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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 was 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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Image of commission group

What did the Commission do?

The Commission analysed 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 proposed 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 participated as partners, helping collect data, develop monitoring frameworks, and provide information and advice on successful and unsuccessful approaches to improve equity and health inequalities. They also had input into the final recommendations made by the Commission.

After meetings with stakeholders and government representatives, field visits and discussions on evidence, the Commission presented a final report in October 2019.

Read: The Final Report of the Commission of the Pan American Health Organisation on Equity and Health Inequalities in the Americas.

Read about past activities of the Commission.

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

The Topics

The Commissioners met periodically with a defined agenda of work to analyze of the evidence and the final recommendations. These meetings provided 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 also conducted evidence reviews in the ten areas of focus that present the most up-to-date data, as well as evidence and good practices on health equity. 

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.