How it can be used

The resource is both a source of primary health intelligence and an applied source of information. It documents examples of health systems actions to counter socially determined health inequalities (SDHI) and seeks to assist in the application of the information to different contexts. 

The template for presenting the examples has been designed to help policy advisers and entrepreneurs make use of the knowledge in the case examples in a systematic way and as a way of generating evidence-informed options for action. This means that each section can be read separately or the example does not need to be read in chronological order.

The resource can be used in two ways:

1. To generate primary information and knowledge using the basic search function. This is for identifying one or more case examples based on the following three characteristics:

  • the level of the action (national, sub-national or local)
  • the type of action (policy, programme, project or practice)
  • the health systems context (taxation- or insurance-based)

2. To review the example(s) using one or more of four different “lenses”.  Each lens helps to present information about the example in a different way and one that may be more suitable to your policy context and or your policy question or issue. The four lenses are:

  1. Focusing on the end point of reducing health inequalities (Section 10). What is the goal of the action - to remedy health disadvantage, narrow the gap between disadvantaged and more privileged groups, or address the whole social gradient in health? This uses Hilary Graham’s typology of the main approaches for tackling inequalities in health (1).
  2. Focusing on the social determinants of the observed health inequalities (Section 11). What are the different ways in which health systems could influence social determinants of health inequalities and what is the focus of the actions in practice? This uses a framework developed in collaboration between the WHO Office for Investment for Health and Development and Margaret Whitehead and colleagues (2-3) to assess where the actual thrust of the action in these examples is aimed.
  3. Focusing on the principal functions of a health system (Section 12) of service delivery; financing; creating resources; and stewardship/governance, as reflected in the WHO European Region’s health systems’ strengthening framework.
  4. Focusing on the four critical features of health systems with potential to promote health equity (Section 13). This uses a framework developed by the Health Systems Knowledge Network  to assess whether the action addresses any of the four critical features for promoting health equity - leveraging inter-sectoral action, engaging and encouraging participation of population groups and civil society, making arrangements that aim at universal coverage, and or revitalizing comprehensive primary health care (4).

Using either approach you will be able to generate a list of relevant examples available in the web-based resource. From the list you will be able to access an individual and detailed version of each example – “the profile”. Each profile contains a link to a more detailed case study and or additional material e.g. the actual policy document or strategy on health inequalities. This version of the resource includes 16 examples with another four in development.

For correct citation of the examples in the web-based resource please email us at info@ihd.euro.who.int

References

1. Graham H. Tackling Inequalities in Health in England: Remedying Health Disadvantages, Narrowing Health Gaps or Reducing Health Gradients? Journal of Social Policy, 2004, 33(1):115–131.

2. Whitehead M et al.  Delivery systems and mechanisms for reducing inequalities in both social determinants and health outcomes. Final report of Task Group 7 to Marmot Review of Inequalities in Health in England. London, Marmot Review, 2009.

3.Ziglio E et al.. Health Systems Confront Poverty. Copenhagen, WHO Regional Office for Europe, 2003 (, accessed 12 September 2010). (PDF,2,18 MB)

4. Gilson L et al.. Challenging inequity through health systems. Final Report of the Knowledge Network on Health Systems, WHO Commission on Social Determinants of Health. Johannesburg, Equinet, CHP, LSHTM, 2007 (accessed 12 July 2010).
(PDF, 1,19 MB)