In the world of natural sciences, the concept of cohesion eludes to the distance between elements, the integration between the elements themselves and everything else, and the force that binds them together. From a sociological point of view, social cohesion can be defined as the degree of consensus among members of a social group with regard to the feeling of belonging to a common situation. Furthermore, social cohesion also refers to both the effectiveness of instituted social inclusion mechanisms and the behaviours and opinions of the subjects that form part of society. Such mechanisms may include employment, educational systems, entitlements, and policies for the promotion of equity, wellbeing and social protection. The behaviours and opinions of subjects may cover aspects as diverse as confidence in institutions, social capital, sense of belonging and solidarity, acceptance of coexistence rules, and willingness to participate in spaces for deliberation and in collective projects.

As for equity, the complexity of this concept is linked to the different philosophical and ethical-value ideas that mould the concepts of social justice in general and health justice in particular. Such ideas vary widely from an individualist standpoint, which sees health as an element of private life, to a point of view centred more on distributive considerations.    

When limiting the concept of social cohesion to the dimensions of social inclusion and the provision of a response to the manner in which inclusion and the relations between the forces of the different social actions operate, then it is necessary to take a wider view of health, seeing it not only as a means of ensuring protection and resolving adverse events, but rather in the wider sense as captured by the World Health Organization (WHO) in its 1946 constitution, which defined health as “complete physical, mental and social wellbeing”. It should also be noted that when we speak of the participation and representation of social actors, of disparities and dynamics of power, and of the role of macro-economic and social policies, we are touching on conceptual and operational dimensions that also fall within the fields of social cohesion and health equity. As such, it is impossible to think of wellbeing and health without considering the social dimensions of the process for determining people’s state of health. This clearly highlights how the weight of such determinations falls mainly outside the healthcare system.

Measuring inequalities in states of health using an approach based on social health determinants is the first step towards the identification of health inequalities and is an essential element of actions aimed at achieving greater health equity. The health equity activities of the EUROsociAL, the European Union programme for social cohesion with Latin America, are founded on the scientific literature currently available and fall within the framework of the efforts made by national and regional institutions to counteract health inequalities. EUROsociAL is tackling issues on which the different governments of Latin America have expressed a specific interest and is involved in priority reform processes in several countries, namely Mexico, Costa Rica, Panama, Ecuador, Colombia, Peru, Chile, Paraguay and Uruguay. EUROsociAL serves as a facilitator in these countries, providing institutions with access to knowledge and experience gained from similar situations in other countries of Latin America and Europe, which may add new and innovative elements to said reforms.

Rita Ferrelli, Investigadora en el Instituto Nacional de Salud de Italia. Socio operativo de EUROsociAL