2021 IANPHI Annual Meeting: Health Equity Tools and Strategies

On December 2, 2021, IANPHI held a session of its annual meeting facilitated by the U.S. Centers for Disease Control and Prevention (CDC) to discuss the development of health equity tools and strategies. Participants heard from NPHIs that have a role in health equity and discussed ideas about how health equity could be a core component of NPHI institutional development and inform NPHI goals, objectives, and strategies.

The speakers were Dr. Juan Rivera, director, Instituto Nacional de Salud Publica; Dr. Ir Por, deputy director, National Institute of Public Health, Cambodia; and Dr. Carlos Castañeda, director, National Health Observatory, Instituto Nacional de Salud, Colombia. The session was moderated by Shelly Bratton, lead of the National Public Health Institute Program at U.S. CDC.

Experiences in Health Equity from the Instituto Nacional de Salud Publica in Mexico (INSP), by Dr. Juan Rivera 

In his presentation, Dr. Rivera explained that INSP’s programs on health equity mainly focus on indigenous population which represent 10% of the population in Mexico and are greatly impacted by health disparities. Indigenous population are more impacted by extreme poverty, stunting, have higher rates of children mortality and have lower rates of prenatal care access. Other health disparities exist as illustrated by the example of COVID-19 antibodies: lower income populations with no university degree are more likely to have antibodies.

According to Dr. Rivera, those inequalities and associated factors show that there is a need to focus on equity in health policies through research (by documenting and monitoring through quantitative and qualitative indicators), training (by developing population-based training programs on health equity, with emphasis on Indigenous health train postgraduate students), and advice to government (by informing about health inequities and promoting intersectoral work to reduce health inequities).

The Role of National Public Health Institutes ​in Promoting Health Equity: ​Lessons Learned from Cambodia National Institute for Public Health (NIPH), by Dr. Ir Por

In recent decades, Cambodia made tremendous progress in improving health care coverage, health and financial protection, and achieved all health Millennium Development Goals targets, but inequalities in health care, health status and financial protection persist. For example, while there has been significant progress in skilled birth attendance rates, strong urban and rural and poor and rich gaps remain. Another example of health inequity is the percentage of households exposed to catastrophic health expenditures and impoverishment with lower income older populations, living in rural areas being more at risk.  

Dr. Por explained that addressing the issues of health inequalities is necessary to further improve health care coverage, health status and financial protection and preserve social justice and human rights. However, even though health equity governance in Cambodia has been central to the government policies, there are no multi-sectoral mechanisms specific to health equity, and no structure or systematic means to monitor health inequalities yet.

Cambodia’s NIPH has contributed to promoting health equity by organizing and participating in a number of national and international workshops to raise awareness and deepen understanding of health equity issues among key stakeholders; joining the World Health Organization and the Ministry of Health to conduct an equity situation analysis to provide a basis for informing joint actions to promote health equity; creating a team and build their capacity in analysis of national survey data or equity monitoring as part of the Sustainable Development Goals and Universal Health Care monitoring end evaluation framework among other activities.

The Social Structure as Cause of Health Inequalities in Colombia National Institute of Health (INS), by Dr. Carlos Castañeda

Colombia’s Health Observatory was created 10 years ago and is collecting data on the social determinants of health (SDH) and carrying out analysis to show gaps in equality. Dr. Castañeda explained that research conducted on those determinants showed strong socioeconomics inequalities; for example, malnutrition rates depend on wealth and family members’ educational levels, with minority indigenous communities suffering more from malnutrition and with higher rates of children mortality than non-indigenous communities. Social status and gender also have an impact on health outcomes as farmers, agricultural and domestic workers, and women have worse health indicators. Populations in armed conflict areas are at higher risk for infectious diseases and mortality associated with malnutrition. Additionally, vector born disease such as malaria and Leishmaniasis are more prevalent in conflict areas.

Colombia has incorporated perspectives of SDH to strategic plans and programs of the health sector and has made progress in research and monitoring of social inequities in health. However, Dr. Castañeda shared that it remains challenging to act on the structural determinants since it implies deep social transformations in diverse sectors.

Questions and Answers

During the Questions and Answers, participants highlighted the needs for intersectoral interventions at the local level to reduce structural issues. They also emphasized the importance of health observatories and their capacity to focus on local and territorial differences to map health inequities at a smallest geographic level. Participants also agreed on the importance of organizing workshops to define methods to observe territories, synthesize conditions and preventionsnd allow local prevention strategies that can be tackled with local governments.


While progress was made in addressing health inequalities, the gaps between poor and rich, indigenous and non-indigenous, rural and urban, men and women, higher-educated and lower-educated are still significant and should be targeted for improvement. Those inequalities are not immutable and it is possible to transform and prevent them through collective action and public policies. NPHIs can play a crucial role in health equity by analyzing and providing recommendations based on data and evidence and by focusing on the local level and across multilateral organizations and ministries to set up surveillance and programs, which could be more effective than national measures only.

Learn more about the 2021 IANPHI Annual Meeting

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