Integrated Approaches to Address the Social Determinants of Health for Reducing Health InequityReport as inadecuate

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Journal of Urban Health

, Volume 84, Supplement 1, pp 164–173

First Online: 29 March 2007


The social and physical environments have long since been recognized as important determinants of health. People in urban settings are exposed to a variety of health hazards that are interconnected with their health effects. The Millennium Development Goals MDGs have underlined the multidimensional nature of poverty and the connections between health and social conditions and present an opportunity to move beyond narrow sectoral interventions and to develop comprehensive social responses and participatory processes that address the root causes of health inequity. Considering the complexity and magnitude of health, poverty, and environmental issues in cities, it is clear that improvements in health and health equity demand not only changes in the physical and social environment of cities, but also an integrated approach that takes into account the wider socioeconomic and contextual factors affecting health. Integrated or multilevel approaches should address not only the immediate, but also the underlying and particularly the fundamental causes at societal level of related health issues. The political and legal organization of the policy-making process has been identified as a major determinant of urban and global health, as a result of the role it plays in creating possibilities for participation, empowerment, and its influence on the content of public policies and the distribution of scarce resources. This paper argues that it is essential to adopt a long-term multisectoral approach to address the social determinants of health in urban settings. For comprehensive approaches to address the social determinants of health effectively and at multiple levels, they need explicitly to tackle issues of participation, governance, and the politics of power, decision making, and empowerment.

KeywordsEmpowerment Governance Health inequity Integrated approaches  Participation Poverty Social determinants of health Urban settings. Barten is with the Radboud University Nijmegen, UMCN, Institute for International Health, PO Box 9101-456, 6500 HB, Nijmegen, The Netherlands; Mitlin is with the University of Manchester and the International Institute for Environment and Development, London, UK; Mulholland is with the World Health Organization, Geneva, Switzerland; Hardoy is with the International Institute for Environment and Development, Buenos Aires, Argentina; Stern is with the School of Public Health, University of the Western Cape, Bellville, South Africa.

An erratum to this article can be found at

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Author: Franςoise Barten - Diana Mitlin - Catherine Mulholland - Ana Hardoy - Ruth Stern


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