Intended for healthcare professionals


How can WHO transform its approach to social determinants of health?

BMJ 2022; 376 doi: (Published 08 February 2022) Cite this as: BMJ 2022;376:e066172
  1. Unni Gopinathan, senior researcher1,
  2. Kent Buse, director2
  1. 1Cluster for Global Health, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
  2. 2Healthier Societies Programme, George Institute for Global Health, Imperial College London, London, UK
  1. Correspondence to: U Gopinathan unni.gnathan{at}

WHO has a pivotal role in reducing health inequities but faces five fundamental constraints to progress, argue Unni Gopinathan and Kent Buse

The social determinants of health are the circumstances in which people are born, grow, live, work, and age, and these are shaped by the inequitable distribution of power, money, and other resources in society.1 Differences in income or unequal exposure to environmental risks contribute to unfair health outcomes within and between populations, something the covid-19 pandemic has brought into sharp focus.2

The World Health Organization was created as a multilateral United Nations agency to support and convene member states to tackle health issues through international collaboration and coordination. The importance of economic and social conditions for health was codified in WHO’s founding constitution in 1948,3 and the link between socioeconomic factors and health was highlighted again in 2008 with the report of the WHO convened Commission on Social Determinants of Health.1 The report emphasised that health inequities are a consequence of poor social policies and unfair economic arrangements and called on governments, civil society, local communities, private sector, and international agencies to take action. Although the report motivated detailed national and regional assessments of the effect of social determinants on health inequities,45 its recommendations have not been widely translated to policy and practice6—a failure that arguably laid the grounds for the unequal effects of the covid-19 pandemic.27

WHO has undertaken a range of actions on social determinants of health at global, regional, and national levels. Globally, it has drawn attention to social protection, housing, and the empowerment of women and girls through its work, for example, on tuberculosis and sexual and reproductive health and rights.89 In 2021, it launched a multiyear initiative to support countries in …

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