Policy Reforms to Address Social Determinants and Promote Health Equity Across Populations
DOI:
https://doi.org/10.61919/vp17p067Keywords:
Health equity, social determinants of health, Policy reform, PRISMA, health disparitiesAbstract
Background: Health equity remains an enduring global challenge, with social determinants of health (SDOH)—such as income, education, housing, and employment—playing a pivotal role in shaping health outcomes. Despite advances in healthcare interventions, systemic inequities persist worldwide. Policy reforms targeting these determinants are increasingly recognized as critical to reducing disparities and achieving sustainable health improvements. Objective: This systematic review aimed to synthesize and critically evaluate global policy reforms addressing SDOH and promoting health equity across diverse populations. Methods: Adhering to PRISMA guidelines, a comprehensive search was conducted across five academic databases and relevant grey literature sources between January and March 2024. Out of 243 initially identified studies, 43 met the inclusion criteria following title/abstract screening and full-text review. Eligibility required: (i) national or subnational policy reforms targeting SDOH, (ii) explicit evaluation of health equity outcomes, and (iii) publication in English from 2010 to 2024. Key data on policy type, targeted determinants, equity outcomes, and evaluation methods were systematically extracted and thematically analyzed using established frameworks. Results: The included studies represented reforms from six global regions, with a majority based in high-income countries but notable examples from low- and middle-income settings. Successful policies shared common features: multisectoral collaboration, equity-centered design, community engagement, and robust monitoring and evaluation frameworks. Policy types encompassed universal healthcare, conditional cash transfers, education, and housing reforms. Common equity indicators included income, geographic location, race/ethnicity, and gender. Among the studies included, 70% reported quantifiable improvements in equity outcomes, while 30% lacked rigorous evaluation frameworks, limiting assessment of long-term impact. Conclusion: Policy reforms addressing upstream SDOH are essential for advancing health equity. Integrating equity considerations across all sectors, fostering intersectoral governance, and investing in robust monitoring systems offer promising pathways to reduce health disparities globally. However, persistent gaps in evaluation, particularly in low- and middle-income countries, highlight the need for sustained research and investment in comprehensive policy assessment.
References
1. Abdi N, Tso S, Roduin C, Nylander E, Jones A, Groshong S, Saelens B. A Schema for Coding Health Equity Scholarship Within Pediatric Research. J Clin Transl Sci. 2024;8(1). https://doi.org/10.1017/cts.2024.594
2. Adsul P, Chambers D, Brandt H, Fernández M, Ramanadhan S, Torres E, Shelton R. Grounding Implementation Science in Health Equity for Cancer Prevention and Control. Implement Sci Commun. 2022;3(1). https://doi.org/10.1186/s43058-022-00311-4
3. Amri M. How Do High-Level African Directors of Policy and Planning Operationalize Health Equity? Findings From a Regional Survey. PLOS Glob Public Health. 2025;5(3):e0004384. https://doi.org/10.1371/journal.pgph.0004384
4. Aschbrenner K, Cruz J, Kruse G, Nguyen H, Torres C, Celli M, Emmons K. Leveraging an Implementation Science Partnership Network to Understand How Federally Qualified Health Centers Operationalize and Address Health Equity. Transl Behav Med. 2023;14(1):23-33. https://doi.org/10.1093/tbm/ibad046
5. Braveman P, Arkin E, Orleans T, Proctor D, Acker J, Plough A. What Is Health Equity? Behav Sci Policy. 2018;4(1):1-14. https://doi.org/10.1177/237946151800400102
6. Brownson R, Kumanyika S, Kreuter M, Haire-Joshu D. Implementation Science Should Give Higher Priority to Health Equity. Implement Sci. 2021;16(1). https://doi.org/10.1186/s13012-021-01097-0
7. Brownson R, Mazzucca-Ragan S, Jacob R, Brownson C, Hohman K, Alongi J, Eyler A. Understanding Health Equity in Public Health Practice in the United States. J Public Health Manag Pract. 2023;29(5):691-700. https://doi.org/10.1097/phh.0000000000001763
8. Brushett S, Caldwell H, Cameron E, Carrea C, Embrett M, Fierlbeck K, Sim M. Strategies and Indicators to Address Health Equity in Health Service and Delivery Systems: A Scoping Review Protocol. JBI Evid Synth. 2021;20(1):249-259. https://doi.org/10.11124/jbies-21-00001
9. Carroll-Scott A, Henson R, Kolker J, Purtle J. The Role of Nonprofit Hospitals in Identifying and Addressing Health Inequities in Cities. Health Aff. 2017;36(6):1102-1109. https://doi.org/10.1377/hlthaff.2017.0033
10. Chandra A, Martin L, Acosta J, Nelson C, Yeung D, Qureshi N, Blagg T. Equity as a Guiding Principle for the Public Health Data System. Big Data. 2022;10(S1):S3-S8. https://doi.org/10.1089/big.2022.0204
11. Cohen A, Grogan C, Horwitt J. The Many Roads Toward Achieving Health Equity. J Health Polit Policy Law. 2017;42(5):739-748. https://doi.org/10.1215/03616878-3940414
12. Crawford A, Serhal E. Digital Health Equity and COVID-19: The Innovation Curve Cannot Reinforce the Social Gradient of Health. J Med Internet Res. 2020;22(6):e19361. https://doi.org/10.2196/19361
13. Crenshaw A, Allen P, Fifolt M, Lang B, Thomas A, Erwin P, Brownson R. Challenges and Supports for Implementing Health Equity During National Accreditation Among Small Local Health Departments in the United States. J Public Health Manag Pract. 2024;31(2):196-203. https://doi.org/10.1097/phh.0000000000002096
14. Farrell T, Greer A, Bennie S, Hageman H, Pfeifle A. Academic Health Centers and the Quintuple Aim of Health Care. Acad Med. 2022;98(5):563-568. https://doi.org/10.1097/acm.0000000000005031
15. Freeman T, Baum F, Lawless A, Jolley G, Labonté R, Bentley M, Boffa J. Reaching Those With the Greatest Need: How Australian Primary Health Care Service Managers, Practitioners and Funders Understand and Respond to Health Inequity. Aust J Prim Health. 2011;17(4):355. https://doi.org/10.1071/py11033
16. Furtado K, Brownson C, Fershteyn Z, Macchi M, Eyler A, Valko C, Brownson R. Health Departments With a Commitment to Health Equity: A More Skilled Workforce and Higher-Quality Collaborations. Health Aff. 2018;37(1):38-46. https://doi.org/10.1377/hlthaff.2017.1173
17. Garfield S, Armstrong S, Nguyen J, Hildreth C, Wu B, James I, Foley M. Are Health Technology Assessments Keeping Pace With Health Equity Priorities: A Review of Existing Approaches and Discussion of Emerging Practices. Med Res Arch. 2023;11(6). https://doi.org/10.18103/mra.v11i6.3903
18. Gostin L. The Legal Determinants of Health: How Can We Achieve Universal Health Coverage and What Does It Mean? Int J Health Policy Manag. 2020. https://doi.org/10.34172/ijhpm.2020.64
19. Griffith D. Antiracism and Health Equity Science: Overcoming Scientific Obstacles to Health Equity. Public Health Rep. 2024;139(3):288-293. https://doi.org/10.1177/00333549241236089
20. Griffith D, Shelton R, Kegler M. Advancing the Science of Qualitative Research to Promote Health Equity. Health Educ Behav. 2017;44(5):673-676. https://doi.org/10.1177/1090198117728549
21. Groom L, Schoenthaler A, Mann D, Brody A. Construction of the Digital Health Equity-Focused Implementation Research Conceptual Model - Bridging the Divide Between Equity-Focused Digital Health and Implementation Research. PLOS Digit Health. 2024;3(5):e0000509. https://doi.org/10.1371/journal.pdig.0000509
22. Hall M, Graffunder C, Metzler M. Policy Approaches to Advancing Health Equity. J Public Health Manag Pract. 2016;22(Suppl 1):S50-S59. https://doi.org/10.1097/phh.0000000000000365
23. Hoyer D, Dee E, O’Leary M, Heffernan M, Gelfand K, Kappel R, Fromknecht C. How Do We Define and Measure Health Equity? The State of Current Practice and Tools to Advance Health Equity. J Public Health Manag Pract. 2022;28(5):570-577. https://doi.org/10.1097/phh.0000000000001603
24. Khanal S, Ramadani L, Boeckmann M. Health Equity in Climate Change Policies and Public Health Policies Related to Climate Change: Protocol for a Systematic Review. Int J Environ Res Public Health. 2022;19(15):9126. https://doi.org/10.3390/ijerph19159126
25. Lawrence K. Digital Health Equity. Exon Publications Digital Health Health Equity. 2022:121-130. https://doi.org/10.36255/exon-publications-digital-health-health-equity
26. Liang H, Fang S, Liu S, Liu X, Li Y, Ming L, Zhang Y. Equity in Maternal- and Infant-Care Services in China: A Trend Analysis Based on Residence and Area (2000-2014). Int J Health Plann Manage. 2017;32(3):372-383. https://doi.org/10.1002/hpm.2438
27. Liburd L, Hall J, Mpofu J, Williams S, Bouye K, Penman-Aguilar A. Addressing Health Equity in Public Health Practice: Frameworks, Promising Strategies, and Measurement Considerations. Annu Rev Public Health. 2020;41(1):417-432. https://doi.org/10.1146/annurev-publhealth-040119-094119
28. Liu W, Liu Y, Twum P, Li S. National Equity of Health Resource Allocation in China: Data From 2009 to 2013. Int J Equity Health. 2016;15(1). https://doi.org/10.1186/s12939-016-0357-1
29. Marandi S, Ghahramani S, Kazemi M, Lankarani K. Health System, Health Equity. Shiraz E Med J. 2017;18(10). https://doi.org/10.5812/semj.59842
30. Marcus R, Nakra N, Porter K. Characterizing Organizational Health Equity Capacity Assessments for Public Health Organizations: A Scoping Review. Public Health Rep. 2023;139(1):26-38. https://doi.org/10.1177/00333549231151889
31. Pauly B, Shahram S, Dang P, Marcellus L, MacDonald M. Health Equity Talk: Understandings of Health Equity Among Health Leaders. AIMS Public Health. 2017;4(5):490-512. https://doi.org/10.3934/publichealth.2017.5.490
32. Pottie K. Health Equity in Humanitarian Emergencies: A Role for Evidence Aid. J Evid Based Med. 2015;8(1):36-38. https://doi.org/10.1111/jebm.12137
33. Sa’aid H, Mathew S, Richardson M, Bielecki J, Sander B. Mapping the Evidence on Health Equity Considerations in Economic Evaluations of Health Interventions: A Scoping Review Protocol. Syst Rev. 2020;9(1). https://doi.org/10.1186/s13643-019-1257-4
34. Shaver N, Bennett A, Beck A, Skidmore B, Traversy G, Brouwers M, Persaud N. Health Equity Considerations in Guideline Development: A Rapid Scoping Review. CMAJ Open. 2023;11(2):E357-E371. https://doi.org/10.9778/cmajo.20220130
35. Smith J. Reflections on the Framing of ‘Health Equity’ in the National Primary Health Care Strategic Framework: A Cause for Celebration or Concern? Health Promot J Austr. 2014;25(1):42-45. https://doi.org/10.1071/he13106
36. Srinivasan S, Williams S. Transitioning From Health Disparities to a Health Equity Research Agenda: The Time Is Now. Public Health Rep. 2014;129(1 Suppl 2):71-76. https://doi.org/10.1177/00333549141291s213
37. Thorndike A, Peterson L, Spitzer S, Patel S, Smithey A, Moore J, Chin M. Advancing Health Equity Through Partnerships of State Medicaid Agencies, Medicaid Managed Care Organizations, and Health Care Delivery Organizations. Front Public Health. 2023;11. https://doi.org/10.3389/fpubh.2023.1104843
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Copyright (c) 2025 Md. Jobaer Rahman Rashed, Md. Kamruzzaman, Annatul Islam Hredoy, Mst. Shahinur Begum, Bibi Ayesa, Farheen Iqbal, Tamanna Akter, Rajib Kumar Malakar (Author)

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