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<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><font
size=2 color="#993300" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#993300;font-weight:bold'>CHALLENGING INEQUITY THROUGH HEALTH
SYSTEMS<o:p></o:p></span></font></b></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-weight:bold'><o:p> </o:p></span></font></b></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-weight:bold'>Final Report - Knowledge Network on
Health Systems - June 2007<o:p></o:p></span></font></b></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-weight:bold'>WHO - COMMISSION ON THE SOCIAL
DETERMINANTS OF HEALTH - CSDOH<o:p></o:p></span></font></b></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>Lucy Gilson, Jane Doherty, Rene Loewenson and Victoria Francis
with inputs and contributions from the members of the Knowledge Network<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-weight:bold'><o:p> </o:p></span></font></b></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=1
color="#333399" face=Arial><span style='font-size:9.0pt;font-family:Arial;
color:#333399'>Available online as PDF [146p.] at: <a
href="http://www.who.int/social_determinants/resources/csdh_media/hskn_final_2007_en.pdf"><font
color="#333399"><span style='color:#333399'>http://www.who.int/social_determinants/resources/csdh_media/hskn_final_2007_en.pdf</span></font></a>
<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-weight:bold'><o:p> </o:p></span></font></b></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><i><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-style:italic'>Political Briefing: Report of the Health
Systems Knowledge Network<o:p></o:p></span></font></i></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>“…..This briefing note presents key messages of the
final report of the <i><span style='font-style:italic'>Health Systems Knowledge
Network </span></i>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).<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'><o:p> </o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>In the report, health systems are seen to include <b><span
style='font-weight:bold'>all activities whose primary purpose is to improve
health</span></b>. 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 <i><span style='font-style:italic'>Women and Gender
Equity </span></i>and <i><span style='font-style:italic'>Globalisation
Knowledge Networks. </span></i>More detailed messages on the role of public
health programmes in addressing health inequity will be presented in the
forthcoming report of the <i><span style='font-style:italic'>Priority Public
Health Conditions Knowledge Network</span></i>.<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-weight:bold'><o:p> </o:p></span></font></b></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-weight:bold'>Why health systems matter to the social
determinants of health inequity<o:p></o:p></span></font></b></p>
<p class=MsoNormal style='margin-left:1.0in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'><br>
1. Health systems offer <b><span style='font-weight:bold'>general population
benefits </span></b>that go beyond preventing and treating illness.<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:1.0in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'> Appropriately designed and managed, they:<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:1.0in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'> - provide a vehicle to improve people's lives, protecting
them from the vulnerability of sickness, generating a sense of life security
and <br>
building common purpose within society;<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:1.0in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'> - ensure that all population groups are included in the
processes and benefits of socio-economic development; and<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:1.0in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'> - generate the political support needed to sustain them
over time.<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:1.0in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'><br>
2. Health systems <b><span style='font-weight:bold'>promote health equity </span></b>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.<o:p></o:p></span></font></p>
<p class=MsoNormal style='mso-margin-top-alt:0in;margin-right:0in;margin-bottom:
12.0pt;margin-left:1.0in;text-autospace:none'><font size=2 color="#333399"
face=Arial><span style='font-size:10.0pt;font-family:Arial;color:#333399'><br>
3. Health systems can, when appropriately designed and managed, <b><span
style='font-weight:bold'>contribute to achieving the Millennium Development
Goals</span></b>.<br>
<br>
<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-weight:bold'>Critical health system features that
address health inequity<o:p></o:p></span></font></b></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>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:<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>- the leadership, processes and mechanisms that <b><span
style='font-weight:bold'>leverage intersectoral action </span></b>across
government departments to promote population health;<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>- organisational arrangements and practices that <b><span
style='font-weight:bold'>involve population groups and civil society
organisations</span></b>, particularly those working with <br>
socially disadvantaged and marginalized groups, in decisions and
actions that identify, address and allocate resources to health needs;<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>- health care financing and provision arrangements that <b><span
style='font-weight:bold'>aim at universal coverage </span></b>and offer
particular benefits for socially disadvantaged and <br>
marginalized groups (specifically: improved access to health care;
better protection against the impoverishing costs of illness; and the
redistribution <br>
of resources towards poorer groups with greater health needs); and<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>- the <b><span style='font-weight:bold'>revitalization of the
comprehensive primary health care approach</span></b>, as a strategy that
reinforces and integrates the other health <br>
equity-promoting features identified above…..”<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-weight:bold'><o:p> </o:p></span></font></b></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-weight:bold'><o:p> </o:p></span></font></b></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-weight:bold'>Table of contents </span></font></b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399'><o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-weight:bold'><o:p> </o:p></span></font></b></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=1
color="#333399" face=Arial><span style='font-size:9.0pt;font-family:Arial;
color:#333399'>POLITICAL BRIEFING <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=1
color="#333399" face=Arial><span style='font-size:9.0pt;font-family:Arial;
color:#333399'>EXECUTIVE SUMMARY</span></font><font size=2 color="#333399"
face=Arial><span style='font-size:10.0pt;font-family:Arial;color:#333399'> <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-weight:bold'>Part 1 Introduction </span></font></b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399'><o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-weight:bold'>Part 2 The evidence base of the report </span></font></b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399'><o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-weight:bold'>Part 3 The health system as a social
determinant of health and health equity<o:p></o:p></span></font></b></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>3.1 The health system as a social determinant of health <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>3.2 The health system as a social determinant of health equity <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>3.3 The equity problems of health systems <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-weight:bold'>Part 4 Strengthening health systems to
address health inequity<o:p></o:p></span></font></b></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>4.1 Revitalize intersectoral action for health <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>4.2 Promote social empowerment <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>4.3 Strengthen the redistributive role of health care <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>4.4 Revitalize Primary Health Care <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-weight:bold'>Part 5 Initiating and sustaining health
system transformation<o:p></o:p></span></font></b></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>5.1 National processes to institutionalise change <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>5.2 International support for transformation <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-weight:bold'>Part 6 Conclusions </span></font></b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399'><o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-weight:bold'>References </span></font></b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399'><o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-weight:bold'>Annexes<o:p></o:p></span></font></b></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=1
color="#333399" face=Arial><span style='font-size:9.0pt;font-family:Arial;
color:#333399'>Annex 1 Terms of reference <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=1
color="#333399" face=Arial><span style='font-size:9.0pt;font-family:Arial;
color:#333399'>Annex 2 Sources of evidence <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=1
color="#333399" face=Arial><span style='font-size:9.0pt;font-family:Arial;
color:#333399'>Annex 3 Contextual factors influencing pro-equity health system
development<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=1
color="#333399" face=Arial><span style='font-size:9.0pt;font-family:Arial;
color:#333399'>Annex 4 List of commissioned reviews and case studies <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=1
color="#333399" face=Arial><span style='font-size:9.0pt;font-family:Arial;
color:#333399'>Annex 5 Summaries of commissioned case studies <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in'><font size=1 color="#333399"
face=Arial><span style='font-size:9.0pt;font-family:Arial;color:#333399'>Annex
6 Selected case study summaries from the literature <o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in'><font size=1 color="#333399"
face=Arial><span style='font-size:9.0pt;font-family:Arial;color:#333399'>Annex
7 Policy experience and guidance<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in'><font size=1 color="#333399"
face=Arial><span style='font-size:9.0pt;font-family:Arial;color:#333399'>References
to annexes<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in'><font size=1 color="#333399"
face=Arial><span style='font-size:9.0pt;font-family:Arial;color:#333399'><o:p> </o:p></span></font></p>
<p class=MsoNormal style='mso-margin-top-alt:auto;margin-bottom:12.0pt;
margin-left:.5in'><b><font size=2 color="#333399" face=Arial><span
style='font-size:10.0pt;font-family:Arial;color:#333399;font-weight:bold'>*
* * * </span></font><font
color="#333399"><span style='color:#333399'> <br>
</span></font></b><b><font size=1 color="#333399" face=Arial><span lang=EN-GB
style='font-size:7.5pt;font-family:Arial;color:#333399;font-weight:bold'>This
message from the Pan American Health Organization, PAHO/WHO, is part of an
effort to disseminate <br>
information Related to: Equity; Health inequality; Socioeconomic inequality in
health; Socioeconomic <br>
health differentials; Gender; Violence; Poverty; Health Economics; Health
Legislation; Ethnicity; Ethics; <br>
Information Technology - Virtual libraries; Research & Science
issues. [DD/ IKM Area] </span></font></b><b><font color="#333399"><span
lang=EN-GB style='color:#333399;font-weight:bold'> </span></font></b><font
color=navy><span style='color:navy'><o:p></o:p></span></font></p>
<p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;
margin-left:.5in'><b><font size=1 color="#333399" face=Arial><span lang=EN-GB
style='font-size:7.5pt;font-family:Arial;color:#333399;font-weight:bold'>“Materials
provided in this electronic list are provided "as is". Unless
expressly stated otherwise, the findings <br>
and interpretations included in the Materials are those of the authors and not
necessarily of The Pan American <br>
Health Organization PAHO/WHO or its country members”.</span></font></b><b><font
size=1 color="#333399" face=Arial><span lang=EN-GB style='font-size:8.0pt;
font-family:Arial;color:#333399;font-weight:bold'> <br>
</span></font></b><b><font size=1 color="#333399" face=Arial><span lang=EN-GB
style='font-size:7.5pt;font-family:Arial;color:#333399;font-weight:bold'> ---------------------------------------------------------------------------------------------------</span></font></b><b><font
color="#333399"><span lang=EN-GB style='color:#333399;font-weight:bold'> <br>
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