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This is the final report of the World Health Organization’s Commission on the Social Determinants of Health (2005-2008). The report gives three main recommendations: 1 improve daily living conditions 2. Tackle the inequitable distribution of power, money, and resources 3. Measure and understand the problem and assess the impact of action. The Commission was created to provide evidence on policies that improve health by addressing the social conditions in which people live and work. The report is addressed to WHO, national governments, civil society, and other global organizations

This publication presents the results of an international initiative to document the effects of how health systems in the developing world have responded to macroeconomic austerity and adjustment measures. Are these systems flexible and resilient to changes or are they rigid? In which circumstances and under which conditions do health systems respond favourably or unfavourably? What are the success stories? Country studies from Burkina Faso, Zimbabwe, India, Thailand, Mexico, and Colombia discuss lessons learned and identify policy measures for safeguarding the health sector

This report considers four sets of reforms that reflect a convergence between the values of primary health care, the expectations of citizens and the common health performance challenges that cut across all contexts. These include: universal coverage reforms, service delivery reforms, public policy reforms, and leadership reforms. "While universally applicable, these reforms do not constitute a blueprint or a manifesto for action. The details required to give them life in each country must be driven by specific conditions and contexts, drawing on the best available evidence"

In 2005, the Member States of WHO adopted a resolution encouraging countries to develop health financing systems capable of achieving and/or maintaining universal coverage of health services – where all people have access to needed health services without the risk of severe financial consequences. In doing this, a major challenge for many countries will be to move away from out-of-pocket payments, which are often used as an important source of fund collection. Prepayment methods will need to be developed or expanded but, in addition to questions of revenue collection, specific attention will also have to be paid to pooling funds to spread risks and to enable their efficient and equitable use. Developing prepayment mechanisms may take time, depending on countries’ economic, social and political contexts. Specific rules for health financing policy will need to be developed and implementing organizations will need to be tailored to the level that countries can support and sustain. In this paper we propose a comprehensive framework focusing on health financing rules and organizations that can be used to support countries in developing their health financing systems in the search for universal coverage.

Many countries rely heavily on patients’ out-of-pocket payments to providers to finance their health care systems. This prevents some people from seeking care and results in financial catastrophe and impoverishment for others who do obtain care.  Data from a large data set (116 surveys covering 89 countries) provided global estimates of the extent of catastrophic spending and impoverishment associated with out-of-pocket payments. Prepayment mechanisms protect people from financial catastrophe, but no strong evidence is reported that social health insurance systems offer better or worse protection than tax-based systems. Health system and population characteristics associated with high levels of catastrophic spending are examined to provide a basis for assessing the policy options available to reduce the incidence of financial catastrophe

This report assesses progress in malaria control and analyses how well countries are making available key interventions that reduce the malaria burden. A particular emphasis is progress across sub-Saharan Africa - whose countries face the greatest malaria burden