Through its critique of politically naive medical and public health approaches and of neo-liberal ideology, the Latin American social medicine tradition offers important lessons for today's efforts to advance action on SDH. Key lessons concern: (1) the model of praxis, consciously uniting reflection and action for political change; and (2) the importance of civil society and community participation in action on SDH.

The goal of the commission, launched in March 2005, is to strengthen health equity by catalysing policy and institutional change to address the social determinants of health.

A renewed concern with social factors has emerged in global public health, spearheaded by the World Health Organization's Commission on Social Determinants of Health. The coming decade may see significant health gains for disadvantaged populations if policies tackle the social roots of health inequities. To improve chances of success, global action on social determinants must draw lessons from history. This article reviews milestones in public health action on social determinants over the past 50 years. The goal is to bring into sharper focus the persistent challenges faced by social determinants agendas, along with distinctive opportunities now emerging. The historical record highlights the vulnerability of health policy approaches incorporating social determinants to resistance from entrenched interests. The Commission on Social Determinants of Health can consolidate political support by building collaborative relationships with policymakers in partner countries. However, this strategy must be complemented by engaging civil society constituencies. Historically, successful action on social determinants has been spurred by organized civil society demand.

One of the paradoxes of globalization is that an increasingly interconnected and interdependent world is simultaneously marked by widening health gaps between privileged and less advantaged groups, both between and within countries. Ambitious development and health objectives, most prominently the Millennium Development Goals (MDGs), have been set by the global community to promote a fairer distribution of the benefits of progress. But gains toward the targets are too slow, particularly in the countries with the greatest needs. This chapter assesses WHO's capacity to lead in meeting these challenges. It begins with a review of key stages of WHO's history, then surveys the current state of global public health. Finally, it explores strategic directions set by WHO's current leadership to respond and help shape a healthier, more equitable future for all.

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