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Competing Interests: We are both involved in programmes to develop Marmot Places and are Director (MM) and Deputy Director (JA) of the Institute of Health Equity (IHE) that is working with collaborators on Marmot Places. Funding for IHE comes from University College London and the places that commission us to advise them. IHE is one of the academic centres collaborating in the WHO Special Initiative. We declare no other competing interests.

Since the 2008 publication of the reports of the Commission on Social Determinants of Health and its nine knowledge networks, substantial research has been undertaken to document and describe health inequities. The COVID-19 pandemic has underscored the need for a deeper understanding of, and broader action on, the social determinants of health. Building on this unique and critical opportunity, the World Health Organization is steering a multi-country Initiative to reduce health inequities through an action-learning process in 'Pathfinder' countries. The Initiative aims to develop replicable and reliable models and practices that can be adopted by WHO offices and UN staff to address the social determinants of health to advance health equity. This paper provides an overview of the Initiative by describing its broad theory of change and work undertaken in three regions and six Pathfinder countries in its first year-and-a-half. Participants engaged in the Initiative describe results of early country dialogues and promising entry points for implementation that involve model, network and capacity building. The insights communicated through this note from the field will be of interest for others aiming to advance health equity through taking action on the social determinants of health, in particular as regards structural determinants., (© 2023. The Author(s).)

Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare. The Stop TB Partnership supported the O’Neill Institute’s work on developing the framework for, and an implementation guide on, health equity programmes of action but did not participate in this article. Patient and public involvement: Although no patients or the public were included in the development of this article, we did involve members of the public in developing the health equity programme of action framework. This included holding meetings with members of civil society from several countries as well as a consultation with civil society from numerous countries, developing an advisory committee that included several people who had had tuberculosis, and opening a draft of the framework for public comment through the O’Neill Institute website.

Health inequities across the Americas are avoidable and unjust yet continue to persist. Systemic social determinants of health, which could be addressed at the policy level, are root causes of many inequities and prevent marginalized individuals and at-risk populations from reaching optimal health and well-being. In this article, we describe our approach to promote health equity through the intersectoral partnerships that were forged, and strategies that were shared, during the convening entitled "Summit 2017: Health Equity in the Americas" and the resulting emergence of the Health Equity Network of the Americas (HENA). We illustrate how this international network will raise awareness of policies and programs to inform decision makers about actions they can take to put an end to the unjust, persistent and mostly avoidable health inequities facing the Americas today., Competing Interests: Competing Interests: None declared.

In the following discussion, we present a quick conceptual history of healthy equity and health justice, some plausible outcomes from the Covid‐19 pandemic for the public's understanding of these concepts, and some recent and relevant learnings for realizing equity and justice that could be useful for dental public health and beyond. [ABSTRACT FROM AUTHOR]

Background: Hong Kong has a relatively low incidence rate of COVID-19 across the globe. Nevertheless, ethnic minorities in Hong Kong, especially South Asians (SAs) and Southeast Asians (SEAs), face numerous physical, mental, social, economic, cultural and religious challenges during the pandemic. This study explores the experiences of SA and SEA women in a predominantly Chinese metropolitan city. Methods: Ten SA and SEA women were recruited and face-to-face interviews were conducted. Questions about participants' daily life experience, physical and mental health conditions, economic situation and social interaction amid COVID-19 pandemic were asked to assess the impact of COVID-19. Results: SAs and SEAs have a distinctive family culture, and women experienced significant physical and mental impact of COVID-19 due to their unique gender role in the family. In addition to taking care of their family in Hong Kong, SA and SEA women also had to mentally and financially support family members residing in their home countries. Access to COVID-related information was restricted due to language barrier. Public health measures including social distancing imposed extra burden on ethnic minorities with limited social and religious support. Conclusions: Even when COVID-19 incidence rate is relatively low in Hong Kong, the pandemic made life even more challenging for SAs and SEAs, which is a community already struggling with language barriers, financial woes, and discrimination. This in turn could have led to greater health inequalities. Government and civil organizations should take the social determinants of health inequalities into account when implementing COVID-19-related public health policies and strategies. [ABSTRACT FROM AUTHOR]

Mental health is impacted by social, economic, and environmental factors, the Social Determinants of Health (SDH). Migrants experiencing precarious living and working conditions may be more at risk of poor mental health than the majority population. This paper aims to evaluate the relationship of educational attainment and other SDH with depressive symptoms among the resident population, including Italians and migrants. This study examined the respondents to the Italian "Progressi delle Aziende Sanitarie per la Salute in Italia" (PASSI) surveillance system, 2014–18. The sample of 144.055 respondents is composed of the resident working adults aged 25–69 with Italian citizenship (n = 136.514) and foreign citizenship (n = 7.491). Findings show that among Italians high level of education appears to be a protective factor for mental health, in accordance with the international evidence (adjPR: tertiary education 0,74 p-value = 0.000). However, among immigrants high level of education is associated with the presence of depressive symptoms (adjPR: tertiary education: 1.61 p-value = 0.006), particularly for men (adjPR: tertiary education: 2.40 p-value = 0.006). The longer the length of stay in Italy for immigrants the higher the risk of depressive symptoms: adjPR for 10+ years: 2.23 p-value = 0.005. The data show that high education could represent a risk factor for mental health of immigrants. Moreover, among migrants there are some significant mental health inequities between male and female related to the duration of stay in Italy, economic activity and educational level. Considering that health is related to the nature of society as well as to access to technical solutions, multicultural societies require culturally oriented interventions for tackling health inequities. This means developing evidence-based policies in order to tackle health inequalities in the population as a whole, including culturally oriented measures in the larger framework of developing diversity sensitive services. [ABSTRACT FROM AUTHOR]

The article discusses highlights of the workshop held by the International Agency for Research on Cancer (IARC) in April 2018 which focused on identifying research priorities in resolving social inequalities in cancer. Topics explored include the data gathering focused on cancer disparities, the importance of developing cancer prevention initiatives, and the effective delivery of cancer control programs.

The article discusses the global public health issues associated with social inequalities in cancer. Topics explored include highlights of the October 2017 Global Conference on Noncommunicable Diseases (NCD) held by the World Health Organization (WHO) and the Uruguay Government, the observed health inequalities between high-income and middle-income countries, and the lifestyle changes deemed necessary for cancer prevention according to Cancer Research UK.

Background: The health gap between the top and the bottom of the income distribution is widening rapidly in the USA, but the lifespan of America's poor depends substantially on where they live. We ask whether two major developments in American society, deindustrialization and incarceration, can explain variation among states in life expectancy of those in the lowest income quartile.Methods: Life expectancy estimates at age 40 of those in the bottom income quartile were used to fit panel data models examining the relationship with deindustrialization and incarceration between 2001 and 2014 for all US states.Results: A one standard deviation (s.d.) increase in deindustrialization (mean = 11.2, s.d. = 3.5) reduces life expectancy for the poor by 0.255 years [95% confidence interval (CI): 0.090-0.419] and each additional prisoner per 1000 residents (mean = 4.0, s.d. = 1.5) is associated with a loss of 0.468 years (95% CI: 0.213-0.723). Our predictors explain over 20% of the state-level variation in life expectancy among the poor and virtually the entire increase in the life expectancy gap between the top and the bottom income quartiles since the turn of the century.Conclusions: In the USA between 2001 and 2014, deindustrialization and incarceration subtracted roughly 2.5 years from the lifespan of the poor, pointing to their role as major health determinants. Future research must remain conscious of the upstream determinants and the political economy of public health. If public policy responses to growing health inequalities are to be effective, they must consider strengthening industrial policy and ending hyper-incarceration. [ABSTRACT FROM AUTHOR]

One way of characterising the good society is one that has achieved a high degree of health equity. For a low-income country, one route to this achievement is to increase national income. But other features of society come to the fore, for low, middle and high-income societies alike. In England, my review of health inequalities highlighted: good early child development, education and life long learning, employment and working conditions, having enough income to lead a healthy life, healthy and sustainable places to live and work, taking a social determinants approach to prevention. Taking action on these requires commitment and cross-government action. [ABSTRACT FROM AUTHOR]

The social gradient in health has the clear implication that action to improve health and reduce inequalities has to take place at social level, not simply depending on individual changes. Individuals’ ability to change is constrained by social circumstances. The evidence that the magnitude of the gradient varies between countries, and can change within a country over time, suggests that conscious strategies to change it can be successful. In my review of evidence in Britain, the Marmot Review, we made recommendations in six domains: give every child the best start in life; education and life-long learning; employment and working conditions; ensure that everyone has at least the minimum income necessary to lead a health life; healthy and sustainable places; taking a social determinants approach to prevention.A big question is the role of health professionals in action on social determinants of health. We have identified five actions in implementing recommendations: education and training; seeing the patient in broader perspective; the health service as employer; working in partnership; advocacy. The evidence is encouraging that health professionals can make a big difference in advancing the cause of health equity. [ABSTRACT FROM AUTHOR]

Background The relationship of childhood socioeconomic position (SEP) to adult cancer has been inconsistent in the literature and there has been no review summarising the current evidence focused solely on cancer outcomes. Methods and results We performed a rapid review of the literature, which identified 22 publications from 13 studies, primarily in the UK and northern European countries that specifically analysed individual measures of SEP in childhood and cancer outcomes in adulthood. Most of these studies adjusted for adult SEP as a critical mediator of the relationship of interest. Conclusions Results confirm that childhood socioeconomic circumstances have a strong influence on stomach cancer and are likely to contribute, along with adult circumstances, to lung cancer through cumulative exposure to smoking. There was also some evidence of increased risk of colorectal, liver, cervical and pancreatic cancers with lower childhood SEP in large studies, but small numbers of cancer deaths made these estimates imprecise. Gaps in knowledge and potential policy implications are presented. [ABSTRACT FROM AUTHOR]

Sir Michael Marmot writes on public health, social determinants of health, and health equity. [ABSTRACT FROM AUTHOR]

Background Relatively large socioeconomic inequalities in health and mortality have been observed in Central and Eastern Europe (CEE) and the former Soviet Union (FSU). Yet comparative data are sparse and virtually all studies include only education. The aim of this study is to quantify and compare socioeconomic inequalities in all-cause mortality during the 2000s in urban population samples from four CEE/FSU countries, by three different measures of socioeconomic position (SEP) (education, difficulty buying food and household amenities), reflecting different aspects of SEP. Methods Data from the prospective population-based HAPIEE (Health, Alcohol, and Psychosocial factors in Eastern Europe) study were used. The baseline survey (2002-2005) included 16 812 men and 19 180 women aged 45-69 years in Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and seven Czech towns. Deaths in the cohorts were identified through mortality registers. Data were analysed by direct standardisation and Cox regression, quantifying absolute and relative SEP differences. Results Mortality inequalities by the three SEP indicators were observed in all samples. The magnitude of inequalities varied according to gender, country and SEP measure. As expected, given the high mortality rates in Russian men, largest absolute inequalities were found among Russian men (educational slope index of inequality was 19.4 per 1000 person-years). Largest relative inequalities were observed in Czech men and Lithuanian subjects. Disadvantage by all three SEP measures remained strongly associated with increased mortality after adjusting for the other SEP indicators. Conclusions The results emphasise the importance of all SEP measures for understanding mortality inequalities in CEE/FSU. [ABSTRACT FROM AUTHOR]

This article investigates to what extent the worldwide increase in body mass index (BMI) has been affected by economic globalization and inequality. We used time-series and longitudinal cross-national analysis of 127 countries from 1980 to 2008. Data on mean adult BMI were obtained from the Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group. Globalization was measured using the Swiss Economic Institute (KOF) index of economic globalization. Economic inequality between countries was measured with the mean difference in gross domestic product per capita purchasing power parity in international dollars. Economic inequality within countries was measured using the Gini index from the Standardized World Income Inequality Database. Other covariates including poverty, population size, urban population, openness to trade and foreign direct investment were taken from the World Development Indicators (WDI) database. Time-series regression analyses showed that the global increase in BMI is positively associated with both the index of economic globalization and inequality between countries, after adjustment for covariates. Longitudinal panel data analyses showed that the association between economic globalization and BMI is robust after controlling for all covariates and using different estimators. The association between economic inequality within countries and BMI, however, was significant only among high-income nations. More research is needed to study the pathways between economic globalization and BMI. These findings, however, contribute to explaining how contemporary globalization can be reformed to promote better health and control the global obesity epidemic. [ABSTRACT FROM AUTHOR]

The article discusses the report "Fair Society Healthy Lives" on the role of health professionals to reduce health inequalities. An overview of the scope and focus of the report is offered. Also explained are recommendations for health professionals to take action on health inequalities, to work with individuals and communities, and to work in partnership and as advocates and the commitments of health professionals and organizations to develop action on the social determinants of health.

Objectives. We examined socioeconomic inequalities in health among older adults in England and Brazil. Methods. We analyzed nationally representative samples of residents aged 50 years and older in 2008 data from the Brazilian National Household Survey (n = 75 527) and the English Longitudinal Study of Ageing (n = 9589). We estimated prevalence ratios for self-rated health, functional limitations, and reported chronic diseases, by education level and household income tertiles. Results. Brazilians reported worse health than did English respondents. Country-specific differences were higher among the poorest, but also affected the wealthiest persons. We observed a strong inverse gradient of similar magnitude across education and household income levels for most health indicators in each country. Prevalence ratios (lowest vs highest education level) of poor self-rated health were 3.24 in Brazil and 3.50 in England; having 2 or more functional limitations, 1.81 in Brazil and 1.96 in England; and having 1 or more diseases, 1.14 in Brazil and 1.36 in England. Conclusions. Socioeconomic inequalities in health affect both populations, despite a less pronounced absolute difference in household income and education in Brazil than in England. [ABSTRACT FROM AUTHOR]

Social inequalities are a proper concern of epidemiology. Epidemiological thinking and modes of analysis are central, but epidemiological research is one among many areas of study that provide the evidence for understanding the causes of social inequalities in health and what can be done to reduce them. Understanding the causes of health inequalities requires insights from social, behavioral and biological sciences, and a chain of reasoning that examines how the accumulation of positive and negative influences over the life course leads to health inequalities in adult life. Evidence that the social gradient in health can be reduced should make us optimistic that reducing health inequalities is a realistic goal for all societies. [ABSTRACT FROM AUTHOR]

The present article identifies how social determinants of health raise two categories of philosophical problems that also fall within the smaller domain of ethics; one set pertains to the philosophy of epidemiology, and the second set pertains to the philosophy of health and social justice. After reviewing these two categories of ethical concerns, the limited conclusion made is that identifying and responding to social determinants of health requires inter-disciplinary reasoning across epidemiology and philosophy. For the reasoning used in epidemiology to be sound, for its scope and (moral) purpose as a science to be clarified as well as for social justice theory to be relevant and coherent, epidemiology and philosophy need to forge a meaningful exchange of ideas that happens in both directions. [ABSTRACT FROM AUTHOR]

The article looks at agendas which address climate change, social conditions, and health inequity. The authors discuss the environmental and health outcomes of climate change. Migration from poor rural areas to urban areas and the environmental consequences of urbanisation are also discussed. The food system and its effect on diet-related health inequities are examined. The authors explain the need to reorient policies with the knowledge about causes of climate change and about the social causes of health inequity. Fairness in international trade arrangements for avoiding food crises is discussed. Urban planning, rural investment, and food distribution systems are also discussed. The requirements for sustainable social policy are addressed.

The article summarises a report by the World Health Organization Commission on Social Determinants of Health on the promotion of health equity for countries at all levels of income and development. The authors explain that a new approach to development which uses policies and programmes that embrace all sectors of society is needed. Recommendations including improvement of daily living conditions, tackling the inequitable distribution of power, money, and resources, and understanding the problem are discussed. Universal health care and fair financing are discussed. Political empowerment and good global governance are recommended.

Background: Various methodologic approaches have been used to estimate the role of risk factors in explaining the social gradient in coronary heart disease (CHD). Our objective was to examine whether there is a discrepancy in results obtained using the relative and absolute approaches.Methods: Data are from the Whitehall II prospective cohort study on 5363 men who were 40- to 62-year-old at the start of the 11-year follow-up period.Results: One or more of the 4 conventional risk factors examined (smoking, hypertension, high cholesterol, and diabetes) were present for 77% of individuals in the low socioeconomic group compared with 68% in the high socioeconomic group. The relative risk for incident CHD in the low socioeconomic group was 1.66 (95% confidence interval = 1.20 to 2.29) compared with the high group. Standardizing the distribution of risk factors in the low and high socioeconomic group to the overall study sample reduced relative risk by 16% and absolute risk by 14%. We also computed the population attributable risk (PAR) to indicate the reduction in CHD if the risk factor were completely removed from the population. The PAR associated with having at least one risk factor was 41% (95% confidence interval = 33% to 57%) in the high and 58% (13% to 91%) in the low socioeconomic group.Conclusions: In situations where the goal is to remove social differences in the distribution of risk factors, conventional risk factors explain a similar proportion of the social gradient in CHD, whether using the relative or absolute approaches to change in risk. This is not comparable to population attributable risk calculations, in which the goal is to completely remove the risk factors from the population. Failure to recognize that these methods address different questions seems to be the reason for discrepancies in previous results. [ABSTRACT FROM AUTHOR]

The authors discuss the Health 2020, the new World Health Organization (WHO) European policy for health that will focus on social determinants of health and improvement of health system in Europe. They state that the goals of Health 2020 are to attain more equitable health for the people in Europe via greater awareness and to improve its governance. They are also critical on the conclusion of the WHO Commission on Social Determinants of Health (CSDH) in achieving health equity in the country.

The article emphasizes the need to create programs that will support early child development and reduce health and social inequalities in Great Britain. It examines the challenges posed by managing social development in rich and poor countries, along with the gradients in child development. An analysis of early child development programs is presented, including the benefits of such programs to disadvantaged children. The role of health care systems in early child development programs is explained. In addition, the article describes the commitment of the government to promote health equality in the country.

The author talks about challenge of health inequality in Brazil and progress made in the same field. Topics discussed include a paper showing non-communicable diseases as more common in people of lower social position, implementation of the Brazilian Unified Health System that has eliminated inequalities and need of development of systems to monitor health inequalities and social determinants.