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Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The conditions in which people live and work can help to create or destroy their health – lack of income, inappropriate housing, unsafe workplaces, and lack of access to health systems are some of the social determinants of health leading to inequalities within and between countries. “Interventions aimed at reducing disease and saving lives In both rich and poor countries, realities of people’s daily lives and the societies people’s health largely depends in which they live. Such an approach requires succeed only when they take the social determinants of on the social conditions in which incorporating health equity into all policies. they live and work – the social The Commission on Social Determinants of health adequately into account.” determinants of health. Health (CSDH) recognizes health is a social goal and a responsibility across the whole The link between people’s health and their of society. There is increasing evidence that Dr LEE Jong-wook, Director-General, surroundings can no longer be ignored. Health better coordination and leadership to address inequities continue to grow across social classes, the social dimensions of health across all World Health Organization, occupations, and ethnic groups within countries, governmental policy-making is possible, and even where more resources are made available results in improved health and access to health The Lancet, 19 March 2005 and in spite of applying “the best” evidence- care. By acting on the social causes of ill- based interventions. Faced with this challenge, health, governments are poised to meet their health policy-makers are seeking ways to shift development goals, reduce health disparities, from disease-focused solutions to people- promote population health, and create and focused solutions, taking into account the sustain economically-viable societies. “At the core of the Commission’s Leading action on - to help build a sustainable global movement Create new alliances for action on health equity and social Action and knowledge agendas are being work is the belief that a society health inequities determinants, linking governments, developed with the simultaneous involvement international organizations, research of leading scientists, practitioners, civil society institutions, civil society and communities. organizations, government offi cials and global that has organized its social The Commission on Social Determinants initiatives, creating new networks of advocates of Health (CSDH) created by the World The Commission’s approach to tackle the social determinants of health. Health Organization draws the attention conditions so that its population allows it to: of governments, civil society, international Set the foundation for a new health agenda organizations, and donors to pragmatic ways has better health is a better Re-dress major gaps in evidence The innovative global, regional and national of creating better social conditions for health, CSDH collects state-of-the-art information on networks being created by the CSDH enable especially for the world’s most vulnerable society. Health is a measure of major social determinants of health on a global it to create the foundations for a new and people. WHO Director-General Dr LEE Jong- scale which will improve the performance of sustainable global agenda, which promotes a wook launched the Commission in March 2005. the degree to which the society health policy, its targeting and monitoring. comprehensive approach to health and health equity. It will operate until May 2008. Promote learning by doing delivers a good life to its citizens.” The goals of the Commission are: Countries advancing action on social - to support health policy change in countries determinants are contributing their learning Sir Prof. Michael Marmot by assembling and promoting effective, to the evidence-gathering work of the evidence-based models and practices that Commission, while learning from the experts Chair, Commission on address the social determinants of health; and evidence assembled by the Commission. - to support countries in placing health equity Social Determinants of Health as a shared goal to which many government departments and sectors of society contribute; A key to achieving development targets Country example: Chile CSDH works with countries to develop more In partnering with countries from both the CSDH is supporting Chile to analyse - target families in extreme poverty, making effi cient health policies that lead to health developing and developed world, CSDH health equity gaps in infant mortality and them priority subjects of public policy; equity. Its main focus is on: creates a learning platform through which life expectancy. Chile is forging ahead with - traverse government departments and use - improving the performance of health policy by countries, already advanced or beginning to act the social determinants of health agenda selective interventions to tackle inequities; tackling the social determinants of health in all on social determinants of health, share their and launched the Health Reform and Chile - include all sectors of policy-making that policies affecting health outcomes experiences and build support mechanisms. Solidario (Chile in Solidarity Programme) infl uence health. across government; Examples from countries as diverse as Brazil to address health inequalities and improve - increasing the capacity to design, implement Chile, and Sweden show how improving one health opportunities for the most vulnerable Families covered under Chile Solidario are and monitor interventions and address the area of development can snowball into other communities. provided with a counsellor who facilitates social gradient of health; and areas and promote the well-being of society. access to a variety of social services including - placing equity at the centre of all government The Ministry of Planning and Cooperation programmes that offer occupational skills, planning, policy and decision-making. was tasked to coordinate different social support for the disabled, and facilities for health sectors, with equity as the goal. Through the and child development. Incentives have been Ministry’s Solidarity and Social Investment created for employers who hire unemployed Fund, the innovative Programa Puente (Bridge heads of households covered by the Solidario Programme) was established to: programme. Between 2002 and 2005, the number of families covered increased from 56 000 to 225 000. Reaching beyond Civil society participation national borders redefi ned Regional-based strategies to address the social In formulating its regional strategies, An innovative approach has been developed The active participation of civil society determinants of health provide opportunities CSDH emphasizes: to work with civil society representatives organizations in the work of the Commission for exchange and collaboration among from across the globe to gather knowledge aims to: countries, both within the same region and - The dissemination and use of from different levels of society outside - provide a global platform for the civil across regions, while ensuring the sustainability existing knowledge in the region, formal structures. Instead of merely “rubber- society voice; of the CSDH process beyond its tenure. including the compilation of country- stamping” decisions made by others, civil - strengthen capacities among participating civil specifi c information on studies, policies and society organizations working with CSDH society organizations; The Commission is playing a key role in interventions on social determinants of health. have developed their own