Health equity frameworks as a tool to support public health action: A rapid review of the literature
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Much is known about the existence of health inequities across Canada, and the underlying structural drivers of these inequities. Less is known about how to advance equity across the public health system. Health equity frameworks are one tool to disrupt systems of oppression and promote health equity.
This report presents the results of a review conducted to answer the question: which health equity frameworks exist that can be used to inform public health planning, decision making and service delivery?
A systematic literature search was conducted, and 47 frameworks were selected for inclusion. Included frameworks come from the United States, Canada, Australia, Europe and New Zealand. A high proportion of the frameworks are found in the grey literature. Many frameworks focus on advancing equity for Indigenous or Aboriginal populations in specified regions. Several frameworks identify the need to disrupt inequitable power imbalances at clinical, organizational, and system levels, and position disrupting racism as central to all health equity work.
This review found that most frameworks lack in-depth implementation guidance, suggesting there is no “right path” or single “recipe” to advance equity. It is not necessary, or always possible, to have all the answers before embarking on health equity work.
In addition, details are limited surrounding framework evaluation. Public health practitioners engaging in action on equity have an opportunity to demonstrate leadership for health equity and to advance organization and system learning by committing to sharing (both favorable and unfavorable) findings and lessons.
This report concludes with considerations for developing and actioning health equity frameworks.
Although frameworks can be a useful tool, readers are invited to challenge the assumed benevolence of all health equity frameworks. Readers are also invited to reflect on how their beliefs, assumptions, and biases, often derived from their social location and world view, influence how they approach health equity work. Continuous learning and unlearning can help practitioners work through the complexities inherent in health equity work.
How we work and journey together matters just as much as the outcome. Meaningful community engagement can support the creation of equitable partnerships, which include shared decision-making power. Public health and other practitioners can use the findings of this report to inform co-development, co-implementation, or co-evaluation of health equity frameworks, as part of comprehensive strategies to disrupt systems of oppression and action health equity.
Use this resource to:
- discover existing health equity frameworks focused on advancing equity in public health contexts; and
- deepen your understanding of how health equity frameworks, coupled with critical thinking, deep reflexivity, and continuous learning and unlearning, can facilitate action on equity.
- Disrupt systems of oppression and advance equity in complex organizations and health systems, at local, regional, provincial, or territorial levels.
Data extraction tables and detailed search strategy for this literature review, and a list of other frameworks of interest are available in English upon request. For access to these documents, please email [email protected].
National Collaborating Centre for Determinants of Health. (2023). Health equity frameworks as a tool to support public health action: A rapid review of the literature. Antigonish, NS: NCCDH, St. Francis Xavier University.