Creating change in government to address the social determinants of health: how can efforts be improved?

摘要: The evidence base for the impact of social determinants health has been strengthened considerably in last decade. Increasingly, public field is using this as a foundation arguments and actions to change government policies. Health All Policies (HiAP) approach, alongside recommendations from 2010 Marmot Review into inequalities UK (which we refer ‘Fairness Agenda’), go beyond advocating redesign individual policies, shaping structures processes that facilitate implementation these In doing so, drawing on recent trends policy towards ‘joined up government’, where greater integration sought between departments, agencies actors outside government. paper provide meta-synthesis empirical research joined government, out characteristics associated with successful initiatives. We use thematic synthesis basis comparing contrasting emerging interventions concerned joined-up action across find HiAP Fairness Agenda exhibit some initiatives, however they also utilise ‘change instruments’ have found be ineffective. Moreover, – like many initiatives there room improvement alignment goals their design. Drawing studies, recommend number strategies increase efficacy current interventions. More broadly, argue up-stream need ‘fit-for-purpose’, cannot easily replicated one context next.