Does public health advocacy seek to redress health inequities? A scopingreview

Abstract

ABSTRACT: The public health (PH) sector is ideally situated to take a lead advocacyrole in catalysing and guiding multi-sectoral action to address socialdeterminants of health inequities, but evidence suggests that PH’sadvocacy role has not been fully realised. The purpose of this review wasto determine the extent to which the PH advocacy literature addressesthe goal of reducing health and social inequities, and to increaseunderstanding of contextual factors shaping the discourse and practice ofPH advocacy. We employed scoping review methods to systematicallyexamine and chart peer-reviewed and grey literature on PH advocacypublished from January 1, 2000 to June 30, 2015. Databases and searchengines used included: PubMed, CINAHL, PsycINFO, Social SciencesCitation Index, Google Scholar, Google, Google Books, ProQuestDissertations and Theses, Grey Literature Report. A total of 183documents were charted, and included in the final analysis. Thematicanalysis was both inductive and deductive according to the objectives.Although PH advocacy to address root causes of health inequities issupported theoretically and through professional practice standards, theempirical literature does not reflect that this is occurring widely in PHpractice. Tensions within the discourse were noted and multiple barriersto engaging in PH advocacy for health equity were identified, including apreoccupation with individual responsibilities for healthy lifestyles andbehaviours, consistent with the emergence of neoliberal governance. If thePH sector is to fulfil its advocacy role in catalysing action to reducehealth inequities, it will be necessary to address advocacy barriers atmultiple levels, promote multi-sectoral efforts that implicate the state andcorporations in the production of health inequities, and rally stateinvolvement to redress these injustices.Keywords: advocacy, health inequalities, public health, public health policy,scoping reviewIntroductionHealth inequities are systematically produced inequal-ities that reflect disparities between populations in theunderlying social and economic conditions necessaryto be healthy (Braveman & Gruskin 2003). Althoughmany of the interventions and policies expectedto redress health inequities will be found outsidethe healthcare sector, its essential role in tacklinghealth inequities is widely recognised (Braveman &© 2016 John Wiley & Sons Ltd 309Health and Social Care in the Community (2017) 25(2), 309–328 doi: 10.1111/hsc.12320