and voice Recommendations 14.1 Govt strengthens the political and legal systems to ensure equity inclusion of all – gender, indigenous people 14.2 Govt supports marginalized groups in policy, legislation, and program that empower people to represent their needs, claims and rights 14.3 Fair participation in policy making, program and service delivery and evaluation 14.4 Empowerment for action on HE through bottom-up, grassroots approaches – HE oriented initiatives, social movements

9 CH15 Good Global Governance Recommendations 15.1 By 2010, the Economic and Social Council, supported by WHO, should prepare for consideration by the UN the adoption of HE as a core global development goal, with appropriate indicators to monitor progress both within and between countries 15.2 By 2010, the Economic and Social Council, supported by WHO, prepare for consideration by the UN the establishment of thematic SDH wking groups – initially on early child development, gender equity, employment and wking conditions, health care system and participatory governance 15.3 WHO institutionalizes a SDH approach across all working sectors, from headquarters to country level

10 Overarching Recommendations 1.Improve Daily Living Conditions (21 Recs) CH5 Equity for the start CH6 Healthy places healthy people CH7 Fair employment and decent work CH8 Social protection across the life course CH9 Universal health care 2. Tackle the Inequitable Distribution (27 Recs) CH10 Health equity in all policies, systems and programmes CH11 Fair financing CH12 Market responsibility CH13 Gender equity CH14 Political empowerment – inclusion and voice CH15 Good global governance 3. Understand the Problem and Assess the Impact of Action (8 Recs) CH16 SDH: Monitoring, research and training CH17 Global movement

11 CH16 SDH: monitoring, training and research Recommendations Action Area 1: Routine monitoring systems for HE and SDH in place, locally, nationally, and internationally Governments ensure that all children are registered at birth without financial cost to the household (civil registration for births and deaths) National governments establish a national HE surveillance system, with routine collection of data on SDH and HE WHO stewards the creation of a global health equity surveillance system as part of a wider global governance structure.

12 CH16 SDH: monitoring, training and research Recommendations Action area 2: Invest in generating and sharing new evidence Research funding bodies create a dedicated budget for generation and global sharing of evidence on SDH and HE, including health equity intervention research.

13 CH16 SDH: monitoring, training and research Recommendations Action area 3: Provide training on the SDH to policy actors, stakeholders, and practitioners and invest in raising public awareness Educational institutions and relevant ministries make the SDH a standard and compulsory part of training of medical and health professionals Educational institutions and relevant ministries act to increase understanding of the SDH among non-medical professionals and the general public Governments build capacity for HE impact assessment among policy-makers and planners across government departments WHO strengthens its capacity to provide technical support for action on the SDH globally, nationally, and locally

14 CH17 Global Movement Target 1: Reduce by 10 years, between 2000 and 2040, the LEB gap between the one third of countries with the highest and the one third of countries with the lowest LEB levels, by levelling up countries with lower LEB. Halve, between 2000 and 2040, the LEB gap between social groups within countries, by levelling up the LEB of lower socioeconomic groups. Target 2: Halve, between 2000 and 2040, adult mortality rates in all countries and in all social groups within countries. In effect, achieving this target means reducing the gap in adult mortality between and within countries by half. Target 3: Reduce by 90%, between 2000 and 2040, the U5MR in all countries and all social groups within countries, and reduce by 95%, between 2000 and 2040, the MMR in all countries and all social groups within countries. In effect, achieving this target means reducing the gap in U5MR between and within countries by 90%, and reducing the gap in MMR between and within countries by 95%.

15 Table 17.1: Milestones DateMilestone Nov 2008Global conference Post-Commission global alliance Costing of Commission recommendations and costs of not taking action 2009Advance global plan for dissemination and implementation of the Rec 2009WHA resolution on SDH and HE Research funders progressively dedicate more resources to research By 2013 at least 50% of all countries have a committed plan a UN interagency mechanism for SDH: specific thematic areas e.g. ECD, gender equity, employment and working conditions, health-care systems, and participatory governance 2010Consideration by the UN of HE as a core global development goal st Report on HE to 1st Global Forum of UN Member States 2013Review of progress on WHO social determinants of health targets 2015MDG target date; review of progress from health equity yearly reviews of progress on reducing health inequities within and between countries