Advocacy for Health Equity: A Synthesis Review

Abstract

ABSTRACT: Context: Health inequalities are systematic differences in health among socialgroups that are caused by unequal exposure to—and distributions of—the socialdeterminants of health (SDH). They are persistent between and within countriesdespite action to reduce them. Advocacy is a means of promoting policies thatimprove health equity, but the literature on how to do so effectively is dispersed.The aim of this review is to synthesize the evidence in the academic and grayliterature and to provide a body of knowledge for advocates to draw on to informtheir efforts.Methods: This article is a systematic review of the academic literature and afixed-length systematic search of the gray literature. After applying our inclu-sion criteria, we analyzed our findings according to our predefined dimensionsof advocacy for health equity. Last, we synthesized our findings and made acritical appraisal of the literature.Findings: The policy world is complex, and scientific evidence is unlikely tobe conclusive in making decisions. Timely qualitative, interdisciplinary, andmixed-methods research may be valuable in advocacy efforts. The potentialimpact of evidence can be increased by “packaging” it as part of knowledgetransfer and translation. Increased contact between researchers and policymak-ers could improve the uptake of research in policy processes. Researchers canplay a role in advocacy efforts, although health professionals and disadvantagedpeople, who have direct contact with or experience of hardship, can be par-ticularly persuasive in advocacy efforts. Different types of advocacy messagescan accompany evidence, but messages should be tailored to advocacy target.Several barriers hamper advocacy efforts. The most frequently cited in the aca-demic literature are the current political and economic zeitgeist and relatedpublic opinion, which tend to blame disadvantaged people for their ill health,even though biomedical approaches to health and political short-termism alsoact as barriers. These barriers could be tackled through long-term actions toraise public awareness and understanding of the SDH and through training ofhealth professionals in advocacy. Advocates need to take advantage of “windowsof opportunity,” which open and close quickly, and demonstrate expertise andcredibility.Conclusions: This article brings together for the first time evidence from theacademic and the gray literature and provides a building block for efforts toadvocate for health equity. Evidence regarding many of the dimensions is scant,and additional research is merited, particularly concerning the applicability offindings outside the English-speaking world. Advocacy organizations have acentral role in advocating for health equity, given the challenges bridging theworlds of civil society, research, and policy.