Table 1.

Five point agenda for WHO to address the fundamental constraints to effective action on the social determinants of health (SDH)

Fundamental constraint	What does it mean for WHO?	Proposed WHO action	Examples of actions
The value of SDH is championed by the health sector, but the main policy changes required are in other sectors	WHO is not the key authority that convenes actors about policies in other sectors that impact health inequities	Share its ownership of the health agenda and promote leadership from other UN and multilateral organisations with relevant mandates, expertise, and networks on the policy choices needed to promote health equity	Partnering with the UNDP on advocating legislative and regulatory measures that can help reduce risk factors for non-communicable diseases36
Tension between WHO’s health mandate and the need to support other sectors’ leadership on SDHs	WHO risks internal professional resistance to emphasising the role that policies in other sectors have in shaping outcomes across WHO’s disease focused areas	Show that WHO considers SDH critical to achieving its mission and supporting countries to achieve SDG3	Building and strengthening staff capacity for dealing with SDH and generating greater internal appreciation of how a dominant biomedical orientation can divert critical attention away from social determinants and the influence of other sectors
SDH is a broad and multifaceted agenda—motivating and sustaining political attention on it can be overwhelming for the health sector	WHO is too overstretched to establish multisectoral partnerships and advance progress on every issue on the SDH agenda	Tailor its intersectoral approach to capitalise on synergies and mitigate harms and focus on areas where WHO’s authority on developing norms and standards can generate the greatest value	Using the effect on specific disease burdens to promote equitable polices (eg, effect of social protection on tuberculosis burden),37 motivating involvement of other sectors by highlighting how their core sectoral policy goals reduce health inequities, and paying special attention to commercial determinants of health and how governments can mitigate these impacts38
Standard approaches to identifying, reviewing, and appraising evidence are insufficient for informing policy on SDH	WHO’s approach to developing evidence informed recommendations is primarily tailored to inform interventions delivered by the healthcare system	Invest in methodological approaches for evaluating broader sources of knowledge and strengthen WHO’s ability to produce recommendations on the complex causal pathways from social determinants to health inequities	Developing an ambitious research programme for SDH that involves different disciplines and community-based perspectives for generating evidence on sectoral policies needed to reduce health inequities11
Policies influencing SDH are politically charged, shaped by ideology and values, and influenced by commercial interests	WHO’s biomedical orientation, member state driven agenda, and conventional response to ideologies and interests limits the secretariat in countering commercial and political drivers of health inequities	Exercise its authority on global health to draw critical attention to the ideologies and interests that run counter to the goal of health equity, mobilise civil society, and hold member states accountable by monitoring their actions	Challenging high income countries to support patent waivers, equitable sharing of vaccines, and labelling the hoarding of vaccines as morally indefensible39