Chile

In Chile, action on the social determinants of health is connected to the universalization of social policies and efforts to build a more integrated health and social care system. The country is reimagining “care systems” to address structural inequities related to gender, income and social class.

Chile is currently undertaking comprehensive health reforms structured around four main pillars: 1) governance of the public health care system 2) achieving universal coverage in primary health care 3) Improving people's health and well-being, while ensuring that no one is left behind, and 4) financing the health system. The work related to SIMASHE is primarily focused on the third pillar, which emphasizes addressing the social determinants of health and promoting equity in health and well-being. In 2023, eight “pioneer” municipalities assessed social determinants of health equity, developed intervention and service change strategies, and began implementing the redesign of primary health care that considers the social determinants of health.

The regional and local WHO teams are assisting the Ministry of Health in redesigning health programmes with an equity perspective, and enhancing capacity among national and sub-national teams regarding the social determinants of health and health equity.

Country achievement highlights

1. Operational model and action plans for integrating the SDH approach at the local level in seven municipalities developed within the framework of the ongoing health reform and the process of universalization of primary health care.
   
2. Letter of commitment letter to develop the Initiative signed by the mayors of each of the seven pathfinder municipalities involved in the Special Initiative.
3. One national and two international courses on social determinants of health and health equity developed and delivered, strengthening capacity among health practitioners, civil servants and professionals across sectors and levels, with the participation of the Ministry of Health and sub-regional governments.

Main activities 2025–2028

• Developing and delivering in-person training courses and workshops on the SDHE, tailored to Chile’s specific historical, administrative and social context, building on foundations established during Phase I.
• Undertaking an analysis of theory of change implementation at the local level, to evaluate progress and reinforce intersectoral approaches for addressing the SDHE.
• Facilitating coordination between the WHO Americas Regional Office (AMRO) and the Pan-American Health Organization (PAHO), local governments, and PHC providers, to co-develop a model for integrating the social determinants of health into primary health care practices.
• Establishing monitoring systems on SDHE and SDH-related policies, both locally and nationally, to improve understanding of the mechanisms involved in the production of health inequities, and to design, support and implement targeted measures to address these inequities.
• Analysing and disseminating findings from a mixed-methods study focused on the perceptions of SDH and health equity among policy-makers and service providers, to guide future action.
• Advancing national-level policy assessment methods, including the development of a model to evaluate policy impacts on SDH and identify evidence gaps to inform innovative, equity-focused solutions.