Action on social determinants is required not only within countries but also internationally. Increasing integration of the global economy has resulted in increasing cross-border flows of goods, services, money, and people, affecting health and health equity both directly and through economic consequences. This trend has also resulted in a major reduction in the policy space available to governments for addressing social determinants.
There is growing concern, particularly within civil society, that this process has prioritized economic considerations over health. Increasing the ability of global actors (including bilateral cooperation agencies, regional agencies, philanthropic groups, and international organizations) to contribute to national and local action on social determinants requires improvements in global governance.
Also essential are coherent global policies that do not undermine each other but instead mutually contribute to development. Like national governance mechanisms, global governance mechanisms are currently inadequate to address multifaceted problems like health inequities along with other global priorities. This situation challenges global institutions to reform in order to accommodate the changing realities of the 21st century.