We briefly consider theories that should contribute to a model of healthy ageing, incorporating important structural and intermediate causes of inequalities and inequities. We then use a modified version of the WHO Commission on Social Determinants of Health framework to take account of factors that are particularly relevant and explain differences in the level and distribution of healthy ageing—at early and later stages of life. We also identify entry points on what can be done to support people to function well into older ages, irrespective of disease or morbidity status. The importance of climate change on the health of older adults is briefly outlined, with a call for in-depth investigation to inform policy and identify actions.

PURPOSE OF THE STUDY:Social and scientific discourses on healthy ageing and on health equity are increasingly available, yet from a global perspective limited conceptual and analytical work connecting both has been published. This review was done to inform the WHO World Report on Ageing and Health and to inform and encourage further work addressing both healthy aging and equity. DESIGN AND METHODS:We conducted an extensive literature review on the overlap between both topics, privileging publications from 2005 onward, from low-, middle-, and high-income countries. We also reviewed evidence generated around the WHO Commission on Social Determinants of Health, applicable to ageing and health across the life course. RESULTS:Based on data from 194 countries, we highlight differences in older adults' health and consider three issues: First, multilevel factors that contribute to differences in healthy ageing, across contexts; second, policies or potential entry points for action that could serve to reduce unfair differences (health inequities); and third, new research areas to address the cause of persistent inequities and gaps in evidence on what can be done to increase healthy ageing and health equity. IMPLICATIONS:Each of these areas warrant in depth analysis and synthesis, whereas this article presents an overview for further consideration and action.

Ritu Sadana, ScDa Erik Blas, DrPHb Health inequalities are disparities in health, reflecting either differences in access to a range of promotional, preventive, curative, or palliative health services or differences in outcomes including disability, morbidity, and mortality spanning physical, mental, and social health. The causes of inequalities in health are dynamic and reflect multiple determinants. Health inequities, however, are differences in health that are judged to be avoidable, unfair, and unjust.1 Health inequities are often revealed through systematic patterns or gradients in access or outcomes across populations with different levels of underlying social advantage or disadvantage—that is, wealth, power, prestige, or other markers of social stratification.2 Numerous reviews across low-, middle-, and high-income countries continue to document that health inequalities are related not only to biological or genetic factors, but also to social factors that are amenable to policy and are potentially avoidable given cross-group or cross-population comparisons. Studies most often document differential access to health services based on an individual’s socioeconomic position or place of residence, rather than on need,3–6 although other approaches exist.7 The place in the social hierarchy that individuals and groups occupy, combined with the epidemiological environment, then determines exposure and vulnerability to health-enhancing or health-damaging conditions in daily life (e.g., where people are born, grow, live, work, and age).8 The underlying causes are complex, often reflecting systematic social, political, historical, economic, and environmental factors that also interface with biological factors. The term “social determinants” is often used as shorthand for all of these factors and is relevant to communicable and non-communicable conditions alike.9 An added complexity is that negative or positive impacts of social determinants of health (SDH) can be accumulated during a lifetime, alter health trajectories across the life course, and be transferred across generations.10 Moreover, labeling an inequality as an inequity also reflects a value judgment. This labeling is sometimes made explicit by deliberating on facts, clarifying underlying values, and designing remedial actions. Often, however, there is no

Uganda is one of only two countries in the world that has successfully reversed the course of its HIV epidemic. There remains much controversy about how Uganda's HIV prevalence declined in the 1990s. This article describes the prevention programs and activities that were implemented in Uganda during critical years in its HIV epidemic, 1987 to 1994. Multiple resources were aggregated to fuel HV prevention campaigns at multiple levels to a far greater degree than in neighboring countries. We conclude that the reversed direction of the HIV epidemic in Uganda was the direct result of these interventions and that other countries in the developing world could similarly prevent or reverse the escalation of HIV epidemics with greater availability of HIV prevention resources, and well designed programs that take efforts to a critical breadth and depth of effort.