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BACKGROUND: The social determinants of health have been widely recognised yet there remains a lack of clarity regarding what constitute the macro-economic determinants of health and what can be done to address them. An umbrella review of systematic reviews was conducted to identify the evidence for the health and health inequalities impact of population level macroeconomic factors, strategies, policies and interventions. METHODS: Nine databases were searched for systematic reviews meeting the Database of Abstracts of Reviews of Effects (DARE) criteria using a novel conceptual framework. Studies were assessed for quality using a standardised instrument and a narrative overview of the findings is presented. RESULTS: The review found a large (n = 62) but low quality systematic review-level evidence base. The results indicated that action to promote employment and improve working conditions can help improve health and reduce gender-based health inequalities. Evidence suggests that market regulation of tobacco, alcohol and food is likely to be effective at improving health and reducing inequalities in health including strong taxation, or restriction of advertising and availability. Privatisation of utilities and alcohol sectors, income inequality, and economic crises are likely to increase health inequalities. Left of centre governments and welfare state generosity may have a positive health impact, but evidence on specific welfare interventions is mixed. Trade and trade policies were found to have a mixed effect. There were no systematic reviews of the health impact of monetary policy or of large economic institutions such as central banks and regulatory organisations. CONCLUSIONS: The results of this study provide a simple yet comprehensive framework to support policy-makers and practitioners in addressing the macroeconomic determinants of health. Further research is needed in low and middle income countries and further reviews are needed to summarise evidence in key gaps identified by this review. TRIAL ...

The �new style� occupational health and safety legislation implemented in Australia from the late 1970s changed the character of OHS legal obligations, establishing general duties supported by process, performance and, more rarely, specification standards,1 and extending obligations to those who propagate risks as designers, manufacturers, importers or suppliers � the �upstream duty holders�. This article examines how OHS agencies inspect and enforce OHS legislation upstream, drawing on empirical research in four Australian states and relevant case law. We argue that upstream duty holders are an increasing area of attention for OHS inspectorates but these inspectorates have not yet risen to the challenge of harnessing these parties to help stem, at the source, the flow of risks into workplaces.

Small workplaces have particular injury risks and are enduringly difficult for the occupational health and safety (OHS) system to reach. This paper puts forward an "upstream" perspective on OHS in small workplaces that moves beyond the attributes of the workplace and those who work there. The paper draws on and synthesizes ideas and findings from emerging upstream OHS research, our own empirical investigations in Ontario and Quebec, and our collected research experience in small workplace health. Upstream structures and processes (regulations, policies, services, interventions, professional practices) are often misaligned with the conditions of work and social relations of small workplaces. Key upstream factors include regulatory exemption, subcontracting, unionization levels, the changing character of small enterprise, joint management, service and inspection constraints, competing institutional accountabilities, institutional orientation to large business, and inappropriate service and policy. Misalignment of the OHS system with the nature and practical realities of small workplaces can undermine prevention and the management of ill health and injury. To address such misalignments, the paper calls for: 1) restructuring of data collection and consultation processes to increase the visibility, voice and credibility of small workplaces; 2) "audits" of OHS-related legislation, policy and interventions to assess and address implications for small workplaces; 3) reflection on current terms and concepts that render workers invisible and capture poorly the essence and (increasing) diversity of these workplaces; and 4) extension of the upstream gaze to the global level.

This report provides a comprehensive examination of political, policy, and economic factors that contributed to the failure of California's 2007 health care reform effort. Specifically, the report focuses on the intersection of four factors: 1) The impacts of long-term systemic forces or limitations — including economic forces, constitutional provisions, and federal statutes —over which state decision makers may have little control; 2) The critical policy challenges and the efforts to overcome them; 3) The perceptions, positions, and impact of major interest groups; and, 4) The role of political and legislative leadership in defining, promoting, and mobilizing support for reform goals. Relying on both extensive documentation and more than 120 interviews with reform participants and knowledgeable observers between January 2007 and July 2008, the author examines how these factors influenced and ultimately undermined an effort that had the support of both Democratic legislative leaders and a Republican governor. The report also examines the efficacy of sweeping reform efforts, highlighting the multiple challenges to comprehensive reform and the systemic rules which favor incremental over comprehensive reform. It concludes that, especially in difficult economic times, federal reform — or at least increased federal financial support — may be the key to insurance coverage expansions. Walter Zelman, PhD, was a visiting researcher at the UCLA Center for Health Policy Research and a visiting professor in the Department of Health Services at the UCLA School of Public Health during the data collection phase of this project. He is now Chair of the Department of Health Science and California State University, Los Angeles. Support for the data collection was provided by grants from The California Endowment and the University of California (UC) Office of the President, California Program on Access to Care.

Background: We rarely teach medical students the skills required to engage in policy change to address the structural factors that underpin the social determinants of health, which are driven by the unequal distribution of power and resources in society. Acquiring the knowledge and skills to influence policy can empower students to act on healthcare inequities rather than simply be aware of them. Methods: Using Metzl and Hansen's structural competency framework, we designed and piloted an intervention for medical students. Participants attended a workshop, presented to a hypothetical political stakeholder, and wrote an opinion editorial piece. Students participated in a focus group that was audio-recorded and transcribed. We coded and analyzed presentations, editorials, and transcripts to develop a thematic analysis. Results: Nine students participated in the workshop. They chose structural interventions and presented potential solutions to structural barriers in written and oral outputs. Students identified a lack of knowledge about health and political systems as a potential barrier to future advocacy work. Conclusion: Medical trainees require training in specific advocacy skills such as oral and written communication, however this alone may be insufficient. As future advocates, trainees must also acquire a specific skill set and associated knowledge about health systems and policy to navigate the systems in which they will practice.

"Social Determinants of Health introduces a range of topics related to health and well-being in the context of a conceptual framework of determinants of health. It provides an introduction to some of the important ideas that underlie the field of public health, aiming to give students an understanding of the causes of health, rather than just the effects of health status in society.By examining the social, cultural, economic and environmental determinants of health, students will gain a greater understanding of current issues in public health in terms of their causes and interrelationships. This book demonstrates how an understanding of social determinants will support students to become knowledgeable health professionals allowing them to practise effectively in the modern healthcare context." -- Provided by publisher

The book comprehensively discusses the various determinants shaping the health sector in India. Based on intensive research, it quantitatively identifies the determinants of health status in India within a macroeconomic framework, taking both the demand and the supply side into consideration. The book also discusses the various economic tools of analysis for understanding the challenges facing the health sector, and explains why policy makers should refrain from applying uniform health policies in the urban and the rural sectors: uniform health policies for the urban and the rural sector cannot be expected to yield uniform outcomes, since the two sectors are characterized by two sets of entirely different challenges. The book further examines health challenges and their determinants separately for India's rural and urban sector. The work also draws attention to the fact that, though finance is extremely important for better health outcomes, how the funds allocated to the health sector are utilised is even more critical. Highlighting the role of health management in this regard, the book provides an in-depth analysis of its role in achieving expected health outcomes, which it claims should constitute a pivotal part of India's health policies

Macrosocial Determinants of Population Health explores social factors such as culture, mass media, political systems, and migration that influence public health while systematically considering how we may best study these factors and use our knowledge from this study to guide public health interventions. Starting from the dual premises that a population is not merely the sum of its individuals and that the improvement of population health is not at odds with the practical desire of improving the health of individuals, Sandro Galea and 33 expert contributors present chapters in three sections. The first section includes eleven chapters that each discuss one macrosocial determinant of population health. The factors covered by these chapters encompass a broad range of intellectual concerns, ranging from regulations and legal frameworks (global governance, patent law and policy), to overarching global phenomena (globalization, migration, urbanization, the media), to a specific consideration of the role of economic, political, and corporate policies and practices. The second section considers particular methodologic issues pertinent to those interested in the study of how macrosocial factors influence the health of populations, offering insights on ecological studies and causal inference, and weighing how we may best study the overlapping roles of determinants at local, state, and national levels. The third section presents a framework for interventions that aim to improve population health and innovative case studies that show this framework in action. Throughout, contributors emphasize the potential of population strategies to influence traditional risk factors associated with health and disease. Each section ends with Galea s integrative chapters, bringing the observations and conclusions from the chapters into clear, usable focus. Macrosocial Determinants of Population Health is a work of major theoretical, empirical, and practical interest for disciplines as varied as public health, epidemiology, health promotion, sociology, and health policy. Its systematic field-building approach makes it as valuable to the public health provider as to the scholars and students studying the health of populations.

Intro -- Table of Contents -- Foreword, by John Mullahy -- Introduction and Acknowledgments -- Part 1. The Demand for Health: Theoretical Underpinnings and Empirical Results -- Introduction to Part 1 -- 1. On the Concept of Health Capital and the Demand for Health, by Michael Grossman -- 2. The Human Capital Model, by Michael Grossman -- Afterword to Part 1 -- Part 2. The Relationship between Health and Schooling -- Introduction to Part 2 -- 3. The Correlation between Health and Schooling, by Michael Grossman -- 4. An Exploration of the Dynamic Relationship between Health and Cognitive Development in Adolescence, by Robert A. Shakotko, Linda N. Edwards, and Michael Grossman -- 5. Parental Education and Child Health: Evidence from a Natural Experiment in Taiwan, by Shin-Yi Chou, Jin-Tan Liu, Michael Grossman, and Ted Joyce -- 6. Women's Education: Harbinger of Another Spring? Evidence from a Natural Experiment in Turkey, by Mehmet Alper DinÃer, Neeraj Kaushal, and Michael Grossman -- Afterword to Part 2 -- Part 3. Determinants of Infant Health with Special Emphasis on Public Policies and Programs -- Introduction to Part 3 -- 7. Variations in Infant Mortality Rates among Counties of the United States: The Roles of Public Policies and Programs, by Michael Grossman and Steven Jacobowitz -- 8. Determinants of Neonatal Mortality Rates in the United States: A Reduced Form Model, by Hope Corman and Michael Grossman -- 9. Birth Outcome Production Functions in the United States, by Hope Corman, Theodore J. Joyce, and Michael Grossman -- 10. Unobservables, Pregnancy Resolutions, and Birth Weight Production Functions in New York City, by Michael Grossman and Theodore J. Joyce -- 11. The Impact of National Health Insurance on Birth Outcomes: A Natural Experiment in Taiwan, Shin-Yi Chou, Michael Grossman, and Jin-Tan Liu -- Afterword to Part 3