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Access to health employment conditions like income, job security, flexibility in working hours, job and task control, and employment-related migration. The effectiveness of regulatory measures, employment and industrial relations policy, and worker safety legal frameworks – structural interventions that seek to prevent and mitigate the effects of employment and working conditions – should be mapped and analyzed 27 . The rapidly changing living environment: urban settings The rapid process of urbanization has seen an explosion of “slums” worldwide and more generally urban conditions often not conducive to healthy living, either through the physical, social or economic environment generated in such settings. Urban slums are characterized as unplanned informal settlements where access to services is minimal-tononexistent and where overcrowding is the norm. Urban settings and in particular the health challenges of slumdwellers constitute a vast and growing challenge, particularly for developing countries. Urban development has historically been seen as both a cause and solution for social inequalities in health. However, social gradients in health within urban areas occur everywhere and are resistant to change. Urban environments, and their effect on health, are influenced by the degree and type of industrialization, availability of sanitary conditions, quality of housing, accessibility of green spaces and by transport, an increasing concern. The urban setting is a lens that magnifies or diminishes other social determinants of health and exposes different population groups in different ways to a whole variety of factors conducive or otherwise to health. Interventions in the urban setting therefore imply the integration of actions simultaneously addressing a range of health determinants. Slum upgrading is an often-used intervention to improve social and environmental determinants of the urban poor. This usually includes: physical upgrading of housing, water and sanitation, infrastructure, and the environment; social upgrading through improved education; violence reduction programmes; better access to and improved health services; governance upgrading through participatory processes; community leadership and empowering civil society through knowledge and information 27 . Globalization in the 21st century The processes, and nature, of globalization may be regarded as the underpinning structural social determinant of health and health equity. Global processes exert a powerful impact at all levels of the social production of health: on the evolution of sociopolitical contexts in countries; on the nature and magnitude of social stratification; and on the configuration of various specific determinants (e.g. working conditions, food availability). We see the global influence within countries operating both formally: multilateral institutions and processes of engagement, multilateral binding and nonbinding treaties and agreements; and informally: cultural production, media and the collapse of “cognitive distance” between global population groups. Among the most relevant aspects of globalization on inequalities on health, with potential for intervention, are: market access, trade barriers and liberalization, integration of production of goods, commercialization and privatization of public services, and changing lifestyle patterns. While recent years have seen a rapid expansion of interest in globalization and health, numerous important questions remain inadequately explored. There is a need to identify and evaluate policy options through which national policy-makers can respond to the challenges posed by globalization and also capitalize on its opportunities in a health-promoting way. It is necessary to identify and characterize the degree of negative or positive health impact of globalization in specific cases: not only to clarify relevant causal processes, but as a contribution to evaluating the impact of interventions and policies on other social determinants of health 27 . In conclusion, if the major determinants of health and health equity are social, so must be the solutions. Areas requiring research then should be ones which address the social factors which influence the global inequities in health. Each of the nine thematic areas for research and intervention, identified by the Commission on Social Determinants of Health, is relevant in all countries. Such research should seek to highlight the transferability of knowledge, elucidate the conditions, processes and actors necessary for effective intervention, and in a systematic manner compile a knowledge base which will underpin action to improve health, reduce the health gap and redress the health gradient. ❏ Sharon Friel is a social and nutritional epidemiologist and has worked in the area of public health nutrition and inequalities in health since 1992. She is currently the Principal Research Fellow for the global Commission on Social Determinants of Health, based at the International Institute for Society and Health, University College London. She is also a Fellow at the National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia, where she is currently working as consultant to the World Cancer Research Fund diet and cancer policy report. Prior to this Dr Friel worked for many years in the Department of Health Promotion, National University of Ireland, Galway, as well as being Chair of the Irish Health Promotion Association for four years. Much of her work is concerned with the interface between research, policy and practice in matters relating to international and national level social determinants of inequalities in health, in particular those relating to diet. Ruth Bell is a Senior Research Fellow in the Department of Epidemiology and Public Health at University College London, working with the global Commission on Social Determinants of Health. She has previously worked as a consultant to the Nuffield Foundation and the King’s Fund. Dr Bell’s early research career at the University of Freiburg, Germany and the Institute of Cancer Research, Royal Marsden Hospital, London was in the area of cancer causation. Tanja AJ Houweling is a social epidemiologist (MSc) and medical anthropologist/sociologist (MA) and has worked in the area of social inequalities in health since 2000. Currently, she works as 052 ✜ Global Forum Update on Research for Health Volume 4
Access to health Senior Research Fellow for the global Commission on Social Determinants of Health, based at the International Institute for Society and Health, University College London. Prior to this, Dr Houweling worked at the Department of Public Health at ErasmusMC University Medical Center Rotterdam, the Netherlands, where she did research on socio-economic inequalities in health, in particular in low- and middle-income countries. She was also involved in a study on health inequalities for the World Bank and in a technical consultation on health inequalities at World Health Organization (WHO) Geneva, Switzerland. She obtained her PhD degree in September 2007 at Erasmus University Rotterdam, on a study on socio-economic inequalities in childhood mortality in lowand middle-income countries. Sebastian Taylor is a Senior Research Fellow for the global Commission on Social Determinants of Health, based at the Institute for International Society and Health, University College London. Since 1992, much of his work has been in designing, managing and evaluating complex humanitarian and developmental programmes. He has worked extensively in China, Laos, India, Pakistan, Nigeria, Egypt and Somalia. With a growing focus on health action in resource-poor settings, Dr Taylor worked with the Polio Eradication Initiative from 2002 to 2004, and retains strong research interests in both the politics of large-scale health interventions, and the political economy of policy-making in global and multilateral aid agencies. References 1. Sachs J. Macroeconomics and Health: Investing in Health for Economic Development, 2001. Commission on Macroeconomics and Health. Geneva: World Health Organization. 2. Dwyer J. Global health and justice. Bioethics, 2005, 19 (5-6): 460-75. 3. Global Forum for Health Research. The 10/90 Report on Health Research 2003–2004, 2004. Geneva: Global Forum for Health Research. 4. Labonte R, Schrecker T, Gupta A. Health for some: death, disease and disparity in a globalising era, 2005. Toronto: Centre for Social Justice. 5. Baum F. Who cares about health for all in the 21st century? Journal of Epidemiology and Community Health, 59 (9): 714-715, 2005. 6. Wilkinson R, Pickett K. Income inequality and health: a review and explanation of the evidence, 2005. 7. Ebrahim S, Smeeth L. Non-communicable diseases in low and middleincome countries: a priority or a distraction? International Journal of Epidemiology, 2005, 34 (5): 961-966. 8. Choi BCK et al. Diseases of comfort: primary cause of death in the 22nd century. Journal of Epidemiology and Community Health, 2005, 59 (12): 1030-1034. 9. Ezzati M et al. Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors, 2004. Geneva: World Health Organization. 10. Gwatkin D, Wagstaff A, Yazbeck A. Reaching the poor with health, nutrition and population services, 2005. Washington DC: The World Bank. 11. Global Fund. The Global Fund to fight AIDS, tuberculosis and malaria. 12. WHO. WHO 3 by 5 initiative. 13. WHO. Roll back malaria partnership. 14. United Nations. Millennium Development Goals, 2000. 15. Monden C. Current and lifetime exposure to working conditions. Do they explain educational differences in subjective health? Social Science & Medicine, 2005, 60: 2465-2476. 16. Bartley M. Job insecurity and its effect on health. Journal of Epidemiology and Community Health, 2005, 59 (9): 718-719. 17. Marmot M, Brunner E. Cohort Profile: The Whitehall II study. International Journal of Epidemiology, 2005, 34 (2): 251-256. 18. Christensen C. World hunger: A structural approach. International Organization, 2002, 32 (3): 745-774. 19. Marmot MG. Tackling health inequalities since the Acheson Inquiry. J Epidemiol Community Health 58 (4): 262-263, 2004. 20. Alvarez-Dardet C, Ashton JR. Inequalities goes global. Journal of Epidemiology and Community Health, 2004, 58 (4): 261-. 21. Ostlin P, Braveman P, Dachs N. Priorities for research to take forward the health equity policy agenda. Bulletin of the World Health Organization, 2005, 83 (12): 948-53. 22. Marmot M, Wilkinson R. Social Determinants of Health (2nd ed.), 2005. Oxford: Oxford University Press. 23. Marmot M. Social determinants of health inequalities. The Lancet, 2005, 365: 1099-1104. 24. Jong-wook L. Public health is a social issue. The Lancet, 2005, 365: 1005-1006. 25. Pang T. Filling the gap between knowing and doing. Nature, 2003, 426:383. 26. Pang T, Gray M, Evans T. A 15th grand challenge for global public health. The Lancet, 2006, 367 (9507): 284-286. 27. Solar O, Irwin A. Towards a Conceptual Framework for Analysis and Action on the Social Determinants of Health, 2005. Geneva: Commission on the Social Determinants of Health. Global Forum Update on Research for Health Volume 4 ✜ 053
Page 1 and 2: Global Forum Update on Research for
Page 3 and 4: Editorial Advisory Board: Luis Gabr
Page 5 and 6: Contents 096 Child immunization: ac
Page 7 and 8: Introduction Research contributions
Page 9 and 10: Introduction Type I Type II Type II
Page 11 and 12: Introduction making), takes account
Page 13 and 14: Access to health Strengthening heal
Page 15 and 16: Access to health raising public awa
Page 17 and 18: Access to health Recent trends in r
Page 19 and 20: Access to health districts with a p
Page 21 and 22: Access to health Understanding heal
Page 23 and 24: Access to health This study investi
Page 25 and 26: Access to health References continu
Page 27 and 28: Access to health combining particip
Page 29 and 30: Access to health 2002 2005 Diff. SU
Page 31 and 32: Access to health References continu
Page 33 and 34: Access to health Americans think th
Page 35 and 36: Access to health threatening and se
Page 37 and 38: Access to health References 1. Worl
Page 39 and 40: Access to health Open access to res
Page 41 and 42: Access to health References 1. Rose
Page 43: Access to health national and globa
Page 47 and 48: Access to health ✜ Rights alone a
Page 49 and 50: Access to health meaningful communi
Page 51 and 52: Access to health Inequality, margin
Page 53 and 54: Access to health questions, develop
Page 55 and 56: Access to health reasonable in abou
Page 57 and 58: Access to health References 1. Kohn
Page 59 and 60: Access to health The diverse pathwa
Page 61 and 62: Access to health 2001, WTO ruled th
Page 63 and 64: Access to health knowledge and educ
Page 65 and 66: Access to health References 1. Lee
Page 67 and 68: Innovation 076 Towards the developm
Page 69 and 70: Innovation ✜ Creating a viable va
Page 71 and 72: Innovation Natural sciences and env
Page 73 and 74: Innovation References 1. Morel C et
Page 75 and 76: Innovation The changes in internati
Page 77 and 78: Innovation promoting health in deve
Page 79 and 80: Innovation efficiently converted in
Page 81 and 82: Innovation future global health fin
Page 83 and 84: Innovation References 1. See http:/
Page 85 and 86: Innovation Health system strengthen
Page 87 and 88: Innovation Being healthy: the role
Page 89 and 90: Innovation when much progress and a
Page 91 and 92: Innovation The role of Knowledge Tr
Page 93 and 94: Innovation knowledge - the “know
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Research resources 110 Research imp
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Decision-making implemented on a sm
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Research resources 30 27.5 25 20 19
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Research resources poliomyelitis an
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Research resources Nursing research
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Research resources utilization are
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Research resources The need to deve
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Research resources ✜ Health resea
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Research resources References 1. Co
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Research resources investigated the
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Research resources A new landscape
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Research resources 13 + 1*- HIV/AID
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Research resources References 1. Da
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Research resources international le
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Research resources Partnership dyna
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Research resources that many public
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Research resources compounds from m
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Research resources References 1. So
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Decision-making Delivering evidence
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Decision-making Equitable access: g
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Decision-making years’ experience
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Decision-making Policy-makers Compl
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Decision-making interview studies),
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Decision-making References 1. Haine
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Decision-making reviews in this fie
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Decision-making Inequities in healt
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Decision-making Deaths Crude death
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Decision-making Group I Group II Gr
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Decision-making Low- and middle-inc
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Decision-making Europe and Central
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Decision-making Europe and Central
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Decision-making References 1. Banni
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Decision-making irresponsible-to be
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Decision-making Several strategies
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To achieve better health, particula
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