1. A global framework for emerging research on the social determinants of health Sharon Friel Professor of Health Equity and Director, Regulatory Institutions Network, Director, Menzies Centre for Health Policy, The Australian National University

2. 1.What are the questions? 2.What type of evidence is needed to answer the questions? 3.What architecture is needed?

3. Point 1. What’s the question?

4. Illuminating health inequities

5. Socio-economic gradient in health, Australia Data source: 45 and Up Study (Korda et al, under review)

6. Understanding the causes of health inequities

7. "why are the poor behaving this way?” "why are they poor?” Re-framing the question

8. Health inequities are socially produced

9. Living & Working Conditions e.g. Planning Housing Employment Health Care Systems e.g. Equitable access to care Health Promotion Power, Money & Resources e.g. Trade and investment Taxation Racism Health Equity Research Domains

10. Health equity Seven political domains that shape health and health inequity Intellectual property Trade and investment treaties Food Corporate activity Finance Migration Armed conflict Ottersen etal. The Lancet–University of Oslo Commission on Global Governance for Health The Lancet, 2014

11. Chief Investigators: Friel, Bammer, Gleeson, Kay, Thow Associate Investigators: Labonte, Snowdon, Stuckler Trade policy: Maximising benefits for nutrition, food security, human health, and the economy ARC Discovery Grant DP130101478 2013-2015 Friel et al. A new generation of trade policy: potential risks to diet-related health from the trans pacific partnership agreement. Globalization and Health 2013, 9:46

12. Domain 1 aim develop a conceptual model of the system linkages between trade, food, the economy, society and health outcomes, investigate how systems science can be used to support integrated trade, food, and health policy-making Domain 2 aim produce quantitative evidence of diet related health effects of a trade agreement (the TPP) Domain 3 aim characterise the main stakeholder groups and institutions involved in the TPP negotiations, within Australia and at the international level assess the capacity of different modes of trade governance to achieve coherence between the goals of trade and health sectors (with respect to food and nutrition)

13. Does social spending save lives? Slide: David Stuckler

14. Greek Tragedy >200% rise in HIV infections 40% rise in homelessness 50% rise in people unable to access medical care 40% increase in infant mortality ~60% reported increase in suicides Kentikelenis et al. Health effects of financial crisis: omens of a Greek tragedy. Lancet 2014

15. Economic growth in Iceland and Greece Slide: David Stuckler

16. What works to improve health equity and how

17. Evaluation of the impact of health-sector policy and programs on health equity; Applying a health equity lens to non-health sector policy and programs Understanding how SDH and health equity gets onto the agenda Understanding the barriers and opportunities: systems, processes and actors What does SDH policy and action look like Framing the question

18. Reflection from Health Ministers Baum Etal. Social Science and Medicine 2013

19. Social innovation

20. The art and science of advocacy and communication

21. 1. Lack of public awareness about the SDH 2. Prominent ideology 3. Human attribution biases 4. Journalistic norms and practice … In two-thirds of the 50 stories [on television news], the main message was that individuals were personally responsible for their weight… Bonfiglioli 2007 Shaping the public discourse Hayes et al. Social Science & Medicine 64 (2007) 1842–1852

22. Point 2. What type of evidence/analysis is needed to answer the question

23. Evidence for policy Evidence of policy

24. Technical analysis Political analysis

25. Policy Market Social innovation

26. Different kinds of research to answer different questions Community trials Economic analysis Case studies Policy & regulatory analysis Epidemiology Natural experiments Natural sciences

27.  Discourse/framing analysis  Network analysis  Systems science  Realist evaluations Emerging theory-informed methods

28. Point 3. What architecture is needed

29. I.Knowledge II.Skills III. Funding and dissemination

30. Disciplinary diversity Epidemiology Health services Psychology Sociology Anthropology For example Law Economics Political science Public administration Systems science Questions of training

31. 1. Disciplined mind 2. Synthesizing mind 3. Creative mind 4. Respectful mind 5. Ethical mind Minds for an equitable future

32. Flood the funders Be on grant selection committees Review every related article that you possibly can Shifting the paradigm with appropriate evidence