WHO: Driving forward health equity – the role of accountability, policy coherence, social participation and empowerment

18 June, 2019

(with thanks to Isabelle Wachsmuth -WHO & lead moderator HIFA-French - who posted an announcement of this publication on HIFA-French today)


A scientific expert review process coordinated by the WHO European Office for Investment for Health and Development of the WHO Regional Office for Europe identified societal and institutional factors that singly and in combination offer new explanations on why progress on health equity has not been as fast as had been hoped when the association between individual determinants and inequities was first established. These four key drivers of health equity are: accountability, policy coherence, social participation and, underlying them, empowerment. Work on these drivers informs the Health Equity Status Report initiative (HESRi) and has resulted in three independent companion papers each elaborating further on one of the common goods for health equity – accountability, policy coherence and social participation – as well as this summary paper.

The author of this paper is: Johanna Hanefeld, Associate Professor in Health Policy and Systems Research, London School of Hygiene and Tropical Medicine, United Kingdom

'Common goods driving health equity seek to move forward rights-based approaches that underpin the delivery of laws, policies and programmes that enable health equity. They do so through the application of core human-rights principles of accountability, participation and due process.'

One of the key messages to emerge is this: 'The common goods and their wider impact on justice, sustainability and prosperity provide new roles and ways of engagement for public health actors, both in non-health processes and in the way in which health processes simultaneously are shaped and engaged with. A key message emerging from the work on social participation and empowerment is the importance of spaces where people and communities are able to define engagement and come together to determine policies and redress inequities.'


... The health community is in a unique position to promote greater levels of participation, given its documented positive effects for health. Six basic components are proposed for a measurement of participation in the Region: inclusion, deliberation, information flow, decision-making, institutional commitment, and community capacity.

A key message emerging from the work on social participation and empowerment is the importance of spaces where people and communities are able to define engagement and come together to determine policies and redress inequities.

Increased social participation:

- Raises awareness and recognition of the rights of those facing greatest disadvantage

- Ensures greater engagement with, and implementation of, policy

- Has an empowering effect for communities and individuals to take greater control over their destiny


Underlying these three common goods is empowerment. A wide body of evidence recognizes that the empowerment of communities is essential to health equity.

This effect occurs through multiple pathways. Increased accountability brings people together to help them redress injustice and gives them a sense of power over collective destiny. Equally, evidence shows how lack of control and power at community level acts as a chronic stressor that negatively affects health and increases inequities...

Public health actors and policy-makers have three key areas through which to further empowerment for health equity: valuing individuals’ and communities’ knowledge and experiences; maximizing the potential of empowering spaces, such as youth groups or citizens’ assemblies; and moving away from stigmatizing narratives of disadvantage. On top of the direct effects on health equity is the extent to which empowerment further facilitates and positively affects the dynamic interplay between the other common goods, leading to greater health equity and a reduction of wider inequities within societies.


COMMENT (NPW): There is lots to consider here. Communities of practice such as HIFA have a significant and increasing role to promote social participation, empowerment, equity and the right to health. Already, for example, we are privileged to hear the voices of community health workers who are joining the HIFA community. One of the many advantages of virtual communities of practice is that hierarchies are flattened - we want to hear from and engage with CHWs as much as we want to hear from senior executives of UN agencies. A few years ago all this was thought by many to be impossible. But in a few years from now, I am sure that we shall see greatly increased participation from those currently at the margins of connectivity - CHWs and other stakeholder groups who have previously been excluded from global health dialogue.

Best wishes, Neil

Coordinator, HIFA Project on Community Health Workers


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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org