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The European network of health promotion agencies Bundeszentrale für gesundheitliche Aufklärung National Institute of Public Health, NIPH Finnish Centre for Health Promotion (FCHP) The Institute of Public Health in Ireland National Social Marketing Centre International Union for Health Promotion and Education European Partners

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You are here: > Publications

Publications on "Health Inequalities/Social Determinants of Health"


DETERMINE Final Publication:


DETERMINE Working Document Series:

DETERMINE Publications:


Other reports and position papers related to the politics of health inequalities:
(Additional scientific work on the matter is provided here)

Chiotan, C & Costongs, C. Can we build on exisiting information systems to monitor health inequalities and the social determinants of health in the EU? Brussels: EuoHealthNet; 2010.
The objective of this paper is to provide a brief overview of the data collected and indicators that are available at national and EU level, to monitor health inequalities and socio-economic determinants of health. It will specifically look at data and indicators with relevance to health inequities and their determinants.
To read the full paper click here.

Health in the European Union: trends and analysis
World Health Organization 2009, on behalf of the European Observatory on Health Systems and Policies
 “…………..this report investigates differences in health status within and between European countries.
The relationship between living conditions, socioeconomic factors and health is discussed and analysed with the objective of stimulating a debate and policy action for creating a healthier and more equitable society.
While the goal to improve average levels of population health is important for any government, there has been an increasing focus on disparities at national and European levels. Improvements have been seen over the past few decades in both health status and living and working conditions in Europe. However, the level of heterogeneity in characteristics of living conditions has widened tremendously in the European Union and will continue to do so as it goes through the enlargement process.
The diversity in living conditions has translated into diversity in patterns of health across the region. Inequalities in income, education, housing and employment affect population health, both directly (for example, good housing reduces risks associated with poor health) and indirectly through psychosocial factors (such as stress)……………….”
To read the full report click here.

Measuring and tackling health inequalities across Europe
Eurohealth on health inequalities -  January 2010
“….Measuring and tackling health inequalities across Europe Articles include a Commission perspective on reducing health inequalities in the EU; challenges with measurement and data availability; and examples of national strategic approaches in France, Hungary and the Netherlands.  

Other articles on health policy developments include morbidity-based risk adjustment in Germany and improving health system performance in New Zealand.
To read the full journal click here.

Environment and health risks: the influence and effects of social inequalities
Report of an expert meeting held in Bonn, Germany, 9-10 September 2009
In recent years, the links between social context and health have been increasingly considered from the perspective of environmental justice, in terms of how and to what extent they affect environmental risk factors and health. This meeting is part of the preparations for the Fifth Ministerial Conference on Environment and Health (Parma, Italy, 10-12 March 2010), where inequalities in environment and health will be one of the main topics.
European experts discussed and reviewed a compilation of evidence on environmental exposures and their distribution by social gradients in the WHO European Region. On this basis, they produced a set of technical and policy recommendation on possible countermeasures.
Evidence summaries, provided as background papers to the meeting, covered the following topics: water and sanitation, injuries, housing, air quality, occupational settings, waste, children, climate change and gender-related inequities.
The discussion of evidence focused on answering four main questions:
   1. what is the health dimension? (priority issues and inequality in the burden of disease)
   2. what are the key mechanisms, i.e. why and how do inequalities appear?
   3. who is most affected, and where?
   4. how can the inequalities be mitigated?
To read the full report click here.

Health Impact Assessment Guidance 2009
Owen Metcalfe, Claire Higgins, Teresa Lavin
Institute of Public Health in Ireland, 23 October, 2009
ISBN Number: 978-0-9559598-3-7
This guidance manual explains what Health Impact Assessment (HIA) is and the stages involved in conducting it. It has been revised and updated based on the experience of HIA practitioners and includes new tools which have been developed to assist each step of the HIA process. It aims to provide a user friendly and practical framework to guide policy-makers and practitioners in undertaking HIA. To find all HIA tools contained in this guidance and further information on HIA  click here
To download the Health Impact Assessment Guidance click here.

A guide to Quantitative Methods in Health Impact Assessment
Hakan Brodin, Stephen Hodge
Swedish National Insitute of Public Health, 2008
This guide is written for people who work with practical analysis in the public health field at local, regional and central levels. It is also useful for decision-makers who may require a Health Impact Assessment to inform and support important decisions in a range of areas both inside and outside public health.
(click here)

Closing the Gap in a Generation:
Health equity through action on the social determinants of health
Final Report of the Commission on Social Determinants of Health
CSDH  August 2008 - Geneva, World Health Organization
The Final Report of the Commission on Social Determinants of Health sets out key areas of daily living conditions and of the underlying structural drivers that influence them in which action is needed. It provides analysis of social determinants of health and concrete examples of types of action that have proven effective in improving health and health equity in countries at all levels of socioeconomic development.
(click here)

Health Equity Through Intersectoral Action: An Analysis of 18 Country Case Studies
World Health Organization (WHO) and the Public Health Agency of Canada (PHAC) - 2008
Recognition of the intersectoral dimensions of the determinants of health has stimulated international efforts on systematic learning about how the action of different sectors can positively influence health and health equity.
The WHO and the PHAC have supported the development of this collaborative work by jointly commissioning a set of 18 case studies from high, middle, and low income countries. The case studies outline diverse experiences of action across sectors with positive impacts for health and health equity.
(click here)

Final Report - EUROTHINE - Tackling Health Inequalities In Europe: an integrated approach
EMC (Erasmus MC) Universitair Medisch Centrum Rotterdam -University Medical Center Rotterdam
(click here)

Health for all? A critical analysis of public health policies in eight European countries
Editors: Christer Hogstedt, Henrik Moberg, Bernt Lundgren and Mona Backhans
Swedish National Institute of Public Health 2008
“…scientific experts from eight different countries to write about the public health policies in their respective countries with a special emphasis on the equity aspect. The countries chosen represented different parts of Europe: from the northern (Denmark, Finland Norway and Sweden) via the western (England and the Netherlands) to the southern parts (Italy and Spain).
(click here)

The Nordic Experience: Welfare States and Public Health
Olle Lundberg, Monica Åberg Yngwe, Maria Kölegård Stjärne, Lisa Björk, Johan Fritzell
Health Equity Studies No 12 - August 2008
Centre for Health Equity Studies (CHESS) Stockholm University/Karolinska Institutet
The social aspects of disease and mortality are particularly central when we discuss ways to improve the health of nations and populations.
This report makes a first attempt to provide analyses of the extent to which the Nordi
(click here)

Comprehensive report on health inequalities in Andalucía, Spain
Editado por: Asociación para la Defensa de la Sanidad Pública de Andalucía. FADSP
(click here)

Learning from our neighbours - Cross-national inspiration for Dutch public health policies: smoking, alcohol, overweight, depression, health inequalities, youth, screening
Wilk EA van der, Melse JM, Broeder JM den, Achterberg PW, National Institute for Public Health and The Environment - The Netherlands, 2008.
This report is mainly looking for inspiration, opportunities and possibilities that can arise from an international orientation towards health policy.
(click here)

Health inequalities - Understanding the essentials
London Health Observatory LHO - Association of Public Health Observatories (APHO)
In order to tackle health inequalities together, we need to share a common understanding of what we mean when we talk of "inequity" and unfairness in health and health care. This introduction to tackling health inequalities aims to explain some of the thinking behind policy and practice on tackling health inequalities. The London Health Observatory (LHO) has a national lead role on behalf of the Association of Public Health Observatories on health inequalities and ethnicity.
(click here)

Inequalities in young people’s health
Health Policy for Children and Adolescents, No. 5 - HBSC 2005/2006 SURVEY
WHO Regional Office for Europe and the University of Edinburgh - June 2008
This international report is the fourth from the Health Behaviour in School-aged Children (HBSC) study, a WHO collaborative cross-national study, and the most comprehensive. It presents the key findings on patterns of health among young people aged 11, 13 and 15 years in 41 countries and regions across the WHO European Region and North America in 2005/2006. Its theme is health inequalities: quantifying the gender, age, geographic and socioeconomic dimensions of health differentials.
(click here)

Unnatural causes - is inequality making us sick?
A sevan part documentary series exploring racial and socio-economic inequalities in health
(click here)

Two CBC radio broadcasts on health inequalities!
We are healthier than ever before, and we live longer, but improvements in health are not distributed evenly. The rich outlive the middle classes, who outlive the poor. Swedes and Japanese live longer than Canadians, and Canadians, longer than Americans. Freelance journalist Jill Eisen discovers that the reasons have little to do with our health care systems.

1) Sick People or Sick Societies? - Part One
Right click to download Sick People or Sick Societies? - Part One [mp3 file: runs 52:10]

2)  Sick People or Sick Societies? - Part Two
Right click to download Sick People or Sick Societies? - Part Two [mp3 file: runs 52:43]

Shaping the world to illustrate inequalities in health
Danny Dorling, Anna Barford
Visualizing inequalities in health at the world scale is not easily achieved from tables of mortality rates. Maps that show rates using a colour scale often are less informative than many map-readers realize. For instance, a country with a very small land area receives less attention, whereas a large, sparsely populated area on a map is more obvious. Furthermore, unlike our visual ability to compare the lengths of bars in a chart, we do not have a natural aptitude for translating different colours or shades to the magnitudes they represent. Here another approach is introduced to mapping the world that can be useful for illustrating inequalities in health.
(click here)

Employment Conditions and Health Inequalities
Final report to the WHO Commission on the Social Determinants of Health
Employment Conditions Knowledge Network (EMCONET), 20 September 2007.
Joan Benach, Carles Muntaner, Vilma Santana (Chairs)
The aim of this Report is to provide a rigorous analysis on how employment relations affect different population groups, and how this knowledge may help identify and promote worldwide effective policies and institutional changes to reduce health inequalities derived from these employment relations.
(click here)

The social determinants of health: Developing an evidence base for political action. Final Report to the WHO Commission on the Social Determinants of Health from Measurement and Evidence Knowledge Network, 2007
Michael P. Kelly (Co-chair) - Josiane Bonnefoy (Co-chair)
This report begins by identifying six problems which make developing the evidence base on the social determinants of health potentially difficult. In order to overcome these difficulties a number of principles are described which help move the measurement of the social determinants forward. The report proceeds by describing in detail what the evidence based approach entails including reference to equity proofing. The implications of methodological diversity are also explored. A framework for developing, implementing, monitoring and evaluating policy is outlined. At the centre of the framework is the policy-making process which is described beginning with a consideration of the challenges of policies relating to the social determinants. The ways to make the case for policies are described and appropriate entry points and communications strategies are identified.
(click here)

Onions and bubbles: models of the social determinants of health.
Wilcox LS. Preventing Chronic Disease 2007;4(4). (click here)

Economic implications of health inequalities in the European Union
Johan Mackenbach, Willem Meerding, Anton Kunst
The authors first calculated the inequalities related losses to population health in the European Union in 2004.
They then estimated various economic effects of those health losses, including health care costs, costs of social
security schemes, losses to Gross Domestic Product through reduced labour productivity, and the monetary value
of total losses in welfare. The European Commission - July 2007. (click here)

Achieving health equity: from root causes to fair outcomes
This paper by Michael Marmot is an abridged version of the Interim Statement of the Commission on Social Determinants of Health. The Lancet 2007, 370:1153-1163. (click here)

How have global health initiatives impacted on health equity?
What strategies can be put in place to enhance their positive impact and mitigate against negative impacts? A literature review commissioned by the Health Systems Knowledge Network WHO Commission on the Social Determinants of Health by Johanna Hanefeld, Neil Spicer, Ruairi Brugha, Gill Walt. (click here)

Tackling Health Inequalities in Europe: an Integrated Approach. Final Report of the Eurothine Project.
Rotterdam: Department of Public Health, University Medical Centre (Erasmus MC)
Work is divided into eleven so-called Work Packages (WPs). Three groups of WPs can be dinstinguished: General Work Packages, Work Packages aimed to describe health inequalities, and Work Packages aimed to evaluate interventions. (click here)

Globalization and social determinants of health - A series of papers written by Ronald Labonte, Ted Schrecker, Department of Epidemiology and Community Medicine, Faculty of Medicine and Institute of Population Health, University of Ottawa, Canada
This is a three-part review of research on globalization and the social determinants of health (SDH). In the first article of the series, an economically oriented definition of globalization was identified and defended and a number of important conceptual and metholodogical issues were addressed. In the second article, seven key clusters of pathways relevant to globalization's influence on SDH were identified and described. The third article describes interventions to reduce health inequities by way of SDH are inextricably linked with social protection, economic management and development strategy.

Globalization and social determinants of health: Promoting health equity in global governance (part 3 of 3); Globalization and Health 2007, 3:7 (19 June 2007) (click here)
Globalization and social determinants of health: The role of the global marketplace (part 2 of 3); Globalization and Health 2007, 3:6 (19 June 2007) (click here)
Globalization and social determinants of health: Introduction and methodological background (part 1 of 3); Globalization and Health 2007, 3:5 (19 June 2007) (click here)

Levelling up
Part 1: a discussion paper on concepts and principles for tackling social inequities in health.
Part 2: a discussion paper on European strategies for social inequities in health by WHO European Office for Investment for Health and Development in Venice.
Part 1 (PDF).  Part 2 (PDF).

Development Outreach [Issue of February: 2006]: Equity and Development
Following on the findings of the World Development Report 2006 , this edition of Development OUTREACH features a special report which further explores how greater equity and growth can be achieved through the design and implementation of the right kinds of policies in various regions of the world. Central to this discussion are the local and international institutions that can help promote equity. Also explored are ways of increasing the democratic participation and representation of the disenfranchised in government (click here).

Health Inequalities: A Challenge for Europe
As the authors (Ken Judge, Stephen Platt, Caroline Costongs, Kasia Jurczak) of this report point out, health inequalities are increasingly recognised as an important public health issue throughout Europe. As a result of the growing recognition of the problem, many countries are responding by developing public policies in a wide variety of ways. The primary aim of this independent paper, which was commissioned by the UK Presidency of the EU, is to review national-level policies and strategies that either have been or are in the process of being developed to tackle health inequalities. (click here)

Health Inequalities: Europe in Profile
As the author (Johan Mackenback) of this report points out, at the start of the 21st century, all European countries are faced with substantial inequalities in health within their populations. People with a lower level of education, a lower occupational class, or a lower level of income tend to die at a younger age, and to have a higher prevalence of most types of health problems. The primary aim of this independent paper, which was commissioned by the UK Presidency of the EU, is to review the evidence on the existence of socioeconomic inequalities in health in the EU and its immediate neighbours. It presents data on inequalities in mortality in 21 countries, on inequalities in self-assessed health in 18 countries, and on inequalities in smoking in 23 countries. (click here)

UK Health Watch 2005 - Politics of Health Group
On the day that the UK government, as part of its EU Presidency, hosted a two day Health Inequalities Summit conference in London, a new report claims that health inequalities have deteriorated as a direct result of government policies. The report - which is published online and is free to download - presents a wide range of articles on what it calls 'the experience of health in an unequal society'. Some articles are by established experts, like Professors Richard Wilkinson, Peter Townsend, Priscilla Alderson, John Appleby and Dennis Raphael, others by activists like the 'McLibel Two' who came out on top in the recent libel case brought by McDonalds. (click here)

Closing the Health Inequalities Gap: An International Perspective
This report presents an analysis of official documents on government policies to tackle health inequalities in 13 developed countries. The report was authored by Iain K. Crombie, Linda Irvine, Lawrence Elliott and Hilary Wallace of the University of Dundee, Scotland, UK. It was comissioned by NHS Health Scotland and published by the WHO European Office for Investment for Health and Development. (click here)

Health Status and Living Conditions in an Enlarged Europe
A report by the European Obrservatory on the Social Situation, Health Status and Living Conditions Network for the EU Commissions Directorate General Employment, Social Affairs, and Equal Opportunities, December 2005. (click here).

Action on the Social determinants of Health: Learning from Previous Experiences
A background paper prepared for the Commission on Social Determinants of Health, WHO, March 2005.
The paper sees an unprecedented opportunity to improve health in some of the world's poorest and most vulnerable communities by tackling the root causes of disease and health inequalities. The most powerful of these causes are the social conditions in which people live and work, referred to as the social determinants of health (SDH).
The Millennium Development Goals (MDGs) shape the current global development agenda. The MDGs recognize the interdependence of health and social conditions and present an opportunity to promote health policies that tackle the social roots of unfair and avoidable human suffering. The Commission on Social Determinants of Health (CSDH) is poised for leadership in this process. To reach its objectives, however, the CSDH must learn from the history of previous attempts to spur action on Social Determinants of Health.
The paper pursues three questions:
(1) Why didn't previous efforts to promote health policies on social determinants succeed?
(2) Why do we think the Commission on Social Determinants of Health (CSDH) can do better?
(3) What can the Commission learn from previous experiences - negative and positive - that can increase its chances for success?
(click here)

The WHO Health Promotion Glossary
The WHO Health Promotion Glossary was written to facilitate understanding, communication and cooperation among those engaged in health promotion at the local, regional, national and global levels. Two editions of the Glossary have been released, the first in 1986 and the second in 1998.
(click here)

New terms for Health Promotion Glossary
Continued revision of the document is necessary to promote consensus regarding meanings and to take account of developments in thinking and practice. In the following update, published in Health Promotion International, 10 new terms are presented.
(click here)

Monitoring and Evaluation (M&E): Some Tools, Methods and Approaches
The booklet presents a sample of M&E tools, methods and approaches, including several data collection methods, analytical frameworks, and types of evaluation and review. For each of these, a summary is provided of the following: their purpose and use; advantages and disadvantages; costs, skills, and time required; and key references. (click here)
The booklet discusses:

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