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Health in All Policies approaches support the integration of health considerations into the policies of traditionally siloed governance systems. These siloed systems are often ignorant of the fact that health is created outside of the health system and starts long before you see a health professional. Thus, the purpose of Health in All Policies approaches is to raise the importance of the broad‐based impacts on health from these public policies and to implement healthy public policy that delivers human rights for all. This approach requires significant adjustments to current economic and social policy settings. A well‐being economy similarly aspires to create policy incentives that increase the importance of social and non‐monetized outcomes, such as increased social cohesion environmental sustainability and health. These outcomes can evolve deliberately alongside economic benefits and are impacted by economic and market activities. The principles and functions underpinning Health in All Policies approaches, such as joined‐up policy making can be helpful to transition towards a well‐being economy. Governments will need to move beyond the currently held principle of “economic growth and profit above all else” if countries are to tackle growing societal inequity and catastrophic climate changes. Rapid digitization and globalization have further entrenched the focus on monetary economic outcomes rather than other aspects of human welfare. This has created an increasingly difficult context within which to prioritize social policies and efforts aimed to achieve primarily social and not profit‐oriented goals. In the face of this larger context, alone, Health in All Policies approaches will not bring about the needed transformation to achieve healthy populations and economic transition. However, Health in All Policies approaches do offer lessons and a rationale that is aligned with, and can support the transition to, a well‐being economy. Transforming current economic approaches to a well‐being economy is imperative to achieve equitable population health, social security and climate sustainability.

ABSTRACTThe World Health Organization’s Innov8 Approach for Reviewing National Health Programmes to Leave No One Behindis an eight-step process that supports the operationalization of the Sustainable Development Goals’ commitment to ‘leave no one behind’. In 2014–2015, Innov8 was adapted and applied in Indonesia to review how the national neonatal and maternal health action plans could become more equity-oriented, rights-based and gender-responsive, and better address critical social determinants of health. The process was led by the Indonesian Ministry of Health, with the support of WHO. It involved a wide range of actors and aligned with/fed into the drafting of the maternal newborn health action plan and the implementation planning of the newborn action plan. Key activities included a sensitization meeting, diagnostic checklist, review workshop and in-country work by the review teams. This ‘methods forum’ article describes this adaptation and application process, the outcomes and lessons learnt. In conjunction with other sources, Innov8 findings and recommendations informed national and sub-national maternal and neonatal action plans and programming to strengthen a ‘leave no one behind’ approach. As follow-up during 2015–2017, components of the Innov8 methodology were integrated into district-level planning processes for maternal and newborn health, and Innov8 helped generate demand for health inequality monitoring and its use in planning. In Indonesia, Innov8 enhanced national capacity for equity-oriented, rights-based and gender-responsive approaches and addressing critical social determinants of health. Adaptation for the national planning context (e.g. decentralized structure) and linking with health inequality monitoring capacity building were important lessons learnt. The pilot of Innov8 in Indonesia suggests that this approach can help operationalize the SDGs’ commitment to leave no one behind, in particular in relation to influencing programming and monitoring and evaluation.

Many intrinsically related determinants of health and disease exist, including social and economic status, education, employment, housing, and physical and environmental exposures. These factors interact to cumulatively affect health and disease burden of individuals and populations, and to establish health inequities and disparities across and within countries. Biomedical models of health care decrease adverse consequences of disease, but are not enough to effectively improve individual and population health and advance health equity. Social determinants of health are especially important in Latin American countries, which are characterised by adverse colonial legacies, tremendous social injustice, huge socioeconomic disparities, and wide health inequities. Poverty and inequality worsened substantially in the 1980s, 1990s, and early 2000s in these countries. Many Latin American countries have introduced public policies that integrate health, social, and economic actions, and have sought to develop health systems that incorporate multisectoral interventions when introducing universal health coverage to improve health and its upstream determinants. We present case studies from four Latin American countries to show the design and implementation of health programmes underpinned by intersectoral action and social participation that have reached national scale to effectively address social determinants of health, improve health outcomes, and reduce health inequities. Investment in managerial and political capacity, strong political and managerial commitment, and state programmes, not just time-limited government actions, have been crucial in underpinning the success of these policies.

Abstract: Objectives: We carried out a scoping review to identify and describe scholarly and grey literature referring to global cases of intersectoral action for health equity featuring a central role for governments. Methods: The scoping review process systematically identified articles describing one or more cases of intersectoral action. Each article was then described in terms of the context of initiation, as well as the strategies, actors, tools and structures used to implement these initiatives. Results: 128 unique articles were found describing intersectoral action across 43 countries. A majority of the cases appear to have initiated in the last decade. A variety of approaches were used to carry out intersectoral action, but articles varied in the richness of information included to describe different aspects of these initiatives. Conclusion: With this examination of cases across multiple countries and contexts, we can begin to clarify how intersectoral approaches to health equity have been used; however, the description of these complex, multi-actor processes in the published documents was generally superficial and sometimes entirely absent and improvements in such documentation in future publications is warranted. Richer sources of information such as interviews may facilitate a more comprehensive understanding from the perspective of multiple sectors involved.

To evaluate opportunities for action on social determinants of health (SDH) requires a historical perspective. Plans for addressing SDH should be developed with an awareness of past similar efforts and factors that contributed to their success or failure. Review of published historical literature on analysis and action on SDH, in particular from the Latin American social medicine movement. In the period since World War II, global public health has oscillated between a social vision of health and a more individualistic, technological and medicalised model. Action on SDH was central to comprehensive primary health care as promulgated at the 1978 Alma-Ata conference and championed by the movement for ‘Health for All by the Year 2000’. Subsequently, commitment to addressing SDH declined under the impact of restrictive interpretations of ‘selective primary health care’ and the pressure of neo-liberal economic and health policies. Through its critique of politically naive medical and public health approaches and of neo-liberal ideology, the Latin American social medicine tradition offers important lessons for today's efforts to advance action on SDH. Key lessons concern: (1) the model of praxis, consciously uniting reflection and action for political change; and (2) the importance of civil society and community participation in action on SDH. Opportunities exist today for significant progress in addressing SDH through national action and global mechanisms such as the Commission on Social Determinants of Health. Historical analysis suggests that civil society participation will be crucial for the success of these efforts.

Objective. To analyze links between social class and health-related indicators and behaviors in Chilean workers, from a neo-Marxian perspective. Methods. A cross-sectional study based on the First National Survey on Employment, Work, Health, and Quality of Life of Workers in Chile, done in 2009-2010 (n = 9 503). Dependent variables were self-perceived health status and mental health, examined using the General Health Questionnaire (GHQ-12). Health-related behavior variables included tobacco use and physical activity. The independent variable was neo- Marxian social class. Descriptive analyses of prevalence were performed and odds ratio (OR) models and 95% confidence intervals (95%CI) were estimated. Results. Medium employers (between 2 and 10 employees) reported a lower prevalence of poor health (21.6% [OR 0.68; 95%CI 0.46-0.99]). Unskilled managers had the lowest mental health risk (OR 0.43; 95%CI 0.21-0.88), with differences between men and women. Large employers (more than 10 employees) reported smoking the least, while large employers, expert supervisors, and semi-skilled workers engaged in significantly more physical activity. Conclusions. Large employers and expert managers have the best health-related indicators and behaviors. Formal proletarians, informal proletarians, and unskilled supervisors, however, have the worst general health indicators, confirming that social class is a key determinant in the generation of population health inequalities. [ABSTRACT FROM AUTHOR]

Objective. To analyze links between social class and health-related indicators and behaviors in Chilean workers, from a neo-Marxian perspective. Methods. A cross-sectional study based on the First National Survey on Employment, Work, Health, and Quality of Life of Workers in Chile, done in 2009-2010 (n = 9 503). Dependent variables were self-perceived health status and mental health, examined using the General Health Questionnaire (GHQ-12). Health-related behavior variables included tobacco use and physical activity. The independent variable was neo- Marxian social class. Descriptive analyses of prevalence were performed and odds ratio (OR) models and 95% confidence intervals (95%CI) were estimated. Results. Medium employers (between 2 and 10 employees) reported a lower prevalence of poor health (21.6% [OR 0.68; 95%CI 0.46-0.99]). Unskilled managers had the lowest mental health risk (OR 0.43; 95%CI 0.21-0.88), with differences between men and women. Large employers (more than 10 employees) reported smoking the least, while large employers, expert supervisors, and semi-skilled workers engaged in significantly more physical activity. Conclusions. Large employers and expert managers have the best health-related indicators and behaviors. Formal proletarians, informal proletarians, and unskilled supervisors, however, have the worst general health indicators, confirming that social class is a key determinant in the generation of population health inequalities. [ABSTRACT FROM AUTHOR]

The authors reflect on the efforts of national governments in the Americas to translate issues of health equity and social determinants of health (SDH) into political action. They explain how social conditions are the single most important determinants of health status for an individual and initiatives for adopting universal health coverage. They discuss the national health strategies of Brazil, Argentina, and Chile.