Disrupting research and learning for health equity

Despite substantial evidence showing that social determinants deeply impact health equity, global efforts to address these inequities have often fallen short. Reconsidering how knowledge is produced, who is involved in creating it and how it is used to shape policy and drive action can help to advance this agenda.

With this goal in mind, the Alliance for Health Policy and Systems Research – with financial support from the Robert Wood Johnson Foundation (RWJF), and in collaboration with the Boston University School of Public Health and the World Health Organization (WHO) Department of Social Determinants of Health – convened a meeting in Geneva, Switzerland, at the beginning of October 2024 to explore strategies for reimagining research and learning for health equity. The event brought together experts from across the research–policy–implementation ecosystem to create a new action-oriented agenda to address knowledge and learning on the social determinants of health equity.

Discussions centred on the urgent need for innovative research approaches. In her opening remarks, Dr Ailan Li, WHO Assistant Director-General for Universal Health Coverage and Healthier Populations, emphasized WHO’s commitment to placing countries at the centre of its work, ensuring that global initiatives align closely with local realities. She acknowledged the gap between evidence generation and practical outcomes, particularly in health equity. Dr Alonzo Plough, Vice President of Research-Evaluation-Learning and Chief Science Officer from RWJF, echoed this sentiment. He encouraged embracing more open science and diverse methodologies, especially structural analyses that address the root causes of inequities, such as racism, gender inequality and economic disparities.

Building coalitions to move health equity forward was another key theme. Dr Camille Busette of The Brookings Institution stressed the importance of collaboration, noting that, “identifying those fellow travellers and using a language that resonates with them will amplify the work we are doing.” Dr Jeanette Vega, former Minister of Social Development and Family of Chile and Vice Chair of the Alliance’s Board, suggested that research outputs need to be better tailored to policy-makers, emphasizing the need for concise, actionable outputs outlining facts and steps for implementation. Dr Sandro Galea, from Boston University, suggested that it goes beyond simple knowledge translation, stressing the need to make sure that “decision-makers are part of the process of science generation and then of science application”.

The conversation also explored the limitations of current research ecosystems, with several participants noting how traditional research models and publishing platforms tend to reinforce existing power structures. For example, Sir Michael Marmot, Professor at University College London, highlighted the ideological tensions in health research, stressing that an overreliance on randomized controlled trials can be inadequate when addressing social determinants of health. He called for blending rigorous evidence with a critical analysis of societal structures and ideologies.

Discussions also emphasized global collaboration, with Dr Piya Hanvoravongchai of Thailand’s National Health Foundation urging collaborative, transnational research that tackles global determinants like commercial and digital health.

Key recommendations from the discussions included:

1. Strengthen community participation: Establish frameworks for community-led research, emphasizing trust-building and long-term relationships with communities.
2. Rethink funding models: Advocate for funding that supports inclusive, community-centered, and disruptive research. This includes challenging traditional funding criteria and prioritizing research that addresses structural determinants of health.
3. Promote intersectional and structural analysis: Incorporate frameworks that address intersectional issues such as race, gender, and economic inequality in health research. This approach should also recognize the importance of non-traditional knowledge systems, including Indigenous knowledge.
4. Enhance knowledge translation for policy impact: Develop clear, actionable messages from research findings that are actionable and feasible for policymakers to implement. Efforts should include simplifying data presentation for policymakers and exploring co-benefits with other sectors, such as climate and education.
5. Build a collaborative network for continued action: Establish a cross-disciplinary network that includes researchers, policymakers, and community representatives to drive an ongoing agenda focused on health equity.
6. Support applied research for equity: Health equity requires applied research that embodies inclusivity, collaboration, and practical impact, carried out by coalitions including the communities affected by health inequities. This requires research and funding to prioritize actionable outputs and results and translate research into real-world policy and systemic change providing learning and inspiration for others.

The views and opinions expressed in this news item are of the speakers themselves and do not necessarily represent the views of the Alliance, WHO or RWJF.