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The role of health systems in addressing health equity

Date: Thursday 1 November 10.45–12.15
Source: Forum 11
Authors: Lucy Gilson, Professor, London School of Hygiene and Tropical Medicine/Centre for Health Policy, University of Witwatersrand, South Africa
with Jane Doherty and Rene Loewenson


The Knowledge Network on Health Systems of the Commission on the Social Determinants of Health explored the role of health systems in promoting health equity. The final report of this network, prepared by the authors with background contributions and peer review by network members, provides the basis for this paper. It aims to: 1) analyse the pathways through which health systems impact on health (in) equity; 2) highlight the key policy implications of this analysis; 3) identify the priorities for further research in this field.

In addressing objective 1, the paper highlights the potential for health systems to: lever intersectoral action for health, promote social empowerment, provide health care that is accessible to socially-disadvantaged population groups, including low- income women, protect poorer groups from the impoverishing effects of ill-health, enable re-distribution and contribute to wider well-being. The key policy implications (objective 2) focus on the actions and approaches that ministries of health, civil society organizations and donors must take in differing contexts to initiate and institutionalize equity-promoting changes within health systems.

Reflecting on the difficulties experienced in assembling the knowledge base in this field, the paper concludes that the research needs in this field are many. Priorities (objective 3) include context-specific and cross-national analysis to understand the health equity impacts of different approaches to: social empowerment; strengthening public health-care financing and provision; changing the organizational culture of public sector health systems; as well as the strategies of political action and international actions needed to bring about these changes. Overall, the paper concludes that health systems are themselves a social determinant of health and that, currently, most health systems work to promote health inequity. This critical weakness demands political and social action to operationalize a primary health care and population health approach across health systems. Health equity must once again become the pre-eminent goal for health systems development. To support action, researchers must develop the knowledge base in this field.