Health inequalities are an outcome of social inequalities and both result from the workings of the economic system, a governmental apparatus that maintains or reinforces these inequalities, and a public discourse that justifies these inequalities. The outcome of these processes is a skewed distribution of exposures among the population to various social (societal) determinants of health. Modifying these societal processes—thereby improving the social determinants of health—requires developing and implementing public policies consistent with reducing these inequalities. Two viewpoints dominate discussions of how this might be brought about: a) professionally-oriented rational or knowledge-based approaches and b) social and political movement-based materialist or political economy-oriented approaches. In political economies dominated by business interests such as those seen in Canada, the US, and UK, adopting a social and political movement-based approach is the most appropriate avenue of action. How this might be accomplished requires critical analysis of the political, economic, and social forces that lead jurisdictions to implement policies that either support or resist equity-oriented public policy innovations.
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