Health inequities – that is, unfair and avoidable or remediable systematic differences in health among population groups defined socially, economically, demographically or geographically – persist globally, despite the commitments of many national and international actors to reduce them. While health care plays a role, social determinants of health (SDH) – broadly defined as the conditions in which people are born, grow, live, work and age, and people’s access to power, money and resources – have a powerful influence on health inequities. Interventions and policies addressing SDH, such as early childhood education programmes and social protection policies, can have positive effects on health and reduce health inequities. This evidence underscores the need for policy action on SDH to reduce inequities in health.

Since the World Health Organization (WHO) established the Commission on Social Determinants of Health in 2005, many countries have committed to addressing SDH and improving health equity. Despite this, policy action has been slow and uneven, with limited focus on key structural determinants, such as inequitable economic systems, structural discrimination including intersecting racism and gender inequality, and weak societal infrastructure. A key challenge facing governments is the development and implementation of effective policies and interventions and the assessment of their impact on health equity. This requires monitoring of SDH and their association with health inequities, as well as monitoring of policies and interventions addressing SDH and health equity. However, many countries lack the data, information systems and capacity to monitor progress on SDH and related policies. Hence, guidance for monitoring social determinants of health equity (SDHE) – that is, SDH and actions (such as policies and interventions) addressing SDH that improve health equity – and using data for action is urgently needed.

The operational framework consists of two main components: (a) a universal menu of indicators for monitoring SDHE adaptable to different settings; and (b) areas and actions for implementation.