Defining and operationalising health equity
The need to break down silos
A new scoping review provides a foundation for developing more consistent ways to define and operationalise health equity – essential for establishing an integrated, whole-system approach to health equity.
The scoping review published in the June 2024 issue of JBI Evidence Synthesis was conducted during the COVID-19 pandemic, a period that has heightened awareness of long-standing health inequities. The authors observed an increasing number of sources related to health equity identified in this review over the years 2020–2022, reflecting this growing attention.
The scoping review, Strategies and Indicators to Integrate Health Equity in Health Service and Delivery Systems in High-Income Countries, found significant variation across health service and delivery systems in terms of the work being done related to health equity. This includes differences in how health equity is defined and operationalised, the types of indicators used, and the strategies employed.
For example, the frameworks used by the sources included in the review to guide their health equity work were inconsistently applied, with most not building on international work published by the WHO.
Health equity is a complex concept with no clear consensus on its definition or application within health service and delivery systems. Consequently, inconsistencies in how it is considered across different systems and settings are not surprising. These inconsistencies, coupled with the finding that most health equity work occurs at the clinical or provider level, indicate that health service and delivery systems cannot elevate this work to an integrated, whole-system approach without strategic direction, adequate governance structures, and dedicated resources.
The authors report that there is a need to eliminate siloed health equity work without undermining the progress made to date. Policymakers and senior leaders responsible for system oversight should consider aligning their efforts with the WHO definition, as demonstrated by some sources in the scoping review.
Health equity work will remain siloed until it is recognised as a collective issue that can be addressed through system-wide measurement and identification of vulnerable populations, implementation of remediation strategies, and application of accountability mechanisms. These mechanisms should employ integrated approaches across the care continuum with the aim of preventing, restoring, and maintaining health.
Read more in the open access scoping review, available in the June 2024 issue of JBI Evidence Synthesis:
Caldwell, Hilary A.T.; Yusuf, Joshua; Carrea, Cecilia; Conrad, Patricia; Embrett, Mark; Fierlbeck, Katherine; Hajizadeh, Mohammad; Kirk, Sara F.L.; Rothfus, Melissa; Sampalli, Tara; Sim, Sarah Meaghan; Tomblin Murphy, Gail; Williams, Lane
JBI Evidence Synthesis 22(6):p 949-1070, June 2024. | DOI: 10.11124/JBIES-23-00051