Primary health care and the social determinants of health: essential and complementary approaches for reducing inequities in health

TLDR

Health inequities have spurred renewed attention to primary health care and the social determinants of health, both of which champion equity, multisectoral action, and community participation, yet their differing lenses can create tensions that hinder reform if they are treated as competing agendas. The study aims to show that a revitalized primary health care system must embed action on social determinants as a core strategy to minimize health inequities. The authors propose that integrating social determinant actions into the structure of primary health care constitutes the essential mechanism for achieving equity. They conclude that keeping the broad focus on both primary health care and social determinants at the forefront of policy, rather than restricting efforts to the health sector alone, is required for successful inequity reduction.

Abstract

Increasing focus on health inequities has brought renewed attention to two related policy discourses - primary health care and the social determinants of health. Both prioritise health equity and also promote a broad view of health, multisectoral action and the participation of empowered communities. Differences arise in the lens each applies to the health sector, with resultant tensions around their mutual ability to reform health systems and address the social determinants. However, pitting them against each is unproductive. Health services that do not consciously address social determinants exacerbate health inequities. If a revitalised primary health care is to be the key approach to organise society to minimise health inequities, action on social determinants has to be a major constituent strategy. Success in reducing health inequities will require ensuring that the broad focus of primary health care and the social determinants is kept foremost in policy - instead of the common historical experience of efforts being limited to a part of the health sector.