The integration of evidence from the Commission on Social Determinants of Health in the field of health equity: a scoping review

Abstract

In 2008, the World Health Organization’s Commission on Social Determinants of Health (CSDH) presented an influential compilation of evidence establishing the relationship between health inequities and the unfair distribution of power, wealth, and resources. A decade later, individual and bio-behavioural responses to health inequities persist. The purpose of this scoping review was to explore the extent to which this evidence guided research, practice, and policy in global and public health. To do this, we assessed different ways the CSDH evidence and calls for action were integrated in scholarly publications (citation, portrayal of health inequities, alignment with calls for action, and orientation toward root causes). A systematic search of peer-reviewed articles (2000–2016) using search terms related to ‘knowledge-to-action’ and ‘health equity’ led to 330 included articles. Results suggest integration of CSDH evidence and calls for action in scholarly work is modest: 59% (n = 163) of authors (2009–2016) cited the report. A large portion of authors did not reference causes of health inequities (52% before and 51% after the CSDH) and few referred to issues of power. Among 110 post-CSDH empirical articles, half did not align with CSDH principles for action. This review illustrates that much scholarly work that purported to contribute to health equity did so in ways that conflicted with the CSDH’s characterization of the remediable nature and distribution of health inequities. These results provide a practical platform for assessing how global and public health efforts can move towards better alignment with the best available evidence about advancing health equity.