Policy Reforms to Address Social Determinants and Promote Health Equity Across Populations

Background: Health equity remains an enduring global challenge, with social determinants of health (SDOH)—such as income, education, housing, and employment—playing a pivotal role in shaping health outcomes. Despite advances in healthcare interventions, systemic inequities persist worldwide. Policy reforms targeting these determinants are increasingly recognized as critical to reducing disparities and achieving sustainable health improvements. Objective: This systematic review aimed to synthesize and critically evaluate global policy reforms addressing SDOH and promoting health equity across diverse populations. Methods: Adhering to PRISMA guidelines, a comprehensive search was conducted across five academic databases and relevant grey literature sources between January and March 2024. Out of 243 initially identified studies, 43 met the inclusion criteria following title/abstract screening and full-text review. Eligibility required: (i) national or subnational policy reforms targeting SDOH, (ii) explicit evaluation of health equity outcomes, and (iii) publication in English from 2010 to 2024. Key data on policy type, targeted determinants, equity outcomes, and evaluation methods were systematically extracted and thematically analyzed using established frameworks. Results: The included studies represented reforms from six global regions, with a majority based in high-income countries but notable examples from low- and middle-income settings. Successful policies shared common features: multisectoral collaboration, equity-centered design, community engagement, and robust monitoring and evaluation frameworks. Policy types encompassed universal healthcare, conditional cash transfers, education, and housing reforms. Common equity indicators included income, geographic location, race/ethnicity, and gender. Among the studies included, 70% reported quantifiable improvements in equity outcomes, while 30% lacked rigorous evaluation frameworks, limiting assessment of long-term impact. Conclusion: Policy reforms addressing upstream SDOH are essential for advancing health equity. Integrating equity considerations across all sectors, fostering intersectoral governance, and investing in robust monitoring systems offer promising pathways to reduce health disparities globally. However, persistent gaps in evaluation, particularly in low- and middle-income countries, highlight the need for sustained research and investment in comprehensive policy assessment.