Priorities for Research on Equity and Health: Towards an
Equity-Focused Health Research Agenda
Introduction
A 2009 World Health Assembly resolu- tion on reducing health inequities through action on social determinants of health [1] calls for stakeholders, including research- ers and research funders, to give this topic high priority. In 2004, the World Health Organization (WHO) established a Task Force on Research Priorities to outline a global research agenda on equity and social determinants of health. Its 2005 report [2] contributed to the selection of themes for nine Knowledge Networks set up by WHO to support the Commission on Social Determinants of Health (CSDH) during 2005–2008.
CSDH defined health equity as the absence of systematic differences in health, between and within countries, that are avoidable by reasonable action. Using health equity as the foundation of its approach, CSDH concluded [3] that
‘‘[s]ocial injustice is killing people on a grand scale’’ and made three overarching recommendations: improve people’s daily
living conditions; tackle the inequitable
distribution of power, money, and resourc- es; and measure and understand the problem and assess the impact of action. CSDH emphasized that knowledge gaps must not be used as a reason for postponing action on the ample body of evidence already available, but also high- lighted the need for ongoing research with
a focus on social determinants of health and health equity.
Subsequently, WHO set up a task force to update the advice provided in 2005, incor- porating evidence collected for the CSDH by Knowledge Networks and benefiting from stakeholder consultations on research prior- ities on equity and health held at seven international meetings during 2007–2009. This article draws from the second task force’s longer report [4] completed in 2010, and responds to two questions:
1. In what areas of research could WHO and other development partners con- centrate support in order to best advance health equity?
2. What aspects of research, including the development of concepts, methods, norms and standards, and synthesis approaches, could best benefit from global collaboration?
The second task force recommended three key additions: focus on identifying and evaluating policy options, propelled by the search for what works in practice to reduce health inequities; empower re- search managers, policy makers, and funders to generate national and regional research agendas and fund priorities that address equity and health; and support the strengthening of collaborations, capacities, and methods to do so. Our hope is to help WHO to further advance the health equity agenda, as recently re-articulated in 2010 in World Health Assembly resolution
63.21 on health research [5].
Advancing Health Equity: A Paradigm Shift in Health Research?
The first wave of contemporary health research focused on medicine and the life sciences, with clinical solutions as a primary endpoint. Although such research remains foundational, understanding the social origins of disease—the ‘‘upstream’’ influences on (ill) health and its distribu- tion [6]—generally and almost unavoid- ably falls outside the biomedical frame of
Summary Points
Based on extensive review of global evidence, the recommendations of the WHO Commission on Social Determinants of Health highlight the need for strengthening research on health equity with a focus on social determinants of
health.
To do so requires a paradigm shift that explicitly addresses social, political, and economic processes that influence population health; this shift is under way and complements existing research in medicine, the life sciences, and public health
Reflecting further synthesis and stakeholder consultations, an agenda for future research on health equity is outlined in four distinct yet interrelated areas: (1)
global factors and processes that affect health equity; (2) structures and processes that differentially affect people’s chances to be healthy within a given society; (3) health system factors that affect health equity; and (4) policies and interventions to reduce health inequity.
Priorities for Research on Equity and Health: Towards an
Equity-Focused Health Research Agenda
Introduction
A 2009 World Health Assembly resolu- tion on reducing health inequities through action on social determinants of health [1] calls for stakeholders, including research- ers and research funders, to give this topic high priority. In 2004, the World Health Organization (WHO) established a Task Force on Research Priorities to outline a global research agenda on equity and social determinants of health. Its 2005 report [2] contributed to the selection of themes for nine Knowledge Networks set up by WHO to support the Commission on Social Determinants of Health (CSDH) during 2005–2008.
CSDH defined health equity as the absence of systematic differences in health, between and within countries, that are avoidable by reasonable action. Using health equity as the foundation of its approach, CSDH concluded [3] that
‘‘[s]ocial injustice is killing people on a grand scale’’ and made three overarching recommendations: improve people’s daily
living conditions; tackle the inequitable
distribution of power, money, and resourc- es; and measure and understand the problem and assess the impact of action. CSDH emphasized that knowledge gaps must not be used as a reason for postponing action on the ample body of evidence already available, but also high- lighted the need for ongoing research with
a focus on social determinants of health and health equity.
Subsequently, WHO set up a task force to update the advice provided in 2005, incor- porating evidence collected for the CSDH by Knowledge Networks and benefiting from stakeholder consultations on research prior- ities on equity and health held at seven international meetings during 2007–2009. This article draws from the second task force’s longer report [4] completed in 2010, and responds to two questions:
1. In what areas of research could WHO and other development partners con- centrate support in order to best advance health equity?
2. What aspects of research, including the development of concepts, methods, norms and standards, and synthesis approaches, could best benefit from global collaboration?
The second task force recommended three key additions: focus on identifying and evaluating policy options, propelled by the search for what works in practice to reduce health inequities; empower re- search managers, policy makers, and funders to generate national and regional research agendas and fund priorities that address equity and health; and support the strengthening of collaborations, capacities, and methods to do so. Our hope is to help WHO to further advance the health equity agenda, as recently re-articulated in 2010 in World Health Assembly resolution
63.21 on health research [5].
Advancing Health Equity: A Paradigm Shift in Health Research?
The first wave of contemporary health research focused on medicine and the life sciences, with clinical solutions as a primary endpoint. Although such research remains foundational, understanding the social origins of disease—the ‘‘upstream’’ influences on (ill) health and its distribu- tion [6]—generally and almost unavoid- ably falls outside the biomedical frame of
Summary Points
Based on extensive review of global evidence, the recommendations of the WHO Commission on Social Determinants of Health highlight the need for strengthening research on health equity with a focus on social determinants of
health.
To do so requires a paradigm shift that explicitly addresses social, political, and economic processes that influence population health; this shift is under way and complements existing research in medicine, the life sciences, and public health
Reflecting further synthesis and stakeholder consultations, an agenda for future research on health equity is outlined in four distinct yet interrelated areas: (1)
global factors and processes that affect health equity; (2) structures and processes that differentially affect people’s chances to be healthy within a given society; (3) health system factors that affect health equity; and (4) policies and interventions to reduce health inequity.
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