Table 4 Stakeholder’s conceptualisation of SDH and health inequity

“For rich countries at least, the landmark Black Report in the UK clearly stands out; it argues that inequality has a strong and independent effect on the health of individuals and entire nations. I don’t know how this would apply in a poor and not-so-unequal country like Tanzania. Here I can think more in terms of things like these: mothers in Pemba who allegedly refuse being immunized against tetanus because they think it will make them infertile..; community members in Lupalilo, Makete, who said it was fine, and normal, for a woman to plough the field until the very final stages of their pregnancy because that’s their job and anyway it was their responsibility if they got pregnant in the first place; family and larger societal pressures that force a girl to marry young rather than complete school, despite the known risks to her health from early pregnancy; economic forces and social pressures that force new mothers to go back to the field just weeks after delivery, thereby compromising their ability to care for their health and breast feed their newborns/infants; traditions that impose FGM (female genital mutilation) upon unsuspecting girls and adolescents, endangering their health; beliefs, such as witchcraft, that put the life of albinos at risk; and if we count economic forces as being part of SDH, then another example would be the poor fishermen who engage in dynamite fishing, are maimed and end up as beggars in a Dar es Salaam street corner.”

“SDHs are the direct and non direct factors related to health outcome, the enabling and pre-disposing factor, individual and structural/ system factors; moving beyond the health sector to all social aspects that may in one way or another contribute to one’s well being, including issues related to empowerment, housing conditions, lifestyles, economic and social status, having clean water, food, education, as well as infrastructures for transporting food, accessing health care. Factors that are associated with either negative or positive outcome of health.”

“In line with our transformative feminist perspective on health, I consider SDH to be rooted in the dominant structures of power in society, including economic, political, cultural and ideological…. understanding that health includes not only the absence of illness, but also a sense of well-being, security, dignity, happiness and self-fulfillment, different groups of people have different levels of access to the basic resources necessary for health, well being, and sustainable livelihoods. These include access to dignified and secure employment and livelihoods with a livable income, and the means to acquire employment and livelihoods – be they land, water, markets, information, credit; and the prerequisites for employment such as formal education and employment such as a formal education and employment experience.”

“Girls and women also experience, on a daily basis, a variety and a barrage of emotional and sexual abuse, discrimination and oppression which eats away at their self-esteem and deprives them of security and safety, as well as physical health……on the other hand, however, SDH also include the way in which marginalized girls/ women, and their communities, respond to the existing structures of power at all levels …women have organized themselves in HISA groups which not only provide a safe space for savings and loans, but also provide mutual support mechanisms in times of illness and death. Community groups along with national/ local NGOs increasingly participate in performance tracking to demand accountability from health delivering institutions…however, there is not yet a high level of community consciousness about basic human and citizenship rights, let alone health rights, nor the development yet of a strong popular movement for health as a basic human right…”