Health promotion, the social determinants of health, and urban health: what does a critical discourse analysis of World Health Organization texts reveal about health equity?

Michelle Amri^{1

2

3}, Theresa Enright⁴, Patricia O'Campo^{5

6}, Erica Di Ruggiero⁷, Arjumand Siddiqi^{5

8

9}, Jesse Boardman Bump^{10

11}

Affiliations

¹ School of Public Policy, Simon Fraser University, Harbour Center, 515 West Hastings Street, Vancouver, BC, V6B 4N6, Canada. michelle_amri@sfu.ca.
² Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Bldg. 1, Boston, MA, 02115-6021, USA. michelle_amri@sfu.ca.
³ Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada. michelle_amri@sfu.ca.
⁴ Department of Political Science, University of Toronto, 100 St George Street, Toronto, ON, M5S 3G3, Canada.
⁵ Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada.
⁶ Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.
⁷ Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada.
⁸ Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, USA.
⁹ Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Harvard University, Boston, USA.
¹⁰ Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Bldg. 1, Boston, MA, 02115-6021, USA.
¹¹ Bergen Centre for Ethics and Priority Setting, University of Bergen, Bergen, Norway.

PMID: 39681886
PMCID: PMC11622871
DOI: 10.1186/s44263-023-00023-4

Health promotion, the social determinants of health, and urban health: what does a critical discourse analysis of World Health Organization texts reveal about health equity?

Michelle Amri et al. BMC Glob Public Health. 2023.

. 2023 Dec 1;1(1):25.

doi: 10.1186/s44263-023-00023-4.

Authors

Michelle Amri^{1

2

3}, Theresa Enright⁴, Patricia O'Campo^{5

6}, Erica Di Ruggiero⁷, Arjumand Siddiqi^{5

8

9}, Jesse Boardman Bump^{10

11}

Affiliations

¹ School of Public Policy, Simon Fraser University, Harbour Center, 515 West Hastings Street, Vancouver, BC, V6B 4N6, Canada. michelle_amri@sfu.ca.
² Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Bldg. 1, Boston, MA, 02115-6021, USA. michelle_amri@sfu.ca.
³ Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada. michelle_amri@sfu.ca.
⁴ Department of Political Science, University of Toronto, 100 St George Street, Toronto, ON, M5S 3G3, Canada.
⁵ Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada.
⁶ Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.
⁷ Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada.
⁸ Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, USA.
⁹ Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Harvard University, Boston, USA.
¹⁰ Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Bldg. 1, Boston, MA, 02115-6021, USA.
¹¹ Bergen Centre for Ethics and Priority Setting, University of Bergen, Bergen, Norway.

PMID: 39681886
PMCID: PMC11622871
DOI: 10.1186/s44263-023-00023-4

Abstract

Background: The World Health Organization (WHO) has focused on health equity as part of its mandate and broader agenda-consider for example, the "health for all" slogan. However, a recent scoping review determined that there are no studies that investigate the WHO's approach to health equity. Therefore, this study is the first such empirical analysis examining discourses of health equity in WHO texts concerning health promotion, the social determinants of health, and urban health.

Methods: We undertook a critical discourse analysis of select texts that concern health promotion, the social determinants of health, and urban health.

Results: The findings of this study suggest that (i) underpinning values are consistent in WHO texts' approach to health equity; (ii) WHO texts reiterate that health inequities are socially constructed and mitigatable but leave the 'causes of causes' vague; (iii) despite distinguishing between health "inequities" and "inequalities," there are several instances where these terms are used interchangeably across texts; (iv) WHO texts approach health equity broadly (covering a variety of areas); (v) health equity may be viewed as applicable either throughout the life-course or intergenerationally, which depends on the specific WHO text at hand; and (vi) WHO texts at times use vague or unclear language around how to improve health equity.

Conclusions: This study does not present one definition of health equity and action to be taken. Instead, this study uncovers discourses embedded in WHO texts to spur discussion and deliberate decision-making. This work can also pave the way for further inquiry on other complex key terms or those with embedded values.

Keywords: Critical discourse analysis; Equity; Global health; Health equity; Health inequity; Health policy; Inequity; Public health; Public policy; World Health Organization.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: MA reports short-term instances of consulting for the World Health Organization and membership with the World Health Organization Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity. ED reports co-directing the World Health Organization Collaborating Centre in Health Promotion. AS reports involvement on the World Health Organization Commission on Social Determinants of Health. The remaining authors declare that they have no competing interests.

Figures

**Fig. 1**
Depiction of interrelations: cross-referencing between selected texts

See this image and copyright information in PMC

References

1. World Health Organization. Declaration of Alma-Ata Alma-Ata, USSR1978. updated 6–12 September. https://www.who.int/publications/almaata_declaration_en.pdf.
1. CSDH. Closing the gap in a generation: health equity through action on the social determinants of health. World Health Organization; 2008. https://apps.who.int/iris/bitstream/handle/10665/43943/9789241563703_eng.... - PubMed
1. Whitehead M. The concepts and principles of equity and health Copenhagen, Denmark: World Health Organization Regional Office for Europe; 1990. p. 18. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.196.7167&rep=re....
1. Braveman P. Health disparities and health equity: concepts and measurement. Annu Rev Public Health. 2006;27:167–94. 10.1146/annurev.publhealth.27.021405.102103. - PubMed
1. Braveman P, Gruskin S. Defining equity in health. J Epidemiol Community Health. 2003;57(4):254–8. 10.1136/jech.57.4.254. - PMC - PubMed

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Health promotion, the social determinants of health, and urban health: what does a critical discourse analysis of World Health Organization texts reveal about health equity?

Affiliations

Health promotion, the social determinants of health, and urban health: what does a critical discourse analysis of World Health Organization texts reveal about health equity?

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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