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Am J Public Health. 2009 Nov;99(11):1967-74. doi: 10.2105/AJPH.2008.154856. Epub 2009 Sep 17.

Changes not for the fainthearted: reorienting health care systems toward health equity through action on the social determinants of health.

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Faculty of Health Sciences, Flinders University, Adelaide, Australia.


Entrenched poor health and health inequity are important public health problems. Conventionally, solutions to such problems originate from the health care sector, a conception reinforced by the dominant biomedical imagination of health. By contrast, attention to the social determinants of health has recently been given new force in the fight against health inequity. The health care sector is a vital determinant of health in itself and a key resource in improving health in an equitable manner. Actors in the health care sector must recognize and reverse the sector's propensity to generate health inequity. The sector must also strengthen its role in working with other sectors of government to act collectively on the deep-rooted causes of poor and inequitable health.

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