Skip to main content Accessibility help
×
Hostname: page-component-848d4c4894-sjtt6 Total loading time: 0 Render date: 2024-06-23T11:49:30.008Z Has data issue: false hasContentIssue false

Chapter 31 - The Determinants of Health Systems

Upstream Approach to Addressing Health and Social Inequities

from Section 2 - Transforming Health Systems: Confronting Challenges, Seizing Opportunities

Published online by Cambridge University Press:  08 December 2022

Sameen Siddiqi
Affiliation:
Aga Khan University
Awad Mataria
Affiliation:
World Health Organization, Egypt
Katherine D. Rouleau
Affiliation:
University of Toronto
Meesha Iqbal
Affiliation:
UTHealth School of Public Health, Houston
Get access

Summary

Just as there are determinants of health of individuals and communities, there are determinants of health system organization and performance which we term structural determinants. This chapter focuses on a set of such determinants considered key in understanding and strengthening health systems in low- and middle-income countries (L&MICs). These determinants include politics and governance; the economy, livelihoods and poverty; climate change, environmental degradation and natural disasters; social and organizational culture; wars and conflicts. Each of these determinants has its own set of issues. For example, with regards to politics and governance, it is intersection of the form of authority, institutional arrangements, political values, citizen participation, corruption, and informal governance channels that determine health system performance. While the influence of structural determinants on health systems is acknowledged, there is still limited attention to integrating work on structural determinants in health system thinking, policies and practice. This chapter argues for a multi-pronged strategy to address this gap: focusing on tackling inequities; removing misconceptions about health determinants among health workers; easing the path to health system work on health determinants; engaging concerned communities; evaluating innovations to address health determinants; and strengthening intersectoral collaboration.

Type
Chapter
Information
Making Health Systems Work in Low and Middle Income Countries
Textbook for Public Health Practitioners
, pp. 479 - 495
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Koeman, J., Mehdipanah, R.. Prescribing housing: a scoping review of health system efforts to address housing as a social determinant of health. Popul Health Manag 2021; 24(3): 316321.Google Scholar
Burkle, F. M.. Declining public health protections within autocratic regimes: impact on global public health security, infectious disease outbreaks, epidemics, and pandemics. Prehosp Disaster Med 2020; 35(3): 237246.Google Scholar
Geloso, V., Berdine, G., Powell, B.. Making sense of dictatorships and health outcomes. BMJ Glob Health 2020; 5(5): e002542.CrossRefGoogle ScholarPubMed
Batniji, R., Khatib, L., Cammett, M., et al. Governance and health in the Arab world. Lancet 2014; 383(9914): 343355.Google Scholar
Wigley, S., Akkoyunlu-Wigley, A.. The impact of regime type on health: does redistribution explain everything? World Polit 2011; 63(4): 647677.Google Scholar
Dianda, I.. Do political factors affect government health spending? Empirical evidence from sub-Sahara African Countries. 2020. https://pdfs.semanticscholar.org/4541/9c8352cc69c5b380ea632373753f74b6113a.pdf (accessed July 18, 2021).Google Scholar
Matsuura, H.. Exploring the association between the constitutional right to health and reproductive health outcomes in 157 countries. Sex Reprod Health Matters 2019; 27(1): 1599653.Google Scholar
Dwicaksono, A., Fox, A. M.. Does decentralization improve health system performance and outcomes in low- and middle-income countries? A systematic review of evidence from quantitative studies. Milbank Q 2018; 96(2): 323368.Google Scholar
Cinaroglu, S.. Politics and health outcomes: a path analytic approach. Int J Health Plann Manage 2019; 34(1): e824e843.Google Scholar
Kiendrébéogo, J. A., Meessen, B. Ownership of health financing policies in low-income countries: a journey with more than one pathway. BMJ Glob Health 2019; 4(5): e001762.Google Scholar
Chalkidou, K., Jain, N., Cluzeau, F., et al. Modicare post-election: recommendations to enhance the impact of public health insurance on UHC goals in India. 2019. www.cgdev.org/sites/default/files/modicare-post-election-recommendations-enhance-impact-public-health-insurance-uhc-goals.pdf (accessed August 26, 2022).Google Scholar
Bolsewicz Alderman, K., Hipgrave, D., Jimenez-Soto, E.. Public engagement in health priority setting in low- and middle-income countries: current trends and considerations for policy. PLoS Med 2013; 10(8): e1001495.CrossRefGoogle ScholarPubMed
Ogbuabor, D. C., Onwujekwe, O. E.. Implementation of free maternal and child healthcare policies: assessment of influence of context and institutional capacity of health facilities in South-east Nigeria. Glob Health Action 2018; 11(1): 1535031.Google Scholar
Chuengsatiansup, K., Tengrang, K., Posayanonda, T., et al. Citizens’ jury and elder care: public participation and deliberation in long-term care policy in Thailand. J Aging Soc Policy 2019; 31(4): 378392.Google Scholar
Ben Mesmia, H., Chtioui, R., Ben Rejeb, M.. The Tunisian societal dialogue for health reform (a qualitative study). Eur J 2020; 30(Suppl. 5): ckaa166-1393.Google Scholar
Kohler, J. C., Martinez, M. G.. Participatory health councils and good governance: healthy democracy in Brazil? Int J Equity Health 2015; 14: 21.CrossRefGoogle ScholarPubMed
Martinez, M. G., Kohler, J. C.. Civil society participation in the health system: the case of Brazil’s Health Councils. Global Health 2016; 12(1): 64.Google Scholar
García, P. J.. Corruption in global health: the open secret. Lancet 2019; 394(10214): 21192124.CrossRefGoogle ScholarPubMed
Richard, D. S., Hanson, K.. Health Systems in Low- and Middle-Income Countries: An Economic and Policy Perspective. Oxford, Oxford University Press, 2012.Google Scholar
Abimbola, S., Baatiema, L., Bigdeli, M.. The impacts of decentralization on health system equity, efficiency and resilience: a realist synthesis of the evidence. Health Policy Plan 2019; 34(8): 605617.CrossRefGoogle ScholarPubMed
Jabbour, S., El-Zein, A., Nuwayhid, I., et al. Can action on health achieve political and social reform? BMJ 2006; 333(7573): 837839.Google Scholar
Ruiz-Cantero, M. T., Guijarro-Garvi, M., Bean, D. R., et al. Governance commitment to reduce maternal mortality: a political determinant beyond the wealth of the countries. Health Place 2019; 57: 313320.Google Scholar
Frakt, A. B.. How the economy affects health. JAMA 2018; 319(12): 11871188.Google Scholar
World Health Organization. Making the economic case for investing in health systems: what is the evidence that health systems advance economic and fiscal objectives? 2018. https://apps.who.int/iris/handle/10665/331982 (accessed July 18, 2021).Google Scholar
Yamey, G., Beyeler, N., Wadge, H., et al. Investing in health: the economic case. Report of the WISH Investing in Health Forum 2016. Salud Publica Mex 2017; 59(3): 321342.Google Scholar
World Health Organization. Investing global, investing local: supporting value for money towards the health SDGs. 2018. www.who.int/docs/default-source/investment-case/value-for-money.pdf (accessed August 19, 2021).Google Scholar
World Health Organization. Economic and social impacts and benefits of health systems: report. 2019. https://apps.who.int/iris/handle/10665/329683 (accessed July 14, 2021).Google Scholar
Ebi, K. L., Berry, P., Campbell-Lendrum, D.. Health system adaptation to climate variability and change. 2019. https://gca.org/wp-content/uploads/2020/12/HealthSystemAdaptationToClimateVariabilityandChange_0.pdf (accessed July 18, 2021).Google Scholar
Benjamin, G. C.. Shelter in the storm: health care systems and climate change. Milbank Q 2016; 94(1): 1822.CrossRefGoogle ScholarPubMed
World Health Organization. Operational framework for building climate resilient health systems. 2015. www.who.int/publications/i/item/operational-framework-for-building-climate-resilient-health-systems (accessed August 19, 2021).Google Scholar
Ridde, V., Benmarhnia, T., Bonnet, E., et al. Climate change, migration and health systems resilience: need for interdisciplinary research. F1000Res 2019; 8: 22.Google Scholar
Frumkin, H., Hess, J., Luber, G., et al. Climate change: the public health response. Am J Public Health 2008; 98(3): 435445.Google Scholar
Van Minh, H., Tuan Anh, T., Rocklöv, J., et al. Primary healthcare system capacities for responding to storm and flood-related health problems: a case study from a rural district in central Vietnam. Glob Health Action 2014; 7: 23007.Google Scholar
Cogburn, C. D.. Culture, race, and health: implications for racial inequities and population health. Milbank Q 2019; 97(3): 736761.CrossRefGoogle ScholarPubMed
Mash, R., De Sa, A., Christodoulou, M.. How to change organisational culture: action research in a South African public sector primary care facility. Afr J Prim Health Care Fam Med 2016; 8(1): e1e9.Google Scholar
Pettersson, T., Öberg, M.. Organized violence, 1989–2019. J Peace Res 2020; 57(4): 597613.Google Scholar
Thompson, R., Kapila, M.. Healthcare in conflict settings: leaving no one behind. 2018. www.wish.org.qa/wp-content/uploads/2018/11/IMPJ6078-WISH-2018-Conflict-181026.pdf (accessed August 13, 2021).Google Scholar
Levy, B. S., Victor, W. S.. War and Public Health. Oxford, Oxford University Press, 2008.Google Scholar
Acerra, J. R., Iskyan, K., Qureshi, Z. A., et al. Rebuilding the health care system in Afghanistan: an overview of primary care and emergency services. Int J Emerg Med 2009; 2(2): 7782.Google Scholar
Fouad, F. M., Sparrow, A., Tarakji, A., et al. Health workers and the weaponisation of health care in Syria: a preliminary inquiry for The Lancet–American University of Beirut Commission on Syria. Lancet 2017; 390(10111): 25162526.Google Scholar
Bhutta, Z. A.. What must be done about the killings of Pakistani healthcare workers? BMJ 2013; 346: f280.Google Scholar
Elamein, M., Bower, H., Valderrama, C., et al. Attacks against health care in Syria, 2015–16: results from a real-time reporting tool. Lancet 2017; 390(10109): 22782286.Google Scholar
Wiist, W. H., White, S. K.. Preventing War and Promoting Peace: A Guide for Health Professionals. Cambridge, Cambridge University Press, 2017.Google Scholar
Arya, N., Barbara, J. S.. Peace through Health: How Health Professionals Can Work for a Less Violent World. Boulder, Kumarian Press, 2008.Google Scholar
Spiegel, P. B.. The humanitarian system is not just broke, but broken: recommendations for future humanitarian action. Lancet 2017; 17: 31278-3.Google Scholar
Canyon, D. V., Burkle, F. M. Jr. The 2016 World Humanitarian Summit Report Card: both failing marks and substantive gains for an increasingly globalized humanitarian landscape. PLoS Curr 2016; 8. doi: 10.1371/currents.dis.a94dd3e2f84d0a5abc179add7286851c.Google Scholar
Martineau, T., McPake, B., Theobald, S., et al. Leaving no one behind: lessons on rebuilding health systems in conflict- and crisis-affected states. BMJ Glob Health 2017; 2(2): e000327.Google Scholar
Ayiasi, R. M., Rutebemberwa, E., Marttineau, T.. Understanding deployment policies and systems for staffing rural areas in Northern Uganda during and after the conflict: synthesis report: ReBUILD consortium. 2016. www.rebuildconsortium.com/resources/understanding-deployment-policies-and-systems-for-staffing-rural-areas-in-northern-uganda-during-and-after-the-conflict-synthesis-report/ (accessed July 13, 2021).Google Scholar
Gilson, L., Doherty, J., Lowenson, R., et al. Challenging inequity through health systems. Final Report. Knowledge Network on Health Systems. 2007. https://researchonline.lshtm.ac.uk/id/eprint/7136/ (accessed July 18, 2021).Google Scholar
Mador, R.. Health system approaches to promoting health equity. Discussion Paper. 2010. www.bccdc.ca/pop-public-health/Documents/HealthSystemApproaches_FINAL.pdf (accessed July 19, 2021).Google Scholar
Labonté, R.. Health systems governance for health equity: critical reflections. Rev Salud Publica (Bogota) 2010; 12(Suppl. 1): 6276.Google Scholar
Ford-Gilboe, M., Wathen, C. N., Varcoe, C., et al. How equity-oriented health care affects health: key mechanisms and implications for primary health care practice and policy. Milbank Q 2018; 96(4): 635671.CrossRefGoogle ScholarPubMed
Palakshappa, D., Miller, D. P. Jr. Rosenthal, G. E.. Advancing the learning health system by incorporating social determinants. Am J Manag Care 2020; 26(1): e4e6.Google Scholar
Marmot, M.. Addressing social determinants of health in primary care. 2018. www.aafp.org/dam/AAFP/documents/patient_care/everyone_project/team-based-approach.pdf (accessed July 19, 2021).Google Scholar
López, N., Gadsden, V. L.. Health inequities, social determinants, and intersectionality. 2016. https://nam.edu/health-inequities-social-determinants-and-intersectionality/ (accessed August 13, 2021).Google Scholar
Watkins, D. A., Nugent, R., Saxenian, H., et al. Intersectoral policy priorities for health. In Jamison, D. T., Gelband, H., Horton, S., et al., eds., Disease Control Priorities: Improving Health and Reducing Poverty, 3rd ed. Washington, DC, International Bank for Reconstruction and Development and the World Bank, 2017.Google Scholar
Prasad, A. M., Chakraborty, G., Yadav, S. S., et al. Addressing the social determinants of health through health system strengthening and inter-sectoral convergence: the case of the Indian National Rural Health Mission. Glob Health Action 2013; 6: 111.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×