title: The feasibility of measuring and monitoring social determinants of health and the relevance for policy and programme - a qualitative assessment of four countries.
abstract: BACKGROUND
  Since the publication of the reports by the Commission on Social Determinants of Health (CSDH), many research papers have documented inequities, explaining causal pathways in order to inform policy and programmatic decision-making. At the international level, the sustainable development goals (SDGs) reflect an attempt to bring together these themes and the complexities involved in defining a comprehensive development framework. However, to date, much less has been done to address the monitoring challenges, that is, how data generation, analysis and use are to become routine tasks.
  
  
  OBJECTIVE
  To test proposed indicators of social determinants of health (SDH), gender, equity, and human rights with respect to their relevance in tracking progress in universal health coverage and population health (level and distribution).
  
  
  METHODS
  In an attempt to explore these monitoring challenges, indicators covering a wide range of social determinants were tested in four country case studies (Bangladesh, Brazil, South Africa, and Vietnam) for their technical feasibility, reliability, and validity, and their communicability and usefulness to policy-makers. Twelve thematic domains with 20 core indicators covering different aspects of equity, human rights, gender, and SDH were tested through a review of data sources, descriptive analyses, key informant interviews, and focus group discussions. To test the communicability and usefulness of the domains, domain narratives that explained the causal pathways were presented to policy-makers, managers, the media, and civil society leaders.
  
  
  RESULTS
  For most countries, monitoring is possible, as some data were available for most of the core indicators. However, a qualitative assessment showed that technical feasibility, reliability, and validity varied across indicators and countries. Producing understandable and useful information proved challenging, and particularly so in translating indicator definitions and data into meaningful lay and managerial narratives, and effectively communicating links to health and ways in which the information could improve decision-making.
  
  
  CONCLUSIONS
  This exercise revealed that for monitoring to produce reliable data collection, analysis, and discourse, it will need to be adapted to each national context and institutionalised into national systems. This will require that capacities and resources for this and subsequent communication of results are increased across countries for both national and international monitoring, including the successful implementation of the SDGs.
authors: International Public Health Consultant, Copenhagen, Denmark; erik@blas.dk.
authors: Erik
authors: E
authors: Blas
authors: Health Economics Unit, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
authors: John E
authors: JE
authors: Ataguba
authors: School of Public Health, University of Sydney, Sydney, Australia.|Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh.
authors: Tanvir M
authors: TM
authors: Huda
authors: Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
authors: Giang Kim
authors: GK
authors: Bao
authors: Institute of Collective Health, Federal University of Bahia, Salvador, Brazil.
authors: Davide
authors: D
authors: Rasella
authors: Social Determinants of Health, World Health Organization, Geneva, Switzerland.
authors: Megan R
authors: MR
authors: Gerecke
mesh_terms: D000288:Administrative Personnel; D001210:Asia, Southeastern; D001938:Brazil; D003625:Data Collection; D005240:Feasibility Studies; D006291:Health Policy; D006295:Health Resources; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006806:Human Rights; D006801:Humans; D036301:Qualitative Research; D015203:Reproducibility of Results; D064890:Social Determinants of Health / Q000706:statistics & numerical data*; D013019:South Africa
keywords: equity; gender; human rights; intersectoral action; sustainable development goals; universal health coverage