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PAHO Commission on Equity and Health Inequalities in the Americas

About the Commission

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The Region of the Americas has seen major improvements in the health of the population in the past years, but significant inequalities remain. Although life expectancy has increased and infant mortality and maternal mortality rates have fallen, these and other achievements in health are not reflected equally in every country and social group in the Americas.

To address the need to reduce these inequalities in health, the Pan American Health Organization of Health (PAHO) created the Commission on Equity and Health Inequalities in the Americas in 2016, to assess the best evidence and propose actions to improve inequalities in health outcomes of the people in the Americas.

PAHO appointed 12 commissioners, including experts on equity, gender, ethnicity and human rights in the Region. The commission is chaired by Sir Michael Marmot, director of the Institute of Health Equity (IHE) at University College London. IHE and the Cross Cutting Themes (CCTs) group at PAHO act as the Secretariat for the Commission.

Meet the Commissioners - more about the team


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What does the Commission do?

This Commission will analyze the main drivers of health inequalities in the Americas, focusing on gender, ethnicity, and human rights as well as the social, economic, environmental, political and cultural factors that shape health. The principles and approaches associated with the Social Determinants of Health, Rights-based Approach to Health, and Health in All Policies Agenda will play a significant role in the recommended measures.

The Commission will propose practical recommendations for countries and international organizations to address health inequities and inequalities, based on evidence and in collaboration with stakeholders and countries.

Fifteen countries of the Americas participate as partners, helping collect data, develop monitoring frameworks, and providing information and advice on successful and unsuccessful approaches to improve equity and health inequalities. They will also have input into the final recommendations made by the Commission.

After meetings with stakeholders and government representatives, field visits and discussions on evidence, the Commission will present a final report in 2018. Read about upcoming and past activities of the Commission.

The commission has created an information brochure, available to read in both English and Spanish

The Topics

The Commissioners meet periodically with a defined agenda of work to analyze of the evidence and the final recommendations. These meetings provide an opportunity to learn from experiences in partner countries, as well as allowing them to hear input from members of civil society, government and academia on local experiences of equity and inequality in health in addition to best practices.



The IHE will conduct evidence reviews in the ten areas that the Commission will focus on. These reports will present the most up-to-date data, as well as evidence and good practices on health equity, and will be used as the inputs to the Commission's final recommendations. Those areas are:

Social and biological factors and the life course 
Social and biological factors and the life course

1. Inter-generational transmission, early years, young people and education

2. Working life

3. Healthy aging

4. Gender, sexuality and gender identity

5. Race and ethnicity; indigenous peoples, and afro-descendent and Roma 

Socioeconomic and political context 
Socioeconomic and political context

6. Macroeconomic and environmental policy–international factors & organizations, fiscal policy, SDGs, global economies and trade.  Health and environmental issues including climate change and resource/land utilization. 

7. Governance – Human rights legislation and protections, whole of government approaches and reforms, multi sectors, governance for health equity and universal health including health in all policies, monitoring, and legislation, SDGs and building capacities. 

Pathways to health 
Pathways to health

8. Material circumstances - social protection, income, housing, environmental quality, food security and intergenerational protections, unpaid work.

9. Social cohesion, resilience and cultural and societal norms and values – social cohesion, community factors, including community resilience, IP violence, community and national and local level.  Crime, military and civic conflict.

10. Health care and public health services and priority public health conditions - including obesity and diet, alcohol, smoking, drugs.