Social determinants of health

Social Determinants of Health Discussion Paper 9

A training process to integrate a focus on social determinants of health and equity into health strategies, programmes and activities (SPAs) was carried out by the Spanish Ministry of Health, Social Services and Equality in 2010–2011. The training process was part of the equity action lines launched by the Ministry and reflected its interest in promoting and developing tools for moving towards the concept of health in all policies.

The training methodologies applied in Spain drew from the experience of the Chilean Ministry of Health in 2008–2009 of revising health programmes for greater health equity. Both the Chilean and Spanish trainings were guided by the work of the Commission on Social Determinants of Health. The training was technically supported by the World Health Organization (WHO) Regional Office for Europe and the Virtual Public Health Campus of the Pan American Health Organization/WHO Regional Office for the Americas.

The goal of the Spanish health equity training was to develop and strengthen the capacity of the management teams of professionals working at the Ministry of Health, Social Services and Equality (national level), regional health departments and other key administration levels in areas considered critical for reducing health inequities. The three specific objectives of the training process were:

      • to build participants’ theoretical understanding of health equity, social determinants of health, and programme evaluation cycles
      • to build participants’ methodological capacity to review public health SPAs from the perspective of health equity and social determinants of health
      • to produce a guide that synthesized the methodology, background resources, and experience of the training.

The guide – entitled the Methodological guide to integrate equity into health strategies, programmes and activities – was published in 2012. The guide was developed with the aims of raising awareness on health equity and the social determinants of health approach among professionals in the health sector and in those sectors with an impact on the health of the population, and providing a practical tool to ease the effective integration of equity into health SPAs. The guide is available in both English and Spanish.

This paper aims to describe the methods and process used for the Spanish health equity training, highlight some of the emerging results and describe lessons learnt across the Spanish experience. It therefore aims to contribute to the Rio Political Declaration on Social Determinants of Health by supporting specifically the priority area on further reorienting the health sector towards reducing health inequities, including moving towards universal health coverage that is accessible, affordable, and good quality for all.