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Table 3 Final core set of 36 indicators and sources of data proposed by the working group to consider for the monitoring system on taking action regarding social determinants of health (SDH)

From: Towards a global monitoring system for implementing the Rio Political Declaration on Social Determinants of Health: developing a core set of indicators for government action on the social determinants of health to improve health equity

Domain/Measurement concept Indicator
Domain 1: National governance
 1.1 Level of public social protection 1.1.1 Percentage of the population covered by social protection floors/systems below the poverty line
[SDG Indicator 1.3.1]
 1.1I Gender inequities in the level of public social protection 1.1I.1 Parity index (female/male) for the percentage of the population covered by social protection floors/systems below the poverty line
[SDG Indicator 1.3.1, disaggregated data]
 1.2 Level of public provision of early childhood education 1.2.1 Participation rate in organized learning (one year before the official primary entry age)
[SDG Indicator 4.2.2]
 1.2I Gender inequities in the level of public social protection 1.2I.1 Parity index (female/male) for participation rate in organized learning (one year before the official primary entry age)
[SDG Indicator 4.2.2, disaggregated data]
 1.2II Income inequities in the level of public social protection 1.2II.1 Parity index (bottom/top wealth quintile) for participation rate in organized learning (one year before the official primary entry age)
[SDG Indicator 4.2.2, disaggregated data]
 1.a Provision of the rights and public laws guaranteeing self-determination of indigenous peoples [no indicator yet identified]
 1.b Provision of public laws guaranteeing human rights for transgender populations 1.b.1 Presence or lack of laws that criminalize transgender identity and expression, protect against discrimination on the basis of gender identity/gender expression as a category, and determine the legal right for individuals to determine their legal gender and namea,*
[United Nations Development Programme]
 1.c Provision of public laws guaranteeing human rights for sex workers 1.c.1 Presence or lack of laws that criminalize sex work and protect the public health of sex workers*
[Review of national legislation]
 1.d Provision of public laws guaranteeing workers human rights for informal work 1.d.1 Increase in national compliance of labor rights (freedom of association and collective bargaining) based on International Labour Organization textual sources and national legislation
[SDG Indicator 8.8.2]
 1.e Level of intersectoral action for health and health equity 1.e.1 Whether a national policy exists that addresses at least two priority determinants of health amongst target populationsb*
[Pan American Health Organization (PAHO)]
Domain 2: Participation
 2.a Mechanisms for guaranteeing transparency in policymaking 2.a.1 Whether country has adopted and implemented constitutional, statutory, or policy guarantees for public access to information
[SDG Indicator 16.10.2]
 2.b Level of implementation of mechanisms for participation of civil society 2.b.1 Whether the country has accountability mechanisms that support civil society engagement in health impact decisions*
[PAHO]
2.b.2 Whether mechanisms exist to engage communities and civil society in the policy development process across all sectors*
[PAHO]
 2.c Level of implementation of mechanisms for participation of civil society in policymaking for indigenous peoples 2.c.1 Number of policies that recognize the duty to consult and cooperate in good faith with indigenous peoples to obtain their free, prior and informed consent before adopting and implementing legislative or administrative measures that may affect them
[World Conference on Indigenous Peoples commitment, paragraph 3*]
2.c.2 (1) Existence of special measures to strengthen capacity of indigenous peoples’ representative institutions; (2) existence and capacity of national human rights institutions to reach out to vulnerable groups such as indigenous peoples; (3) institutional mechanisms and procedures for consultation with indigenous peoples, in accordance with international standards*
[UN Declaration on the Rights of Indigenous Peoples]
2.c.3 (1) Provisions for direct participation of indigenous peoples’ elected representatives in legislative and elected bodies; (2) recognition in the national legal framework of the duty to consult with indigenous peoples before adopting or implementing legislative or administrative measures that may affect them*
[United Nations (UN) Declaration on the Rights of Indigenous Peoples]
 2.d Level of implementation of mechanisms for participation of civil society in policymaking for transgender populations 2.d.1 Presence/lack of laws that prohibit lesbian, gay, bisexual, transgender, and intersex persons from forming organizations and participating in political parties and social movements*
[United Nations Development Programme]
Domain 3: Health sector reorientation
 3.1 The level of comprehensive, equitable basic service coverage by health systems (including primary health care and the right to health) 3.1.1 Percentage of population using safely managed drinking-water services
[SDG Indicator 6.1.1]
3.1.2 General government expenditure on primary health care and health promotion as a proportion of general government expenditure
(proxy, if data are unavailable: 3.1.2 General government expenditure on health as a proportion of general government expenditure)
[WHO]
 3.1I Inequities in the level of comprehensive, equitable basic service coverage by health systems (including primary health care and the right to health) 3.1I.1 Parity index (by wealth quintile) in coverage with safely managed drinking water
[SDG Indicator 6.1.1, disaggregated data]
 3.2 Level of financial health protection 3.2.1 Percentage of population with catastrophic health expenditure (universal health coverage)
[WHO]
 3.2I Inequities in level of financial health protection 3.2I.1 Out-of-pocket (OOP) payments as % of income amongst lowest wealth quintile or OOP as % of income amongst highest wealth quintile
[WHO, disaggregated data]
 3.3 Level of integration of equity into health systems, policies and programmes 3.3.1 Percentage of total government health expenditure on prevention and public health services
[Organization for Economic Co-operation and Development health accounts; WHO national health accounts]
3.3.2. Equity-adjusted universal health service coverage index*
[WHO]
 3.a Mechanisms for ensuring integration of equity into health systems, policies and programmes 3.a.1 Existence of policies and strategies to address health inequalities and social determinants of health
(Existence of a national policy that supports routine consideration of health equity in health promotion and disease prevention programs)
[World Health Organization European Region (EURO)]
3.a.2 Elements in national policies to address health inequities and social determinants of health
(Existence of a national policy that supports routine consideration of health equity in health promotion and disease prevention programs)
[EURO]
Domain 4: Global governance
 4.1 Level of international funding for comprehensive, equitable basic service coverage by health systems (including primary health care and the right to health) 4.1.1 Amount of water- and sanitation-related official development assistance that is part of a government coordinated spending plan
[SDG Indicator 6.a.1]
 4.a Level of implementation of international agreements that improve the SDH 4.a.1 The country’s performance on the International Health Regulations capacity and health emergency preparedness index
[SDG Indicator 3.d.1]
4.a.2 Number of countries with tax policies that have been implemented to reduce tobacco demand
[World Health Organization Framework Convention on Tobacco Control]
 4.b Participation of developing countries in international policymaking 4.b.1 Percentage of members or voting rights of developing countries in international organizations
[SDG Indicator 10.6.1/16.8.1]
 4.c North-South, South-South sharing to develop holistic policies addressing inequities and sustainable development 4.c.1 US dollar value of financial and technical assistance (including through North-South, South-South and triangular cooperation) committed to developing countries
[SDG 17.9.1]
Domain 5: Monitoring and accountability
 5.1 Disaggregation of health data according to SDH 5.1.1 Percentage of indicators in the Global Health Observatory that are provided and disaggregated by a social characteristic
[WHO]
 5.a. Level of implementation of SDH-focused monitoring systems 5.a.1 Country has dedicated SDH action monitoring system (as per WHO definition to be developed)*
[WHO/PAHO]
5.a.2 Country has dedicated monitoring system for health inequalities
[WHO]
 5.b. Financial investment in research and evaluations of SDH interventions to promote equity 5.b.1 Proportion of national health research spending related to actions on SDH*
[Canadian Institutes of Health Research—Institute of Population and Public Health]
 5.c. Mechanism for guaranteeing access to information as a key component of research, monitoring and evaluations to ensure accountability and justice 5.c.1 Whether country has adopted and implemented constitutional, statutory or policy guarantees for public access to information
[SDG Indicator 16.10.2]
  1. Key: Governance interventions (or processes) are indicated with a lowercase letter (e.g., 3.a.1 measurement). A capital Roman numeral I or II refers to indicators measuring inequities in the population coverage with an intervention (e.g., 3.1I.1) (mainly parity indices [ratio of disadvantaged to advantaged population in intervention coverage])
  2. *Indicator does not have comprehensive data availability (i.e., does not have all of: established methods, international standards, and data available across many countries)
  3. aComposite index composed from three individual binary indicators
  4. bA composite index could be composed of this indicator and additional binary indicators from the Pan American Health Organization’s Health in All Policies regional monitoring system