The WHO Commission on Social Determinants of Health was launched in Chile in
March 2005. The WHO Regional Office for the Eastern Mediterranean, working with
WHO headquarters and through the country offices, seeks to capitalize on its experience
in formulating regional priorities and strategies and providing technical support to
ministries of health in Member States, to forward the agenda on social determinants of
health and health equity in individual countries. In May 2005, the second global meeting
of the Commission was held in Cairo, immediately followed by a regional meeting at the
Regional Office. Discussions at these two meetings revealed that the links between social
determinants and health outcomes were not at present well understood or documented
in the Region. Without such a knowledge base it was not possible to formulate policies
and interventions that could address health inequalities.
This finding served to emphasize that a first stage in any initiative on the social
determinants of health would be to build up an evidence base for the major social
determinants and for the health disparities and health inequities that result from them,
and to illuminate the processes by which these determinants affect health outcomes.
The first activities therefore were the preparation of a regional discussion paper and a
series of country studies in the Region. The purpose of this publication is to present the
summaries of these country level reviews of the existing body of evidence on the social
determinants of health and health inequalities, within the framework of the work of
the Commission on Social Determinants of Health. The summaries illustrate the range
of the social determinants that affect health outcomes and health equity in the Region,
examine the processes by which these produce health outcomes (most often negative
health outcomes) and identify some strategies to improve these health outcomes by
tackling social determinants.
The scope and range of this evidence for the impact of social determinants on health
outcomes should be a central concern for country level policy-makers and advisers, for
the WHO staff who provide ministries of health with technical support and for other
interested parties. It is to the producers and users of this evidence that this review is
directed. The publication invites readers to explore social determinants in their own
countries, to identify the characteristics of particular disadvantaged groups and the
processes which result in poor health, and to go on to develop policies which are fully
cognizant of these determinants, and identify specific strategies to tackle them.