Addressing Equity Challenges for Sustainable Development Goals

NO ONE LEFT BEHIND Some reflections Dr. Orielle Solar & Dr. Patricia Frenz PRESENTATION AT THE EVALUATION CENTRE FOR COMPLEX HEALTH INTERVENTIONS, UNIVERSITY OF TORONTO April 8th 2021

WHAT CHALLENGES FOR EQUITY SHOULD BE ADDRESSED TO ENSURE THE SUSTAINABLE DEVELOPMENT GOAL OF NO ONE LEFT BEHIND ? WEAKNESS TO ADDRESS INEQUITY PROBLEM EQUITY SOLUTIONS Restrictive vision of health & well- being. Absence of analysis and action to address social determinants of health. Limited consideration of socioeconomic-political context. Lack of recognition of heterogeneity of subpopulations Social basis of health Social determinants addressed Application of life-course approach Prioritization with equity approach Proportional universalism Multisector action Community engagement Measurement and accountability Conceptual framework for action on the social determinants of health inequities

WHAT ISNT EXPLICIT? Pro - equity Vision Vision DEFINTIONS OF EQUITY / INEQUITY (EXPLANATION OF PRINCIPLES) LIFE COURSE PERSPECTIVE STRUCTURAL SOCIAL DETERMINANTS OF HEALTH

CHALLENGE OF ENHANCING GUIDANCE FOR ACTION ON HEALTH INEQUITIES CHALLENGE OF INTEGRATING MULTISECTORAL ACTION & SOCIAL PARTICIPATION TO ADDRESS INEQUITIES CHALLENGES FOR PROCESSES OF REGIONAL ADAPTATION CHALLENGE OF SUPPORTING CAPACITY-BUILDING / STRENGTHENING AND EXCHANGES CHALLENGE OF STRENGTHENING THE EQUITY LENS IN MONITORING & EVALUATION

CHALLENGE OF ENHANCING GUIDANCE FOR ACTION ON HEALTH INEQUITIES RECOMMENDATIONS Strengthening orientations for action on equity: know that, know why and know how Social determinants framework - underlying mechanisms that must be addressed. Incorporate equity challenges specific for the region: ethnicity, migration, violence, Informal work and urban-rural differences. Strengthen the gender perspective. Focus on structural social determinants using a life-course perspective. Establishing criteria to set equity-based priorities: Where to start (which groups, settings, problems, interventions)? Intersectoral action and social participation (ISA & SP) are cornerstones for achieving greater equity. Participation is end and not just a means

CHALLENGE OF STRENGTHENING THE EQUITY LENS IN MONITORING & EVALUATION RECOMMENDATIONS Measuring progress in indicators of equity and evaluating impact is fundamental. Promote and support evaluation-thinking in national plans, beyond the indicator and monitoring framework: do interventions work and close gaps, for which groups and under what conditions. Follow a set of indicators that account for inequalities between social groups in terms of outcomes, relevant social determinants, and key implementation processes. Stratify indicators as an essential requirement and not an option, identifying the social groups to be compared, based inequality axes specific to regional and national contexts. Specify for each indicator methods to measure absolute and relative gaps and the gradient.

CHALLENGE OF SUPPORTING CAPACITY-BUILDING / STRENGTHENING AND EXCHANGES RECOMMENDATIONS Build capacities of professionals, academics and civil society actors to understand and act upon the social determinants to address equity: Promote forums, courses and activities related to equity- oriented design, implementation, monitoring and evaluation of interventions. Develop a platform and repository to share and update good practice, learning and evidence from regional and national experiences. Promote a research agenda on policy/intervention evidence for equity-effectiveness, including evidence associated with intersectoral work and participatory approaches. Discuss the findings and recommendations of this and other equity analysis with regional and national experts to develop consensus recommendations.