Medical Journal of the Islamic Republic Of Iran

other Social Determinants of Health in Iran: Policy Evolution, Intersectoral Governance, and Equity Monitoring Health Health Policy Review Policy Review     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.   Social Determinants of Health, Health Equity, Intersectoral Collaboration, Primary Health Care, Iran, Public Policy 282 302 http://mjiri.iums.ac.ir/browse.php?a_code=A-10-1-1125&slc_lang=other&sid=1 Hamid Reza Baradaran baradaran.hr@iums.ac.ir 200319475328460097321 200319475328460097321 No Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran Ali Azimi azimia@khu.ac.ir 200319475328460097322 200319475328460097322 Yes Faculty of Psychology and Education, Kharazmi University, Tehran, Iran Mohsen Asadi-Lari mohsen.asadi@yahoo.com 200319475328460097323 200319475328460097323 No Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran Marzieh Khadem Sharif sharif.m@iums.ac.ir 200319475328460097324 200319475328460097324 No Deputy of Research and Technology, Iran University of Medical Sciences, Tehran, Iran Sara Aghababa 200319475328460097325 200319475328460097325 No Health Diplomacy Research Center, Iran University of Medical Sciences, Tehran, Iran Shadrokh Sirous 200319475328460097326 200319475328460097326 No Team Lead for UHC Health System, WHO Representative Office, Iran Alireza Olyaeemanesh 200319475328460097327 200319475328460097327 No Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran Ahad Bakhtiari 200319475328460097328 200319475328460097328 No Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran Efat Mohamadi 200319475328460097329 200319475328460097329 No Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran