Tackling health inequalities: new approaches in public policy.

Abstract

That social and environmental factors account for a substantial portion of health inequalities between and within countries has long been recognized (1). Much less is understood about how these determinants can be tackled. A multi-sectoral approach to policy design and implementation is urgently needed to confront persisting infectious epidemics and rising noncommunicable disease burdens in developing countries.The mainstream policy response to socially determined health inequali-ties is “pro-poor” strategies: interven-tions targeted on low-income groups. While often important, such strategies are insufficient, as they focus only on a specific population subset defined by income level. In countries characterized by pervasive widespread deprivation, access to health-enabling conditions and a broad scaling-up of health services are required (2). Factors other than income powerfully shape the social hierarchy that determines chances to be healthy. Pro-poor approaches limit interven-tion to the end of the social production chain that creates health or sickness: they tend to leave untouched the core social processes that generate health inequities, including gender and ethnicity (3).Genuinely pro-equity health policy is needed, considering not only income but all “systematic disparities in health between more and less advantaged social groups” (4) and intervening on the social factors that influence health. The pro-equity agenda demands an evolu-tion in the delivery of clinical services, in health information systems, and in the relationship between the health sector and other policy areas.A few countries have moved to-wards a pro-equity approach. Sweden’s new national public health policy, for example, focuses on “determinants of health mainly at the societal level”. Government departments and social sectors — including education, trans-port, environmental protection and labour policy — assume explicit respon-sibility for improving population health