1. Social determinants of Health’s universe. Final. Marcio Ulises Estrada Paneque. MD. PhD.* Genco Estrada Vinajera. MD.** Caridad Vinajera Torres. PhD.***

2. Objectives. To know the Primary Health Care and civil society importance in public policies lead to equity and social justice, and its relations with SDH. Establish priorities in health’s interventions. Look for keys and strategies of actions to deal SDH. Interventions and experiences to approach SDH in countries and regions contexts.

3. Health intervention priority. Million people have affected their right to health by controllable and avoidable social causes with policies and public actions On what axes or dimensions to work to face this challenge? How to settle the social debt, generated in surroundings of poverty and inequality in the wealth distribution?

4. Intervention in health. Ethical vision. Availability of sanitary services, programs effectiveness and the confrontation to the new scenes and challenges must have the ethical vision of: To put in sanitary action center the social justice, like improving way of population health, diminishing equity breaches, negative factors impact and diseases frequency in unprotected groups with respect to other groups.

5. Intervention in health. Ethical vision. Identify and take actions in relation to SDH imply to solve the way to undertake the study of the impact of those social factors and the form to prevent its injurious action. It entails a methodological change since the breaches in health results of different social groups (life expectancy and incapacity), matter plus than health population average results.

6. Intervention in health. Ethical vision. More than separated universes of individual actions, relevance of inter-sectoral action is marked to approach the social multicausality. Change the reality’s sectorial vision and to execute integrating public policies, of social cohesion improvement, from work on the deepest causes of inequity in health and to surpass them.

7. Keys strategies actions on SDH. 1.Improve the health of underprivileged groups through programs focused by objectives. 2.Diminish the breaches between poorest groups and the most advantaged socially. 3.Adhere to all health gradients the socio- economic position and the health conditions in all population.

8. Focused programs strategy. It identifies a segment of objective population and monitors results that are reached around the program development. Is of extended use and aligned to other social programs. It has his limits: only benefits to small sub- group of the problematic population and in a specific problematic. Could not reduce the inequity, because it does not work with other structural and intermediary factors, nor with other social groups.

9. Breaches reduction strategy. It socially approximates the most vulnerable groups expectancy of life to the other social groups or enlarge access to the education of most underprivileged. This strategy offers results, but these specific efforts also benefit only to a sector, due it when not affect other social groups, nor other determinants.

10. Strategy of gradients Implies a understanding effort directed to hit in all the population health, including groups of different social positions. It is more expensive and of long term, which prevents monitoring health results in short term. It is necessary to consider that breaches and gradients strategies are not mutually excluding, and can be combined in a interventions plan.

11. Strategies options. Reduction search of structural determinants that perpetuate inequalities, inequity and exclusion, acting centrally on the social context and differentials consequences (work and education). Actions on intermediary determinants (work conditions, gender right and healthful environment), to diminish differential exposure and specific vulnerability to health damages)

12. Strategies options. Work to revert the socio-economic position effects (loss of the work source) and to assure curative care for which suffer damages, without distinguishing between social positions. To approach determinants with specific strategies according to the context. Economic growth is important, but nonsufficient if is not accompanied by policies against inequalities

13. Keys of the interventions. To prioritize inter-sectoral work. It surpasses the historical model that considers that the health field is exclusive and excluding competition of the health sector. It renews the PHC strategy. Promote civil society and community participation and vulnerable groups empowerment expressed in concrete public policies that improve the situation of the citizens who become ill and die due to avoidable causes.

14. Interventions keys. Successful policies of health, experiences and studies that indicate the importance of creating the conditions so that the population obtains a general well-being that leads to the individual well-being and the good health. Focus health like participating and collective right (ex. joint networks of municipalities by health, law, programs with NGOs, participating budgets, etc.)

15. SDH Commission (SDHC). Constituted in March 2005, on the decision of 57a World-wide Assembly of the Health, with the mission to collect data and evidences on the social and environmental causes of the sanitary inequalities and on possible forms to correct them. Its mandate was formulated so that it provided rule of work about SDH to all WHO programs. Its work concluded in August 2008, with the launching in Geneva, of the Recommendations Closing Report.

16. SDH analysis spectrum. Children early development. High-priority conditions of public health. Health systems. Measurements and evaluation. Employment conditions. Globalization. Urbanization. Social exclusion. Gender. Other problems in communities or vulnerable social groups: migrant and informal workers, indigenous and resident towns in marginal districts.

17. SDHC recomendations. 1.Equity since the beginning. 2.Healthful surroundings for healthy population. 3.Right practices in employment and worthy work. 4.Social protection throughout the life. 5.Health universal attention. 6.Sanitary equity in policies, systems and programs. 7.Equitable financing. 8.Market responsibility.

18. SDHC recomendations. 9. Gender equity. 10. Political emancipation: integration and expressing itself possibility. 11. An effective world-wide government. 12. To measure problem magnitude, analyze it and evaluate the interventions effects. Goal: Eliminate inequalities in a generation and reach equity in health acting on the SDH

19. Eliminate inequalities in a generation and reach the equity in health, will be possible, but… it will be necessary to wait for so much?