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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

By
Samer Jabbour ,
Carine Naim ,
Nyambura Muriuki  and
Fadi Martinos
Edited by
Sameen Siddiqi ,
Awad Mataria ,
Katherine D. Rouleau  and
Meesha Iqbal
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
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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.

Keywords

DeterminantsGovernancePoliticsCorruptionOrganizational cultureEconomyPovertyClimate changeWarConflictHealth inequitiesHealth systemsHealth determinantsSocial inequitiesL&MIC
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

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