E q u i t y , s o c i a l d e t e r m i n a n t s a n d p u b l This book was commissioned by the Department of Ethics, Equity, Trade and ic h Human Rights as part of the work undertaken by the Priority Public Health e a Conditions Knowledge Network of the Commission on Social Determinants of l t h HHeallth, iin collllabboration with 16 of the majjor publiic health programmes of WHOO: p r alcohol-related disorders, cardiovascular diseases, child health, diabetes, food o g safety, HIV/AIDS, maternal health, malaria, mental health, neglected tropical r a diseases, nuttritiion, oral hheallth, sexuall andd reprodducttiive hheallth, ttobbacco and hheallth, m tuberculosis, and violence and injuries. In addition to this, through collaboration m e with the Special Programme of Research, Development and Research Training s in Human Reproductionn, the Special Programme for Research and Training in Tropical Diseases, and the Alliance for Health Policy and Systems Research, 13 case studies were commissioned to examine the implementation challenges in addressing social determinants of health in loww-and middle-iincome settings. The Priority Public Health Conditions Knowledge Network has analysed the impact of social determinants on specific health conditions, identified possible entry-points, and explored possible interventions to improve health equity by addressing social determinants of health. For more information on the work of WHO on social determinants of health, please visit http://www.who.int/social_determinants/en/ 978 92 4 156397 0 Edited by Erik Blas and Anand Sivasankara Kurup Closing the gap in a generation: Health equity through action on the social determinants of health Social justice is a matter of life and death. It affects the way people live, their consequent chance of illness, and their risk of premature death. We watch in wonder as life expectancy and good health continue to increase in parts of the world and in alarm as they fail to improve in others. The full report is available from: http://www.who.int/social_determinants/ thecommission/finalreport/en/index.html Equity, social determinants and public health programmes Edited by Erik Blas and Anand Sivasankara Kurup About this book This book was commissioned by the Department of Ethics, Equity, Trade and Human Rights as part of the work undertaken by the Priority Public Health Conditions Knowledge Network of the Commission on Social Determinants of Health, in collaboration with 16 of the major public health programmes of WHO: alcohol-related disorders, cardiovascular diseases, child health, diabetes, food safety, HIV/AIDS, maternal health, malaria, mental health, neglected tropical diseases, nutrition, oral health, sexual and reproductive health, tobacco and health, tubercu- losis, and violence and injuries. In addition to this, through collaboration with the Special Programme of Research, Development and Research Training in Human Reproduction, the Special Programme for Research and Training in Tropical Diseases, and the Alliance for Health Policy and Systems Research, 13 case studies were commissioned to examine the implementation challenges in addressing social determinants of health in low-and middle-income set- tings. The Priority Public Health Conditions Knowledge Network has analysed the impact of social determinants on specific health conditions, identified possible entry-points, and explored possible interventions to improve health equity by addressing social determinants of health. For more information on the work of WHO on social determinants of health, please visit http://www.who.int/social_determinants/en/ For more information on the content of the book, please write to [email protected] WHO Library Cataloguing-in-Publication Data Equity, social determinants and public health programmes / editors Erik Blas and Anand Sivasankara Kurup. 1.Health priorities. 2.Health status disparities. 3.Socioeconomic factors. 4.Health care rationing. 5.Patient advocacy. 6.Primary health care. I.Blas, E. II.Sivasankara Kurup, A. III.World Health Organization. ISBN 978 92 4 156397 0 (NLM classification: WA 525) © World Health Organization 2010 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatso- ever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The named authors alone are responsible for the views expressed in this publication. Design and Layout: Inís Communication Cover photos: Column 1 (1) © 2005 Todd Shapera, Courtesy of Photoshare; (2) Alejandro Lipszyc / World Bank; (3) © 2005 Stéphane Janin, Courtesy of Photoshare; Column 2 (1) 123RF; (2) © 2009 Kyaw Thar, Courtesy of Photoshare; (3) iStockphoto; Column 3 (1) 123RF; (2) Tran Thi Hoa, 2002 / World Bank; (3) Inís Communication; Column 4 (1) © Manoocher Deghati / IRIN; (2) © 2007 Galina Toktalieva, Courtesy of Photoshare; (3) © 2003 Bale-Robe Health Center, Courtesy of Photoshare The photographs in this material are used for illustrative purposes only; they do not imply any particular health status, attitudes, behav- iours, or actions on the part of any person who appears in the photographs. Printed in Switzerland. Acknowledgements This book was produced under the overall direction of Tim Evans (Assistant Director- General), Jeanette Vega, Nick Drager (former Directors of the Department of Ethics, Equity, Trade and Human Rights) and Rüdiger Krech (present Director of the Department of Ethics, Equity, Trade and Human Rights). Financial contribution of the Department of Health, United Kingdom for the publication of the book is also gratefully acknowledged. The authors of various chapters of the book are: Jens Aagaard-Hansen, Awa Aidara-Kane, Amitava Banerjee, Fernando C. Barros, Erik Blas, Claire-Lise Chaignat, Joanne Corrigall, Annette David, Chris Dye, Katharine Esson, Christopher Fitzpatrick, Alan J. Flisher, Michelle Funk, Davidson Gwatkin, Sean Hatherill, Norman Hearst, Ernesto Jaramillo, Jean-Louis Jouve, Stella Kwan, Knut Lönnroth, Crick Lund, Pia Mäkelä, Shawn Malarcher, David Meddings, Shanthi Mendis, Les Olson, Vikram Patel, Anne-Marie Perucic, Poul Erik Petersen, Sophie Plagerson, Mario Raviglione, Jürgen Rehm, Helen Roberts, Gojka Roglic, Robin Room, Robert W. Scherpbier, Laura A. Schmidt, Anand Sivasankara Kurup, Nigel Unwin, Cesar G. Victora, David Whiting and Brian Williams. Valuable inputs in terms of contributions, peer reviews and suggestions on various chapters were received from a number of WHO staff at headquarters, regional offices and country offices, as well as other partners and collaborators, including Palitha Abeykoon, Marco Ackerman, Thérèse Ange Agossou, Awa Aidara-Kane, Daniel Albrecht, Mazuwa Banda, Amal Bassili, Sara Bennett, Douglas Bettcher, Anjana Bhushan, Adriana Blanco, Claire-Lise Chaignat, Pierpaolo de Colombani, Vera da Costa Silva, Catherine D’Arcangues, Denis Daumerie, Hernan Delgado, Ridha Djebeniani, Martin Christopher Donoghoe, Alberto Concha Eastman, Fatimah Elawa, Jill Farrington, Edwige Faydi, Mario Festin, Christopher Fitzpatrick, Sharon Friel, Michelle Funk, Gauden Galea, Luiz Augusto Galvao, Massimo Ghidinelli, Francisco Martínez Guillén, Anthony Hazzard, Norman Hearst, Samuel Henao, James Hospedales, Tanja Houweling, Ernesto Jaramillo, Brooke Ronald Johnson, Tigest Ketsela, Gauri Khanna, Mary K. Kindhauser, Rüdiger Krech, Stella Kwan, Jerzy Leowsky, Knut Lönnroth, Prerna Makkar, Shawn Malarcher, Emmalita Manalac, Michael Marmot, Matthews Mathai, David Meddings, Shanthi Mendis, Patience Mensah, Maristela Monteiro, Charles Mugero, Davison Munodawafa, Benjamin Nganda, Carla Obermeyer, Patricia Palma, Anne-Marie Perucic, Poul Erik Petersen, Vladimir Pozyak, Kumanan Rasanathan, Dag Rekve, Eugenia Rodriguez, Gojka Roglic, Ritu Sadana, Sarath Samrage, Alafia Samuels, Robert Scherpbier, Santino Severino, Iqbal Shah, Aushra Shatchkute, Sameen Siddiqi, Sarah Simpson, Johannes Sommerfeld, Birte Holm Sørensen, Shyam Thapa, Luigi Toma, Jaana Marianna Trias, Nicole Valentine, Pieter van Maaren, Eugenio Villar, Xiangdong Wang, Susan Watts