Public Health Policy to Tackle Social Health Inequalities: A Balancing Act Between Competing Institutional Logics

Social health inequalities (or inequities) continue to represent a great challenge for public health research worldwide. Since 1991, the World Health Organization established that the study and analysis of health inequalities represented a priority for all countries. To better guide methodological and practical implications of health inequalities, research on this topic should present a solid theoretical model, able to impact future public health policies. Previous studies of health inequalities in Latin America are often inspired from abroad experiences, encouraging the reproduction of mainly European theoretical positions and methodologies. However, especially when it comes to this topic, it is known the important role of the social context and culture, playing an important role in promoting differences in health outcomes. From this perspective, to operationalize the different social determinants in health, a critical perspective and thoughtful analysis of the context is mandatory. In order to provide a critical analysis and useful tools for both research and health decision making, we recommend that the theoretical and methodological approaches used in social health inequalities research must be well adapted to the specific contexts; that health social stratification must be assessed as a priority; that individual and the wider health determinants must be well characterized; and that the theoretical justification of the methodological decisions made in the studies and the selected measures must be explicit and should answer specific hypotheses. This research provides a brief historical background, to share the basis for the conceptual evolution of social health inequalities; the main underlying concepts related to the definition of health inequalities (social determinants, equity, justice, stratification and social gradient in health); and some recommendations for the future perspectives of health inequalities research in Latin America.

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The Swedish national public health policy and its achievements after ten years

European Journal of Public Health ◽

10.1093/eurpub/ckz185.710 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

N Lindqvist

Keyword(s):

Public Health ◽

Health Policy ◽

Health Inequalities ◽

Public Health Policy ◽

Policy Framework ◽

Political Agenda ◽

Health Work ◽

Public Health Perspective ◽

National Public Health ◽

The Government

Abstract Public health issues and their equality aspects have been on the political agenda in Sweden since the early 1980s. Already in the 1990s, the Government presented the first public health policy bill. This highlighted the conditions for a sustainable development from a public health perspective. Increased equality was set to be the overriding objective in prioritizing public health work and that priority should be given to efforts that would improve the situation of the most disadvantaged. The foundation of today’s public health policy was laid in 2003 when the parliament decided on a new bill in which an overall goal for national public health policy was established: ‘Creating social conditions for good health on equal terms for the entire population’. The bill also established a cross-sectoral target structure for the overall public health work with eleven target areas. It also pointed out that public health policy is cross-sectoral and must be a part in all policy areas. In June 2008, the parliament adopted the bill A Renewed Public Health Policy. Changes made were (among other things) a rewording of the target areas, but many of the starting points were kept. The Swedish Commission for Equity in Health was set up in 2015 and given two main tasks, to produce a proposal that can help to reduce the health inequalities in society and to work for raised awareness of health inequalities in society and among stakeholders. The work of the commission was finished in 2017 and presents an analysis of how the public health policy works in practice, with regard to the intentions of policy framework. A number of problems or areas of development appear which the Commission considers need to be addressed. The presentation will first give a short overview of the Swedish public health policy from 2008 and will then present the commission’s conclusions and proposals for development areas.

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Addressing the social determinants of health at the local level: Opportunities and challenges

Scandinavian Journal of Public Health ◽

10.1177/1403494817743896 ◽

2018 ◽

Vol 46 (20_suppl) ◽

pp. 47-52 ◽

Cited By ~ 4

Author(s):

E. Fosse ◽

M.K. Helgesen ◽

S. Hagen ◽

S. Torp

Keyword(s):

Public Health ◽

Health Policy ◽

Health Inequalities ◽

Public Health Policy ◽

Social Inequalities ◽

Local Level ◽

Qualitative Interviews ◽

Social Gradient ◽

New Public Health ◽

The Social

Aims: The gradient in health inequalities reflects a relationship between health and social circumstance, demonstrating that health worsens as you move down the socio-economic scale. For more than a decade, the Norwegian National government has developed policies to reduce social inequalities in health by levelling the social gradient. The adoption of the Public Health Act in 2012 was a further movement towards a comprehensive policy. The main aim of the act is to reduce social health inequalities by adopting a Health in All Policies approach. The municipalities are regarded key in the implementation of the act. The SODEMIFA project aimed to study the development of the new public health policy, with a particular emphasis on its implementation in municipalities. Methods: In the SODEMIFA project, a mixed-methods approach was applied, and the data consisted of surveys as well as qualitative interviews. The informants were policymakers at the national and local level. Results: Our findings indicate that the municipalities had a rather vague understanding of the concept of health inequalities, and even more so, the concept of the social gradient in health. The most common understanding was that policy to reduce social inequalities concerned disadvantaged groups. Accordingly, policies and measures would be directed at these groups, rather than addressing the social gradient. Conclusions: A movement towards an increased understanding and adoption of the new, comprehensive public health policy was observed. However, to continue this process, both local and national levels must stay committed to the principles of the act.

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