Social Determinants of Health in Iran: Policy Evolution, Intersectoral Governance, and Equity Monitoring Publisher



Baradaran H R ; Azimi A ; Asadi Lari M ; Sharif M K ; Aghababa S ; Sirous S ; Olyaeemanesh A ; Bakhtiari A ; Mohamadi E
Source: Medical Journal of the Islamic Republic of Iran Published:2026

Abstract

Background: The Social Determinants of Health (SDH) encompass the systemic conditions shaping daily life and health outcomes. In the Islamic Republic of Iran, health equity and SDH have been institutionalized as core components of sustainable national policy to address the causes of the causes behind health disparities. This study aims to evaluate the strategic evolution of Iran's health system, focusing on upstream SDH policies, intersectoral institutional frameworks, national research productivity, and the longitudinal development of monitoring mechanisms established to identify and mitigate inequities. Methods: This is a policy review article with qualitative key-informant input, covering the initiation of SDH efforts through the end of 2023. The study analyzed 25 national upstream policies, the functionality of 32 effective intersectoral councils, and the outputs of 38 specialized SDH research centers. Primary data were gathered through 26 semi-structured interviews with key authorities conducted between 2020 and 2023 and verified through member checking. Results: Since the 1980s, Iran has established significant infrastructure, primarily through the Primary Health Care (PHC) network. Key reforms include the Universal Health Insurance Act (1994) and the Comprehensive Welfare and Social Security System (2004). Governance is driven by the Supreme Council of Health and Food Safety. While research output is robust—exceeding 4,200 indexed articles—operational challenges persist, including a 39% out-of-pocket expenditure rate, overlapping council mandates, and the deteriorating impact of international sanctions on equitable access. Conclusion: Iran possesses an advanced architecture for tracking 69 health equity indicators. However, reducing disparities requires moving beyond indicator collection to sustained political commitment, legally institutionalized intersectoral alignment, and translating data into targeted socioeconomic interventions. Copyright © Iran University of Medical Sciences. This work has been published under CC BY-NC-SA 4.0 license.