Social determinants of health

Intersectoral factors influencing equityoriented progress towards Universal Health Coverage: results from a scoping review of literature

Discussion Paper Series on Social Determinants of Health, no. 10

World Health Organization, Carmen de Paz … [et al]

Publication details

Number of pages: 54
Publication date: 2013
Languages: English
ISBN: 978 92 4 151232 9


Objectives and methods

Achieving UHC is a major responsibility and goal of the health sector. But it cannot be done by the health sector alone. Its achievement depends on factors affecting the population being serviced, that are not under the direct control of the health sector (e.g., an individual’s family environment, access to infrastructure and resources, knowledge and education, etc.). Inequities across these intersectoral factors affect equity-oriented progress towards UHC (e.g. the denominator of income in the impoverishment measure of financial health coverage). To ensure these gaps are adequately considered and addressed, WHO is developing guidance for a global framework to measure, evaluate and monitor these other factors affecting UHC.


The results of the search are summarized.

  • Type of studies
  • Thematic barrier domains
  • Indicators for measuring barriers:
  • Sources of data.


The scoping literature review described the relevance of a key set of domains for different health conditions as well as characterizing specific variables indicative of barriers to care. Search terms selected for the monitoring framework were derived from an a priori assumptions based on expert opinion from the fields of human rights, social determinants and gender equality. The research, which focussed on barriers to care, supported a range of barrier domains extending well beyond socio-economic costs associated with financial health protection for direct medical expenditures.

Given that many of the quantitative studies reviewed developed their own metrics for barriers, the identification of potential global indicators for monitoring intersectoral barriers to service access appears challenging. Yet the qualitative studies indicate that these barriers are important to people and are worth tracking and targeting for change. Several indicators that are commonly used to capture education, employment and socioeconomic status are likely to be available in cross-country comparable surveys.

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