PHA-Exchange> Challenging Inequity Through Health Systems

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 from "Ruggiero, Mrs. Ana Lucia (WDC)" <ruglucia at PAHO.ORG> -----
 EQUIDAD at LISTSERV.PAHO.ORG

CHALLENGING INEQUITY THROUGH HEALTH SYSTEMS

 
Final Report - Knowledge Network on Health Systems - June 2007

WHO - COMMISSION ON THE SOCIAL DETERMINANTS OF HEALTH - CSDOH

Lucy Gilson, Jane Doherty, Rene Loewenson and Victoria Francis with
inputs and contributions from the members of the Knowledge Network


Available online as PDF [146p.] at:
http://www.who.int/social_determinants/resources/csdh_media/hskn_final_2
007_en.pdf

Political Briefing: Report of the Health Systems Knowledge Network

".....This briefing note presents key messages of the final report of
the Health Systems Knowledge Network established by the World Health
Organization's Commission on the Social Determinants of Health. The
messages have been formulated for the political executive, particularly
Ministers of Health, and their senior advisors. They have been generated
by Network members and are based on review of evidence and experience
(members were drawn from a range of policy, civil society and academic
bases across the world).

In the report, health systems are seen to include all activities whose
primary purpose is to improve health. The report discusses important
health system features and actions that can address health inequity.
While it focuses on low- and middle-income countries, many of the
recommendations may be appropriate to high-income countries. The
messages are complementary to, and do not repeat, those in the reports
of the Women and Gender Equity and Globalisation Knowledge Networks.
More detailed messages on the role of public health programmes in
addressing health inequity will be presented in the forthcoming report
of the Priority Public Health Conditions Knowledge Network.

Why health systems matter to the social determinants of health inequity
1. Health systems offer general population benefits that go beyond
preventing and treating illness.
  Appropriately designed and managed, they:
  - provide a vehicle to improve people's lives, protecting them from
the vulnerability of sickness, generating a sense of life security and 
    building common purpose within society;
  - ensure that all population groups are included in the processes and
benefits of socio-economic development; and
  - generate the political support needed to sustain them over time.

2. Health systems promote health equity when their design and management
specifically consider the circumstances and needs of socially
disadvantaged and marginalized populations, including women, the poor
and groups who experience stigma and discrimination, enabling social
action by these groups and the civil society organisations supporting
them.

3. Health systems can, when appropriately designed and managed,
contribute to achieving the Millennium Development Goals.

Critical health system features that address health inequity

The key overarching features of heath systems that generate preferential
health benefits for socially disadvantaged and marginalized groups, as
well as general population gains, are:

- the leadership, processes and mechanisms that leverage intersectoral
action across government departments to promote population health;

- organisational arrangements and practices that involve population
groups and civil society organisations, particularly those working with 
  socially disadvantaged and marginalized groups, in decisions and
actions that identify, address and allocate resources to health needs;

- health care financing and provision arrangements that aim at universal
coverage and offer particular benefits for socially disadvantaged and 
  marginalized groups (specifically: improved access to health care;
better protection against the impoverishing costs of illness; and the
redistribution 
  of resources towards poorer groups with greater health needs); and

- the revitalization of the comprehensive primary health care approach,
as a strategy that reinforces and integrates the other health 
  equity-promoting features identified above....."

Table of contents 
POLITICAL BRIEFING 
EXECUTIVE SUMMARY 
Part 1 Introduction 
Part 2 The evidence base of the report 
Part 3 The health system as a social determinant of health and health
equity
3.1 The health system as a social determinant of health 
3.2 The health system as a social determinant of health equity 
3.3 The equity problems of health systems 
Part 4 Strengthening health systems to address health inequity
4.1 Revitalize intersectoral action for health 
4.2 Promote social empowerment 
4.3 Strengthen the redistributive role of health care 
4.4 Revitalize Primary Health Care 
Part 5 Initiating and sustaining health system transformation
5.1 National processes to institutionalise change 
5.2 International support for transformation 
Part 6 Conclusions 


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