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Constructing the Evidence Base on the Social Determinants of Health: a Guide

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Constructing the Evidence Base on the Social Determinants of Health: a Guide Constructing the evidence base on the social determinants of health: A guide Authors: Josiane Bonnefoy, Antony Morgan, Michael P. Kelly Jennifer Butt, Vivian Bergman With Peter Tugwell, Vivian Robinson, Mark Exworthy, Johan Mackenbach, Jennie Popay, Catherine Pope, Thelma Narayan, Landon Myer, Sarah Simpson, Tanja Houweling, Liliana Jadue November 2007 CONSTRUCTING THE EVIDENCE BASE ON THE SOCIAL DETERMINANTS OF HEALTH: A GUIDE The Measurement and Evidence Knowledge Network (MEKN) of the WHO Commission on Social Determinants of Health is co-chaired by Michael P. Kelly and Josiane Bonnefoy. The hub which coordinates the MEKN is run by Universidad del Desarrollo, Chile, and National Institute for Health and Clinical Excellence, United Kingdom. Five key words for indexing purposes: Social determinants of health, health equity, evidence into policy, evidence into practice, inequalities/ inequities in health. Statement on conflict of interest: We declare that we have no conflicts of interest. This work was made possible through funding provided by the World Health Organization (WHO) and undertaken as work for the Measurement and Evidence Knowledge Network (MEKN) established as part of the WHO Commission on Social Determinants of Health. The views presented in this guide are those of the authors and do not necessarily represent the decisions, policy or views of WHO or Commissioners. The authors would like to thank Somsak Chunharas, John Lynch, Carlos Silva, Cesar G Victora and Michael C Wolfson for their peer reviews of the MEKN final report. The authors are also grateful for comments received both on the MEKN scoping paper and the draft final report from Knowledge Network colleagues Ted Schrecker and Ron Labonte (Globalization) and Piroska Ostlin and Gita Sen (Women and Gender Equity). The authors are very pleased to acknowledge our Measurement and Evidence Knowledge Network colleagues for their involvement in the network meetings and their contributions to and comments on the different pieces of work. 2 CONSTRUCTING THE EVIDENCE BASE ON THE SOCIAL DETERMINANTS OF HEALTH: A GUIDE Table of contents i. Introduction.......................................................................................................................... 7 PART I ISSUES AND PRINCIPLES 1 The challenge of measurement and evidence about the social determinants of health ...................................................................................................................................... 11 1.1 Conceptual and theoretical issues.......................................................................................11 1.2 Eight principles for developing the evidence base ..............................................................20 1.3 Conclusion...........................................................................................................................24 2 Taking an evidence based approach ......................................................................... 26 2.1 Lessons from evidence based medicine ...............................................................................27 2.2 Applying the evidence based approach to the social determinants of health ......................30 2.3 Building an integrated evidence base for the social determinants of health .......................33 2.4 ‘Equity proofing’ .................................................................................................................36 2.5 Illustrative case studies .......................................................................................................37 3 Gaps and gradients ...................................................................................................... 38 3.1 The pioneering work of Antonovsky and Victora.................................................................38 3.2 Health gaps..........................................................................................................................40 3.3 Health gradients..................................................................................................................41 3.4 Shape of health gradients ....................................................................................................43 3.5 Illustrative case study..........................................................................................................44 3.6 Remainder of this guide.......................................................................................................44 PART II TOOLS AND TECHNIQUES 4 Framework for policy development, implementation, monitoring and evaluation 46 4.1 Purpose of the policy framework.........................................................................................46 4.2 Using the framework ...........................................................................................................48 5 Getting social determinants on the policy agenda – understanding the policy- making process ..................................................................................................................... 50 5.1 Introduction.........................................................................................................................50 5.2 Understanding policy-making .............................................................................................52 5.3 SDH and the policy-making process ...................................................................................58 5.4 Policy-making in context .....................................................................................................62 5.5 Models to inform policy-making..........................................................................................65 5.6 Conclusions .........................................................................................................................72 5.7 Illustrative case studies .......................................................................................................74 3 CONSTRUCTING THE EVIDENCE BASE ON THE SOCIAL DETERMINANTS OF HEALTH: A GUIDE 6 Getting social determinants on the policy agenda – making the case for change 75 6.1 Policy pointers.....................................................................................................................75 6.2 Making the case for change.................................................................................................78 6.3 Illustrative case studies .......................................................................................................82 7 Getting social determinants on the policy agenda – equity proofing ..................... 83 7.1 Equity filter/ lens .................................................................................................................83 7.2 Equity audits/ health equity audits ......................................................................................85 7.3 Equity-effectiveness loop.....................................................................................................87 7.4 Equity gauge........................................................................................................................88 7.5 Equity-focused health impact assessment............................................................................91 7.6 Conclusion...........................................................................................................................95 7.7 Illustrative case studies .......................................................................................................95 7.8 Specific tools........................................................................................................................96 8 Generating evidence for policy and practice............................................................. 98 8.1 Status of the evidence base on the social determinants of health ........................................98 8.2 Getting the questions right ..................................................................................................99 8.3 Achieving methodological diversity...................................................................................101 8.4 Assessing the quality of the diverse evidence base ............................................................103 8.5 Conclusion.........................................................................................................................105 8.6 Illustrative case studies .....................................................................................................105 8.7 Related reading .................................................................................................................106 8.8 Specific tools......................................................................................................................107 9 Evidence synthesis and action ................................................................................. 108 9.1 Synthesizing complex and diverse data .............................................................................109 9.2 Producing guidance for action..........................................................................................126 9.3 Illustrative case studies .....................................................................................................129 9.4 Related reading .................................................................................................................130 Specific
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