A novel conceptual model and heuristic tool to strengthen understanding and capacities for health inequalities research

Abstract

Background Despite increasing evidence on health inequalities over the past decades, further efforts to strengthen capacities to produce research on this topic are still urgently needed to inform effective interventions aiming to address these inequalities. To strengthen these research capacities, an initial comprehensive understanding of the health inequalities research production process is vital. However, most existing research and models are focused on understanding the relationship between health inequalities research and policy, with less focus on the health inequalities research production process itself. Existing conceptual frameworks provide valuable, yet limited, advancements on this topic; for example, they lack the capacity to comprehensively explain the health (and more specifically the health inequalities) research production process at the local level, including the potential pathways, components and determinants as well as the dynamics that might be involved. This therefore reduces their ability to be empirically tested and to provide practical guidance on how to strengthen the health inequalities research process and research capacities in different settings. Several scholars have also highlighted the need for further understanding and guidance in this area to inform effective action. Methods Through a critical review, we developed a novel conceptual model that integrates the social determinants of health and political economy perspectives to provide a comprehensive understanding of how health inequalities research and the related research capacities are likely to be produced (or inhibited) at local level. Results Our model represents a global hypothesis on the fundamental processes involved, and can serve as a heuristic tool to guide local level assessments of the determinants, dynamics and relations that might be relevant to better understand the health inequalities research production process and the related research capacities. Conclusions This type of knowledge can assist researchers and decision-makers to identify any information gaps or barriers to be addressed, and establish new entry points to effectively strengthen these research capacities. This can lead to the production of a stronger evidence base, both locally and globally, which can be used to inform strategic efforts aimed at achieving health equity.

Sense-Making, Mutual Learning and Cognitive Shifts When Applying Systems Thinking in Public Health – Examples From Sweden Comment on "What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health"

“…It is important for researchers and policy-makers to understand this cognitive change process, so that they in turn can support practitioners in making sense of policy intentions and changing their views and practices accordingly. 28 For ST to be useful for policy-makers a closer analysis of their views on how policy-induced change is understood and how ST and knowledge of the system (eg, organization theory) and targets groups (eg, behavioral psychology) can benefit the development of healthcare and public health.…”

Health Inequalities in the Time of COVID-19: The Globally Reinforcing Need to Strengthen Health Inequalities Research Capacities

“…Subsequently, the socio-political context in which public health and health inequalities research, and political priorities are planned and implemented, also need to be evaluated to better understand the causal forces and dynamics operating at different (macro-to-micro) levels, which influence and determine the capacity to act in an equitable manner. 19,23,37 The increase in social inequalities in health, infectious disease outbreaks, and ecological changes over the past few decades are arguably symptoms of systemic dysfunctions, and incompatibilities with our decisions and choices in pursuit of progress and prosperity, 8,42 which are adversely shaping and influencing our opportunities to lead healthy lives in the process. 7 Going forward, widespread recognition, sensitivity, and concern for these problems need to be instilled, at the political, social, institutional, and individual level.…”

“…Limited stewardship, limited provision of human, financial and technical resources, facilities, and infrastructure 19,21,40 ; conflicting social-political value judgments, ideology and interests 19,38,39 ; limited demand for, and prioritization of, locally relevant health equity-oriented COVID-19 research 19,21 ; limited academic freedom or creative autonomy to reflect, propose, and pursue critical research on global-societal-health issues such as health inequalities, particularly during pandemics. 19 Research infrastructure:…”

“…As well as a better-contextualized understanding of the process of disease embodiment, that is the complex biological effects of the bio-psycho-social-environmental interplay to produce health inequalities, 35 and the cumulative impact of socio-economic adversity, political marginalization, in different settings. 2,19,36 Furthermore, conducting health inequalities research capacity assessments at the local/national level could help identify pending challenges, barriers, and information gaps, and assist to guide future strategies that aim to address their specific capacities. 19,37 We summarize some of the potential challenges that will likely need to be addressed in different contexts, in order to strengthen their capacity to generate health equity-oriented COVID-19 research, which can be used to inform appropriate and equitable responses 23 (see Table 1).…”

How to strengthen a health research system: WHO’s review, whose literature and who is providing leadership?

“…The titles include 'Building an integrated knowledge translation (IKT) evidence base: colloquium proceedings and research direction' [76], 'Using a 'rich picture' to facilitate systems thinking in research coproduction' [77], 'Exploring the evolution of engagement between academic public health researchers and decision-makers: from initiation to dissolution' [78], 'Research co-design in health: a rapid overview of reviews' [79], and 'Conceptualising the initiation of researcher and research user partnerships: a metanarrative review' [80]. Finally, another article in May 2020 presented a new conceptual model for health research systems to strengthen health inequalities research [81]. Here, we have focused on just one journal, HARPS, because it was the largest single source of papers in the HEN report, which totalled 140 publications (additional publications were included to the 112 in the review to help set the background, provide examples of key tools, etc).…”