Special Initiative for Multi-country Action on the Social Determinants of Health Equity 

As the countdown to the current Sustainable Development Agenda target fast approaches, and the challenges for the next generation of development goals are discussed by the Second World Summit for Social Development, the need to foster social development with equity is more urgent than ever.

In 2019, to address the problem of insufficient concerted action for health equity, WHO launched the WHO Special Initiative for Action on the Social Determinants of Health for Advancing Health Equity – the Organization’s first globally coordinated programme to tackle health inequities stemming from social determinants, and to bring about concrete, demonstrable change.

Phase 1 (2021–2024)

Gathering evidence and starting action:

• At the global level, the Special Initiative:
  • highlighted the impact of the COVID-19 pandemic on health equity, and the need for renewed evidence on actions to address health inequities
  • produced the “World report on the social determinants of health equity”, as endorsed by the World Health Assembly (WHA74.16), as a focus for further compilation of evidence
  • updated data on the World Health Organization Health Inequality Data Repository with associated indicators derived from the “Operational Framework for Monitoring the Social Determinants of Health Equity”
  • produced a self-directed training course on the WHO Academy
  • organized a network for multi-country action-learning and support, to bring about concrete, demonstrable change on the ground and in the Organization’s ways of-working from global to local levels.
    
• Regional strengthening and country work contributed to the evidence collection for the world report; advocacy, and the development of training materials This strengthening process also began in-depth knowledge translation and the piloting of equity-driven approaches in selected Country Pathfinders and with “pioneer” areas across the Americas, Western Pacific and Eastern Mediterranean regions (see SIMASHE’s work in regions and countries for key achievements).

Phase 2 (2025–2028)

• In Phase 2, supporting implementation of the world report recommendations is central. WHO and core partners will support knowledge translation through the investment case and policy briefs, and enhance action-learning on implementation of the world report recommendations, deepening work in Pathfinder Countries and pioneer areas, evaluating and refining successful strategies, and scaling up actionable insights.

SIMASHE’s theory of change (TOC) outlines the strategic pathway to achieving the initiative’s goal. The diagram illustrates the barriers to equity; the key activities and resources to promote equity; the initiative’s outputs, and the expected outcomes. These are all aligned with the 2030 Sustainable Development Goals and a broader vision of a world where health equity is a shared social value.

The SIMASHE TOC has been instrumental in the planning, implementation and evaluation of interventions, servings several key purposes. It clarifies the pathway to impact, identifies key barriers, aligns multisectoral efforts, guides monitoring and evaluation, and strengthens advocacy and investment.

WHO leads the initiative in close partnership with the Swiss Agency for Development and Cooperation, University College London’s Institute of Health Equity, and the University of Lausanne and UNISANTÉ. This international collaboration ensures that research, technical expertise and policy action are effectively integrated to drive measurable progress in health equity worldwide.