eco ct 10 for mit

EDITORIAL

Monitoring health determinants with an equity focus: a key role in addressing social determinants, universal health coverage, and advancing the 2030 sustainable development agenda

This paper is part of the Special Issue: Monitoring health determinants with an equity focus. More papers from

this issue can be found at http://www.globalhealthaction.net and http://www.co-action.net/2015/09/si_who/

I n the 2030 Sustainable Development Agenda (SDA),

population health is characterized as an intersectoral

development challenge for all countries and for the

international community as a whole (1). Health-related

targets are therefore placed throughout the Sustainable

Development Goals (SDGs) with the aim of highlighting

the contribution of action across sectors to health and

health justice, also referred to as ‘health equity’. Health

indicators make explicit reference to reductions in mor-

bidity, mortality, or burden of disease. Health-related

indicators make explicit reference to improving the coverage

of health services and reducing harmful physical exposures

related to water, pollution, chemicals, violence, and climate

change, to health states (e.g. malnutrition) and to health and

health service events (e.g. coverage, births) (2, 3). In all, the

SDA contains 23 health and ‘health-related’ targets of

which 13 are in SDG goal 3 for health, with 35 indicators

(26 of which are in this health goal) (2, 3).

The other 10 ‘health-related’ targets are spread across

five other goals and in this way are intended to motivate

other sectoral partners to take action to address health

determinants. Yet aside from these, many other targets

also have profound effects on health, and, in particular,

on health equity. For example, there is an enormous body

of evidence supporting the role of cash transfer policies in

promoting health equity; yet the SDG social protection

target and one of its proposed indicators, ‘Proportion of

population covered by social protection floors/systems’

[SDG 1.3.1], is not listed as ‘health-related’ per se (4�6). There is a clear need to base monitoring systems on a

broader defined set of determinants that are important for

health (7), while supporting efforts to have more health-

related indicators included in the goals of other policy

sectors. These are two related but separate streams of work.

The former implies the need for a clearer position on

all important determinants to hold multiple policy actors

to account for their health impacts, even if partial or

sophisticated measures, such as exposure rates or the

attributable fraction of burden of disease, are not available.

This proposition also moves the focus from issue-specific

health governance (e.g. tobacco, non-communicable dis-

eases, climate change, and air pollution) to systemic

approaches, like Health in All Policies (8), and to a focus on

consequent implications for health systems’ monitoring,

with particular emphasis on the health sector’s public

health monitoring function. The monitoring of health

determinants, as characterized in this issue, can be thought

of as a type of public health surveillance that focuses on

upstream socioeconomic, environmental, and governance

aspects determining population health and health equity.

Public health surveillance is defined by the Centers for

Disease Control and Prevention as ‘the ongoing, systema-

tic collection, analysis, interpretation, and dissemination

of data regarding a health-related event for use in public

health action to reduce morbidity and mortality, and to

improve health. Data disseminated by a public health sur-

veillance system can be used for immediate public health

action, program planning and evaluation, and formulating

research hypotheses’ (see www.cdc.gov/mmwr/preview/

mmwrhtml/rr5013a1.htm, and similar for WHO, see:

www.who.int/topics/public_health_surveillance/en/).

There is uneven international guidance for national

governments on health systems’ monitoring functions as

they extend to health determinants. The World Health

Organization (WHO) global monitoring documents make

limited reference to monitoring of the more upstream

determinants (9). Yet there has been no in-depth discussion

of these systems combining these indicators (10). The latest

WHO 2016 World Health Statistics report represents a

considerable step forward in advancing more systematic

discussion of the health determinants. In previous WHO

reports, health determinants were referred to as ‘risk

factors’ or other ‘demographic and socioeconomic statis-

tics’ (11�13). In order to promote health equity, it is important to have in place national monitoring systems

that address health determinants (14). The evidence base

shows that the social gradients in health pervade, even in

countries where extensive national health systems are in

Global Health Action �

Global Health Action 2016. # 2016 Nicole B. Valentine et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license.

1

Citation: Glob Health Action 2016, 9: 34247 - http://dx.doi.org/10.3402/gha.v9.34247 (page number not for citation purpose)

place, implying an important role for other determinants of

health (15).

The papers compiled for this Special Issue of Global

Health Action address the theme of monitoring health

determinants, and how this monitoring function can

contribute to promoting action to address equity (‘jus-

tice’), human rights, and gender equality in health (16).

The papers derive from work undertaken at WHO with a

network of consultants between late 2013 and early 2015,

prior to the finalization of the SDGs. At that time, the early

think pieces on the post-2015 development agenda de-

scribed the emergence of an intersectoral vision of health.

Health sectors in countries would need to adapt their

monitoring functions to embrace this intersectoral vision

of health. While the vision for public health surveillance in

the 21st century had been a topic of discussion for specific

countries (e.g. USA) (17, 18), no global guidance existed.

The work was seen as a way of addressing this gap to

support implementation of the SDGs (19). The monitoring

context which is discussed in these papers is largely at the

national level. Studying the national level in light of the

upcoming SDGs was considered important as the SDA

effectively negotiated an international agreement on a

common set of national development goals across policy

sectors within and across countries. In the SDA discus-

sions, the international health community, led by WHO

and the World Bank, also singled out universal service

and financial coverage of the population (‘Universal

Health Coverage’ (UHC)) for emphasis by governments

in the SDGs (20). As a result of these discussions, a special

subtheme of the work was added to cover the implications

of monitoring health determinants with respect to UHC

(21). This subtheme is also reflected in the papers discussed

below.

The papers in this Special Issue specifically focus on the

scope of indicators needed in national monitoring systems

if they are to address the determinants of health equity, and

also how related analyses would be perceived by policy-

makers. Before describing the contribution of each of

the papers to this subject, a brief outline is given on the

development of the indicators and the proposed analytical

orientation of the monitoring framework for equity-

oriented analysis of linkages between health and other

sectors (termed the ‘EQuAL’ framework). The scope of

policy areas was initially identified on the basis of literature

reviews which covered evidence of causal pathways for

health inequalities, a rapid review of data availability, and

expert advice from workshops and key informants.

Following the philosopher Amartya Sen’s conceptuali-

zation of both process (e.g. social justice) and capacities

(e.g. material conditions) (22), as well as the General

Comment No. 14 on The Right to the Highest Attainable

Standard of Health, which emphasizes civil, political rights

(e.g. participation), as well as economic, social, and

cultural rights (e.g. access to food) (23), it was determined

at the outset that monitoring should refer to a broad

spectrum of conditions of daily life that promote health,

including but beyond health care and material conditions.

The final set of indicators covered 12 measurement

domains aligned with typical national sectoral ministries

and their policy mandates (and different SDGs): Income

and poverty (SDG 1, 2), Knowledge and education

(SDG 4), Housing and infrastructure (SDG 6, 7, 11),

Travel (SDG 11), Community and infrastructure (SDG 9,

12), Social protection and employment (SDG 1, 8), Early

child development (SDG 4), Gender norms (SDG 5), Parti-

cipation (SDG 16), Registration (institutional constraints)

(SDG 16), Accountability (institutional constraints) (SDG

10, 16), and Discrimination (SDG 5, 10). Given the

abovementioned emphasis on UHC in the SDG agenda,

it was determined that indicators should also expose

barriers related to health services. Following a workshop

held to discuss EQuAL, other criteria were introduced

(16). This provided scope to include the so-called ‘policy’

indicators, which are also important for monitoring

human rights and ensuring the accountability of policy-

makers. This recognizes that policies can be changed

within the policy-makers’ time of office (whereas outcomes

and conditions may have longer lag-times) (16). Finally,

the monitoring of health determinants was considered to

be linked to, but separate from, monitoring inequalities

in coverage and health outcomes (including through the

enhanced availability of high-quality, timely and reliable

data disaggregated by income, sex, age, race, ethnicity,

migratory status, disability, geographic location and other

characteristics relevant in national contexts (as called for

by the associated SDG 17 target).

Figure 1 visualizes how all these concepts provided the

broad parameters for the equity-oriented health determi-

nants monitoring proposal on which the papers in the

Special Issue are based.

The first paper in this Special Issue intentionally

addresses the area of monitoring health inequalities in

order to not only distinguish this area from monitoring

• Laws, policies (and programmes) and practices (norms and human rights conventions)

Distributive role of the state

Realized rights of individuals

Social distribution in

health and UHC

• Conditions for utilization and access to health services and prevention programmes

• Living and working conditions promoting health throughout the life course

• Population service and financial coverage (UHC)

• Population health

Fig. 1. Important aspects of the scope of monitoring health

determinants and its linkages with health and UHC inequal-

ity monitoring.

Nicole B. Valentine et al.

2 (page number not for citation purpose)

Citation: Glob Health Action 2016, 9: 34247 - http://dx.doi.org/10.3402/gha.v9.34247

determinants but also to show its complementarity and

illustrate an approach to guidance and tools that may also

be possible for monitoring health determinants. The paper

by Hosseinpoor et al. (24) describes the extent of health

inequalities monitoring, both globally and nationally, and

the available tools for capacity building. A substantive

volume of guidance and practical tools have been produced

by WHO to assist countries with national monitoring of

health inequalities. In order to advance action on health

determinants, making health inequalities visible is a key

step (25). Monitoring health inequalities has two func-

tions. First, it makes the extent of health injustices visible.

Second, where backed by evidence on the linkages between

outcomes and determinants, inequality monitoring pro-

vides tools for visualizing the linkage between health

and a subset of health determinants in a simple yet

powerful way. For example, infant mortality stratified by

maternal education principally describes social injustice;

however, this can also be used as a tool to communicate

the causal pathway related to lower health literacy. The

approach to monitoring service coverage inequalities

follows several of the principles developed for monitoring

health outcomes (26).

Four countries were invited to test the EQuAL frame-

work through the production of case studies that used

largely qualitative techniques to assess the domains,

indicators and analytical framing for feasibility, reliability,

validity, and usefulness to policy-makers. The paper by

Blas et al. (27) describes this process and the results

obtained from four countries: Brazil, Bangladesh, Viet-

nam, and South Africa. The assessment describes how the

country research teams found the data, developed the

indicators, and discussed the domains using policy narra-

tives with policy-makers from within the health sector and

beyond. In general, there was cross-case support for the

domains, but the case study authors indicated that the link

between some indicators and public health goals were

more difficult for target audiences to understand, in

particular for the EQuAL domains oriented to civil and

political rights (e.g. Participation and Accountability). The

case studies noted that many issues covered by the domains

were not institutionalized in data collection, analysis,

or discussion in national systems. The authors propose

that capacity building would be necessary in the countries

studied in order to institutionalize equity-oriented mon-

itoring of health determinants (27).

Following production of these four case studies, the

individual country research teams were invited to develop

a quantitative analysis to test the usefulness of the EQuAL

framework as a tool for analysis. Each research group

chose a different analytical emphasis for their study. The

broad emphases discussed as part of the EQuAL project

were 1) the presentation of ‘dashboards’ of indicators; 2)

stratification of determinants, intersecting areas of strati-

fication (e.g. transport/travel by education by sex), and the

calculation of composite indicators for certain domains

(for the housing and infrastructure domain, a composite

for energy, water, sanitation, and waste removal was

proposed); 3) multi-level analyses in evaluating the relative

effects of different determinants; 4) the role of determi-

nants of health and health inequalities versus determinants

acting as health service ‘barriers’; and 5) the association of

determinants with different types of health outcomes (e.g.

non-communicable, reproductive/maternal, and commu-

nicable) and health services (e.g. preventive, treatment).

Using regression analyses, the research teams were asked

to compare the different determinants and the implications

for intersectoral policy advice.

For Brazil, Rasella et al. (28) placed an emphasis on

dashboards and intersecting inequalities in descriptive

analyses. They developed indicator tables and mapped

displays to describe inequalities in health determinants

(stratified according to income quintiles, urbanization,

race, and geographical region). In discussing results with

policy-makers and comparing the indicator framework

with existing monitoring efforts, the researchers concluded

that monitoring and evaluation practices could be im-

proved using the set of indicators assessed in their study,

especially from a health equity perspective.

The Bangladesh research group investigated the area

of neonatal, infant, and under-five child mortality and

emphasized the use of multi-level analysis in their meth-

odology. They used multilevel logistical regression model-

ing that adjusted determinants by level (children, nested

in households, with mothers, and in sampling community

clusters). The data allowed them to compare three time

periods in Bangladesh. The regression odds ratio for

childhood mortality was highest among children of young

mothers, of parents with lower education, of mothers who

lacked the power to take decisions about health-related

matters of their children, and of poorer households.

Here, poverty was a multidimensional measure, which

could explain why, at the individual level, housing was not

considered a statistically significant variable. The employ-

ment status of the mother was not significant either. At the

community level, children born in rural communities or

living in areas with roads that were not accessible in all

seasons, had a higher risk of death.

In the study from Vietnam, Van Minh et al. (29) focused

on developing indicators of intersecting disadvantage

and composite indicators and also conducted regression

analyses comparing determinants of health outcomes

and barriers to service coverage. The composite barrier

indicator performed well. Their results stressed the role of

key determinants, namely, education and access to basic

amenities in creating inequitable barriers to health services,

thereby jeopardizing progress toward UHC goals. In

particular, barriers for ethnic minority communities living

in rural areas were prominent.

Editorial

Citation: Glob Health Action 2016, 9: 34247 - http://dx.doi.org/10.3402/gha.v9.34247 3 (page number not for citation purpose)

Finally, for the South Africa case, Ataguba et al. (30)

described association between the determinants with a

single more general measure, self-reported health. The

advantage of this measure is that it reflects the health of

the broader adult population, compared with the other

country papers, which focused on particular population

groups, and on reproductive and child health. Decom-

position analysis was used to measure the relative contri-

bution of various determinants to adult health inequality.

The authors ranked social protection and employment,

followed by knowledge and education, and then housing

and infrastructure, as having the most important con-

tributions to self-assessed health. They argued that their

results provide a motivation for promoting actionable

policies across the different responsible sectors. For

example, the Ministry of Labour could improve imple-

mentation of active labor policies, the Ministry of Housing

could improve the provision of social housing, and muni-

cipal governments could improve access to basic amenities.

Although all the above national studies used cross-

sectional designs, their results provide a promising start

to understanding the scope of possible analyses relating

determinants (or variables) to a range of different health

outcomes, from across the life course, and to a range of

important service coverage variables.

A paper by Valentine and Bonsel (31) explains different

models for describing associations between determinants

and health and coverage outcomes, including area-level

inequalities. While their paper is applied to multi-country

data, the modeling approaches are applicable to subna-

tional area-level analyses. The outcome indicators cover a

range of health conditions, including non-communicable,

reproductive and childhood, and communicable diseases.

With respect to UHC and health services, their analyses

cover prevention (e.g. immunization) and treatments. The

authors found different patterns between the two. One of

their innovations with respect to the determinants was to

introduce measures of interpersonal barriers to UHC that

are close to the EQuAL Discrimination and Participation

domains and the UHC concepts of people-centered care,

for which data availability in the case studies was found to

be relatively sparse. These ‘health systems responsiveness’

indicators were associated with poorer health and worse

health service coverage, in particular for measles vaccina-

tion coverage in poorer populations. Another innovation

was the use of an accountability policy variable, which

was found to be statistically significant in several mortal-

ity regressions. The qualitative feedback from Blas et al.

(27) and the literature review of Pedrana et al. (32)

indicated that this was a less commonly studied area. If

subnational variables on accountability could be identi-

fied, this analysis confirms that accountability indicators

could be useful inclusions in national monitoring systems.

A paper by Pedrana et al. (32) reviews the literature from

2004 to 2014. The authors identified a final set of 96

articles of largely quantitative studies, most of which

presented analyses of associations between a range of

determinants with health and health coverage inequalities

at the national level. The domains covered by the review

studies tended to concentrate on socioeconomic indicators

rather than domains related to processes (such as Account-

ability and Participation). The most frequent policy

intervention themes that were addressed by the analyses

of health determinants were health promotion and health

literacy (25%), social protection (22%), and large socio-

economic development interventions (20%). There were

also studies promoting anti-discrimination policies and

occupational health services. New insights obtained from

this review have implications for taking forward work

on national monitoring standards. Many of the studies

used explanatory models with multiple determinants

as dimensions influencing health population outcomes.

More nuanced definitions of individual and family socio-

economic status with measures and indexes of deprivation

and financial hardship were noted. Other complex multi-

dimensional measures of inequality considered inequity

at different levels of social aggregation (individual level to

family, neighborhood, community, municipal, and regio-

nal levels). Also, specific measures of inequality related to

race, ethnicity, and gender were developed for the context

of work or employment and family or social limitations.

Finally, a series of short communications describe on-

the-ground national experiences of monitoring health

determinants in England, Finland, and Mexico. In Eng-

land, Goldblatt (33) stresses that monitoring has progres-

sively shifted from a small set of targets to a wider set of

determinants of the causes of ill-health and of health

service performance. The paper emphasizes the experience

of ‘localism’, referring to the need for monitoring systems

to help find local solutions to local problems and to

encourage community empowerment. Goldblatt argues

that indicators need to be available at subnational levels

and that methods need to rely on smaller in-depth surveys

and cohort studies. This trend also implies the need to

ensure harmony between local, national, and global moni-

toring efforts. In Finland, Kilpeläinen et al. (34) observe

that monitoring covers a spectrum of information includ-

ing with the purpose of evaluating the effects of health

policies and interventions. In this regard, it is notable that

the Finnish Welfare Compass provides indicators disag-

gregated at subnational levels on the provision of social

and health services as well as the conditions (needs) of the

households. The authors note that in spite of their good

data, some health policy targets related to socioeconomic

health differences have persisted. They conclude that data

availability is not sufficient, but there is a need for wider

dissemination and use of this information, in particular by

political decision-makers and healthcare professionals. In

Mexico, Martinez Valle (35) presents two case studies to

show how public policies addressing health determinants

Nicole B. Valentine et al.

4 (page number not for citation purpose)

Citation: Glob Health Action 2016, 9: 34247 - http://dx.doi.org/10.3402/gha.v9.34247

with an equity focus have been monitored and evaluated,

and how this has led to a better culture of monitoring and

evaluation. The author describes how the monitoring of

the Prospera, the living conditions of families in extreme

poverty in terms of health, nutrition, education and

income, has also helped policy-makers to improve the

design and operation of this program. The monitoring of

Seguro Popular, the financial health protection program,

has helped to evaluate how financial barriers to health care

have been reduced. The author says that evidence, legal

mandates, and having a regulatory evaluation agency, have

been fundamental to institutionalizing monitoring and

evaluation in Mexico.

Taken together, this body of work provides evidence

of the feasibility and validity of undertaking monitoring

of the determinants of health. The papers highlight the

importance of health determinants acting as barriers

to UHC. The UHC barriers related to non-medical

costs when accessing health services and completing

health treatments, like transport and food, as well as

inter-personal barriers associated with discrimination,

communication, and other infrastructural or administra-

tive requirements are important. These barriers to health

service access were found to be inequitably experienced by

disadvantaged populations in the case studies, and in the

reviews of different countries (36). Although not being

monitored systematically as yet, these types of barriers

have received mention in the first global monitoring report

for UHC (37).

Between 2015 and 2016, WHO has further advanced

monitoring determinants through the development of a

proposal for a global monitoring framework for action on

social determinants of health (SDH) (38). This global

monitoring framework is based on agreements made in

the World Conference on Social Determinants of Health

and is described in the Rio Political Declaration on

Social Determinants of Health (39). Several measurement

concepts and indicators proposed for global monitoring

are common to the ones tested in national-level monitoring

in the EQuAL framework (e.g. basic amenities coverage,

health promotion expenditure, and social protection

coverage). These areas emerged as strong priorities

for action in the Rio Political Declaration. However,

several other indicators of the Rio proposal differ from

the EQuAL framework as the Rio Political Declaration

focuses several measurement concepts on global level

governance, and national-level policy interventions (40),

rather than on the conditions of households (see Fig. 1). To

make several of these governance indicators relevant for

national policy-makers to assess within-country progress,

new measurement approaches that assess subnational level

implementation policies are needed.

To conclude, the range of domains, variables, and

analytical approaches used and described in EQuAL

demonstrates that promising opportunities exist for

the development of national guidance on monitoring

health determinants with an equity focus. Further work

toward standards for national monitoring systems would

need to take into account both the action (policies,

programs and practices, including governance interven-

tions) and the conditions experienced (26) by different

populations.

In going forward, an interdisciplinary approach that

learns from existing national monitoring frameworks and

reviewing the evidence-base on indicator effectiveness,

as well as from previous harmonization efforts in health

promotion and environmental monitoring, will benefit

the development of guidance for national and global

monitoring. Building more effective national capacities to

draw on and share data across different policy sectors

and platforms, and to support within-country monitoring

of health determinants with an equity lens, will promote

achievement of the SDGs.

Competing interests and funding The authors are staff members of the World Health

Organization. The authors alone are responsible for the

views expressed in this publication and they do not neces-

sarily represent the views, decisions or policies of the World

Health Organization.

Acknowledgments

The authors would like to acknowledge Eugenio Villar, Coordinator,

Social Determinants of Health, WHO Headquarters; Veronica

Magar, Team Leader, Gender, Equity and Human Rights, WHO

Headquarters; and Colin D Mathers, Coordinator, Mortality and

Health Analysis Unit, WHO Headquarters, for their oversight and

support for the work described in this editorial. In addition, special

gratitude is expressed for the contributions of the Government of

Chile, FONASA (through Jeanette Vega); the Health, Employment

and Equity Programme of FLACSO (through Orielle Solar and

Patricia Frenz), Chile; and the Rockefeller Foundation (2013 THS

319, through Hilary Brown Tabish) in support of this project.

Nicole B. Valentine

Department of Public Health, Environmental and

Social Determinants of Health

WHO, Geneva

Email: [email protected]

Theadora Swift Koller

Gender, Equity and Human Rights

WHO, Geneva

Email: [email protected]

Ahmad Reza Hosseinpoor

Department of Information, Evidence and Research

WHO, Geneva

Email: [email protected]

Editorial

Citation: Glob Health Action 2016, 9: 34247 - http://dx.doi.org/10.3402/gha.v9.34247 5 (page number not for citation purpose)

References

1. Galvão LA, Haby MM, Chapman E, Clark R, Câmara VM,

Luiz RR, et al. The new United Nations approach to sustain-

able development post-2015: findings from four overviews of

systematic reviews on interventions for sustainable development

and health. Rev Panam Salud Publica 2016; 39: 157�65. 2. World Health Organization (2016). World health statistics 2016:

monitoring health for the SDGs, sustainable development goals.

Geneva: World Health Organization.

3. Murray CJ. Choosing indicators for the health-related SDG

targets. Lancet 2015; 386: 1314�6. 4. Lagarde M, Haines A, Palmer N. The impact of conditional

cash transfers on health outcomes and use of health services in

low and middle income countries. Cochrane Database Syst Rev

2009: CD008137.

5. Ranganathan M, Lagarde M. Promoting healthy behaviours

and improving health outcomes in low and middle income

countries: a review of the impact of conditional cash transfer

programmes. Prev Med 2012; 55 Supp l: S95�S105. 6. Pega F, Carter K, Blakely T, Lucas PJ. In-work tax credits for

families and their impact on health status in adults. Cochrane

Database Syst Rev 2013: CD009963.

7. Vega J, Irwin A. Tackling health inequalities: new approaches in

public policy. Bull World Health Organ 2004; 82: 482.

8. Krech R, Valentine NB, Reinders LT, Albrecht D. Implications

of the Adelaide statement on health in all policies. Bull World

Health Organ 2010; 88: 720.

9. World Health Organization (2010). Monitoring the building

blocks of health systems: a handbook of indicators and their

measurement strategies. Geneva: World Health Organization.

10. World Health Organization (2015). Global reference list of 100

core health indicators, 2015. Geneva: World Health Organization.

11. World Health Organization (2015). World Health Statistics

2015. Geneva: World Health Organization.

12. World Health Organization (2014). World Health Statistics

2014. Geneva: World Health Organization.

13. World Health Organization (2013). World Health Statistics

2013. Geneva: World Health Organization.

14. Valentine NB, Solar O, Irwin A, Nolen L, Prasad A. (2008).

Health equity at the country level: building capacities and

momentum for action. A report on the country stream of work

in the Commission on Social Determinants of Health. Geneva:

World Health Organization.

15. Commission on Social Determinants of Health (2008). Closing

the gap in a generation: health equity through action on the

social determinants of health. Final report of the Commission

on Social Determinants of Health. Geneva: World Health

Organization.

16. World Health Organization (2014). Measuring and monitoring

intersectoral factors influencing equity in universal health

coverage (UHC) and health: summary report of a meeting in

Bellagio. Geneva: World Health Organization.

17. Buehler JW, Centers for Disease Control and Prevention.

CDC’s vision for public health surveillance in the 21st century.

MMWR Suppl 2012; 61: 1�40. 18. Harrison KM, Dean HD. Use of data systems to address social

determinants of health: a need to do more. Public Health Rep

2011; 126 (Suppl 3): 1�5. 19. UNAIDS, UNICEF, UNFPA, WHO. (2012). Health in the post-

2015 UN development agenda: thematic think piece. New York:

United Nations.

20. World Health Organization, World Bank (2014). Monitoring

progress towards universal health coverage at country and

global levels: framework, measures and targets. Geneva: World

Health Organization.

21. Hosseinpoor AR, Bergen N, Koller T, Prasad A, Schlotheuber A,

Valentine NB, et al. Equity-oriented monitoring in the context of

universal health coverage. PLoS Med 2014; 11: e1001727.

22. Sen A. Why health equity? Health Econ 2002; 11: 659�66. 23. Rasanathan K, Norenhag J, Valentine NB. Realizing human

rights-based approaches for action on the social determinants of

health. Health Hum Rights 2010; 12: 49�59. 24. Hosseinpoor AR, Bergen N, Schlotheuber A. Promoting health

equity: WHO health inequality monitoring at global and

national levels. Glob Health Action 2015; 8: 29034, doi:

http://dx.doi.org/10.3402/gha.v8.29034

25. Whitehead M. A typology of actions to tackle social inequalities

in health. J Epidemiol Community Health 2007; 61: 473�8. 26. World Health Organization, International Center for Equity in

Health (2015). State of inequality: reproductive, maternal,

newborn and child health. Geneva: World Health Organization.

27. Blas E, Ataguba JE, Huda TM, Bao GK, Rasella D, Gerecke

MR. The feasibility of measuring and monitoring social deter-

minants of health and the relevance for policy and programme � a qualitative assessment of four countries. Glob Health Action

2016; 9: 29002, doi: http://dx.doi.org/10.3402/gha.v9.29002

28. Rasella D, Machado DB, Castellanos MEP, Paim J, Szwarcwald

CL, Lima D, et al. Assessing the relevance of indicators in

tracking social determinants and progress toward equitable

population health in Brazil. Glob Health Action 2016; 9: 29042,

doi: http://dx.doi.org/10.3402/gha.v9.29042

29. Van Minh H, Giang KB, Hoat LN, Chung le H, Huong TT,

Phuong NT, et al. Analysis of selected social determinants of

health and their relationships with maternal health service

coverage and child mortality in Vietnam. Glob Health Action

2016; 9: 28836, doi: http://dx.doi.org/10.3402/gha.v9.28836

30. Ataguba JE, Day C, McIntyre D. Explaining the role of the

social determinants of health on health inequality in South

Africa. Glob Health Action 2015; 8: 28865, doi: http://dx.doi.

org/10.3402/gha.v9.28865

31. Valentine NB, Bonsel GJ. Exploring models for the roles

of health systems’ responsiveness and social determinants in

explaining universal health coverage and health outcomes. Glob

Health Action 2016; 9: 29329, doi: http://dx.doi.org/10.3402/

gha.v9.29329

32. Pedrana L, Pamponet M, Walker R, Costa F, Rasella D.

Scoping review: national monitoring frameworks for social

determinants of health and health equity. Glob Health Action

2016; 9: 28831, doi: http://dx.doi.org/10.3402/gha.v9.28831

33. Goldblatt PO. Moving forward monitoring of the social

determinants of health in a country: lessons from England 5

years after the Marmot Review. Glob Health Action 2016; 9:

29627, doi: http://dx.doi.org/10.3402/gha.v9.29627

34. Kilpeläinen K, Parikka S, Koponen P, Koskinen S, Rotko T,

Koskela T, et al. Finnish experiences of health monitoring:

local, regional, and national data sources for policy evaluation.

Glob Health Action 2016; 9: 28824, doi: http://dx.doi.org/10.

3402/gha.v9.28824

35. Martinez Valle A. The Mexican experience in monitoring and

evaluation of public policies addressing social determinants of

health. Glob Health Action 2016; 9: 29030, doi: http://dx.doi.

org/10.3402/gha.v9.29030

36. de Paz C, Valentine NB, Hosseinpoor AR, Koller Swift T,

Gerecke M. Intersectoral factors influencing equity-oriented

progress towards Universal Health Coverage: results from a

scoping review of literature. Geneva: World Health Organization.

(Forthcoming)

37. World Health Organization (2015). Tracking universal health

coverage: first global monitoring report Geneva: World Health

Organization.

Nicole B. Valentine et al.

6 (page number not for citation purpose)

Citation: Glob Health Action 2016, 9: 34247 - http://dx.doi.org/10.3402/gha.v9.34247

38. WHO/PHAC/CIHR-IPPH Working Group for Monitoring

Action on the Social Determinants of Health (2016). Imple-

menting Rio: monitoring action on the social determinants of

health. Geneva:World Health Organization.

39. World Health Organization (2011). Rio Political Declaration

on the social determinants of health. Geneva: World Health

Organization.

40. Pega F, Valentine NB, Rasanathan K, Hosseinpoor AR,

Torgersen TP, Ramanathan V, et al. Sustainable Development

Goal indicators for action on the social determinants of

health: fostering multisectoral partnerships using a ‘Health in

All Goals’ lens. Bulletin of the World Health Organization.

(Submitted for initial review).

Editorial

Citation: Glob Health Action 2016, 9: 34247 - http://dx.doi.org/10.3402/gha.v9.34247 7 (page number not for citation purpose)