Social determinants of health in Tunisia: the case-analysis of Ariana

Background: Few research projects have analyzed how social determinants of health impact cities in North Africa. The sustained growth in these countries has nevertheless proven to exacerbate health disparities and create many social and economic inequalities. This strategic analysis examines selected social determinants of health in a major urban centre of Tunisia, identifies the most influential stakeholders able to influence equity/inequity, and reviews the accomplishments and need for action to foster health equity. Methods: This analysis was performed through a literature review and participatory research methods that included focus groups discussions and interview with key informants. Results: Access to health care, changes in lifestyles, housing issues and gender-related inequities are prime, socially-determined elements that affect health in Ariana. Conclusion: Recognition of emerging health issues is needed along with improved inter and intrasectoral coordination among stakeholders. The community-participatory approach used in this paper proved to be a useful scoping technique for this setting. A similar methodology could be used by other researchers as a first step toward health equity action at a city level.