Health Equity: Is It Even Possible?

Equity and equality in health and health care

This seminar will introduce our cross-journal Special Collection on Health Equity, held across our portfolio of open access public health and nursing journals. Featuring some of our expert Guest Editors from the series, we will discuss the key current topics and future directions in health equity by addressing the pressing questions facing this critical area of public health research.This seminar and associated Special Collection seek to explore, highlight, and advance the understanding of the various dimensions and determinants of health equity within public health, nursing, and health professions. Our aim is to disseminate research that addresses the root causes of health disparities and promotes strategies to achieve equitable health outcomes for all populations.We are excited to announce that our joint Special Collection on Health Equity is now open for submissions. Authors are invited to submit their work to any of the following eight Gold Open Access journals:- [The Journal of Public Health Research](https://journals.sagepub.com/topic/collections-phj/phj-1-cross_journal_special_collection_on_health_equity?journalCode=phj) - [Health Services Insights](https://journals.sagepub.com/topic/collections-his/his-1-cross-journal_special_collection_on_healthy_equity?journalCode=his) - [INQUIRY](https://journals.sagepub.com/topic/collections-inq/inq-1-cross_journal_special_collection_on_health_equity?journalCode=inq) - [Journal of Primary Care and Community Health](https://journals.sagepub.com/topic/collections-jpc/jpc-1-cross_journal_special_collection_on_health_equity?journalCode=jpc) - [The Journal of Medicine Access](https://journals.sagepub.com/topic/collections-map/map-1-cross_journal_special_collection_on_health_equity?journalCode=map) - [American Journal of Men’s Health](https://journals.sagepub.com/topic/collections-jmh/jmh-1-cross_journal_special_collection_on_health_equity?journalCode=jmh) - [Women’s Health](https://journals.sagepub.com/topic/collections-whe/whe-1-cross_journal_special_collection_on_health_equity?journalCode=whe) - [Digital Health](https://journals.sagepub.com/topic/collections-dhj/dhj-1-cross_journal_special_collection_on_health_equity?journalCode=dhj)The scope of this Special Collection series encompasses a broad range of topics related to health equity, including investigations into social determinants of health, evaluations of health policies, community-driven initiatives, analyses of health systems and services, global health comparisons, innovative interventions, training/education innovations, theoretical perspectives, and new methodologies for addressing health inequities.We invite submissions from researchers, practitioners, policymakers, and community leaders who are engaged in advancing health equity through innovative research, education and practice. You may choose from our list of eight gold open access journals and submit directly to the most relevant one for your research. Articles accepted for publication following peer review will be hosted on each journal’s website and a cross-journal landing page, as well as disseminated widely to the relevant audience.Panel discussion of international and regional perspectives on matters affecting health outcomes and equity today and in the future.Umair Shafique, Executive Editor of INQUIRY, provided the introduction to the Cross-Journal Special Collection on Health Equity held across a portfolio of public health and nursing journals.

Health Systems Need to Transform Data Collection to Advance Health Equity.

Health equity-focused implementation research requires using definitions and approaches that are relevant and meaningful to implementation partners. We examined how health equity was operationalized and addressed at Federally Qualified Health Centers (FQHCs). We conducted semi-structured interviews with leadership (n = 19) and staff (n = 12) at 10 FQHCs in an implementation science partnership network for cancer control equity to understand how they operationalized and addressed health equity. We performed rapid qualitative analysis and shared findings with a larger group of 13 community health centers (including the 10 FQHCs) at an Implementation Learning Community (ILC) to identify action areas for research and practice, followed by a second phase of synthesizing qualitative codes into themes and mapping themes onto a framework for advancing health equity in healthcare organizations. Participants defined health equity as central to the mission of FQHCs, and identified barriers (e.g. financing models) and facilitators (e.g. interpreter services) to advancing health equity at FQHCs. These findings resonated with ILC participants who emphasized the challenge of addressing root cause social determinants of inequities using limited available resources in FQHCs and the importance of developing meaningful collaboration with communities for data collection, data interpretation, data use, and data ownership. Themes captured recommendations to advance health equity in daily work at FQHCs, including investments in staffing, training, and resources. Mapping qualitative themes from health equity-centered interviews with FQHC partners onto a framework for advancing health equity in healthcare organizations can provide clear, context-specific direction for actions aimed at improving health and healthcare equity.

Background Public Health researchers increasingly make use of sophisticated study designs and methods to evaluate the effects of policies on health and social outcomes. Natural experiment evaluation (NEE) conceptualises policies as ‘natural’ experiments that occur outside of the control of researchers. Often, NEE employs quasi-experimental methods (QEM) which enable researchers to rigorously evaluate the effect of population-level interventions. As for other health-related research, it is unclear to what extent such public health evaluations can and do consider the (health) equity implications of policies. We sought to investigate how health equity is addressed in NEEs and other policy evaluations that employ QEM. Methods We identified a random sample of primary research as part of a pre-registered scoping review (https://osf.io/3h6cb/). Studies that employed methods labelled as interrupted time series, difference-in-differences, controlled before and after, regression discontinuity, and synthetic control were included. Through content analysis, we examined how health equity was considered in data analysis and discussion sections. Results We analysed 59 studies, of which 25 were stratified for one or more socially-stratifying factors. Results were mainly stratified by sex (n = 15, 25.4%), age (n = 13, 22%), and diverse measures of socioeconomic status (n = 14, 23.7%), i.e. income, employment, education, or other factors. Of these, 21 studies included a discussion of health equity-related results, ranging from a few sentences to a holistic discussion including recommendations for decision-makers. Most commonly, researchers recommended monitoring of policy effects in different sub-populations, and careful policy design that conceptualises complex policy effects, including unintended and unequitable effects. Conclusions Policy evaluations have great potential for informing public health decision-making but health equity aspects were under-examined in these studies. Key messages • Health equity is assessed by evaluating policy effects in relevant sub-populations. Only 25 of 59 studies included results that were stratified for one or more socially stratifying factors. • Studies that were focused on disadvantaged populations commonly included recommendations for policymakers, calling for better policy design and improved monitoring of policy effects.

Growing health, inequity, economic and environmental challenges threaten the well-being of present and future generations. Current investment policies and practices are unsustainable and result in high human, social, economic and environmental costs. Countries require the tools to build the case for investment in areas of greatest need by applying evidence-informed practice. A practical guide with tools and resources was developed on how to develop an evidence-informed product to make the case for investment in well-being and health equity. Stakeholder interviews with national and international experts in health policy, equity, economics and social sciences were conducted to inform the outline of the guide and identify enablers for creating evidence-informed products. An evidence review gathered tools and resources on how to translate and communicate public health evidence into policy and practice. An international cross-sector expert consultation assured relevance and transferability of the guide across countries, contexts and policies. The guide aims to prevent disinvestment in health and increase investment in prevention as well as mainstream cross-sector investment to target the wider determinants of well-being and health equity. It outlines how to synthesise, translate and communicate public health and health economic evidence into policy and practice and proposes a step-by-step approach following four key phases (i) project scoping and planning, (ii) evidence gathering, synthesis and design, (iii) dissemination and communication, (iv) monitoring and evaluation. The guide presents information to develop an evidence-informed product to make the case for sustainable investment in an innovative and informative way for use by a range of stakeholders. It accounts for policies and contexts and is communicated in a way that is accessible for decision-makers, easy to use and available as hard copy and interactive version. Key messages Investing in well-being and health equity drives and enables sustainable development. Making the case for investment in health equity requires a well-planned, evidence-informed approach.

Multisector community partnerships play a pivotal role in public health strategy for understanding and addressing social determinants of health (SDOH) and promoting health equity. The work of these partnerships is well aligned with building community resilience. The Year 2 Improving Social Determinants of Health-Getting Further Faster (GFF) retrospective evaluation was designed to gather practice-based evidence that can inform future community-driven partnerships to improve chronic disease outcomes and advance health equity by addressing social determinants of health (SDOH). This paper sought to determine how the efforts of multisector community partnerships could also support community resilience. Guided by CDC's Framework for Program Evaluation in Public Health and health equity principles, the GFF evaluation engaged 14 Multisector Community Partnerships to better understand how their SDOH interventions contribute to community changes that improve chronic diseases and advance health equity. Data collection included qualitative discussions along with additional quantitative analyses of SDOH outcomes, costs, and prevention impacts. This paper focuses on insights gathered from qualitative discussions (2 virtual 60-minute discussions with members of each of the 14 Partnerships) around community resilience. Results from qualitative discussions demonstrate how Partnerships' SDOH efforts created parallel opportunities for nurturing community resilience. For example, Partnerships engaged community members in the design and implementation of SDOH interventions in ways that nurtured a sense of belonging and empowerment to shape their community. To further build community resilience, Partnerships mentioned the importance of sustained and flexible funding, help building stronger partnerships, and a shared goal to build resilience and engage community members. Findings indicate that community partnerships working to address SDOH can drive reciprocal improvements in community resilience-contributions that are critical for advancing health equity. Partnerships suggested that health departments may have opportunities to enhance community resilience through their role as funder, facilitator, and convener.

Background Increasingly, paediatricians are asserting the urgent need for effective practices and policies to address child health inequities. Yet there is a paucity of data on the current approaches implemented in Canadian paediatric tertiary care centres. According to the Institute of Health Improvement (IHI), health equity is paramount for a just society that moves toward better well-being for all. The IHI framework lists five priorities to guide health equity initiatives: make health equity a strategic priority; develop structures and processes to support health equity work; deploy specific strategies to address the multiple determinants of health on which health care organizations can have a direct impact; decrease institutional racism within the organization; and develop partnerships with community organizations. Objectives The objectives of this study were to: 1) Map out current initiatives addressing health equity, and 2) Explore the facilitators and barriers to achieving health equity, in the tertiary paediatric health care setting in Canada. Design/Methods We conducted an environmental scan using in-depth, semi-structured interviews as well as a review of the grey and published literature. We interviewed at least one paediatric resident and one staff (including paediatricians, allied health professionals, and administrators involved in health equity) at all 17 paediatric tertiary care centres in Canada. The interview guide was structured using the IHI framework, to characterize initiatives, as well as facilitators and barriers, to address health equity. We performed a thematic analysis using NVivo. Codes were generated using an inductive and deductive approach, from which themes were identified, refined, and finalized. Results We conducted 41 interviews from Fall 2021 to Fall 2022. Recent events, including Black Lives Matter and the COVID pandemic, fuelled health equity initiatives at the hospital- and university-levels. Most institutions were in a reactionary state, with few having formal strategic approaches to address inequities. The initiatives served a variety of priority populations: Indigenous, Black, migrants, rural communities, and children with disabilities, with the focus differing based on geography and the unique challenges faced by each institution. To achieve equity throughout an organization, equity at the staffing level was identified as being a necessity. The barriers to implementing health equity initiatives included lack of accountability, lack of leadership support, limited resources, and lack of institutional awareness. The facilitators included leadership support, health equity champions, and increasing awareness and resources. Conclusion A myriad of health equity initiatives are taking place in Canadian paediatric tertiary care centres, which are evolving.

IMPACT: This study provides a framwork to inform and organize health equity efforts and initiatives at CTSA institutes. OBJECTIVES/GOALS: to map the activities of the Clinical and Translational Science Award (CTSA) Program hubs across the EQ-DI framework, to depict opportunities for interaction between health equity and dissemination & implementation (D&I) science. METHODS/STUDY POPULATION: The EQ-DI framework demonstrates the dynamic interaction between D&I science and health equity. Health equity could be a lens to sensitize and inform D&I planning (through goal-setting and team development), execution (through ‘adaptation’ and D&I strategies), and evaluation (through incorporating health equity in D&I outcome assessment). On the other hand, D&I models, methods, and study designs can operationalize dissemination and implementation of evidence-based interventions to improve equity. Stakeholder engagement is at the center of the framework to inform and direct the sensitization and operationalization cycles. RESULTS/ANTICIPATED RESULTS: We reviewed the activities of Colorado Clinical & Translational Sciences Institute (CCTSI) and University of Rochester Clinical and Translational Science Institute (UR CTSI) to improve health equity and mapped them across the EQ-DI framework. The sensitizing activities included health equity training, eliciting community priorities, and inclusion of health equity as a critical axis in funding mechanisms. The operationalizing activities included D&I methodological training and consultation, collaborative team science, and funding mechanisms to support implementation of health equity EBIs. Community engagement through studios, community liaisons, and consults was a core priority guiding sensitizing and operationalizing activities. DISCUSSION/SIGNIFICANCE OF FINDINGS: The CTSA Program has been a champion for community engagement and translational collaboration to improve individual and population health. CTSA hubs provide infrastructure and resources to facilitate equity-focused D&I.

BackgroundThe past decade of research has seen theoretical and methodological advances in both implementation science and health equity research, opening a window of opportunity for facilitating and accelerating cross-disciplinary exchanges across these fields that have largely operated in siloes. In 2019 and 2020, the National Cancer Institute’s Consortium for Cancer Implementation Science convened an action group focused on ‘health equity and context’ to identify opportunities to advance implementation science. In this paper, we present a narrative review and synthesis of the relevant literature at the intersection of health equity and implementation science, highlight identified opportunities (i.e., public goods) by the action group for advancing implementation science in cancer prevention and control, and integrate the two by providing key recommendations for future directions.DiscussionIn the review and synthesis of the literature, we highlight recent advances in implementation science, relevant to promoting health equity (e.g., theories/models/frameworks, adaptations, implementation strategies, study designs, implementation determinants, and outcomes). We acknowledge the contributions from the broader field of health equity research and discuss opportunities for integration and synergy with implementation science, which include (1) articulating an explicit focus on health equity for conducting and reviewing implementation science; (2) promoting an explicit focus on health equity in the theories, models, and frameworks guiding implementation science; and (3) identifying methods for understanding and documenting influences on the context of implementation that incorporate a focus on equity.SummaryTo advance the science of implementation with a focus on health equity, we reflect on the essential groundwork needed to promote bi-directional learning between the fields of implementation science and health equity research and recommend (1) building capacity among researchers and research institutions for health equity-focused and community-engaged implementation science; (2) incorporating health equity considerations across all key implementation focus areas (e.g., adaptations, implementation strategies, study design, determinants, and outcomes); and (3) continuing a focus on transdisciplinary opportunities in health equity research and implementation science. We believe that these recommendations can help advance implementation science by incorporating an explicit focus on health equity in the context of cancer prevention and control and beyond.

Health Equity in Housing: Evidence and Evidence Gaps

Health equity guiding frameworks and indices in injury: A review of the literature

Governing Health Equity in Housing

This paper focuses on equity in health, one of the key principles of the Ottawa Charter. It aims at analysing and discussing how the concept was defined, applied, and integrated in health-promotion articles by authors with a Nordic affiliation. Abstracts were first identified by the search word ''health promotion'' as a key word. The search was limited to 1986-2008 and abstracts written in English by authors with a Nordic affiliation. Abstracts/articles for the present study were subsequently selected from these abstracts using the search word ''equity'' and analysed by quantitative and qualitative content analysis. A majority of the 18 articles in the study did not include any proper definition of the term ''equity in health''. Most articles dealt with health in general or ''Health for All'' aspects and did not focus on specific strategies for vulnerable individuals or groups. The theoretical papers had a clear focus on equity aspects even though the concept of equity was sometimes included in an implicit way. In contrast, most papers reporting empirical studies did not specifically target equity aspects. Instead, the analysis gave the impression that many authors used the term ''equity'' synonymously with ''equality in health''. The findings may indicate that the concept of ''equity in health'' has been attenuated or even forgotten by Nordic health-promotion researchers and needs to be re-established as a strong concern within health promotion.

Although the terms "health equity" and "health disparities" have become increasingly familiar to health professionals in the United States over the past two decades, they are rarely defined. Federal agencies have often defined "health disparities" in ways that encompass all health differences between any groups. Lack of clarity about the concepts of health disparities and health equity can have serious consequences for how resources are allocated, by removing social justice as an explicit consideration from policy agendas. This paper aims to make explicit what these concepts mean and to discuss what a life-course perspective can contribute to efforts to achieve health equity and eliminate health disparities. Equity means justice. Health equity is the principle or goal that motivates efforts to eliminate disparities in health between groups of people who are economically or socially worse-off and their better-off counterparts-such as different racial/ethnic or socioeconomic groups or groups defined by disability status, sexual orientation, or gender identity-by making special efforts to improve the health of those who are economically or socially disadvantaged. Health disparities are the metric by which we measure progress toward health equity. The basis for these definitions in ethical and human rights principles is discussed, along with the relevance of a life-course perspective for moving toward greater health equity.