Creating a supportive environment for transformative change at the decision-making level is essential to advancing health equity and addressing systemic inequities. Decision-makers – including policy-makers, public administrators and intersectoral leaders – are uniquely positioned to drive structural changes that prioritize equity. However, traditional governance models often fail to integrate health equity considerations, focusing instead on narrow sectoral goals that neglect the broader social, economic and political determinants of health

Building on the world report recommendation 4.5, “Strengthen focus on social determinants in health systems and policy platforms”, this strategic entry point aims to establish enabling environments at various levels to foster transformative change that prioritizes health equity and community well-being at the local level. The focus is on fostering systemic shifts in how strategies, policies and investments are developed and implemented to address the root causes of health inequities.

A central aspect of this strategic line is the development of actionable frameworks and investment arguments that demonstrate the societal and economic benefits of equity-focused policies. It also builds on communities of practice at the international and national levels, demonstrating how those communities generate shared knowledge to advance health equity. This approach emphasizes the interconnected nature of health and other sectors, advocating for comprehensive strategies that yield co-benefits, such as improved social welfare, stronger economies and more resilient communities. It consists of a series of interconnected processes organized into three core areas:

This strategic entry point is interlinked with other strategies to address the social determinants of health and advance health equity, as outlined in the SIMASHE knowledge-sharing diagram.