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The 2008 final report of the Commission on the Social Determinants of Health (CSDH) made a clear case for addressing structural determinants of health to improve health equity.1 The 2011 Rio Declaration took this further as 165 countries committed to take greater action on the Social Determinants of Health including the implementation of Health in All Policies (HiAP),2 which is a governance approach for health equity based on a mandate to systematically address policies beyond the healthcare sector.
Almost all health inequities are influenced by policies outside of the health sector. The pursuit of health equity objectives through the adoption of HiAP therefore demands a paradigm shift in governance; away from sectors making policy within ‘silos’ (ie, based on a specific mandates and budgets), towards a more integrated governance (p.2) approach where diverse policymakers integrate health equity considerations, alongside other objectives.3 One challenge with HiAP is establishing and maintaining, over the long term and multiple political cycles, political support for addressing health inequities in government.
Health equity does not gain the attention of policymakers as a value-free governance technique. Instead, policymakers adopt different understandings about the nature of such problems, their causes and …
Contributors LK, KS, PO and CM collectively wrote the paper.
Competing interests None declared.
Provenance and peer review Commissioned; externally peer reviewed.