Values are not enough: qualitative study identifying critical elements for prioritization of health equity in health systems
Open accessAbstract
BACKGROUND: Health system policies and programs that reduce health inequities and improve health outcomes are essential to address unjust social gradients in health. Prioritization of health equity is fundamental to addressing health inequities but challenging to enact in health systems. Strategies are needed to support effective prioritization of health equity. METHODS: Following provincial policy recommendations to apply a health equity lens in all public health programs, we examined health equity prioritization within British Columbia health authorities during early implementation. We conducted semi-structured qualitative interviews and focus groups with 55 senior executives, public health directors, regional directors, and medical health officers from six health authorities and the Ministry of Health. We used an inductive constant comparative approach to analysis guided by complexity theory to determine critical elements for prioritization. RESULTS: We identified seven critical elements necessary for two fundamental shifts within health systems. 1) Prioritization through informal organization includes creating a systems value for health equity and engaging health equity champions. 2) Prioritization through formal organization requires explicit naming of health equity as a priority, designating resources for health equity, requiring health equity in decision making, building capacity and competency, and coordinating a comprehensive approach across levels of the health system and government. CONCLUSIONS: Although creating a shared value for health equity is essential, health equity - underpinned by social justice - needs to be embedded at the structural level to support effective prioritization. Prioritization within government and ministries is necessary to facilitate prioritization at other levels. All levels within health systems should be accountable for explicitly including health equity in strategic plans and goals. Dedicated resources are needed for health equity initiatives including adequate resourcing of public health infrastructure, training, and hiring of staff with equity expertise to develop competencies and system capacity.
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- Authors
- van Roode, T., Pauly, B. M., Marcellus, L., Strosher, H. W., Shahram, S., Dang, P., Kent, A., & MacDonald, M.
- Affiliations
- University of Victoria (CA)
- University of British Columbia (CA)
- ORCID
- Venue
- International Journal for Equity in Health
- Published
- 2020-09-15
- Volume
- 19
- Issue
- 1
- Pages
- 162-162
- ISSN
- 1475-9276 (ISSN-L)
- PMC
- PMC7493313
- OpenAlex
- W3086319671
- Cited by
- 40
- References
- 51
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 7 · 2023: 7 · 2022: 5 · 2021: 4
- FWCI
- 4.17
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- International Journal for Equity in Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- cIRcle (University of British Columbia) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Open Collections
- Funders
- Canadian Institute for Health Research (FRN 116688)
- Topics
- Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
- Social Sciences › Health › Public Health and Social Inequalities
- Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Practices
- Keywords
- health equity, health system policy, health disparities, health authorities, organizational capacity building, public health infrastructure, social justice, complexity theory, British Columbia
- MeSH terms
- Health Equity, British Columbia, Delivery of Health Care, Health Priorities, Humans, Focus Groups, Qualitative Research
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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