Connecting knowledge with action for health equity: a critical interpretive synthesis of promising practices

Abstract

Connecting knowledge with action (KWA) for health equity involves interventions that can redistribute power and resources at local, national, and global levels. Although there is ample and compelling evidence on the nature, distribution, and impact of health inequities, advancing health equity is inhibited by policy arenas shaped by colonial legacies and neoliberal ideology. Effective progress toward health equity requires attention to evidence that can promote the kind of socio-political restructuring needed to address root causes of health inequities. In this critical interpretive synthesis, results of a recent scoping review were broadened to identify evidence-informed promising practices for KWA for health equity. Following screening procedures, 10 literature reviews and 22 research studies were included in the synthesis. Analysis involved repeated readings of these 32 articles to extract descriptive data, assess clarity and quality, and identify promising practices. Four distinct kinds of promising practices for connecting KWA for health equity were identified and included: ways of structuring systems, ways of working together, and ways of doing research and ways of doing knowledge translation. Our synthesis reveals that advancing health equity requires greater awareness, dialogue, and action that aligns with the what is known about the causes of health inequities. By critically reflecting on dominant discourses and assumptions, and mobilizing political will from a more informed and transparent democratic exercise, knowledge to action for health equity can be achieved.

In Pursuit of Health Equity in Pediatrics

“…Given that many datasets are based on limited sampling among minorities and researchers tend to aggregate raw data into a series of broad categories, the use of existing such datasets has been associated with the masking of inequities and/or the exaggeration of improvements. 39 For example, research on birth outcomes among Latina women in the US has consistently demonstrated paradoxically favorable outcomes in the context of socioeconomic disadvantage and barriers to health care. 40 However, research on subgroup variation within Latinas has documented significant differences by national origin and birth place and inequities by race or immigration status.…”

“… 43 Similarly, the use of traditional categories of gender in existing datasets has obscured the health needs of non-cisgender and other sexual minority individuals, which contribute to entrenchment of inequities among LGBTQ communities. 39 , 44 …”

“…This dearth of actionable studies may be related to a traditional emphasis on the manifestations of health inequities rather than on the investigation of root causes, including the historical contexts that reify disadvantage. 39 Research studies that are oriented toward outcomes instead of prevention have contributed to oversimplified conceptual models, wherein the characteristics of individuals or population subgroups are defined as the problem. Instead, a sharper focus on the structural context and upstream factors that culminate in disproportionate distribution of disease burden is needed.…”

An overview of reviews on strategies to reduce health inequalities

“…The present review identified a large amount of existing literature on strategies or interventions that facilitate the reduction of health inequalities, which allowed a robust body of information to be put together that could help in health decision-making. Within the results, the wide variety of health conditions and intervened sectors with the aim of reducing health inequalities was highlighted, which reinforces the fact that the problem of inequalities occurs throughout the health system, and implies that work in reducing inequalities is intersectoral and multidisciplinary [ 68 ]. Most of the studies included focused on the general population, vulnerable populations, and minority populations.…”

Advocacy for renal replacement therapy: the role of renal registries

“…Advancing health equity involves recognizing and replacing standard practices that maintain unfair distributions of power and resources in a given society. The scientific literature suggests that critical consideration of dominant discourses and assumptions and the mobilization of political will from a more informed and transparent democratic process can use knowledge to take action to achieve health equity [ 8 ].…”