PHA-Exch> Constructing the evidence base on the social determinants of health: A guide

[Claudio Schuftan]

.From: Ruggiero, Mrs. Ana Lucia (WDC) <ruglucia at paho.org>
.crossposted from: EQUIDAD at listserv.paho.org

 *Constructing the evidence base on the social determinants of health: A
guide*

* *

Josiane Bonnefoy, Antony Morgan, Michael P. Kelly, Jennifer Butt, Vivian
Bergman With Peter Tugwell, Vivian Robinson, Mark Exworthy, Johan
Mackenbach, Jennie Popay, Catherine Pope, Thelma Narayan, Landon Myer, Sarah
Simpson, Tanja Houweling, Liliana Jadue

*The Measurement and Evidence Knowledge Network (MEKN) of the WHO Commission
on Social Determinants of Health*

*November 2007*

* *

Available online as PDF file [337p.] at:
http://whqlibdoc.who.int/hq/2007/a91145.pdf



"……This guide is designed for practitioners interested in developing and
implementing policies and programmes to tackle the social determinants of
health inequities. It sets out state of the art recommendations on how best
to measure the social determinants of health and the most effective ways of
constructing an evidence base which provides the basis for translating
evidence into political action…



The guide is divided into two parts:

I Issues and principles

II Tools and techniques..."



*Table of contents*

 Introduction

*PART I - ISSUES AND PRINCIPLES*

*1 The challenge of measurement and evidence about the social determinants
of health *

*1.1 Conceptual and theoretical issues*

*1.2 Eight principles for developing the evidence base *

*1.3 Conclusion*

*2 Taking an evidence based approach *

*2.1 Lessons from evidence based medicine *

*2.2 Applying the evidence based approach to the social determinants of
health *

*2.3 Building an integrated evidence base for the social determinants of
health *

*2.4 'Equity proofing' *

*2.5 Illustrative case studies *

*3 Gaps and gradients *

*3.1 The pioneering work of Antonovsky and Victora*

*3.2 Health gaps*

*3.3 Health gradients *

*3.4 Shape of health gradients *

*3.5 Illustrative case study *

*3.6 Remainder of this guide*

*PART II - TOOLS AND TECHNIQUES*

*4 Framework for policy development, implementation, monitoring and
evaluation *

*5 Getting social determinants on the policy agenda – understanding the
policymaking process *

*5.1 Introduction*

*5.2 Understanding policy-making *

*5.3 SDH and the policy-making process *

*5.4 Policy-making in context *

*5.5 Models to inform policy-making*

*5.6 Conclusions *

*5.7 Illustrative case studies *

CONSTRUCTING THE EVIDENCE BASE ON THE SOCIAL DETERMINANTS OF HEALTH: A GUIDE

*6 Getting social determinants on the policy agenda – making the case for
change *

*7 Getting social determinants on the policy agenda – equity proofing *

*7.1 Equity filter/ lens *

*7.2 Equity audits/ health equity audits *

*7.3 Equity-effectiveness loop *

*7.4 Equity gauge*

*7.5 Equity-focused health impact assessment*

*7.6 Conclusion*

*7.7 Illustrative case studies *

*7.8 Specific tools*

*8 Generating evidence for policy and practice *

*8.1 Status of the evidence base on the social determinants of health *

*8.2 Getting the questions right *

*8.3 Achieving methodological diversity*

*8.4 Assessing the quality of the diverse evidence base *

*8.5 Conclusion*

*8.6 Illustrative case studies *

*8.7 Related reading *

*8.8 Specific tools*

*9 Evidence synthesis and action *

*9.1 Synthesizing complex and diverse data *

*9.2 Producing guidance for action*

*9.3 Illustrative case studies *

*9.4 Related reading *

*9.5 Specific tools *

*10 Effective implementation and evaluation *

*10.1 Health equity auditing, needs assessment and impact assessment *

*10.2 Organizational development and change management*

*10.3 Readiness for intersectoral action*

*10.4 Effective ways of involving local communities *

*10.5 Evaluation *

*10.6 Illustrative case studies *

*10.7 Related reading *

*10.8 Specific tools*

CONSTRUCTING THE EVIDENCE BASE ON THE SOCIAL DETERMINANTS OF HEALTH: A GUIDE

*11 Learning from practice*

*12 Monitoring*

*12.1 Introduction*

*12.2 Use of data to monitor health inequities*

*12.3 Sources of health data *

*12.4 Issues in interpreting key equity stratifiers*

*12.5 Special issues in low and middle income countries*

*12.6 Special issues in high income countries *

*12.7 Improvements in monitoring systems *

*12.8 Illustrative case studies *

*12.9 Related reading *

*13 Further issues for consideration*

*13.1 Attribution of effects and outcomes *

*13.2 The challenge of policy*

*13.3 Hierarchies of evidence*

*13.4 Equity: relative or absolute? *

*13.5 Where further research and development is required *

*14 Conclusion*

*14.1 Social structure and the operation of the determinants of health
inequities *

*14.2 Towards a causal hypothesis*

*14.3 A plea for action*

*15 References*

*
Appendix I – Illustrative case studies*

* *

*Case study 1: United Kingdom – Using evidence to inform health policy: the
Acheson Inquiry *

*Case study 2: Brazil, Peru and United Republic of Tanzania – Failure to
equity proof interventions for children in low and middle income countries *

*Case study 3: Bolivia – Evaluating Bolivia's Social Investment Fund*

*Case study 4: Brazil – Use of survey data to determine and refine
state-wide policies and programmes; persistent inequities between rich and
poor *

*Case study 5: Canada – A decade of children's policies based on evidence
(1990-2001)*

*Case study 6: Mexico – Use of evidence to reform national health system *

*Case study 7: Thailand – Introduction of universal health coverage *

*Case study 8: Various countries – Linking research and evidence to
policy-making*

*Case study 9: Thailand – Use of locally-defined health determinants to push
for change, Mun River dam *

*Case study 10: Brazil and Chile – Use of national conferences to bring
together policy and evidence *

*Case study 11: Uganda – Community-based monitoring and evaluation of
Poverty Action Fund *

*Case study 12: Various countries – Synthesis of qualitative studies of
effectiveness of tuberculosis treatment*

*Case study 13: Various countries – Synthesis of different types of evidence
to assess the impact of school feeding *

*Case study 14: United Kingdom – Development of evidence based guidance*

*Case study 15: Slovenia – Health impact assessment of agriculture, food and
nutrition policies.*

*Case study 16: United Kingdom – Health impact assessment of a housing
estate regeneration project*

*Case study 17: Mexico – Use of monitoring and evaluation to continuously
improve the Oportunidades programme*

*Case study 18: Sweden – Use of evidence to develop the intersectoral
National Public Health Strategy and the challenges of monitoring its
implementation*

*Case study 19: Bangladesh – Evaluating the Food for Education programme
using existing data sources *

*Case study 20: Kenya – Impact of grassroots involvement in gathering data
on successful introduction of change*

*Case study 21: The Netherlands – Introduction of a multi-level surveillance
system for monitoring health inequalities*

*Appendix II – Low and middle income countries by income group, equity and
health indicators, and data sources*

*Appendix III – Content of standard surveys *

*Appendix IV – Recommendations from MEKN final report*

*Appendix V – List of abbreviations.*

* *
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