Closing the measurement-action gap in health inequities

The recent WHO Commission on Social Determinants of Health issued as its third overarching recommendation to 'measure and understand the problem and assess the impact of action'. Measurement of health inequities is often a necessary condition for action on the social determinants. The Commission itself marshals a comprehensive survey of the evidence on global inequities. It builds on an explosion of research and evidence on inequities in health over the past two decades. Yet measurement is not sufficient to generate action. Despite the overwhelming evidence on health inequities between and within countries, health and other sectors have generated limited or fragmented action on social determinants in most countries. In many of the countries with the best evidence on health inequities, they continue to widen. While emphasis continues to be placed on measuring health inequities, there is much less evidence on the second part of the Commission's recommendation - the effectiveness of interventions which act on the social determinants and reduce health inequities. Very few countries have reduced health inequities. In light of the Commission, this presentation evaluates the role that measurement has played in countries which have been successful, and considers the obstacles to realising the Commission's vision of 'closing the gap in a generation'. Furthermore, given that one does not necessarily lead to the other, the presentation asks the question as to what is the optimal balance between measurement of health inequities and moving ahead on plausible interventions.