Reviews on interventions for health equity with a One Health focus

Reviews on interventions for health equity with a One Health focus | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Reviews on interventions for health equity with a One Health focus Delisle Hélène, Ingabire Angélique, Søvold Lene, Vissandjee Bilkis This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6024650/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: The One Sustainable Health for All (OSH) Forum was launched in 2021 to promote a transdisciplinary “One Health / Planetary Health” approach in line with the 2030 Sustainable Development Goals. The ‘One Health’ approach is a holistic and system-based approach that recognizes the interconnection between health of humans, animals and ecosystems. ‘One Sustainable Health for all ’ implies health equity, that is, fair access of all human beings to quality health-related services and the health outcomes achieved. The OSH Forum leads thematic international working groups (IWGs), and the IWG on health equity undertook a scoping review as part of its mandate. Aim: The scoping review of reviews focused on actions to achieve health equity in the realm of One Health. The aim was to describe the types of health equity actions, to identify knowledge gaps and to recommend evidence-based approaches to integrate health equity into One Health initiatives. Methods: The comprehensive search identified 62 reviews out of 295 action-focused papers. The WHO building blocks were adapted to categorize the lines of action into six key areas: Governance and policy; Information and evidence data; Technologies; Human resources; and Health-related service delivery. Results: Predominant actions were within service delivery (26/62 reviews). Health equity was addressed through governance in 13 reviews, evidence data in 7, technologies in 11, and human resources in 5. Refugees, immigrants, and racial/ethnic minorities were the main targeted groups. The intersection of health equity and One Health was not directly addressed except in two reviews. Most reviews were from high-income countries. Few studies assessed the impact of the interventions on health equity. Strong themes across the reviews were: the importance of addressing the social determinants of health; the need for disaggregated data; the critical role of human resources and community engagement; and the need to analyze power imbalances. Conclusion: The review highlighted a dire need for studies on the impact of interventions on health equity, particularly in LMICs. Given the limited connections made between health equity and One Health, using a health equity lens to assess One Health initiatives appears warranted. Health equity One Health Achieving health equity One Sustainable Health Health equity actions Figures Figure 1 Introduction Planetary health is far from a reality, with increased disease burden, the threats associated with climate change, conflicts in several parts of the world, and persistent inequities. The One Sustainable Health (OSH) for All Forum was launched in 2021 to promote a transdisciplinary “One Health / Planetary Health” approach in line with the 2030 Sustainable Development Goals (SDGs). ‘ One Health ’ is an integrative, collaborative, multisectoral, and transdisciplinary approach to pursuing optimal health. It integrates optimal health of people, animals, plants, and their shared environment at local and global levels. ‘One Sustainable Health’ emphasizes the need to address the long-term impacts of policies and practices across human, animal, and planetary health. Central to the concept of ‘One Sustainable Health for all ’ is health equity, which implies fair access of all human beings to quality health-related services and the health outcomes achieved. Inherent concepts are ‘Universal Health Coverage’ and ‘Leaving No One Behind’. Universal health coverage (UHC) is a concept and goal that claims that all individuals and communities should receive the health services they need without suffering debilitating financial hardship [1] . UHC is firmly based on the 1948 WHO Constitution, which declares health a fundamental human right and commits to ensuring the highest attainable level of health for all. It includes the full spectrum of essential, quality health services, encompassing health promotion and prevention, treatment, rehabilitation, and palliative care across the life course. As part of one of the nine OSH working groups’ activities [1] , a scoping review of initiatives to improve health equity was undertaken to describe the different types of health equity actions, to identify knowledge gaps and to recommend evidence-based approaches integrating health equity and One Health. The ‘One Health’ (OH) approach is a holistic and system-based approach that recognizes the interconnection between health of humans, animals and ecosystems [2] . The approach mobilizes multiple sectors, disciplines and communities at varying levels of society to work together to foster well-being and tackle threats to health and ecosystems. Collaboration is a key principle of the OH and equity must be prioritized in OH implementation to ensure the active participation of vulnerable groups [3] . Health equity and One Health initiatives can enhance the ability to meet the health-related SDGs, especially in reducing health disparities and addressing global health threats [4, 5] . Almost all SDGs are connected to health, and some in a direct manner: SDG 2 Zero hunger; SDG 3 Good health and well-being; SDG 5 Gender equality; SDG 6 Clean water and sanitation; SDG 10 Reduced inequalities; SDG 11 Sustainable cities and communities; and SDG 13 Climate action. Health equity generally refers to the absence of unfair and avoidable differences in health among population groups defined socially, economically, demographically, and/or geographically [6] . Conversely, WHO [7] defines health inequities as differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work, and age. The term ‘global health equity’ can also be used to describe equitable health as a key outcome of global health activities [8] . Health equity covers not only health but its determinants [9] . Increased focus on health equity is important, given that there are population groups who systematically experience lower access to health services, lower health status, limited well-being outcomes, and higher exposure to risks and stressors in many countries all over the world [10] . For instance, persons living with disabilities – 16% of the world population -, experience a life expectancy shortened by 10-20 years as they are more exposed [11] . The recent COVID-19 pandemic dramatically showed that mortality and morbidity followed a social gradient [12] . Profound inequalities in access to the COVID-19 vaccines and the adverse consequences including in mental health were also highlighted. [1] Working group on Equitable access to health-related services. The other groups focus on: Environmental health; Sustainable food systems; One health and urban settings; Financing for sustainable health; Governance and policy; Education and communication; One health next generation; and One health in humanitarian settings. Methodology The initial literature search on health equity actions was conducted in June 2022 and a search update in April 2024. Only papers in English or French were included. We used the following databases: PubMed; Embase (Elsevier); APA PsycInfo; CINAHL; Érudit; Global Health; Social Sciences Abstracts; Sociological Abstracts; and Web of Science (WoS). The final concept plan and the search words are given in the appendix. Because of the action focus, the search strategy was to include issues, inputs, and potential outcomes, which are represented in the three columns. A total of 830 papers were identified, out of which 295 were retained owing to the focus on action (Figure). Based on abstracts, we excluded papers only describing health inequities, duplicates, study protocols, research only papers, and articles without full online access. The first author selected the papers and validated them with at least one research team member. The 295 selected papers included 233 individual studies and 62 reviews. The present scoping review covers these review papers, whether standard reviews or overviews based on the literature. The first author selected the papers and the selection was validated by at least one research team member. The WHO building blocks for assessing health system performance [13] were adapted to classify the reviews into six key areas: Governance and policy; information and evidence data; technologies; human resources and capacity building; and health-related service delivery. The scoping review method followed the stages of the framework by Levac, Colquhoun and O’Brien [14] . The table used to extract the data from each selected review paper was developed by the research team (see Table 1). A narrative overview of the breadth of the initiatives reviewed under each key area is presented in the results, followed by a thematic discussion leading to recommendations to link one health and health equity actions. Results Our review showed that predominant actions taken to foster health equity were centered around health service delivery (26/62): primary healthcare, as well as specialized medical care, preventive services, maternal care, access to vaccines specifically for COVID-19, and mental health. Marginalized or underserved groups such as indigenous people, refugees and immigrants, ethnic minorities, and persons with disabilities were targeted in several reviews. Thirteen reviews addressed health equity through governance and policy, including practice guidelines, policy reforms, addressing the social determinants of health (SDOH), and organization capacity assessment. The reviews on information and evidence data (N=7) focused on methods to assess and report the impact of interventions on health equity; two reviews addressed the effects of climate change and CO 2 reduction actions on health inequities; these were the only ones that considered the ecosystems, beyond human health. Eleven reviews on technologies pertained to digital health equity, healthcare algorithms, and the role of Artificial Intelligence (AI). The reviews on human resources and equity (N=5) referred to the training of nurses, other health professionals, and community health workers, as well as community participation. Details on the reviews are provided in Table 1 and an overview by key area is given below. Table 1. Summary of studies included in the review 1. Governance and policy Authors and title Objectives Theme/ focus Methods Findings Recommendations by authors Arcaya, Ellen and Steil (2024) Neighborhoods and health: Interventions at the neighborhood level could help advance health equity [13] 1) To critically review the relationships between neighborhoods and health; 2) to discuss policy responses Social determinants of health (SDH): neighborhoods (USA) Overview of the topic, without a strict methodology Neighborhood can contribute to health and well-being in different ways: 1) Institutions, e.g., number and quality of healthcare facilities 2) Physical characteristics, which affect safety, ability to engage in physical activity, access to healthy foods 3) Social conditions, e.g., violence, networks, segregation Policy responses include better enforcement of fair housing laws, reforms to land use, and housing choice vouchers. Other measures to advance health equity include policy change to strengthen communities’ social and physical infrastructure, and in particular, community-led initiatives to change material and social conditions, with explicit or non-explicit health promotion goals. Jindal et al (2024) Policy solutions to eliminate racial and ethnic disparities in childhood in the USA [15] To critically review policies that reinforce and perpetuate health disparities in children, and key policy solutions Social determinants of health: housing, economic opportunity and employment, health insurance, the criminal legal system, and immigration (USA) No description of the search method. For each social sector, landmark articles are stated and examples of inequities are provided. Housing quality, cost and segregation all have an impact on children’s opportunities and health. Black and Asian children have less social mobility. Racial income gaps persist across generations unless targeted interventions are implemented. The US justice system is racially biased, including for youth. Immigrant-related policies which increase eligibility for employment, education and access to resources, termed inclusive policies, have been associated with better pediatric health outcomes. There is a great need for political will to improve racial/ethnic child health equity. Investing in the SDHs could improve safety and reduce incarceration, which is racially biased. The funding of Immigrant-led and community organizations that support immigrant communities, providing language, food, legal, after-school, and health services, should be prioritized. McMillan-Boyles et al (2023) Representations of clinical practice guidelines and health equity in healthcare literature: An integrative review [18] To explore how equity is discussed in the health literature in relation to clinical practice guidelines (CPG) Clinical practice guidelines Integrative review, with literature search in PubMed, CINAHL, Cochrane, EMBase, Medline, and Web of Science. Equity in CPG development, implementation and evaluation was documented. 139 papers published between 2010 and 2022 were screened and 19 were included in the review. CPGs can exacerbate health inequities if the resources and services outlined are not readily available and accessible. How health equity is integrated into CPG development is problematic, and the use of existing tools and checklists is challenging. Equity should be clearly articulated into CPG at the outset of their development and throughout the different phases. Otherwise, the ability of health care professionals to implement the CPGs effectively and provide equitable health services may be hindered. Shaver et al (2023) Health equity considerations in guideline development: a rapid scoping review [19] To synthesize current best practices for integrating health equity into guideline development, and the benefits or drawbacks of these practices Guideline development A ‘rapid’ scoping review, with some components of the scoping review omitted or simplified. Scientific and grey literature papers were screened. The results were organized in four phases of guideline development: planning, evidence review, development and dissemination. 26 articles proposed best practices for incorporating health equity within guideline development. Equity guidance strategies were available for all four phases, and advantages and disadvantages were summarized. There are too many exemplary practices to summarize them here. Gaps were identified, for instance, no equity related guidance was captured to identify or report on conflicts of interest. Guideline developers should consider the use of guideline checklists and tools to implement health equity promoting practices throughout guideline development. Any equity framework or plan should be developed in partnership with experts in the field of health equity, as well as health system stakeholders and community organizations. Lee‑Foon et al. (2023) Saying and doing are different things: a scoping review on how health equity is conceptualized when considering healthcare system performance [16] To explore how healthcare systems around the world conceptualize equity when considering healthcare system performance. Healthcare system performance Levac’s [. ] scoping review approach was used to locate relevant articles and develop a protocol. The peer-reviewed articles included were published between 2015 to 2020, Oral health and clinical training were excluded. Of the 16 studies included, six were from North America, six from Europe and one each from Africa, Australia, China and India. Quantitative or qualitative studies centered on: indicators; equity policies; evaluating the equitability of healthcare systems; creating and/or testing equity tools; and using patients’ sociodemographic characteristics to examine healthcare system performance. The definitions of equity varied widely, ranging from no definition to distributional fairness of healthcare services to populations with differing levels of disadvantage. All papers acknowledged that social determinants of health affected patients’ health and their outcomes in various healthcare settings. More research is needed to better understand the lack of consensus and how to ensure researchers are truly assessing the state of equity in their respective healthcare systems. More research should also be conducted to see if the impact of racism is being captured when assessing healthcare system performance. Additional resources are needed to address many of the social determinants of health that healthcare systems may have the capacity to address Marcus, Monga Nakra N and Pollack Porter KM (2024) Characterizing organizational health equity capacity assessments for public health organizations: a scoping review [21] To identify and characterize existing organizational health equity capacity assessments (OCAs). Health equity performance assessment The standard scoping study framework was used: identifying the research question and relevant studies; selecting studies; charting the data; collating and summarizing the results; and validating the findings with practitioners. 17 OCAs were included. Most aimed to provide considerations or strategies to increase organizational health equity capacity or readiness and can be used repeatedly to monitor progress. Many OCAs lack specific definitions of organizational health equity capacity. Future publications and case studies should include data related to OCA implementation, including capacity findings, implementation lessons learned, and resources required, where possible. Contextual information should be included in OCA publications, if possible. Thornton et al (2023) Addressing population health inequities: investing in the social determinants of health for children and families to advance child health equity [17] To provide a critical assessment of recent pediatric population health research with a specific focus on child health equity, and to address the role of the healthcare sector in addressing fundamental social drivers of health. Addressing the SDOH Overview without a defined methodology The overall emphasis in the SDOH literature in pediatric populations focuses on the processes surrounding implementation: screening, uptake, response, and referral. What is less clear is whether screening accurately identifies social needs or improves overall health outcomes. Healthcare system efforts to identify and address individual needs are important but approaches centered on the individual level put the burden on patients and caregivers to disclose unmet needs in healthcare setting. Screening and responding to urgent health related social needs and changing the social conditions that impact population health require a closer examination of systemic factors that produce certain patterns of disparities within the overall population. Social needs interventions need to pay attention to systems and structures and to explicitly recognize race and racism as key social determinants of health. Significant investments are needed in affordable housing, early childhood and universal pre-school programs, mental health support, and other upstream contributors to health outcomes. Researchers should partner with community organizations and policymakers to address root causes of health inequities. Value-based payment innovation to address SDOH has the potential to move investments upstream. Reichman et al (2021) Using rising tides to lift all boats: Equity-focused quality improvement as a tool to reduce neonatal health disparities [24] To provide a broad overview of neonatal health disparities scholarship, review the potential impact of Quality Improvement (QI) work on health disparities, and provide a framework for centering neonatal QI endeavors around equity. Improvement of quality of care Overview without a defined methodology Infants of color experience significantly higher rates of low birthweight, preterm birth, and neonatal mortality compared to White infants. Geographic location also plays a role, with disparities in mortality and neonatal care quality observed between urban and rural areas, and even within different neighborhoods of the same city. The quality of care varies significantly between hospitals, contributing to disparities. Black and Hispanic infants are more likely to receive care in lower-quality hospitals, which exacerbates outcomes. There are also significant differences in neonatal mortality rates among different Asian subgroups and Hispanic subgroups, which are often overlooked. Other parental attributes may also contribute to disparities but are under-researched in neonatal care. QI methodologies can inadvertently exacerbate disparities if not explicitly designed to focus on equity. Eight foundational concepts for designing and executing Equity Focused Quality Improvement (EF-QI) projects: 1. Foster a culture of equity 2. Identify the disparities 3. Incorporate equity in QI design 4. Involve families and community partners 5. Consider alternative comparator groups 6. Focus on root causes 7. Adapt data visualization tools 8. Disseminate data with equity in mind. Plamondon et al (2019) Connecting knowledge with action for health equity: a critical interpretive synthesis of promising practices [14] To critically examine promising and empirically-derived strategies for advancing productive action on the root causes of health inequities. Multi-disciplinary practices A critical interpretive synthesis of empirical studies and literature reviews published whose authors framed health inequities as having known causes. 16 papers were included. Four groups of promising practices were identified: (re) structuring systems, working relationally, doing research, and carrying out knowledge translation. Restructuring systems involves the explicit analysis of power. Deploying social determinants of health nurses within the healthcare system was a key determinant of the efficacy and direction of the health equity work. Working relationally means fostering inclusion and connectedness, and mitigating power imbalances. In research, a promising practice was identified as embracing complexity in health equity work. Regarding knowledge translation, blending numbers with human experience was deemed promising. However, there were few studies examining how to advance health equity at an institutional or societal level. Cross-sectoral partnerships are needed since many structural determinants of health lie outside the health sector. Such partnerships also need to be studied: there is a gap in the literature. There is a need for capacity to recognize how societal structures, including dominant social values such as individualism and bio-behaviourism can promote actions that are directly in conflict with the evidence about root causes of health inequities. Jensen, Kelly and Avendano (2022). Health equity and health system strengthening – Time for a WHO re-think [20] 1) To provide a critical reading of key policy documents and secondary literature to trace the conceptual and normative development of health equity as a guiding principle of WHO; 2) To highlight the limitations in the current conceptualization of equity in the framework of health system strengthening at the WHO. The concept and practice of health equity An overview without a defined methodology The authors argue for the importance of re-considering what health equity implies in the context of health systems strengthening (HSS). Tracing the conception of equity at key periods in WHO’s history, they cautioned against increasingly unidimensional conceptions of equity; as being a problem of either unequal access to specific healthcare services, or the differential health impacts of specific health interventions. They argue that a HSS agenda that focuses predominantly on improving health service delivery falls short of considering the structural political, social and economic dimensions that drive and sustain ill health and health inequities worldwide. The authors point to potential avenues of interrogation: 1.The need to replace simplistic standardised frameworks to measure equity with broadened frameworks that identify intersecting forms of social disadvantage in particular contexts. 2. A first step in rethinking equity could involve addressing the equity questions that arise in relation to health workers in the context of HSS. 3. The need to re-focus attention onto the imbalances in resources and power and forms of oppression that undergird health inequities – and shape the global health field itself. Sumah, Baatiema and Abimbola (2016) The impacts of decentralisation on health-related equity: A systematic review of the evidence [22] To review the implications of decentralised governance of health care on equity in health, health care and health financing Equity in health and healthcare A systematic search of reviews that examined entire health systems and the relationship between implementing decentralised governance and health-related equity. The quality of reporting of the included studies was assessed. Only 9 papers (out of 808) met the inclusion criteria. The included studies were mostly explorative and used a range of quantitative techniques to analyse the relationship between variables of interest. The impact of decentralisation on inequities in health and health care depends on pre-existing socio-economic disparities and financial barriers to access. While decentralisation can lead to inequities in health financing between sub-national jurisdictions, this is minimised with substantial central government transfers and cross subsidisation. The effect of decentralisation on health-related equity can be best characterised as mixed. The need for central coordination in decentralised health systems is paramount to define health system goals and outline the broad framework for their achievement when designing policy interventions. Equally important is the need for mechanisms to redistribute income to assuage disparity in financing health care between regions. Further research should look at comparative country study of decentralised and centralised national health systems. Burström et al (2017). Equity aspects of the Primary Health Care Choice Reform in Sweden -- a scoping review. [23] To review the existing evidence of the impact of a recent Primary Health Care (PHC) Choice Reform on health equity, and to Identify the gaps in the current literature. PHC policy reform A scoping review to evaluate the equity aspects of the PHC reform in Sweden, The studies to date indicate that the PHC Choice Reform, as implemented, increased access to PHC and increased the average number of visits to PHC, but seems to have particularly benefited those in more affluent groups and with lower health care needs. The PHC Choice Reform has made integrated care for those with complex needs more difficult. The PHC Choice Reform may have damaged equity of primary health care provision, contrary to the tenets of the Swedish Health and Medical Service Act. This situation needs to be carefully monitored. Further studies are needed to follow up on the long-term impacts of the reform on the structure, process, and outcomes of PHC in Sweden and how different types of reimbursement systems may modulate these impacts. Spitzer-Shohat and Chin (2019) The “Waze” of Inequity Reduction Frameworks for Organizations: a Scoping Review [25] To identify existing frameworks focused on reducing inequities in patient care and outcomes; To assess to what extent the frameworks address key organizational change elements. Tools for organizations to become more equitable A scoping review to evaluate the implementation of frameworks that guide organizations to make care and outcomes more equitable for patients. The analyses were conducted on context, processes, outcomes and time, that is, the four constructs of organizational change. 14 frameworks and models were analyzed, all of them from rich countries. They were developed by governments, healthcare associations, not-for-profit associations, and academia. Most frameworks did not guide the translation of equity across multiple organizational departments and levels. Existing equity intervention frameworks often lack specific guidance for implementing organizational change. Most frameworks primarily focused on the organization’s outer context through the analysis of data on race and ethnicity. Two frameworks recognize the importance of existing culture: the CLAS (Culturally and Linguistically Appropriate Services Standards), and the Disparity Leadership Program. Most frameworks address the implementation process at the macro level, but the Roadmap to Reduce Disparities model offers change directives not only on the macro level, but also the meso and micro levels. Regarding outcomes, the Achieving Health Equity framework suggests measuring performance for individual socio demographic attributes. The measurements are combined into a summary index, which is then compared with the best health level among all groups as reference. Providing organizations clear, effective, and concrete guidance has great potential from improving health equity. Frameworks should include guidelines on assessment of inner organization context parameters such as readiness for change. Organizations also require specific guidance on how to implement equity within and across all organizational levels. Guidance for institutionalization and sustainability are crucial. Future frameworks should assess the inner organizational context to guide the translation of programs across different organizational departments and levels and provide specific guidelines on institutionalization and sustainability of interventions. 2. Information and evidence data Authors and title Objectives Theme/ focus Methods Findings Recommendations by authors 60. Hirsch Stevenson & Givens (2023) Evidence clearinghouses as tools to advance health equity: What we know from a systematic scan [26] To explore how clearinghouses communicated an intervention’s health equity impact and to review their health equity definition and underlying methods. Informing on health equity impact A systematic scan, a comprehensive directory of clearinghouses and a comparative analysis of clearinghouses with publicly available health equity impact reviews on their websites. The authors identified 18 clearinghouses that were USA-focused, web-based registries of interventions that assigned an effectiveness rating for improving community health and the social determinants of health. Only 7 clearinghouses summarized an intervention’s potential impact on health equity. However, they defined and operationalized equity differently, and most lacked transparency in their review methods. One or more approaches were used to communicate the findings: summarize study findings on differential impact for subpopulations, curate interventions that reduce health disparities, and/or assign a disparity/equity rating to each intervention. Advancing equity through an evidence- informed approach will require researchers to conduct more equity-focused research and clearinghouses to evolve as practice-oriented tools with health equity impact reviews based on clear and transparent underlying definitions, values and methods 62. Hollands et al (2024) Methods used to conceptualize dimensions of health equity impacts of public health interventions in systematic reviews [27] 1)To identify and summarize methods, frameworks, and tools used as a conceptual basis for investigating dimensions of equity impact of public health interventions; 2) To document challenges and opportunities encountered in the application of such methods, as reported in the systematic reviews. Assessment of health equity impacts An overview of systematic reviews with a focus on the equity impacts of public health interventions. Electronic searches of the Cochrane Database of Systematic Reviews, the Database of Promoting Health Effectiveness Reviews (DoPHER), the Finding Accessible Inequalities Research in Public Health Database, and the automated searches of the Open Alex dataset. The majority of reviews originated from European countries, especially the UK. 37.5% used PROGRESS-Plus. Some reviews adapted PROGRESS-Plus with additional dimensions linked to equity. Planned methods for conceptualizing equity impacts were fully applied in less than half of the reviews. The primary reasons for the incomplete application were the lack of necessary information in primary studies, a lack of included studies, inadequate study quality, and low heterogeneity by key dimensions. Measurement issues related to dimensions of equity impact were a notable problem, the primary concern being the difficulty of investigating constructs that lack standardized definitions, operationalization, and ultimately measurement, particularly for socioeconomic status and closely related concepts. Primary studies need to collect and report equity-related data consistently. Support from research funders, regulators, and scientific journals is necessary. Standardized guidelines and practical guidance are needed to operationalize and analyze equity dimensions consistently. Broader conceptual frameworks, such as socioecological models, may better capture complex and intersecting pathways of inequities. More explicitly rationalized and considered approaches to the design, conduct, and reporting of primary research and systematic reviews are necessary to address these challenges. 64.Hosseinpoor et al (2023) Strengthening and expanding health inequality monitoring for the advancement of health equity: a review of WHO resources and contributions [28] To review WHO’s work on health inequality monitoring, and to demonstrate how this multi- faceted strategy and associated resources can accelerate health inequality monitoring practices among Member States and raise the profile of global evidence on health inequalities. Health inequality monitoring A review of various strategies, resources, and tools developed by WHO including the overview of the 2022-2027 Inequality Monitoring and Analysis Strategy, specific goals, activities, and resources: manuals, workbooks, eLearning courses, workshops, and software applications like the Health Equity Assessment Toolkit (HEAT). The Inequality Monitoring and Analysis Strategy has 3 goals: strengthening the capacity for health inequality monitoring; generating and disseminating high-quality evidence on health inequality; and developing and refining health inequality monitoring methods, tools, resources, and best practices Guiding material for health inequality monitoring includes manuals and accompanying workbooks, the Health Inequality Monitoring eLearning channel, and capacity building workshops. HEAT and HEAT Plus is a free and open-source software application that facilitates the assessment of within-country health Inequalities using disaggregated data. The Health Inequality Data Repository is the largest collection of publicly available disaggregated data about health and its determinants. To use the evidence generated from health inequality monitoring to inform and guide policy changes and program improvements. To utilize WHO resources and tools to improve data collection, analysis, and reporting. To use WHO’s eLearning courses and workshops for continuous learning and capacity building. To encourage the integration of health inequality monitoring into routine health information systems and research initiatives. 114.Pearson et al (2023) Climate Change and Health Equity: A Research Agenda for Psychological Science [33] To examine the role of climate change as a unique source and magnifier of health inequities, and consider mediating psychological processes that may fuel and magnify health inequities Consider the infrastructure needed to speed the development and adoption of science and community-informed solutions, including perspectives of communities. Climate change and health inequities Overview without a defined methodology. The authors extend on two existing frameworks (social vulnerability, and direct and indirect effects of climate change on health and well-being) to Globally, small island nations and indigenous communities are among the most affected by climate change. At the same time, these communities play a central role in managing earth’s ecosystem Inequities can stem from both adaptation and mitigation policies that are designed without considering or including vulnerable groups. Three systemic factors shape climate health equity: structural racism, segregation and displacement. Misperception of climate health risk and social vulnerability is an additional factor. The intersection of climate change and health inequities presents new challenges and opportunities for health intervention that will require new research infrastructure, collaborations, and training initiatives. Climate interventions that address existing inequities may be more effective in mitigating climate change than those that fail to take health inequities into account. Highlighting cobenefits of climate measures that improve health outcomes and reduce inequities can help secure public support for climate action. A “whole-of-science” approach is needed to address climate-related health inequities. 25.Cené et al (2023) Racial health equity and social needs interventions a review of a scoping review [30] To understand how studies of interventions addressing social needs among multiracial or multiethnic populations conceptualize and analyze differential intervention outcomes by race or ethnicity Social needs interventions A rapid review, with specific methodological adjustments: reliance on existing searches for the evidence map; no second review of the risk of bias; single reviewer recheck of data for subgroup or effect modification analyses; focused data extraction outcomes; no strength of evidence grading; and a primarily narrative or qualitative synthesis. The focus was on studies in multiracial or multiethnic populations to examine differential intervention outcomes by race or ethnicity. The review developed and applied a simple framework of conceptual thoughtfulness and analytical informativeness to understand how social needs interventions may advance racial health equity. Among 152 studies, 44 (28%) included race or ethnicity in their analyses. Only 9% of the 44 studies were considered conceptually thoughtful, explaining race as a proxy for exposure to racism. Few studies (21 [14%]) conducted race or ethnicity–stratified analyses that were considered analytically informative for advancing health equity research, with 14 reporting no differences. Of the 7 that did report differences, 3 had mixed outcomes and 4 found interventions benefited minoritized populations more and provided conceptually thoughtful explanations for race as a proxy for root causes of racial health inequities. Nearly 9 in 10 (86%) of the 152 studies in multiracial or multiethnic populations did not examine whether intervention effects differed by race or ethnicity. Continued education on the need to provide theory-driven conceptualizations of race and ethnicity, the risks of not doing so, and standard guidance on where such descriptions should be provided. Adoption of the authors’ innovative two-concept framework for assessing a study’s contribution to racial health equity (conceptually thoughtful, analytically informative). The proposed framework should be Incorporated into standards for systematic reviews on health equity. Journals should revise instructions to emphasize handling race and racism from conceptualization through data analyses and interpretation. 48. Garrett et al (2023) Antibias efforts in United States maternity care: A scoping review of the publicly-funded health equity intervention pipeline [31] To investigate whether recent national public funding reflects the heightened priority of the increase in public and governmental support for antibias and antiracism interventions; to identify and characterize publicly funded interventions designed to reduce bias, racism, and discrimination among maternal healthcare providers in the United States. Reducing bias and racism in maternal healthcare A community-guided rapid scoping review to characterize new antibias research. The search for publicly funded grants was conducted in the Dimensions database, a comprehensive registry of federal, public/private, and large philanthropic grantees. Only four of 508 projects met the search criteria, featuring an intervention to reduce bias or racism in maternal healthcare providers. One of the projects proposes a “racial equity training” for perinatal care clinicians to benefit Black women receiving prenatal care. A second project proposes to deliver antiracism training to medical providers to reduce Black and African American patients’ experiences of racism or mistreatment and promote respectful maternity care. A third project proposes a five-year, multilevel intervention co-developed with community partners to reduce the rate of maternal morbidity and mortality among Medicaid-insured African American women by intervening at various levels, including antibias training at the provider/ practice level for physicians, midwives, hospital administrators, and front desk staff. The fourth project implements an “interactive racial equity training” designed to help prenatal clinic staff to recognize their implicit biases and understand how racism affects pregnancy care for patients of color. The reviewed projects employ promising and innovative components such as community-based participatory research, but there is little material in support of intervening on racial bias. Several gaps were identified, e.g., how best to develop and implement bias training, and what is their impact on patient outcomes. Philanthropically funded and community-grounded work will be important to help bridge this knowledge gap. Large funders should support iterative national reviews of emergent research and convene multiple sectors—including policymakers, payers, providers, community members, and patients—to align interventions and policies with new evidence while centering on the needs of Black women, birthing people, and others harmed by bias and racism in the healthcare system. 124.Ramanadhan et al (2023) Using participatory implementation science to advance health equity [29] To provide guidance on the principles and practice of participatory implementation science (IS); to introduce readers to the value of participatory approaches for strengthening sustainable implementation of health-related evidence-based interventions; to provide a framework for applying the principles, practices, and lessons from participatory research to IS; and to outline challenges and considerations for optimizing the potential of participatory IS. Participatory approach to implementation science Detailed objectives but no methodology Traditional IS often lacks a focus on health inequities and typically uses a top-down approach, whereas participatory IS emphasizes iterative co-creation of knowledge and action, integrating diverse perspectives, including those from lived experiences. The participatory approach enables researchers, community members, and other relevant actors to work together, generate knowledge and drive change. It also decentralizes dominant perspectives to address health inequities and explicitly engages with issues of power and representation to facilitate the meaningful participation of marginalized groups in creating transformational knowledge and change. It focuses on relevant evidence, deeper understanding of local contexts, and building capacity and solutions for health issues. Additionally, it values the research process and aims to advance justice, inclusion, and equity. Participatory IS moves beyond making EBIs work, deploying implementation efforts to reshape systems and intervention contexts in ways that center equity. However, participatory IS requires time and resources, and engagement. To optimize participatory Implementation Science (IS): Assessing team readiness and engaging in critical reflexivity considering how team members' roles and social positions impact research—is crucial; Navigating tensions between world views within teams to prevent frictions and misunderstandings; Aligning projects with broader perspectives; And developing measures to advance the evidence base for participatory IS. 3. Technologies and Tools Authors and title Objectives Theme/ focus Methods Findings Recommendations by authors 130.Rojas‑ Rueda, McAuliffe and Morales-Zamora (2024) Addressing Health Equity in the Context of Carbon Capture, Utilization, and Sequestration Technologies [41] To describe the role of health equity in the context of carbon capture, utilization, and sequestration (CCUS) technologies. Specifically, to identify recent finding related to the implementation of CCUS technologies and their impacts on social determinants of health and discuss the challenges and opportunities related to health equity. Climate change technologies Literature review and reports on CCUS technologies. No defined methodology CCUS technologies have the potential to both improve and worsen health equity. They could help reduce greenhouse gas emissions, a major contributor to climate change, but they could also have negative health impacts like air and noise pollution. Efforts to reduce carbon emissions should prioritize the needs and perspectives of the most vulnerable populations and ensure that the benefits and burdens of carbon reduction policies not only are distributed equitably but also contribute to restoring relationships with and opportunities for historically marginalized groups. The effective deployment of CCUS technologies requires a critical assessment of their potential impacts on public health and environmental equity. Decision-makers must confirm aggressive climate mitigation policies are already in place before considering CCUS as part of a comprehensive emission reduction strategy. Rabet R et al (2024) Barriers and facilitators to digital primary health care access in immigrant and refugee populations: a scoping review [34] To identify: 1) The barriers and facilitators for access to digital primary health care among immigrants and refugees 2) The primary health care needs addressed through digital modalities Primary health care access through digital health technology Scoping review of qualitative studies in high and in low or middle-income countries. Levesque’s model [71] was used to examine approachability, acceptability, availability/accommodation, affordability and appropriateness. 25 papers were included. The flexibility of digital modalities was a facilitator, but older age or limited digital literacy skills were barriers. Social networks (family, community) were important to support this access. Immigration systems play a role by affecting living conditions and financial means of these groups. Privacy and data security are major concerns and can be important barriers for these groups Social assistance programs and affordable housing schemes can provide refugees and immigrants with safe living arrangements, income support and digital technologies. Providing digital literacy programs and use of cheaper and accessible forms of technology such as text messaging and audio-calling are also recommended. Research should explore how the personal data of those with precarious status are managed and develop guiding principles for digital health applications among these groups. 24. Cary et al (2023) Mitigating racial and ethnic bias and advancing health equity in clinical algorithms: a scoping review [42] To review health care applications, frameworks, reviews and perspectives, and assessment tools that identify and mitigate bias in clinical algorithms, with a specific focus on racial and ethnic bias. Discrimination and bias Comprehensive, multidisciplinary scoping review of tools, frameworks, reviews and perspectives on bias mitigating strategies 109 studies were included; reviews and perspectives were the most frequent type. Several mitigation strategies were identified. The technical strategies pertained to various stages of the algorithm development process. The operational strategies included governance, design principles and the engagement of multidisciplinary teams. System-wide strategies included training and education on risk of bias, collaborative platforms, and development of standards. No consensus on a single best practice was found. To ensure professional diversity; To require auditable clinical algorithms; To foster transparent organizational culture; To implement health equity by design; To accelerate research; To establish governance structures; and to amplify patients’ voices. Future research should identify optimal bias mitigation methods for various scenarios, depending on factors such as patient population, clinical setting, algorithm design, and types of bias to be addressed. 45. Fisher et al (2023) Occupational safety and health equity impacts of artificial intelligence: a scoping review [44] To summarize the recent literature on the way in which Artificial Intelligence (AI) can reduce or exacerbate inequities in occupational safety and health (OSH). Artificial intelligence Scoping review adapting PRISMA and designed around three concepts: artificial intelligence, occupational safety and health (OSH), and health equity. Research questions were: How can AI be used to promote OSH equity? How does Ai present barriers and challenges to OSH equity? What are best practices to address emerging OSH equity challenges related to AI? 112 papers included. Certain communities take on a higher burden of dangerous work and traumatic injuries (in construction, transportation, mining). By reducing exposure to hazardous conditions in these industries, AI has the potential to reduce occupational health inequities for workers from these communities. Algorithmic integrity in the form of proper systems to curb the mishandling and misuse of received data is necessary in order to reduce bias. The digital divide mainly affects individuals from low-resourced communities. Increases in depression, suicide, and alcohol and drug abuse, including opioid-related death, may occur, exacerbating health inequities An ethical code or framework for justice in AI development and implementation was frequently recommended in the literature, and would facilitate OSH equity. AI’s role in OSH equity is vastly understudied. An urgent need exists for multidisciplinary research that addresses where and how AI is being adopted and evaluated and how its use is affecting OSH across industries, wage categories, and sociodemographic groups. OSH professionals can play a significant role in identifying strategies that ensure the benefits of AI in promoting workforce health and wellbeing are equitably distributed. 116. Petretto et al (2024) Telemedicine, e-health, and digital health equity: a scoping review [35] The research questions were: How did previous papers: 1) define and describe digital health equity (DHE) in telemedicine and e-health 2) describe barriers and risk factors in the promotion of DHE in those e-environments; 3) describe the advantages of the use of telemedicine and e-health for the promotion of DHE; and 4) describe ways to improve equity in e-health and telemedicine Digital health A scoping review using the PRISMA-ScR guidelines 31 papers were included: editorials, commentaries, viewpoints and only a few research papers. An interesting one is the distinction of 3 levels of digital divide: lack of access, lack of skills, and lack of possibility to use the tools for one’s health. The digital divide or disadvantage is the consequence of the interaction between any person and an environment that is “not sufficiently equipped to promote health equity”. The role of telemedicine and e-health in reducing the gap in access to health services is widely recognized. The digital and the social determinants of health interact to increase or reduce digital health equity. It is useful to list the reasons/variables that can facilitate the occurrence of the condition of disadvantage. There is a need to have an overall and integrated picture of all these variables, a multilevel complex model of “telemedicine and e-health ecosystem”. Government, scientific societies, stakeholders, and health policymakers may have a central role in planning and implementing specific interventions to promote digital health equity, providing system-level changes according to the chosen multilevel complex model. 136. Sharrief et al (2023) Telehealth trials to address health equity in stroke survivors [36] To review the telehealth advantages and barriers for the chronic care of stroke survivors and to discuss strategies to address barriers to telehealth use in stroke patients with adverse social determinants of health Telehealth (or tele-medicine) for stroke care Review without description of the methods Telestroke has increased access to acute stroke care for populations at risk for poor outcomes. However, the use of telehealth applications for expanding access to other aspects of stroke patient care and for reducing disparities in stroke outcomes has been under-studied. Telehealth for the ambulatory care of various chronic diseases (heart failure, diabetes, Parkinson’s disease, neurological diseases) was usually found to be as effective as in-person care. However, the results of telehealth care on health inequities among groups at higher outcome risk has not been studied. Telehealth for transitional and chronic care of stroke survivors with a higher proportion of adverse social determinants of health (economic instability, low educational attainment, low health literacy, and low levels of social support) may help to address access- related issues and therefore holds promise for addressing disparities in stroke outcomes. However, the need for a patient to access care via telehealth requires digital literacy, consistent telephone and internet access, and increasingly, the ability and willingness to engage with the electronic medical record through patient portals. There are also health system barriers, such as billing restrictions. it is essential that systems be built with health equity in mind. 151. Vakkalenka et al (2024) Telehealth Use and Health Equity for Mental Health and Substance Use Disorder During the COVID-19 Pandemic: A Systematic Review [38] To evaluate health equality in clinical effectiveness and utilization measures associated with telehealth for clinical management of mental health disorders and substance use disorders and to identify under-represented groups. Digital health for mental disease and drug abuse Systematic review using relevant elements of PRISMA guidelines. Studies on tobacco cessation only or neurocognitive conditions (e.g., dementia, Alzheimer’s disease, autism) were excluded. Overall, the most common dimensions captured included race/ethnicity or gender. Risk of bias was also assessed. 25 studies were included, 20 of which on mental health. All 25 evaluated synchronous, direct-to-consumer video telehealth. These conditions in themselves reflect underserved and marginalized populations. Most studies identified that telehealth implementation suffered from significant and widening disparities for disadvantaged populations, including rural populations, older patients, and racial/ethnic minorities. If the technological vehicle used to address inequities further propagates a digital divide, policymakers should examine individual-, innovation-, and system-level implementation processes and policies that promote or hinder equity in adoption, utilization, and clinical effectiveness. Future efforts should focus on measuring the contribution of utilization disparities on outcomes and strategies to mitigate disparities in implementation. Campanozzi et al (2023) The role of digital literacy in achieving health equity in the third millennium society: a literature review [40] To assess the extent of the impact of digital literacy on access to telemedicine services Access to digital health services Review, with the search covering 2011-2022. Databases for the gray literature were omitted 37 articles were included. The importance of digital literacy for the equitable distribution of health services in the third millennium is recognized. Ensuring equity of access to digital health must be a priority felt by the various stakeholders. It is essential to develop screening tools that can accurately identify the population groups in need of digital literacy interventions. It is not only important to implement digital education programs that can bridge as much of the “digital divide” as possible, but it is equally important to plan for evaluation studies of the effectiveness of such programs in the immediate future. Hynie et al (2023) Access to virtual mental healthcare and support for refugee and immigrant groups: a scoping review [39] To explore the potential of increased access through virtual mental healthcare services (VMHS) for these populations using the patient-centred model of Levesque [71] Access to virtual mental health care A scoping review from November 2020 through October 2021. The authors investigated the accessibility (affordability, availability/accommodation, appropriateness, and acceptability) of virtual mental health services for immigrants, refugees, and asylum seekers. 2561 abstracts were reviewed, and 40 unique interventions identified. Studies include cultural adaptations, feasibility/pilot studies, usability studies, and formative evaluations. Nature of Interventions: primarily mental health interventions, diagnostic assessment studies, screening tools, and user-testing of interventions. Delivery modalities were web/mobile apps primarily, video calls, phone interventions, tablet-based, and text-based. Accessibility depended on individual (e.g., literacy), program (e.g., computer required) and contextual/ social factors (e.g., housing characteristics, internet bandwidth). Participation often required financial and technical support, raising important questions about the generalizability and sustainability of VMHS’ accessibility for immigrant and refugee populations. The importance of more implementation research was highlighted. Unique barriers determined by systemic, contextual, clinical and personal characteristics for immigrant and refugee populations were identified. Such obstacles warrant further attention. It is proposed that working with the intended user population on the planning and delivery of virtual mental health services will help increase accessibility for these populations, both now and in the future. Bakken et al (2019). Behavioral interventions using consumer information technology as tools to advance health equity [37] To demonstrate the use of mHealth, telehealth, and social media as behavioral intervention platforms in health disparity populations, to identify challenges to achieving their use, to describe strategies for overcoming the challenges, and to recommend future directions. Consumer information technology (CIT) for behaviour change Literature and case examples are summarized. A substantial number of systematic reviews and meta-analysis assessed the quality of intervention studies and the evidence across studies was synthesized, particularly randomized controlled trials, to advance CIT-enabled interventions. The examples presented suggest that mHealth, telehealth, and social-media-enabled behavioral interventions, particularly the multicomponent interventions, show promise and in some instances influence health outcomes of interest in health disparity populations. The challenges in the design, implementation and evaluation of CIT-enabled behavioral interventions with health disparity populations are described. Future directions include improved design methods, enhanced research reporting. advancement of multilevel interventions, rigorous evaluation, efforts to address privacy concerns, and inclusive design and implementation decisions, and to advance multilevel interventions by linking mHealth and social media-enabled interventions with healthcare delivery system. Also, to evaluate mHealth, telehealth, and social media-based interventions throughout the stages of developing and implementing the CIT-enabled intervention. Furthermore, to make design and implementation decisions that foster the inclusion and sustained engagement of health disparity populations in CIT-enabled intervention studies, and to address user privacy concerns. Siddique et al (2024) The Impact of health care algorithms on racial and ethnic disparities: a systematic review [43] To examine: 1) The evidence on whether and how healthcare algorithms (aggravate, perpetuate, or reduce racial and ethnic disparities in access to healthcare, quality of care, and health outcomes; and 2) Strategies that mitigate racial and ethnic bias in the development and use of algorithms Impact of healthcare algorithms on racial and ethnic disparities in health Systematic review using predefined criteria to assess one or both key questions: the effect of algorithms on racial and ethnic disparities in healthcare and outcomes, and the effect of strategies or approaches to mitigate racial and ethnic bias in the development validation, dissemination, and implementation of algorithms. The review includes 63 studies in the USA, out of which 49 pertain to mitigating strategies. The most common algorithms evaluated kidney function and cardiovascular risk. Strategies involved removing, adding, or changing variables. The algorithms can affect racial and ethnic disparities in health care (and outcomes) even if race and ethnicity are explicit inputs. Evidence suggesting that algorithms may reduce disparities, perpetuate or exacerbate them, or not affect them was found. Most studies reported that mitigation strategies reduced racial and ethnic disparities in care. However, there were wide variations in the populations and diseases considered. Investing in further research to assess the real-world effect of algorithms on racial and ethnic disparities before widespread implementation is recommended. 4. Human resources Authors and title Objectives Theme/ focus Methods Findings Recommendations by authors 2. Adams et al. (2023) Integrating nurse practitioners into primary healthcare to advance health equity through a social justice lens: An integrative review [45] To develop a framework to guide the successful integration of nurse practitioners (NPs) into practice settings and, working from a social justice lens, deliver comprehensive primary healthcare which advances health equity Workforce issues: integrating nurse practitioners (NPs) into primary healthcare (PHC) An integrative review, a method that allows for the combination of diverse review methodologies. PRISMA guidelines were also followed. Data were extracted and thematically analysed using NVivo. 28 articles were included. Six themes were identified at the individual (micro), local health provider (meso), and national systems and structures (macro) levels of the health sector: (1) autonomy and agency; (2) awareness and visibility; (3) shared vision; (4) leadership; (5) funding and infrastructure; and (6) intentional support and self-care Based on this the authors developed a framework to guide the integration of NPs into PHC. The proposed framework based on the review and the six identified themes is to support the integration of NPs into PHC settings where they can optimize their scope of practice and deliver healthcare services that improve healthcare access and health outcomes to achieve equity. The framework should be tested in practice in a range of settings and adapted to meet the local context, community needs and the NP workforce capabilities. Working with communities and co-designing health service delivery with other health and social agencies is critical if local community health needs are to be met and disparities eliminated. 52. Graefe et al (2024) Advancing health equity in prelicensure nursing curricula: findings from a critical review [46] To determine the extent to which health equity concepts are explicitly present in prelicensure undergraduate nursing curricula globally. Workforce related issues: training of nurses Critical review. Health equity content was categorized based on the Commission on Social Determinants of Health (CSDH) framework categories 20 unique studies were included and reviewed. Frequency and quantity of health equity content, concepts and topics, teaching strategies, evaluation strategies, and the overall extent of integration varied widely. Only two papers described overall well‐integrated explicit health equity content, and there was little attention to whether students transferred this learning into practice. A focus on individualism rather than population and community was noted. The findings suggest there is a gap (and need of) health equity content throughout the nursing curriculum. The authors argue that such an intervention could help nursing students understand the root causes of health outcomes beyond the individual and intermediary levels and prepare nurses to enter practice with a critical awareness of social and systemic health barriers (e.g., whiteness) and facilitators (e.g., community strength and healing) that influence health and illness. Additional content related to governance and policy, history and historic context, and cultural and social values is needed. Nursing faculty and program directors should critically review their curriculum, courses, assignments, and clinical placements to identify strengths and opportunities for improvement. Chandler et al (2022) Training public health students in racial justice and health equity: a systematic review [48] To identify approaches, programs, pedagogical methods, and curricula that exist to support the training of US public health students in understanding racism as structural determinant of health. The purpose is to address racial disparities in healthcare settings and practice Racism as a determinant of health A systematic review of peer-reviewed literature following the Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only 11 examples of peer-reviewed articles were found on curricula, lessons and competencies developed to better understand racism as a structural determinant of health. Programs included workshop or seminars, and went from 90-minute workshops to semester-long courses. Materials and resources included in-person presentations, music, artistic material, YouTube videos, a local museum, documentaries, television shows, and toolkits. Six out of the eleven programs included some form of evaluation. However, existing peer-reviewed literature provides little pedagogical guidance to inform schools on how to teach about racism and health equity. There is little consensus on how best to teach about racism. More research on public health pedagogy on structural racism is needed. Schools and programs of public health must explain the social, political, and economic determinants of health and how they contribute to population health and health inequities. The article suggests more systematic and rigorous approaches to public health pedagogy, including through the development of competency-based models and learning communities on evidence-based education. More research is needed to document how to educate public health students on the health issues such as racial disparities they will address in their practice. Ahmed et al (2022) Community health workers and health equity in low- and middle-income countries: systematic review and recommend-ations for policy and practice [47] To synthesize research findings on: Effectiveness of community health workers (CHWs) interventions at reaching more disadvantaged groups in low- and middle-income countries (LMICs); Evidence on whether and how these programs reduce health inequities Workforce: CHW-led programs The “equity stratifiers” of the PROGRESS framework, such as race, gender, religion, social capital, etc., are used to assess the impact of CHWs’ interventions on inequities. 167 studies were included, carried out in 33 LMICs; 72 were qualitative. Only eight studies were high-quality randomized trials. The results suggest that CHW programmes achieved greater equitability in service delivery than outcomes. Regarding service delivery, pro-equity findings outnumbered anti-equity findings across several stratifiers, but some marginalized groups are still being excluded. Pro-equity outcomes outnumbered the anti-equity ones only for gender and occupation; equitable service delivery did not always translate into improved outcomes. CHW programs may also influence health equity through CHW advocacy, investment of their personal resources, or hiring of CHWs in disadvantaged groups. However, they often have poor working conditions To reduce inequities of access to health services, several recommendations are made according to major equity stratifiers, such as: -Place of residence: transportation for CHWs and patients; -Socio-economic status: food parcels as part of CHWs services and financial incentives for those most in need; -Gender: division of tasks between male and female CHW; -Education: the use of illustrated informative material to serve low-education people; -Minority race or ethnic groups: recruiting CHWs within the minority group; -Social capital: CHWs accompanying the patient to the health facility or writing a referral slip; -Occupation: adjusting CHW schedule to fit with those of working patients. It is important to also consider intersectionality in (for instance, gender intersecting with poverty and rural remoteness), Curtis et al (2019) Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition [49] Redefining cultural safety to achieve health equity Social determinants of health (violent colonial history and current racism) and health systems A literature review of 59 international articles on the definition of cultural competency and cultural safety published between 1989 and 2018. This review and analysis were conducted from an Indigenous research position that draws from Kaupapa Māori theoretical and research approaches Equitable care is further compromised by the paradox of well-intentioned physicians providing inequitable care: poor communication, a lack of partnership via participatory or shared decision-making, a lack of respect, familiarity or affiliation and an overall lack of trust. Cultural safety requires health providers to question their own biases, attitudes, assumptions, stereotypes and prejudices that may be contributing to a lower quality of healthcare for some patients. Health practitioners, healthcare organisations and health systems need to be engaged in working towards cultural safety as defined by patients and communities, and critical consciousness rather than narrow cultural competency. The objective of cultural safety activities also needs to be clearly linked to achieving health equity. Cultural safety activities should extend beyond formal training curricula or acquiring knowledge about other cultures. The framing of cultural safety requires a focus on power relationships and inequities within healthcare interactions. 5. Service delivery Authors and title Objectives Theme/ focus Methods Findings Recommendations by authors 83. Lopez et al (2023) Achieving health equity in the care of patients with heart failure [50] To discuss the prevailing racial and ethnic disparities in heart failure (HF) care by identifying barriers to equitable care and proposing solutions for achieving equitable outcomes Service delivery, heart failure The review method is not described. From prevention to advanced interventions, current efforts are described and recommendation made for improvement. Racial and ethnic disparities prevail throughout the entire spectrum of HF care, from prevention to implementation of guideline-directed medical therapy and advanced interventions. Factors such as differential distribution of risk factors, poor access to care, inadequate representation in clinical trials, and discrimination from healthcare clinicians, among others, contribute to these disparities. This review emphasizes the importance of a multifaceted approach involving policy changes, quality improvement strategies, targeted interventions, and intentional community engagement. The authors proposed a framework integrating equity into routine quality improvement efforts, tailoring interventions to specific populations, and advocating for policy transformation. 84. Lopez et al (2024) Health equity and policy considerations for pediatric and adult congenital heart disease care among minoritized populations in the United States [51] To review the existing disparities among marginalized or racially minoritized populations with congenital heart disease in the USA and to propose solutions; To critically examine multilevel factors and health policies that continue to drive health inequities, including varying social determinants of health (SDOH), systemic inequities, and structural racism. Service delivery, heart failure The precise methodology for this comprehensive review is not described. After documenting the causes of disparities throughout the lifespan of minoritized populations with congenital heart disease in the USA, potential solutions for the various minoritized populations taken separately are exposed. The review addresses system-level health policies that impact on reimbursement and research funding, as well as institutional policies that impact leadership diversity and representation in the workforce This review describes the challenges facing various population groups with congenital heart disease: Native, Black, Latino, LGBTQ and persons with disabilities. Disparities begin as early as prenatal care, with lower prenatal screening rates and poorer health outcomes among minoritized groups. Insurance status and maternal education play significant roles in these disparities. Disinvestment in marginalized communities leads to poorer education, income, and healthcare access, contributing to higher mortality rates and persistent health disparities in CHD populations. Conditions of reimbursement, including lower reimbursement rates for pediatric care exacerbate disparities. Minoritized groups are underrepresented in medicine, particularly in pediatric cardiology, impacting patient care and health outcomes A wealth of solutions are proposed at the system and institutional level. Only those at system level are mentioned here. Solutions for American Indian/Alaska native (AI/AN) populations include: a policy to encourage Indigenous sovereignty, preserving culture, language, and community, and supporting the funding and structure of programs, including home visitation programs. Potential solutions for non-Hispanic Black populations include: improved neighborhood conditions, food assistance programs, and improved health literacy. Solutions for Hispanic/Latino populations are to expand Medicaid for children and provide translation services. For other groups: prohibit discrimination in health insurance and integrate LGBTQ health content into medical curricula and ensure healthcare accessibility and support insurance coverage for persons with disabilities. 96. McNeill et al (2023) Uses of social determinants of health data to address cardiovascular disease and health equity: a scoping review [53] To explore what and how social determinants of health data are being used to address cardiovascular disease and improve health equity; To identify gaps in evidence by focusing on the ways in which SDOH data have been applied to improve CVD outcomes, largely in the United States but also in other high-income countries. Social determinants of health A scoping review including studies published between 2014 and 2022, involving adult populations, and containing data related to SDOH and outcomes related to CVD. The review included 50 articles and examined three broad domains of data, social determinants of health, and CVD. Practicing clinicians have called for the use of big data on SDOH to address CVD and health equity. The most common SDOH domain among the studies were healthcare access and quality, followed by the neighborhood and built environment. Few studies focused on economic stability, social and community context, or education access and quality. SDOH data have been used to understand the relationship between the built environment and CVD outcomes in 27 studies. The data were used to describe the prevalence or incidence of CVD risk factors and outcomes, and to create climate vulnerability maps. Other uses of the data were to evaluate social risk scores, and for the development of interventions, including to develop digital health applications for patient self-management and health literacy. Healthcare providers, policymakers, and researchers should consider integrating multiple SDOH domains to develop interventions and improve CVD outcomes, including economic stability and social and community context, as well as the neighborhood and built environment, and education access and quality. More research is needed to measure and examine the role racism plays as a driver of cardiovascular health inequities. Combining a wide array of data sources, including non-health sector data, could provide a more comprehensive understanding of SDOH and CVD outcomes and help limit bias. 85. Lopez-Suarez et al (2023) A toolkit of health equity strategies in research, clinical care, education and innovation for radiologists [59] To provide a practical approach to advancing equity through evidence-based strategies in the four pillars (research, clinical care, education, innovation) Service delivery - radiology For each of the four pillars, an overview of existing barriers and gaps, and of current best practices, are presented with examples, based on the literature In research, there are under-represented communities such as rural and native populations. Regarding clinical care, disparities in access result from a variety of factors including medical mistrust, varying familiarity with healthcare systems, implicit bias by practitioners or patients, and race-based algorithms. Medical students with increased education on the social determinants of health are more confident when working with underserved populations. Regarding innovations, there is increasing use of AI in radiology but there are potential biases because of incomplete data Efforts to recruit underrepresented groups as research participants; patient navigator programs and community health workers to mitigate barriers to care; more emphasis on social determinants of health in radiology education and recruitment of radiologists among under-represented groups; and enhancing equitable uptake of emerging radiology innovations. 6. Asnaani (2023) What role can (and should) clinical science play in promoting mental health care equity? [63] To provide a summary of the documented mental health care inequities (across a range of identity markers) and briefly review recent movements to address these inequities, such as social justice and equity Mental health equity Review without description of the methods , but a detailed outline Several specific areas of scholarship were reviewed in terms of their contributions to promoting mental health care equity, namely: community-based research and community-driven mental health treatment adaptations, task-shifting efforts in domestic and global settings, utilization of technology innovations to promote such work and increase access, and policy efforts. Several ongoing structural inequalities related to social determinants of health have been identified as underlying causes of inequitable mental health care, including (but not limited to), language barriers, differential (and lower) financial resources for many historically minoritized groups, immigration complications, and the experience of ongoing racism and discrimination within the health care system. These barriers are in addition to other persisting barriers to mental health care that include stigma toward mental health, a scarcity of treatments that have been tested and validated in minoritized identity groups, and a shortage of culturally responsive treatment providers To examine the effectiveness of culturally adapted and culturally driven interventions, and to investigate why or how such interventions are successful, with an interdisciplinary lens. Otherwise, it will not be possible to engage in important replication work and to fully understand the elements that make such community-based practices most likely to succeed. Open science approaches are being encouraged across clinical science to improve adherence to core principles of the discipline, including transparency (with data sharing), ethics, and replicability/reproducibility, all of which are relevant to the study of diverse societies. it would serve the field (and our society overall) well to adopt a stance that diversity science truly applies to all psychological science. Clinical psychologists should take on the challenge/responsibility to incorporate the principles reviewed in this article that are central to promoting mental health care equity across all segments of society, across psychological phenomena, and across professional roles. 157.Washington et al (2024) A systematic review of the effectiveness of cervical cancer screening and prevention interventions for African American women: implications for promoting health equity [58] To evaluate the effectiveness of cervical cancer screening interventions for African American women, and to assess their attention to health equity. Precisely: (1) To describe the characteristics of screening and prevention interventions that target African American women; (2) To compare the effectiveness of these interventions; and (3) To determine whether these studies address health equity factors. Prevention: cervical cancer screening The review protocol was registered with PROSPERO and guided by the PRISMA guidelines. A literature search was conducted on PubMed, Embase, CINAHL, and Scopus. Reference sections of included studies and relevant systematic reviews were also searched for additional articles. Study quality was assessed. The review also used the Healing ARC framework and Ford’s Public Health Critical Race (PHCR) praxis [82] for additional health equity assessments. A meta-analysis was conducted 23 articles met inclusion criteria, there was a wide variety of intervention strategies: community health workers, patient navigation, patient reminders, self-sampling collection, and Human papilloma virus (HPV) vaccination. Cultural tailoring and community-based methods were commonly used, with several studies showing increased screening behavior and knowledge. Meta-analysis showed that interventions significantly increased the likelihood of participating in cervical cancer screening (OR: 2.43, 95% CI: 1.47–4.02). Health equity assessment revealed that approximately half of the studies struggled to address health equity concerns, while others incorporated cultural tailoring or community-based methods effectively. Few studies acknowledged the impact of racism and structural inequities explicitly This review supports the importance of incorporating health equity principles and community-based methods in screening and prevention interventions. Future research and practice should incorporate African American women’s perspectives in intervention development and implementation. Two major implications for future research and practice are self-sampling and deep cultural tailoring. Cykert (2022) A path toward health care equity: system- based interventions for change [55] To review recent studies that used system-based interventions to reduce disparities and improve outcomes for everyone in North Carolina, and to outline how clinicians can apply results to practice. Service delivery – chronic disease Overview of successful systemic strategies to reduce chronic disease treatment and outcome disparities. No clear methodology defined Communities of color, in particular Black people, have worse health outcomes than white people, in cancer, chronic disease, maternal health and infant mortality. This is due to social determinants of health, (SDOH) but also other factors such as poor patient-clinician communication, mistrust, or clinician implicit bias. According to outcomes, the strategy based on principles of real-time transparency, accountability and enhanced communication was successful in patients with cancer, diabetes and hypertension Community insights into barriers and solutions are imperative in building systemic solutions. The principles that reduced disparities and improved health care in chronic diseases could also apply to maternal and child health: Transparency through real-time digital data; accountability through quality improvement that is mindful of disadvantaged groups; and serial enhanced communication incorporating community voices. To truly achieve health equity, additional efforts on SDOH—such as access to health insurance, healthy foods, and a living wage—coupled with interventions to attenuate the physiologic effects of experienced racism, will be needed. 9. Bell et al (2023) Can evidence drive health equity in the COVID‑19 pandemic and beyond? [74] To systematically search, identify, and collate published, well-described, and policy-relevant approaches in which someone has applied epidemiological methods to COVID-19 pandemic inequities in healthcare and health outcomes; and to critically assess the potential of proposals for addressing pandemic-related health inequities Service delivery, COVID-19 A scoping review in accordance with (PRISMA-ScR) guidelines. Eleven databases were searched for relevant articles published from January 1 st 2020 through February 17 2021 to identify and synthesize published scientific literature describing policy-relevant and evidence-based approaches using epidemiological methods to address health inequities related to the COVID-19 pandemic 77 papers were included in the review. Significant health inequities affected infection rates, morbidity, and mortality among different socio-economic and racial groups: Inequitable access to testing and vaccines in marginalized communities; disparities in treatment access particularly for culturally and linguistically diverse groups; exacerbation of existing non-COVID-19 health issues due to disruptions in healthcare services and social determinants of health; and other inequities such as race, socioeconomic status, and gender. Proposed solutions target: the inequity in risk of infection, morbidity, and mortality from COVID‑19; the inequity in access to testing and vaccines for COVID‑19; the inequity in access to treatment for COVID‑19; multiple inequities in COVID‑19; and non‑COVID‑19 morbidity and mortality. Some of the proposed solutions, however, could unintentionally exacerbate health inequities . Health policymakers should co-create, co-design, and co-produce equity-focussed, evidence-based interventions with communities, focussing on those most at risk to protect the population as a whole. They should target structural systems of disadvantage which place entire communities at increased risk. Policymakers and practitioners need to examine algorithms for potential discrimination from in-built biases in the data or decisions made in their development. Epidemiologists collaborating with people from other relevant disciplines may provide methodological expertise for these processes. There is a need for robust, evidence-based interventions to combat systemic health and social inequities to allow everyone in our communities to thrive. 12.Boden-Albala et al (2023) Use of community-engaged research approaches in clinical interventions for neurologic disorders in the united states a scoping review and future directions for improving health equity research [64] To identify and synthesize the intervention studies that have actively engaged with the community in the conceptualization and implementation of interventions to reduce disparities in neurologic conditions, and to describe the common community engagement processes used by the studies. Community engagement A scoping review to describe the frequency and manner in which community engagement strategies have been used as part of intervention strategies to address neurologic conditions. The scoping review methodology followed Arksey and O’Malley’s 5-stage model: (1) identify the research question; (2) identify relevant studies using a systematic search strategy; (3) select studies (we used PRISMA guidelines); (4) chart (synthesize, code, and interpret) the data; and (5) collate, summarize, and report the results. The articles were screened and reviewed using Covidence. The review focused on neurologic conditions such as stroke, Alzheimer disease and related dementia, epilepsy, Parkinson disease, spinal cord injury, and traumatic brain injury A total of 53 studies were included. Community engagement strategies were integrated into interventions in numerous forms with some studies using multiple approaches. Local organizations as community partners were used by 42% of the studies. Culturally Tailored Materials and Mobile Health (mHealth) were used in 40% of studies to improve accessibility and health promotion. An example is Boden-Albala's trial, which reduced systolic blood pressure in Hispanic stroke survivors. Community health workers were employed by 32% of the studies, enhancing trust and effective delivery of interventions. Faith-based organizations and local businesses were involved in 28% of interventions. Focus groups/health need assessments were a strategy for 25% of studies. Community Advisory Boards were utilized in19% of studies for feedback and feasibility. Personnel was recruited from the community/champions in 19% of studies. Finally, caregiver/social support was a strategy used in 15% of studies. To involve the community early and continuously, aligning objectives and expectations with the community through a collaborative process; to build curricula that address challenges to community engagement; to prioritize Inclusion of community engagement reporting in peer-reviewed journals; to prioritize and incentivize research that will identify best practices around community engagement to enhance our understanding of subpopulations who experience disparities. 53. Gréaux et al (2023) Health equity for persons with disabilities: a global scoping review on barriers and interventions in healthcare services [68] To provide a comprehensive global overview of access to healthcare services for persons with disabilities as characterized by both the barriers they face and the interventions that have been implemented to remove these barriers. To provide insights to inform the actions that governments and other key stakeholders can take to respond more efficiently to the requirements of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) Access to healthcare services A scoping review following the methodological framework proposed by Arksey and O’Malley. Scholarly databases and the websites of Organizations of Persons with Disabilities, and reviewed evidence shared during WHO-led consultations on the topic of health equity for persons with disabilities. A total of 182 articles (published between 2011 and 2022) were included in the review. The majority of sources originated from high-income countries. Barriers were identified worldwide across different levels of the health system and through wider contributing factors of health inequities that expand beyond the health system. Human resources issues, the lack of reliable disability data in healthcare services, financial issues, lack of leadership and policy alignment, availability and quality of services, lack of accessible or specialized medical and rehabilitation equipment, products, and devices, the lack of disability guidelines and legislation enforcement, and the negative attitudes toward persons with disabilities across all strata of society were major barriers. Socio-cultural discriminatory beliefs about disability, Internalized stigma by persons with disabilities could also impact their access to healthcare services. SDOH factors, lack of opportunities for developing health literacy and limited availability of accessible transport are other problems. Eighteen interventions targeting the negative societal attitudes toward persons with disabilities were identified. However, the interventions to promote equitable access to healthcare services for persons with disabilities were not readily mapped onto the needs, their sources of funding and projected sustainability were often unclear, and few offered targeted approaches to address issues faced by marginalized groups of persons with disabilities with intersectional identities Health needs and priorities of different groups of persons with disabilities can differ widely and require tailored actions. Addressing the barriers faced by the most marginalized groups of persons with disabilities can foster health equity for everyone. Service providers, policymakers, and stakeholders should consult with persons with disabilities with a wide range of intersectional identities to better understand and address their unique health needs and intersectional mediating and risk factors to improve access to healthcare services. Special considerations should be given to the needs of women and girls, sexual and gender minority groups, children and older persons, ethnic minorities, and immigrants and refugees with disabilities. Governments and decision-makers in the health sector should be encouraged to set expectations and establish a collaboration mechanism to work efficiently with Organizations of Persons with Disabilities. Global health decision-makers and funders, in close collaboration with Organizations of Persons with Disabilities have a key role to play in overseeing and coordinating the distribution of resources, building the capacity of country partners, prioritizing the most disadvantaged, and monitoring progress on health equity for persons with disabilities worldwide. A global research agenda is needed, and its development requires the close collaboration and engagement of multisectoral partners and research networks to better address the deep and multidimensional roots of health inequities. 97 Meadows et al (2023) Strategies to promote maternal health equity the role of perinatal quality collaboratives [60] To examine the role and strategies of perinatal quality initiatives and collaboratives to deliver safe and equitable maternity care and the evidence of demonstrated success. Maternal health equity A narrative review exploring the contribution of perinatal quality improvement (QI) projects in hospitals, health systems, public health departments, or state perinatal quality collaboratives to address equity in maternal outcomes. Perinatal quality improvement is a method to increase obstetric safety and promote health equity. The authors identified six equity-promoting QI strategies, provided examples and characterized each using a classification system based on Bingham’s ABCDE’S of QI Strategies and Tactics A: Accountability; B: Buy-in (incentives or disincentives); C: Collaboration and Communication; D: data; E: education; and S: structure change To establish and maintain a culture of equity within healthcare systems. To use data to identify gaps in care and track progress over time. To engage and collaborate with a diverse set of strategic partners and stakeholders. To include patients and communities in the design and implementation of QI interventions. To educate clinicians on evidence-based practices and the impact of bias and racism on maternal health outcomes. To implement standardized protocols and safety bundles to minimize variations in practice and improve care quality. In sum, leaders should prioritize maternal equity, acknowledge racism's impact on health outcomes, and invest in staff education and data systems to improve care quality and equity. 115. Peek et al (2023) Advancing health equity through social care interventions [75] To use evidence on addressing racism in social care intervention research to create a framework for advancing health equity for all populations with marginalized social identities (e.g., race, gender, and sexual orientation); To recommend how the Agency for Healthcare Research and Quality (AHRQ) could advance health equity for marginalized populations through social care research and care delivery. Social care interventions This commentary is informed by a literature review of social care interventions that were affiliated with healthcare systems, input from health equity researchers, policymakers, and community leaders attending the AHRQ Health Equity Summit; and consensus of the authors. Groups with marginalized social identities have disproportionate social needs (e.g., food insecurity) and negative SDOH (e.g., poverty). Payors and healthcare systems are interested in addressing patient's social needs and community-level social determinants of health as a part of comprehensive healthcare strategies to reduce health inequities. However, few social care intervention studies have conceptualized race as a proxy for exposure to racism or examined differential treatment effects of the intervention by race or ethnicity. Addressing specific sociocultural priorities of populations with marginalized social identities is an important strategy to increase the effectiveness of social care interventions. The authors recommend that AHRQ: (1) create an ecosystem that values research on SDOH and the effectiveness and implementation of social care interventions in the healthcare sector; (2) work with other federal agencies to (a) develop position statements with actionable recommendations about racism and other systems that perpetuate marginalization based on social identity and (b) develop aligned, complementary approaches to research and care delivery that address social marginalization; (3) advance both inclusive care delivery and inclusive research teams; (4) advance understanding of racism as a social determinant of health and effective strategies to mitigate its adverse impact on health; (5) advance the creation and scaling of effective strategies for addressing SDOH in healthcare systems, particularly in co-creation with community partners; and (6) require social care intervention researchers to use methods that advance our understanding of social health equity. 150. Ukke et al (2023) Lifestyle Interventions to prevent type 2 diabetes in women with a history of gestational diabetes: a systematic review and meta-analysis through the lens of health equity [56] To assess the prevention of type 2 diabetes in women with prior gestational diabetes (GDM) using population characteristics according to the PROGRESS criteria: place of residence, race /ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, and social capital Behavior change Reviews databases were searched for interventional studies of diet, physical activity, or behavioural interventions published up to February 2023. Random effects subgroup meta-analysis was conducted to evaluate the association of population characteristics and intervention effects. Randomized controlled trials, non-randomized controlled trials, and pre-post single-arm studies were included. All studies were conducted in high-or middle-income countries. Were excluded studies combining pharmacological or supplementation components with lifestyle intervention A total of 40 unique studies were included in the systematic review. The meta-analysis included 26 unique studies that reported the primary outcomes using the PROGRESS criteria. Two-thirds of the studies reported on race/ethnicity and education level. Less than one-third reported on place (urban/rural), occupation, and socioeconomic status. None reported on religion or social capital. Lifestyle interventions from high-income countries showed a greater reduction in bodyweight, a key factor for the prevention of T2DM compared with the studies conducted in middle-income countries for subgroup difference. In the studies that did report findings based on the PROGRESS criteria, participants were mostly (73.9%) tertiary educated and had a high level of income (61.5%). This review highlights the lack of the inclusion of participants at the highest risk of T2DM. There were no studies in low-income countries in Africa or the Pacific region despite these regions being disproportionately burdened with T2DM and GDM. Virtually delivered interventions have a better effect than those with both virtual and in-person components, with in-person delivered interventions being the least effective in women with a history of GDM Substantial heterogeneity between studies needs to be considered when interpreting the results of this meta-analysis. The high risk of bias in most studies needs to be considered when applying the results of this meta-analysis. There are ethnic disparities in the overall prevalence of T2DM as well as in the progression of GDM io T2DM, and an adequate representation of ethnic groups bearing the greater burden of the disease and the disaggregation of data, where feasible, is needed in the research to better understand the effectiveness of interventions in these groups. To advance the understanding of T2DM prevention in all population subgroups, future researchers and funders need to close the equity research gap in the prevention of T2DM in women with a history of GDM by focusing on the inclusion of disadvantaged groups (or groups which are under-represented) and by collecting and reporting disaggregated data on equity. Kanengoni‑ Nyatara et al (2023) Barriers to and recommendations for equitable access to healthcare for migrants and refugees in Aotearoa, New Zealand: an integrative review [70] To synthesise the evidence on barriers to accessing healthcare services and where present, propose interventions to improve services in various healthcare settings for migrants and refugees Access to healthcare for migrants and refugees An integrative review of studies published between January 2016 to September 2022 to mirror the adoption of the 2030 Sustainable Development Goals in 2015. The review followed the PRISMA guidelines. Data were thematically analyzed using vote counting to identify frequent themes, which were refined through discussion. A narrative synthesis was then used to integrate the findings and highlight relationships among the themes Out of 237 identified studies on migrants and refugees, 13 were included in the review. All except one were qualitative, and the other one used a mixed methodology. Most studies focused on refugees. Participants were from LMICs or non-English speaking countries. Studies predominantly involved women. Attitudinal barriers included the lack of culturally competent healthcare providers, discrimination by healthcare providers, and personal, social, and cultural attributes. Structural barriers referred to policies and frameworks that regulated the accessibility of health services such as the cost of healthcare, accessibility and acceptability of interpreter services, length of allocated appointments and long waiting times for an appointment, difficulties navigating the health system, and logistical barriers. Migrants stated that it took them around two years to understand and navigate the health system in Aotearoa, with others reporting not being provided with information by their local doctor about services available. Mobility barriers were also reported during COVID-19 lockdowns where participants’ support services were disrupted. For mothers who could not drive or did not have a car, using public transport to access healthcare was particularly difficult for those who had two or more children The authors recommend: 1) Fostering a Sense of Belonging: people from former refugee backgrounds to influence policy makers to recognise the unique individual, social, cultural and historical factors that affect their health and promote a culture of acceptance that celebrates diversity; 2) Enabling a Whole-of-Society Approach, with collaboration between healthcare providers and non-governmental organizations, the integration of a gender perspective, and community engagement; 3) Government, Organizational Structures, and Policies: Implementation of culturally centered policies, funding for interpreter services, addressing structural barriers, and improving healthcare workforce diversity. Jackson-Triche, Unützer and Wells (2020) Achieving mental health equity: collaborative care [65] To review what is known about the impact of integrated care programs on improving health equity, with special emphasis on collaborative care (CC) Collaborative care (CC) in mental health / behavioral health Rapid literature review of reviews and individual studies The review gives strong evidence that CC is a model that has the potential to reduce disparities for ethnic minorities and other at-risk populations who are often poorly served by usual primary care systems, and who have lower engagement and health outcomes because of other underlying risk factors. As a systems-based approach, CC has been shown to not only improve access to care but also to improve the quality of care received and health outcomes To fully realize the promise of CC, there is a need for approaches that focus on effective community engagement, coalition building, and cultural adaptation, as well as developing innovative approaches such as addressing social determinants. The authors argue that key first steps are using health equity–focused strategies when planning and implementing CC and giving careful thought and attention to engaging diverse populations and considering their specific preferences and needs. Kibakaya and Oyeku (2022) Cultural humility: a critical step in achieving health equity [62] To identify and discuss research pertaining to cultural sensitivity in pediatric primary care and comment on its role for achieving health equity. Cultural sensitivity Commentary/ viewpoint article without any systematic method of analysis. They define culturally sensitive care as “the delivery of care within the context of appropriate physician knowledge, understanding, and appreciation of cultural distinctions”. An alternative concept is one of cultural humility, which incorporates elements of self-questioning, immersion into an individual patient's point of view, active listening and flexibility, which all serve to confront and address personal and cultural biases or assumptions There is scarcity in breadth and depth of existing literature that addresses culturally sensitive interventions in pediatric primary care. There is a notable deficiency of research tackling the array of medical, developmental, social, and emotional issues that primary care providers address daily. One current strategy that health systems and educational institutions are leveraging to reduce health disparities is addressing the role of implicit bias and structural racism. Medical schools in the USA have developed various curricula incorporating elements of cultural competence. Demonstrating cultural humility frees health care professionals from having to possess expert knowledge about a myriad of cultural differences and fosters open communication with patients to achieve shared health and developmental outcomes. Physicians, leaders, interprofessional collaborators and health systems must fully participate in the effort to transform current practices. The authors argue that it is imperative that healthcare professionals work in partnership with patients and their families to reduce health disparities. The authors and other researchers posit that cultural sensitivity may improve physician-patient communication and collaboration, increase patient satisfaction, and potentially enhance adherence, improve clinical outcomes and reduce health disparities. Doyle et al (2019) Achieving health equity in hypertension management through addressing the social determinants of health [54] To examine recent literature on the social determinants of health as they relate to hypertension and cardiovascular disease and discuss relevance to the practice of emergency medicine Hypertension management Examples from the literature of the intersection of social determinants of health and hypertension management or outcomes Positive impact on behavior or outcomes was shown in minorities by improving access to resources, behaviour counseling, education, the action of community health workers, and technology. There is a need for innovative methods to modify the factors that affect health upstream (and that can be modified, at variance with race and ethnicity) before the symptoms appear, such as education and neighborhood characteristics. Multidimensional partnerships involving healthcare systems, communities, public health organizations and social welfare entities are important to better prevent and manage hypertension through action on social determinants of health. Richard et al (2016) Equity of access to primary healthcare for vulnerable populations: the IMPACT international online survey of innovations [67] To identify, refine and then trial best practice innovations to improve access to PHC, particularly for vulnerable populations Access to primary health care As part of IMPACT project, an environmental scan was used to identify the breadth of current innovations from the field. The authors distributed a brief online survey to an international audience of PHC researchers, practitioners, policy makers and stakeholders using a combined email and social media approach. Respondents were invited to describe a program, service, approach or model of care that they considered innovative in helping vulnerable populations to get access to PHC. Written descriptions of innovations were mapped against the framework of Levesque et al [71] to identify which access dimensions were involved The study collected 240 unique examples of innovations, which were Innovations were primarily health sector focused (71.3 %). Almost all innovations were operating at the practice or community level (90.4 %). Most innovations addressed supply-side dimensions of access, with less focus on demand-side dimensions. Few innovations targeted both supply- and demand-side dimensions simultaneously. The study also noted that many innovations were funded by government sources and were primarily implemented in community health settings Increasing efforts are needed to address both supply- and demand-side dimensions of access simultaneously to improving the effectiveness of innovations. More comprehensive and integrated approaches are needed to achieve transformative change in access to PHC for vulnerable populations. More research is needed, in particular for more rigorously undertaken systematic evaluations of initiatives that are developed, considering the particular context in which innovations are implemented and having indicators which cover the broad range of access determinants (health and social) for accurate measurement of the effects of intervention components on specific access dimensions. Schneider et al (2021) Increasing equity while improving the quality of care [52] Highlighting the efforts to reduce inequities in the quality of cardiovascular care, building on insights from recent scholarship on the effects of structural racism in the broader society and also within medicine Cardio-vascular care The authors adapt a tool frequently used in quality improvement work—the driver diagram, which maps out a path toward an intended outcome—to chart likely areas for diagnosing root causes of disparities and developing and testing interventions There are persistent racial and ethnic disparities in cardiovascular disease (CVD) outcomes, particularly among Black, Latino, Asian, Pacific Islander, and Indigenous populations. In the case of heart failure mortality, disparities have widened over time. Clinical and behavioral risk factors like hypertension, diabetes, diet, and tobacco use partly explain these disparities. Genetic factors play a minimal role. There are persistent disparities in care quality among racial and ethnic groups. The authors developed an equity-centred quality improvement model and a roadmap to advance cardiovascular health equity as guides to improve the measurement and analysis of quality problems and the implementation of care interventions and policies that reduce racial and ethnic disparities in outcomes The Equity-Centered Quality Improvement Model explicitly maps the many influences within and outside of health care that contribute to inequitable patient outcomes. Reducing discriminatory interactions with patients and families and enhancing access to care can increase the trustworthiness of institutions and professionals. Physicians, other health professionals, and health care systems can reduce racial and ethnic disparities in cardiovascular mortality and other outcomes if they simultaneously and intentionally address both quality and equity. Designing interventions should take a broader perspective than modifying care for patients while they are in a clinical care setting. Tailoring solutions to patients and their communities may involve actively engaging patients and community health workers in developing and evaluating interventions. The use of geospatial and clinical data is recommended to identify disparities, diagnose their root causes, and design targeted interventions. Engaging patients and community health workers in developing and evaluating culturally tailored interventions is also needed. 76.Kohler et al (2023) Population‑ based physical activity promotion with a focus on health equity: a review of reviews [32] To identify current evidence on the effectiveness of population- based physical activity (PA) promotion in the community with a particular focus on health equity. Prevention, physical activity promotion Review of systematic reviews on population- based PA promotion for the period 2015 to 2021. Six electronic databases were examined. A reference list and grey literature search were also conducted. A quality assessment was conducted for each identified review. All included reviews of population-based approaches for PA promotion with a focus on disadvantaged populations Six reviews were included, and they were all rated as high quality. Mass-media campaigns, point-of-decision prompts, environmental approaches, policy approaches, and community-based multi-component approaches can promote PA in the general population. Across populations with social disadvantages, mass-media campaigns, point-of-decision prompts and policy approaches are likely to be effective if they are tailored. However, none of the reviews on community-based multi-component approaches provided evidence on health equity The evidence regarding health equity is still sparse and future studies should assess the theoretical basis of these approaches, their differential impact including the potential negative and unintended consequences as well as the long-term impact on PA promotion and health equity. Tailoring interventions to the needs of disadvantaged populations, and engaging people with social disadvantages in the development, implementation and evaluation of population-based PA programs for their empowerment are recommended, as well as community-based multi-component approaches combining structural (environment and policy) and behavioural components. Arsenault et al (2018) Equity in antenatal care quality: an analysis of 91 national household surveys [61] Identifying the reasons for inequitable access of women for antenatal care in LMICs Antenatal care based on status of the country A systematic review of antenatal care quality using information from 2007-2016 Demographic and Health Survey (DHS) and Multiple Indicator cluster surveys (MICS) The study shows that there are much lower and inequitable levels of quality in many LMICs even though they reached high levels of antenatal care coverage. The wealthiest women were four times more likely to report good quality antenatal care than the poorest. Poorer people mostly live in rural areas where there are poor functioning health systems. Other factors that influence antennal care inequalities include availability of good facilities nearby, cost of diagnostic procedures, provider discrimination or bias, and degree of a patient to seek high-quality care, skills of care providers and equipment available. Equity in effective coverage should be used as the new metric to monitor progress towards universal health coverage. However, assessing the social inequalities for different nations is still a challenge. The study suggests that more work is still needed to understand factors responsible for inequities in health-care quality. The article recommends better measurement and systematic improvement in healthcare quality especially in poor and vulnerable populations. In the SDG era, achieving parity in health outcomes between rich people and poor people, within and across countries, will require greater focus on the quality of health services and its equitable distribution. Davy C, et al (2016) Access to primary healthcare services for indigenous peoples: A framework synthesis [69] To identify issues that hinder Indigenous peoples from accessing primary health care and then explore how these were addressed by Indigenous health care services Access to primary healthcare services for indigenous peoples A thematic analysis of 50 papers/studies with focus on access to primary healthcare services for indigenous peoples using Levesque’s accessibility framework. [71]. These studies were from the United States, Canada, New Zealand, South America, and Papua New Guinea. Issues relating to the cultural and social determinants of health (such as unemployment, poverty, and low levels of education) influence whether Indigenous patients, their families and communities were able to access health care. Indigenous health care services addressed these issues in a number of ways including the provision of transport to and from appointments, a reduction in health care costs for low-income people and close consultation with community members in identifying and then addressing health care needs. Indigenous health care services appear to be best placed to overcome both the social and cultural determinants of health which hinder Indigenous peoples from accessing health care. Common factors for successful navigation include the importance of culturally safe and wherever possible, locally owned Indigenous health care services. Findings also suggest that Levesque and colleague’s accessibility framework [71] should be broadened to include factors related to the health care system, such as funding. Mainstream services are set up to cater to dominant, often non-Indigenous cultures with a set of socially constructed values and norms which can be at odds with Indigenous communities’ beliefs and values. The authors acknowledge a need to further explore factors relating to the health care system which facilitate or impede access to Indigenous health care services. Tao, Agerholm and Burström (2016) The impact of reimbursement systems on equity in access and quality of primary care: A systematic literature review To compare the different types of reimbursement system in relation to socioeconomic and racial inequalities in access, utilization and quality of healthcare. Access to, and quality of primary healthcare Systematic literature review 22 papers on experimental or observational studies conducted in the primary care settings were included. Only studies from high-income countries were included. Schemes considered were fee-for-service, capitation, and pay-for-performance (the Quality and Outcome Framework). Seven studies compared capitation and fee-for-service. Access, uptake and quality of services, and chronic disease management were considered. Little scientific evidence supports an association between reimbursement system and socioeconomic or racial inequity in access, utilization, and quality of primary care. The reimbursement scheme may have a differential impact depending on the outcome under study, the context including various healthcare systems, and social stratifiers other than race or SES. Vertical and horizontal equity were not differentiated. Furthermore, a combination of reimbursement schemes, which was observed, does not allow to isolate the impact of a given scheme. Policies for resource allocation that matches the increased healthcare needs of underserved groups might have a greater impact on health inequalities that the type of reimbursement. Further empirical studies are necessary and recommended. Malou et al (2020) Promotion de la santé globale et approche socio-écologique de l’autodétermi-nation chez les personnes présentant une déficience intellectuelle: une revue systématique des interventions [66| To analyze the contexts and highlight conclusive results of interventions that promote overall health and the place of self-determination among people with intellectual disabilities (ID) Behaviour change Systematic review of interventions promoting self-determination and overall health among people with intellectual disabilities. The paper analysed relevant interventions focusing on individuals with ID, on environment, and on both ID and environment. Significant results of both types of interventions were observed from a quantitative and qualitative point of view when they considered different factors such as the interaction between individuals and the environment in a broad sense (material, human, living environment, etc. development of self-determination and improving health literacy) Future actions should further evaluate the improvement of overall health through the development or strengthening of self-determination both at the individual and environmental level. Gandhi (2015) Charting the evolution of approaches employed by the Global Alliance for Vaccines and Immunizations (GAVI) to address inequities in access to immunization: a systematic qualitative review of GAVI policies, strategies and resource allocation mechanisms through an equity lens (1999-2014) [73] To assess how GAVI’s approach to address equity/inequity in immunization has evolved over time Access to immunization A systematic qualitative review of the literature on the evolution of GAVI’s focus on reducing inequities in access to vaccines, immunization, and GAVI funds between and within countries. The review included electronic databases search and a direct review of available GAVI Board papers, policies, and program guidelines Over time, GAVI has progressively added vaccines to its portfolio. This expansion should have addressed inter-country, inter-regional, intergenerational and gender inequities in disease burden. However, evidence is scant with respect to final outcomes. A focus on addressing inequities between higher-income countries and lower-income countries may reflect the viewpoint of the Alliance stakeholders. In terms of resource allocation mechanics and program policies, GAVI focused almost exclusively on between-country equity concerns. By building on its successes, GAVI is well-positioned to bring the benefits of vaccination to previously unreached and underserved communities towards provision of universal health coverage. Reliance on national averages makes sense when speaking of vaccines that are generally regarded as highly equitable interventions (e.g. targeting boys and girls alike) and, most importantly, capable of conferring population-wide herd immunity benefits against VPDs at high enough levels of coverage. Future research should illustrate the evolution and quantitative effects of GAVI’s efforts to address between- and within-country inequities in access to new vaccines, utilization of immunization services, access to GAVI resources, and impact on vaccines preventable diseases. Nelson et al (2020) Achieving health equity in preventive services: a systematic review for a national institutes of health pathways to prevention workshop [57] To examine effects of barriers that create health disparities in recommended preventive services for adults, and to evaluate effectiveness of interventions to reduce them. Preventive services Systematic literature review of preventive services related to cancer, cardiovascular diseases, and diabetes in adults. Articles published between 1996 and 2019; 120 studies synthesized. Disadvantaged populations in the USA experience disparities in the use of preventive health services. Patient navigation services increased colorectal, breast, and cervical cancer screening rates. Some patient navigation interventions included additional services such as reminder calls, lay health workers, etc. Telephone calls and prompts improved colorectal cancer screening. Reminders from lay health workers improves breast cancer screening Further research to address gaps and deficiencies of existing studies, and involving unstudied populations experiencing adverse effects of healthcare disparities: racial and ethnic minorities, socioeconomically disadvantaged populations, underserved rural populations, sexual and gender minority populations, and others subject to discrimination. 1. Governance and policy action Out of the 13 reviews about governance and policy approaches for health equity, three were outside the health sector. One reviewed the importance of neighborhood policies in the USA to advance health equity through institutions, the physical, and the social environment [15] . The recommended measures included fair housing laws and strengthening of community-led initiatives to improve material and social conditions. The second one reviewed promising strategies to advance addressing root causes of health inequities, including the analysis of structural power structures to address equity issues [16] . The third one reviewed policies that perpetuate health disparities in children in the USA [17] . Several social and structural determinants of health were considered, such as housing as highlighted in Arcaya’s review [15] , the criminal legal system, and immigration. Supporting community organizations, in this case those that support immigrant communities, is recommended. Which social determinants of health the healthcare systems have the capacity to address is an interesting question raised in two review papers on health sector actions [18, 19] . Reviews on health sector actions (N=10) pertained to clinical practice guidelines and their development [20, 21] , and to various strategies for healthcare systems [18, 19, 22–24] Regarding clinical guidelines, health equity promoting practices need to be integrated from the onset of their development, and community organizations must be among the involved stakeholders. Healthcare system strategies include health equity as part of health system performance assessment [18] and organizational capacity for health equity assessment [23] or strengthening [22] . The results of a primary health care (PHC) policy reform in Sweden were assessed, including the impact on health equity [25] . It was found that while the reform increased access to PHC and the number of visits, the improvements were primarily in affluent areas and among people with lower health needs. The study showed that resources were more influenced by provider location, patient choice and demand than need, which suggested potential damage to health equity. The effect of decentralization on health equity was assessed in a systematic review encompassing a quality assessment of the studies [24] . The results were mixed, with a risk of increased disparities due to financing; central coordination and redistribution were deemed necessary. One review on neonatal health disparities emphasized the quality of care [26] . Spitzer-Shohat and Chin [27] assessed the implementation of guidance frameworks provided to organizations implementing interventions to make care and outcomes more equitable by changing policies and practices. Several models and frameworks were analyzed and most of them concentrated on the organization’s external context such as analysis of data on race and ethnicity. Also addressing the inner context such as readiness for change was deemed important. As part of health system strengthening approaches for health equity, Jensen, Kelly and Avendano [22] concluded on the need for broadened frameworks to measure intersecting forms of social disadvantage. Among the strategies for healthcare systems in the USA to address social determinants of health and improve health equity in the pediatric population, the value-based payment is described as promising [19] . This system has the goal of supporting pediatricians in intervening on upstream influences on health to reduce long-term cost. Incentives are used to address the social determinants of health through universal screenings, referrals to community-based organizations, and investing in various supports. 2. Information and evidence data Seven reviews were classified under this theme. In a systematic scan of 18 USA-focused clearinghouses that assigned an intervention effectiveness rating for improving community health and the social determinants of health [28] , it was found that less than half provided information on the potential impact on health equity. These clearinghouses defined and operationalized health equity differently. They lacked transparency in their methods and used various approaches to communicate the findings. Clear and transparent definitions, values, and methods would be needed. Action is guided by conceptual frameworks. Hollands et al [29] recently reviewed methods, frameworks, or tools used as a conceptual basis for investigating dimensions of health equity impact in systematic reviews of public health interventions. In this overview of systematic reviews, planned methods for conceptualizing equity impacts were fully applied in less than half of the reviews. The predominant framework was PROGRESS-Plus, used in more than one-third of the reviews. However, there are conceptual and measurement issues owing in part to the lack of standardized definition, operationalization, and measurement of health equity dimensions. Additionally, the nature of the differential impacts is complex, and dimensions of health equity may interact with each other. WHO has developed several health inequality monitoring resources as part of its 2022–27 inequality monitoring and analysis strategy; these were reviewed [30] . The resources include a health inequality data repository, a health equity assessment toolkit (HEAT and HEAT Plus), health inequality monitoring tools and resources including a handbook, step-by-step manuals and statistical codes, and eLearning courses. Health inequality reports focusing on specific health topics or countries are periodically released. The WHO strategy and tools respond to the need for high-quality evidence on health inequalities to advance health equity. Participatory implementation science may be regarded as a tool or strategy to advance health equity, as shown in an overview with examples from the literature [31] .It is an iterative approach that offers an inclusive and collaborative perspective on implementing and sustaining evidence-based interventions to advance health equity. With a focus on health equity, participatory implementation science emphasizes processes for, and impacts of, community engagement, dissemination, social action, capacity building, and systems changes. System changes include, for example, assessing power distributions and how they can be shifted to create equity-promoting contexts. Four reviews provided information or evidence data. The review by Cené et al [32] examined how and whether social needs interventions in multiracial or multiethnic populations in the USA advanced health equity. The interesting framework considered whether the studies were “conceptually thoughtful” in that they helped explain the root causes of racial health inequities, and whether they were “analytically informative”, that is, they examined if the effects differed by race or ethnicity. Out of 152 studies, less than 10% were conceptually thoughtful and only 14% were analytically informative, and mixed effects on health equity were reported. In a scoping review of publicly funded projects to reduce bias/racism in maternal care in the USA [33] , only four publicly funded such interventions were identified since 2018, which reveals an evidence gap. These projects are nonetheless promising as they used innovative strategies including participatory research responding to community needs, multi-component and multi-level interventions, and human resource training in three out of four cases. A review of six high-quality reviews on community-based promotion of physical activity showed that mass-media campaigns, point-of-decision prompts, and policy approaches could be effective for socially disadvantaged groups provided the messages were tailored [34] . However, none of the reviews provided evidence of an impact on health equity. Finally, a review of climate change impact on health inequities and mitigating efforts [35] concluded on the need for a ‘whole of science’ approach to address the current climate change and health inequality crisis as climate change magnifies health inequalities. Cross-cutting initiatives are given as examples of integrative approaches, such as the Pathfinder Initiative which draws on case studies to improve planetary health, the Pacific Regional Environmental Program, and the Rockefeller Foundation’s 100 climate resilient cities’ initiative, which develops resilient climate plans. Community-based participatory research, local knowledge, a better understanding of climate inequities, and expanding training opportunities were among promising strategies. 3. Technologies Digital health or telemedicine is the topic of seven out of the eleven reviews on technologies and health equity. Such technologies may indeed contribute to more equitable access to health services as the digital divide related to consumer information technologies has diminished. A scoping review on barriers and facilitators for digital primary health care in refugees and immigrants found that flexibility of digital modalities was a facilitator while older age and lack of digital literacy were obstacles [36] . In another review, the social determinants of health were found to interact to increase or reduce digital equity [37] . Three levels of digital divide were identified: lack of access, lack of skills, and lack of possibility to use the tools for one’s health. Telehealth for the ambulatory care of various chronic diseases (e.g., heart failure, diabetes, Parkinson’s disease, neurological diseases) was usually found to be as effective as in-person care; however, the results on equity among those at higher outcome risk has not been studied [38] . In a review on the use of consumer information technologies (CITs) for behavioral interventions in health disparity populations [39] , these technologies, including mobile health, telehealth and social media, showed potential in promoting self-management of chronic diseases, supporting activities like diet and physical activity monitoring, enhancing motivational learning and providing health education. Such technologies also proved useful for the evaluation of interventions. Another application of digital health is for mental health. In a systematic review, most studies (using direct-to-consumer telehealth videos) observed widening disparities for disadvantaged populations, including rural populations, older patients, and racial/ethnic minorities [40] . The generalizability and sustainability of access to digital mental health services for immigrants and refugees was questioned in another review which showed that participation not only depended on the individual (e.g., literacy), the program (computer and software) and the social context, but also depended on financial and technical support [41] . Digital literacy is important for the equitable distribution of e-health resources, as confirmed in a review [42] . Screening to identify population groups in need of digital literacy interventions is important to advance health equity. Carbon capture, utilization and sequestration technologies are promising to reduce greenhouse gas emissions. These have the potential to worsen or improve health equity. The benefits and burdens must be distributed equitably, and the needs and perspectives of the most vulnerable groups must be prioritized [43] . Clinical algorithms are a technology, in a sense, and they may be biased. Strategies to mitigate these biases were reviewed [44] . The strategies were technical (e.g., the algorithm development process), operational (e.g., governance) or system-wide (e.g., training on the risk of bias), but no single best practice was identified. How healthcare algorithms impact racial and ethnic disparities was reviewed [45] . The algorithms tested referred mainly to kidney function and cardiovascular risk. The evaluation strategies consisted in the removal, addition, or modification of variables. The review suggested that that mitigation strategies reduced racial and ethnic disparities in care. Artificial intelligence (AI) is another technology that can contribute to health equity. Its impact is still little studied, but a review summarized existing literature on the way AI has the potential to exacerbate or reduce inequities in occupational safety and health [46] . AI has the potential to improve occupational safety and health particularly in high-risk industries such as construction and mining. These jobs are mainly filled by workers from racialized ethnic minority groups. AI may also have negative health effects owing to job insecurity, new jobs and income disparities. Social safety nets may improve equity in communities that experience the negative impact of AI integration. Considerable research on both the positive and adverse impacts of AI is direly needed. 4. Human resources Only five reviews on health equity focused on human resources, but some reviews on other topics also included training or human resources components. Education has nonetheless emerged as a pivotal factor in promoting health equity. One review is on the integration of nurse practitioners into primary health care as a strategy to deliver comprehensive care and advance equity [47] . For their successful integration, six requirements were compiled from the literature, at the micro, meso and macro levels, and provided a framework: (1) autonomy and agency; (2) awareness and visibility; (3) shared vision; (4) leadership; (5) funding and infrastructure; and (6) intentional support and self-care. Another review examined nursing curricula to determine to what extent the principles of health equity are explicit in prelicensure curricula [48] . Only two papers out of 20 described overall well‐integrated explicit health equity content, and there was little attention to whether students transferred this learning into practice. The conclusion was that there is a gap in the health equity content despite the need. A review evaluating over 150 studies carried out in low- and middle-income countries revealed that community health worker programs were effective in reaching the most disadvantaged populations [49] . However, such programs achieve better equity in service delivery than outcomes as many individuals still face barriers in adopting health advice and referrals. Another review focused on the teaching of racism as a determinant of health in public health training [50] . Few examples of peer-reviewed literature were found on curricula, lessons and competencies developed to better understand racism. The review revealed a lack of consensus on the most effective approach to teaching about racism in public health. Cultural competency and safety as essential for health equity is the object of a review centered on indigenous healthcare in New Zealand [51] . The authors highlighted the significance of cultural safety in addressing racism, power imbalances in healthcare, and historical factors affecting healthcare experiences in marginalized populations. Cultural safety training and monitoring within healthcare organizations was deemed essential. 5. Service delivery This includes health equity issues and initiatives in general care, in medical treatment, and in public health interventions. Of a total of 26 reviews, 10 pertained to medical care and three to mental healthcare. Two papers on care of heart disease reviewed the factors of racial and ethnic disparities from prevention to advanced interventions and then discussed existing or recommended strategies to reduce these disparities [52, 53] . In the USA, the burden of modifiable risk factors for heart disease is higher among Black, Asian, Native, and Hispanic populations. Despite some progress, there are significant gaps in the management of hypertension and diabetes among Black and Hispanic patients because of financial barriers, missed visits, and poor access to prevention. Other factors that drive inequities in treatment include social determinants of health, systemic inequities, and structural racism. Examples of ongoing promising initiatives are American Heart Association’s ‘Life’s Simple 7’, community-level efforts to reduce tobacco consumption and obesity, and pay-for-performance programs for more equitable or better-quality programs. More equity in clinical trials, culturally tailored community interventions, cross-cultural training, enhanced diversity in organizations and recruitment in medicine are among the numerous recommended approaches to improve health equity through the spectrum of care. The review by Schneider et al [54] also highlights cardiovascular outcome disparities, particularly among Black, Latino, Asian, Pacific Islander, and Indigenous populations. Beyond clinical and behavioral risk factors, the clinical management of cardiovascular disease risk factors also shows significant disparities, which extend to the adoption of new technologies. Another review focusing on cardiovascular disease examined how data on social determinants of health were used to improve health equity [55] . The social determinants most often considered were healthcare access and quality, followed by the neighborhood and built environment. Few studies focused on economic stability, social and community context, or education access and quality. Data on neighborhoods and built environments were used to determine, for instance, areas with limited access to pharmacies, and to draw maps of cardiovascular disease incidence and climate vulnerability. Similarly, Doyle et al [56] reviewed the literature on social determinants of health as they related to the management of hypertension and cardiovascular disease. A positive impact on behavior or outcomes was observed in minorities by improving access to resources, behavior counseling, education, the action of community health workers, and technology. In an overview of successful systemic strategies to reduce chronic disease treatment and outcome disparities, Cykert [57] found that according to outcomes, successful strategies were based on principles of transparency through real-time digital data; accountability through quality improvement that is mindful of disadvantaged groups; and serial enhanced communication incorporating community voices. A systematic review focused on the effectiveness of lifestyle interventions for the prevention of diabetes among women who had had gestational diabetes according to social determinants of health [58] . The interventions were all carried out in high- or middle-income countries. Studies from high-income countries showed a greater reduction in body weight compared with the studies conducted in middle-income countries. It was noted that a high proportion of participants had higher education or higher income. The conclusion was that the women most at risk may not have been included in the programs. In a systematic review, Nelson et al [59] explored the barriers contributing to disparities in preventive services and the interventions aimed at reducing these among disadvantaged populations in the USA. It was found that clinician-delivered interventions played a crucial role in smoking cessation while technology-assisted interventions (patient navigations, telephone calls, community engagement) were linked to positive outcomes including improved cancer screening rates. In a review of cervical cancer screening and equity among African American women [60] , the meta-analysis showed that interventions significantly increased the likelihood of their participating in cervical cancer screening. A wide variety of intervention strategies were used, that is, community health workers, patient navigation, patient reminders, self-sampling collection, and HPV (human papillomavirus) vaccination. Evidence-based health equity strategies under the pillars of research, clinical care, education and innovation were reviewed for radiologists [61] , but they would as well apply to other medical specialties. Regarding research, there are under-represented communities such as rural and native populations. In clinical care, disparities in access result from factors such as medical mistrust, implicit bias by practitioners or patients, and race-based algorithms. Medical students with increased education on the social determinants of health are more confident when working with underserved populations. Regarding innovations, there is increasing use of AI in radiology but there are potential biases because of incomplete data. A narrative review explored the contribution of perinatal quality collaboratives on perinatal health equity [62] . These collaboratives are state-based networks of stakeholders in hospitals, health systems, and public health departments. Their aim is to advance maternal equity through improving the quality of care. All 50 USA states belong to these networks. Six equity-promoting quality improvement strategies were documented in the review and used in the collaboratives (ABCDES): Accountability; Buy-in; Collaboration and communication; Data leverage; Education; and Structural changes. Published papers have highlighted the success of this quality improvement approach to reduce or eliminate racial inequities, based on the occurrence of severe maternal morbidity. A study on the quality of antenatal care in 91 low- and middle-income countries revealed that wealthier women were four times more likely to receive high-quality care compared to poorer women [63] . The authors advocated using care quality as a key metric to monitor progress in universal health coverage. Another determinant of health equity is cultural sensitivity. In a viewpoint article on cultural sensitivity in pediatric primary care, [64] noted that the literature on this topic is scarce, whether addressing implicit bias or structural racism, although there are some elements of cultural competency included in medical school curricula. We identified a few reviews on health equity in mental healthcare and care of neurologic conditions [65–67] . Marked inequalities in mental health care in minoritized population groups are widely recognized. Among the contributing factors as reviewed by Asnaani [65] , social determinants of health are important but other drivers are involved, such as discrimination and racism, stigma regarding mental health, and the lack of treatments tested and validated in minoritized groups. Community-based research and community-driven mental health service adaptations are among the strategies identified, as well as task-shifting efforts in domestic and global settings, utilization of technology innovations to promote such work and increase access, and policy efforts. In their scoping review, Boden-Alba;a et al [66] identified various community engagement strategies in the management of conditions such as Alzheimer disease, dementia and Parkinson’s disease that could also apply to mental health care. The strategies included linking with community partners, employing community health workers, recruiting personnel from the community, and caregiver support. A related study is that of [68] who analyzed the role of context and self-determination in promoting overall health of people with intellectual disabilities. The review highlighted the importance of self-determination and the role thereupon of education and financial autonomy. A review examined what is known about the impact of integrated care programs on improving mental health equity, with special emphasis on collaborative care [67] . This review provides evidence that collaborative care is a model that has the potential to reduce disparities for ethnic minority and other at-risk populations who are often poorly served by usual primary care systems, and who have lower engagement and health outcomes because of other underlying risk factors. As a systems-based approach, collaborative care has been shown to also improve the quality of care received and health outcomes. The collaborative care team is led by a primary care provider and includes behavioral health care managers, psychiatrists and frequently other mental health professionals. The team implements measurement-guided care plans based on evidence-based practice guidelines and focuses particular attention on patients not meeting their clinical goals. The reviews on healthcare access barriers and improvement strategies were general [69] or they targeted specific groups, persons with disabilities [70] , indigenous people [71] , and migrants and refugees (in New-Zealand) [72] .Richard et al [69] carried out an environmental scan using an international brief survey to identify innovations in this area according to researchers, practitioners, policy makers and other stakeholders. Over 200 unique innovations to help people living in vulnerable situations to access healthcare were identified. Most innovations addressed supply-side dimensions of access, such as appropriateness and approachability (according to Levesque’s framework [73] , with less focus on demand-side dimensions. Most innovations were funded by governments and were implemented in the realm of community health. Davy et al [71] , in their study including high-income countries, South America and Papua-New Guinea, identified numerous barriers that indigenous peoples face in accessing primary health care, including discrimination, high healthcare costs, and broader social determinants of health such as unemployment. The authors highlighted the need for tailored healthcare services, employing staff from local indigenous communities, providing transport facilities and reducing healthcare costs for low-income individuals. A review on the impact of various reimbursement systems on health equity [74] found that the impact depended on the specific outcomes studied, the context and social factors beyond race or socio-economic status. Designing reimbursement systems that address the greater healthcare needs of underserved populations was recommended. The other reviews on healthcare access [70, 72] focused primarily on barriers - possibly because improvement initiatives are not well documented. Barriers to access by people with disabilities or by immigrants/refugees are considered structural or related to health systems, they are attitudinal, or else they are attributable to social determinants. Among the structural or social barriers, healthcare and specialized equipment costs, language issues (for immigrants and refugees) and logistics constraints are present. Attitudinal barriers include discrimination, negative attitudes, or lack of cultural competence among health care providers. Other health system-related barriers pertain to leadership and policies, as well as the paucity of disaggregated information. The role of the Global Alliance for Vaccines and Immunization (GAVI) initiatives in reducing inequities in vaccine access and immunization has been widely praised. A review showed that GAVI had significantly improved immunization coverage in eligible countries through targeted policies and supply strategies [75] . The paper highlighted, however, that approaches such as tiered pricing have created inequities between GAVI-eligible and ineligible middle-income countries. This was before the COVID-19 pandemic which illustrated inequalities in access to prevention and treatment in a dramatic way. Strategies and proposals to address inequities in testing, vaccines, and treatment for COVID-19 as reviewed by Bell et al [76] included: mobile testing and vaccination centers; at the global level COVAX and Fair Priority model; linguistically and culturally tailored medical care of COVID-19; telemedicine to limit face-to-face interactions; and addressing structural causes of inequities such as racism through whole-of society approaches. However, the real impact of these measures is not documented. Other groups exposed to health inequities are those with marginalized social identities because of race, gender and sexual orientation. In a commentary informed by a literature review on social interventions and inputs from health equity-involved stakeholders, Peek et al [77] listed several recommendations for the Agency for Healthcare Research and Quality to advance health equity in such groups, including: research on SDOH and the effectiveness and implementation of social care interventions in the healthcare sector; to work with other federal agencies to develop complementary approaches addressing social marginalization; and to require social care intervention researchers to use methods that advance our understanding of social health equity. Discussion This scoping review of reviews on actions to improve health equity was undertaken to describe the types of actions, to identify knowledge gaps, and to recommend evidence-based approaches integrating health equity into One Health initiatives. We had initially intended to document the links between, and interconnections of, One Health and health equity initiatives, and to make recommendations to integrate the two, but this intersection was not directly addressed in most reviews. Only two reviews addressed the effects of climate change or CO 2 reduction actions on health inequities [35, 43] . Among the negative impacts of the ongoing climate change and its increasing acceleration, there are changes in food and water supply which hamper nutritional security. Climate and environmental changes induce disproportionate adverse effects on specific populations, which are associated with risks of exacerbating, among others, existing gender and socio-economic inequities. It also affects populations' health outcomes, either directly or indirectly. These range from populations’ physical and mental health and wellbeing to the emergence and distribution of vector-borne disease patterns. As only reviews are included in the present paper, however, relevant intervention studies may have been missed. Additionally, perhaps with additional search terms such as planetary health, climate justice, or environmental health, additional relevant reviews might have been identified. Notwithstanding, this gap underlines the need for health equity concerns to be integrated into One Health endeavors. The One Health approach and its implementation may be challenging and even more so if one attempts to integrate health equity. Four United Nations technical agencies have developed a joint One Health plan of action for the period 2022-2026 [78] . The need for equity is stated but not the strategies. The following cross-table was designed to provide broad examples of interventions addressing various dimensions of One Health and health equity (using the WHO building blocks). Evidently, our review only captured initiatives in human health, that is, the first row of the table, where more specific examples based on the review are added. In this table, we use ‘priority populations’ instead of marginalized, vulnerable, underserved or minoritized groups, as the groups most in need and therefore targeted will depend on the context, and the type of action. Table 2 Health Equity Actions for One Health Governance & policy Information & evidence data Technologies Human Resources Service Delivery Human Health Universal health Insurance Institutional capacity for health equity assessment and Integration into policy Tailoring health literacy initiatives with and for priority populations Disaggregated data according to social determinants of health Community spaces and services with and for priority populations Digital health access for priority populations Inclusive and diversified health workforce Health equity training for health personnel Tailored screening programs for increased access and effective use by priority populations Community-based tailored prevention programs Animal Health Regulation for Standards of Practice for animal health protection with and for priority populations Tailored agriculture and husbandry literacy with and for priority populations Clean and safe drinking and irrigation water with and for priority populations Inclusive and diversified husbandry and harvesting strategies Tailored community-based animal health services with and for priority populations Ecosystem Health Regulation of heavy polluting industries proximal to population centres and related damaged green space Inclusive and diversified environmental outreach initiatives with and for priority populations Tailored measures to adapt to adverse climate events with and for priority populations inclusive and diversified strategies to address the intersecting determinants of an ecosystem Tailored community-based monitoring systems for water quality with and for priority populations Using the WHO building blocks for this matrix, as well as to categorize the reviews we analyzed, helps to better understand key areas for future action and research. For instance, ‘human resources’ was the area with fewer reviews although the critical role of human resources for the delivery of comprehensive healthcare with a focus on social justice was a strong theme across the reviews. Yet institutional capacity to assess health equity or to integrate health equity into practice guidelines was central to some reviews. Gaps were identified in support of a diverse healthcare workforce, especially in relation to Indigenous communities. Training the next generation of healthcare providers, at various levels of the health system, is essential for embedding equity principles within the One Health framework. Only a few reviews reported on the impact of interventions on health equity [24, 25, 32, 35, 56, 71] . Furthermore, multiple definitions of health equity were used, many overlapping, but without real consensus. For instance, health inequities and inequalities are often used interchangeably. We also identified gaps in how healthcare systems currently assess equity, underscoring the need for more robust definitions and tools for measuring and promoting health equity. Braveman's definition [9] was identified as a promising approach to addressing health inequities, particularly when applied alongside the One Health framework. It summarizes three overlapping core principles: (1) social justice; (2) removing obstacles to health for disenfranchised, marginalized, and excluded groups; and (3) addressing all determinants of health, not only health care. Many reviews emphasized the importance of addressing SODH in reducing disparities, notably in managing chronic conditions. The PROGRESS-Plus framework was effective in analyzing social determinants of health inequities. However, its limited assessment of intersectionality, the predominant focus on high-income countries and the omission of, say, structural determinants of health are noted as areas for improvement. Social determinants, but also geopolitical and planetary determinants of health inequities must be increasingly considered [79] . There is a need for further exploration of how economic policies, education, and sociocultural contexts shape healthcare access. Multilevel interventions that address structural determinants are crucial for advancing equity. "Diversity science" was introduced as a framework that, alongside "proportionate universalism," can help bridge the gap between interventions aimed at the general population and those designed for socially disadvantaged groups [80] . Proportionate universalism, which promotes population-wide interventions with additional focus on marginalized communities, is recognized as key to ensuring equitable healthcare access under the One Health framework [81] . The increasing role of digital literacy as a new determinant of health, especially in access to healthcare services, was highlighted in several reviews. Similarly, the role of artificial intelligence (AI) in exacerbating or mitigating inequities was reviewed in at least one paper [46] . AI and its impact on health equity is particularly important in agricultural sectors where One Health interventions are relevant. Reviews demonstrated that a holistic, system-level approach, combined with institutional-level interventions, is necessary to achieve health equity and reduce fragmentation of actions under One Health. The papers emphasized the importance of addressing power imbalances, engaging with communities, and tackling other root causes of health inequities. Local-level approaches were shown to have the potential for systemic impact, particularly in chronic disease management and prevention. However, long-term outcomes of community engagement and local interventions were not thoroughly explored. The role of participatory implementation science in this regard was emphasized [82] . Social needs interventions and neighborhood-scale initiatives - often situated outside formal health systems - can play a critical role in advancing health equity. These strategies resonate with One Health principles by recognizing the interconnectedness of human, animal, and environmental health and the importance of localized responses. The importance of data is stressed in many reviews. Evidence clearinghouses were identified as essential tools for promoting health equity, although challenges remain in ensuring their methods are transparent and equity focused. Disaggregated and context-sensitive health data for identifying and addressing barriers according to specific intersecting demographic factors and social determinants of health such as age, socio-economic and immigration status, sex, gender, and disability are essential, as shown in many of the reviews included in this paper. Disaggregating health data to reveal disparities and tailor policies was seen as vital, though operational barriers, such as data privacy concerns and technological limitations, hinder widespread implementation. Systematic disaggregation of health data is critical for creating evidence-based policies that directly address inequities, aligning with One Health’s integrated, cross-sectoral approach. We also noted that the number of health equity-focused reviews has increased over the last recent years, indicating a growing concern about health inequities which may partly result from the COVID-19 pandemic, even if only one review dealt with inequities in the prevention and treatment of COVID-19 [76] . Most papers were from high-income countries, particularly the USA, where yet little progress in health equity is observed [83] . Only a few reviews included LMICs [18, 36, 49, 63, 72] , where health inequities are likely even more marked and where more equity-focused action is called for. At variance with systematic reviews, scoping reviews do not generally include an assessment of the quality of the selected studies, and this is the case for the present review. According to Grant [84] , this may limit the uptake of the findings into policy and practice. However, the ongoing consultation with stakeholders may confer additional meaning and applicability to the scoping study and indeed, this consultation is considered by Levac, Colquhoun and O’Brien [14] as the last stage of the process and as a knowledge transfer mechanism. Conclusion Our scoping review of reviews on actions to improve health equity highlights the need for clearer, more nuanced definitions of health equity within One Health contexts. Without empirical evidence, it remains challenging to establish best practices for integrating health equity into One Health interventions. 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Doyle SK, Chang AM, Levy P, et al. Achieving Health Equity in Hypertension Management Through Addressing the Social Determinants of Health. Curr Hypertens Rep 2019; 21: 58. Cykert S. A Path Toward Health Care Equity: System-Based Interventions for Change. N C Med J 2022; 83: 178–181. Ukke GG, Boyle JA, Reja A, et al. Lifestyle Interventions to Prevent Type 2 Diabetes in Women with a History of Gestational Diabetes: A Systematic Review and Meta-Analysis through the Lens of Health Equity. Nutrients 2023; 15: 4666. Nelson HD, Cantor A, Wagner J, et al. Achieving Health Equity in Preventive Services: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med 2020; 172: 258–271. Washington A, Smith L, Randall J, et al. A Systematic Review of the Effectiveness of Cervical Cancer Screening and Prevention Interventions for African American Women: Implications for Promoting Health Equity. J Womens Health 2002 2024; 33: 409–425. Lopez-Suarez N, Abraham P, Carney M, et al. Practical Approaches to Advancing Health Equity in Radiology, From the AJR Special Series on DEI. Am J Roentgenol 2023; 221: 1–10. Meadows AR, Byfield R, Bingham D, et al. Strategies to Promote Maternal Health Equity: The Role of Perinatal Quality Collaboratives. Obstet Gynecol 2023; 142: 821–830. Arsenault C, Jordan K, Lee D, et al. Equity in antenatal care quality: an analysis of 91 national household surveys. Lancet Glob Health 2018; 6: e1186–e1195. Kibakaya EC, Oyeku SO. Cultural Humility: A Critical Step in Achieving Health Equity. Pediatrics 2022; 149: e2021052883. Asnaani A. What role can (and should) clinical science play in promoting mental health care equity? Am Psychol 2023; 78: 1041–1054. Boden-Albala B, Rebello V, Drum E, et al. Use of Community-Engaged Research Approaches in Clinical Interventions for Neurologic Disorders in the United States. Neurology 2023; 101: S27–S46. Jackson-Triche ME, Unützer J, Wells KB. Achieving Mental Health Equity: Collaborative Care. Psychiatr Clin North Am 2020; 43: 501–510. Malou V, Batselé É, Rinaldi R, et al. PROMOTION DE LA SANTÉ GLOBALE ET APPROCHE SOCIO-ÉCOLOGIQUE DE L’AUTODÉTERMINATION CHEZ LES PERSONNES PRÉSENTANT UNE DÉFICIENCE INTELLECTUELLE : UNE REVUE SYSTÉMATIQUE DES INTERVENTIONS. Rev Francoph Défic Intellect 2020; 30: 15–28. Richard L, Furler J, Densley K, et al. Equity of access to primary healthcare for vulnerable populations: the IMPACT international online survey of innovations. Int J Equity Health 2016; 15: 64. Gréaux M, Moro MF, Kamenov K, et al. Health equity for persons with disabilities: a global scoping review on barriers and interventions in healthcare services. Int J Equity Health 2023; 22: 236. Davy C, Harfield S, McArthur A, et al. Access to primary health care services for Indigenous peoples: A framework synthesis. Int J Equity Health 2016; 15: 163. Kanengoni-Nyatara B, Watson K, Galindo C, et al. Barriers to and Recommendations for Equitable Access to Healthcare for Migrants and Refugees in Aotearoa, New Zealand: An Integrative Review. J Immigr Minor Health 2024; 26: 164–180. Levesque J-F, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health 2013; 12: 18. Tao W, Agerholm J, Burström B. The impact of reimbursement systems on equity in access and quality of primary care: A systematic literature review. BMC Health Serv Res 2016; 16: 542. Gandhi G. Charting the evolution of approaches employed by the Global Alliance for Vaccines and Immunizations (GAVI) to address inequities in access to immunization: a systematic qualitative review of GAVI policies, strategies and resource allocation mechanisms through an equity lens (1999–2014). BMC Public Health 2015; 15: 1198. Bell K, White S, Diaz A, et al. Can evidence drive health equity in the COVID-19 pandemic and beyond? J Public Health Policy 2024; 45: 137–151. Peek ME, Gottlieb LM, Doubeni CA, et al. Advancing health equity through social care interventions. Health Serv Res 2023; 58: 318. FAO, UNEP, WHO, et al. One Health Joint Plan of Action, 2022–2026 . FAO ; UNEP ; WHO ; World Organisation for Animal Health (WOAH) ;, https://openknowledge.fao.org/handle/20.500.14283/cc2289en (2022, accessed 5 February 2025). Persaud A, Bhugra D, Valsraj K, et al. Understanding geopolitical determinants of health. Bull World Health Organ 2021; 99: 166. Clark US, Hurd YL. Addressing racism and disparities in the biomedical sciences. Nat Hum Behav 2020; 4: 774–777. Carey G, Crammond B, De Leeuw E. Towards health equity: a framework for the application of proportionate universalism. Int J Equity Health 2015; 14: 81. Ramanadhan S, Alemán R, Bradley CD, et al. Using Participatory Implementation Science to Advance Health Equity. Annu Rev Public Health 2024; 45: 47–67. Benjamin GC, DeVoe JE, Amankwah FK. Ending Unequal Treatment and Achieving Optimal Health for All. JAMA . Epub ahead of print 9 September 2024. DOI: 10.1001/jama.2024.14268. Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Inf Libr J 2009; 26: 91–108. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6024650","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":477799157,"identity":"6acf73f1-2c17-448b-a677-a038558c51e9","order_by":0,"name":"Delisle Hélène","email":"data:image/png;base64,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","orcid":"","institution":"University of Montreal","correspondingAuthor":true,"prefix":"","firstName":"Delisle","middleName":"","lastName":"Hélène","suffix":""},{"id":477799158,"identity":"97f93a8b-d484-4dc4-b755-8b12197e8fb4","order_by":1,"name":"Ingabire Angélique","email":"","orcid":"","institution":"University of Montreal","correspondingAuthor":false,"prefix":"","firstName":"Ingabire","middleName":"","lastName":"Angélique","suffix":""},{"id":477799159,"identity":"30edefb9-3489-4ec6-90a7-3f79c1ea3b7b","order_by":2,"name":"Søvold Lene","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Søvold","middleName":"","lastName":"Lene","suffix":""},{"id":477799160,"identity":"1669c6d8-3bdf-44b3-ba7f-9e1d108a0aca","order_by":3,"name":"Vissandjee Bilkis","email":"","orcid":"","institution":"University of Montreal","correspondingAuthor":false,"prefix":"","firstName":"Vissandjee","middleName":"","lastName":"Bilkis","suffix":""}],"badges":[],"createdAt":"2025-02-13 16:08:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6024650/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6024650/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85815995,"identity":"5e4d2868-1249-4ed3-9294-43afb406dd07","added_by":"auto","created_at":"2025-07-02 05:33:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":64230,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of paper selection\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6024650/v1/eaba2464b48d2986554ca462.png"},{"id":85816513,"identity":"3f35ced8-8bd8-42bd-945e-a6c883ce68c5","added_by":"auto","created_at":"2025-07-02 05:41:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1797291,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6024650/v1/b99b2990-4305-40c6-bdd3-e697d7e3e90e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Reviews on interventions for health equity with a One Health focus","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePlanetary health is far from a reality, with increased disease burden, the threats associated with climate change, conflicts in several parts of the world, and persistent inequities. The One Sustainable Health (OSH) for All Forum was launched in 2021 to promote a transdisciplinary \u0026ldquo;One Health / Planetary Health\u0026rdquo; approach in line with the 2030 Sustainable Development Goals (SDGs). \u0026lsquo;\u003cstrong\u003e\u003cem\u003eOne Health\u003c/em\u003e\u003c/strong\u003e\u0026rsquo; is an integrative, collaborative, multisectoral, and transdisciplinary approach to pursuing optimal health. It integrates optimal health of people, animals, plants, and their shared environment at local and global levels. \u0026lsquo;One \u003cstrong\u003e\u003cem\u003eSustainable\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eHealth\u0026rsquo; emphasizes the need to address the long-term impacts of policies and practices across human, animal, and planetary health. Central to the concept of \u0026lsquo;One Sustainable Health \u003cstrong\u003e\u003cem\u003efor all\u003c/em\u003e\u003c/strong\u003e\u0026rsquo; is health equity, which implies fair access of all human beings to quality health-related services and the health outcomes achieved. Inherent concepts are \u0026lsquo;Universal Health Coverage\u0026rsquo; and \u0026lsquo;Leaving No One Behind\u0026rsquo;. Universal health coverage (UHC) is a concept and goal that claims that all individuals and communities should receive the health services they need without suffering debilitating financial hardship \u003cstrong\u003e[1]\u003c/strong\u003e . UHC is firmly based on the 1948 WHO Constitution, which declares health a fundamental human right and commits to ensuring the highest attainable level of health for all. It includes the full spectrum of essential, quality health services, encompassing health promotion and prevention, treatment, rehabilitation, and palliative care across the life course.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs part of one of the nine OSH working groups\u0026rsquo; activities\u003csup\u003e\u003csup\u003e[1]\u003c/sup\u003e\u003c/sup\u003e, a scoping review of initiatives to improve health equity was undertaken to describe the different types of health equity actions, to identify knowledge gaps and to recommend evidence-based approaches integrating health equity and One Health. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe \u0026lsquo;One Health\u0026rsquo; (OH) approach is a holistic and system-based approach that recognizes the interconnection between health of humans, animals and ecosystems \u003cstrong\u003e[2]\u003c/strong\u003e.\u003cem\u003e\u0026nbsp;\u003c/em\u003eThe approach mobilizes multiple sectors, disciplines and communities at varying levels of society to work together to foster well-being and tackle threats to health and ecosystems. Collaboration is a key principle of the OH and equity must be prioritized in OH implementation to ensure the active participation of vulnerable groups \u003cstrong\u003e[3]\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eHealth equity and One Health initiatives can enhance the ability to meet the health-related SDGs, especially in reducing health disparities and addressing global health threats\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e[4, 5]\u003c/strong\u003e . Almost all SDGs are connected to health, and some in a direct manner: SDG 2 Zero hunger; SDG 3 Good health and well-being; SDG 5 Gender equality; SDG 6 Clean water and sanitation; SDG 10 Reduced inequalities; SDG 11 Sustainable cities and communities; and SDG 13 Climate action.\u003c/p\u003e\n\u003cp\u003eHealth equity generally refers to the absence of unfair and avoidable differences in health among population groups defined socially, economically, demographically, and/or geographically\u003cstrong\u003e[6]\u003c/strong\u003e .\u003c/p\u003e\n\u003cp\u003eConversely, WHO\u0026nbsp;\u003cstrong\u003e[7]\u003c/strong\u003e defines health inequities as differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work, and age. The term \u0026lsquo;global health equity\u0026rsquo; can also be used to describe equitable health as a key outcome of global health activities\u0026nbsp;\u003cstrong\u003e[8]\u003c/strong\u003e . Health equity covers not only health but its determinants \u0026nbsp;\u003cstrong\u003e[9]\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIncreased focus on health equity is important, given that there are population groups who systematically experience lower access to health services, lower health status, limited well-being outcomes, and higher exposure to risks and stressors in many countries all over the world\u0026nbsp;\u003cstrong\u003e[10]\u003c/strong\u003e. For instance, persons living with disabilities \u0026ndash; 16% of the world population -, experience a life expectancy shortened by 10-20 years as they are more exposed\u0026nbsp;\u003cstrong\u003e[11]\u003c/strong\u003e \u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe recent COVID-19 pandemic dramatically showed that mortality and morbidity followed a social gradient\u0026nbsp;\u003cstrong\u003e[12]\u003c/strong\u003e . Profound inequalities in access to the COVID-19 vaccines and the adverse consequences including in mental health were also highlighted.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e\u003csup\u003e[1]\u003c/sup\u003e\u003c/sup\u003e Working group on Equitable access to health-related services. The other groups focus on: Environmental health; Sustainable food systems; One health and urban settings; Financing for sustainable health; Governance and policy; Education and communication; One health next generation; and One health in humanitarian settings.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eThe initial\u0026nbsp;literature search on health equity actions was conducted in June 2022 and a search update\u0026nbsp;in April 2024. Only papers in English or French were included. We used the following databases: PubMed; Embase (Elsevier); APA PsycInfo; CINAHL; \u0026Eacute;rudit; Global Health; Social Sciences Abstracts; Sociological Abstracts; and Web of Science (WoS). The final\u0026nbsp;concept plan and the search words are given in the appendix. Because of the action focus, the search strategy was to include issues, inputs, and potential outcomes, which are represented in the three columns.\u003c/p\u003e\n\u003cp\u003eA total of 830 papers were identified, out of which 295 were retained owing to the focus on action (Figure). Based on abstracts, we excluded papers only describing health inequities, duplicates, study protocols, research only papers, and articles without full online access. The first author selected the papers and validated them with at least one research team member. The 295 selected papers included 233 individual studies and 62 reviews. The present scoping review covers these review papers, whether standard reviews or overviews based on the literature. The first author selected the papers and the selection was validated by at least one research team member.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe WHO building blocks for assessing health system performance\u003cstrong\u003e[13]\u003c/strong\u003e were adapted to classify the reviews into six key areas: Governance and policy; information and evidence data; technologies; human resources and capacity building; and health-related service delivery. The scoping review method followed the stages of the framework by Levac, Colquhoun and O\u0026rsquo;Brien \u003cstrong\u003e[14]\u003c/strong\u003e . The table used to extract the data from each selected review paper was developed by the research team (see Table 1). A narrative overview of the breadth of the initiatives reviewed under each key area is presented in the results, followed by a thematic discussion leading to recommendations to link one health and health equity actions.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOur review showed that predominant actions taken to foster health equity were centered around health service delivery (26/62): primary healthcare, as well as specialized medical care, preventive services, maternal care, access to vaccines specifically for COVID-19, and mental health. Marginalized or underserved groups such as indigenous people, refugees and immigrants, ethnic minorities, and persons with disabilities were targeted in several reviews. Thirteen reviews addressed health equity through governance and policy, including practice guidelines, policy reforms, addressing the social determinants of health (SDOH), and organization capacity assessment. The reviews on information and evidence data (N=7) focused on methods to assess and report the impact of interventions on health equity; two reviews addressed the effects of climate change and CO\u003csub\u003e2\u003c/sub\u003e reduction actions on health inequities; these were the only ones that considered the ecosystems, beyond human health. Eleven reviews on technologies pertained to digital health equity, healthcare algorithms, and the role of Artificial Intelligence (AI). The reviews on human resources and equity (N=5) referred to the training of nurses, other health professionals, and community health workers, as well as community participation. Details on the reviews are provided in Table 1 and an overview by key area is given below.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1. Summary of studies included in the review\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.\u0026nbsp; \u0026nbsp;Governance and policy\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"1021\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eAuthors and title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eObjectives\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eTheme/ focus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eMethods\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eFindings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eRecommendations by authors\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eArcaya, Ellen and Steil (2024) Neighborhoods and health: Interventions at the neighborhood level could help advance health equity [13]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1) To critically review the relationships between neighborhoods and health; 2) to discuss policy responses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eSocial determinants of health (SDH): neighborhoods (USA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eOverview of the topic, without a strict methodology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eNeighborhood can contribute to health and well-being in different ways:\u003c/p\u003e\n \u003cp\u003e1) Institutions, e.g., number and quality of healthcare facilities\u003c/p\u003e\n \u003cp\u003e2) Physical characteristics, which affect safety, ability to engage in physical activity, access to healthy foods\u003c/p\u003e\n \u003cp\u003e3) Social conditions, e.g., violence, networks, segregation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003ePolicy responses include better enforcement of fair housing laws, reforms to land use, and housing choice vouchers. Other measures to advance health equity include policy change to strengthen communities\u0026rsquo; social and physical infrastructure, and in particular, community-led initiatives to change material and social conditions, with explicit or non-explicit health promotion goals.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eJindal et al (2024) Policy solutions to eliminate racial and ethnic disparities in childhood in the USA [15]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo critically review policies that reinforce and perpetuate health disparities in children, and key policy solutions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eSocial determinants of health: housing, economic opportunity and employment, health insurance, the\u003c/p\u003e\n \u003cp\u003ecriminal legal system, and immigration (USA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eNo description of the search method. For each social sector, landmark articles are stated and examples of inequities are provided.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eHousing quality, cost and segregation all have an impact on children\u0026rsquo;s opportunities and health. Black and Asian children have less social mobility. Racial income gaps persist across generations unless targeted interventions are implemented.\u003c/p\u003e\n \u003cp\u003eThe US justice system is racially biased, including for youth. Immigrant-related policies which increase eligibility for employment, education and access to resources, termed inclusive policies, have been associated with better pediatric health outcomes.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eThere is a great need for political will to improve racial/ethnic child health equity. Investing in the SDHs could improve safety and reduce incarceration, which is racially biased. The funding of Immigrant-led and\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ecommunity organizations that support immigrant communities, providing language, food, legal, after-school, and health services, should be prioritized.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMcMillan-Boyles et al (2023) Representations of clinical practice guidelines and health equity in healthcare literature: An integrative review [18]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo explore how equity is discussed in\u003c/p\u003e\n \u003cp\u003ethe health literature in relation to clinical practice guidelines (CPG)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eClinical practice guidelines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eIntegrative review, with literature search in PubMed, CINAHL, Cochrane, EMBase, Medline, and Web of Science. Equity in CPG development, implementation and evaluation was documented.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e139 papers published between 2010 and 2022 were screened and 19 were included in the review. CPGs can exacerbate health inequities if the resources and services outlined are not readily available and accessible. How health equity is integrated into CPG development is problematic, and the use of existing tools and checklists is challenging.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eEquity should be clearly articulated into CPG at the outset of their development and throughout the different phases. \u0026nbsp; \u0026nbsp; Otherwise, the ability of health care professionals to implement the CPGs effectively and provide equitable health services may be hindered.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eShaver et al (2023) Health equity considerations in guideline development:\u003c/p\u003e\n \u003cp\u003ea rapid scoping review [19]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo synthesize current\u003c/p\u003e\n \u003cp\u003ebest practices for integrating health equity into guideline development, and the benefits or drawbacks of these practices\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eGuideline development\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eA \u0026lsquo;rapid\u0026rsquo; scoping review, with some components of the scoping review omitted or simplified. Scientific and grey literature papers were screened.\u003c/p\u003e\n \u003cp\u003eThe results were organized in four phases of guideline development: planning, evidence review, development and dissemination.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e26 articles proposed best practices for incorporating\u003c/p\u003e\n \u003cp\u003ehealth equity within guideline development. Equity guidance strategies were available for all four phases, and advantages and disadvantages were summarized. There are too many exemplary practices to summarize them here.\u003c/p\u003e\n \u003cp\u003eGaps were identified, for instance, no equity related\u003c/p\u003e\n \u003cp\u003eguidance was captured to identify or report on conflicts of interest.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eGuideline developers should consider the use of guideline\u003c/p\u003e\n \u003cp\u003echecklists and tools to implement health equity\u003c/p\u003e\n \u003cp\u003epromoting practices throughout guideline development. Any equity framework or plan should be developed in partnership with experts in the field of\u003c/p\u003e\n \u003cp\u003ehealth equity, as well as health system stakeholders and community organizations.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eLee‑Foon et al. (2023) Saying and doing are different things: a scoping review on how health equity\u003c/p\u003e\n \u003cp\u003eis conceptualized when considering healthcare system performance [16]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo explore how healthcare systems around the world conceptualize equity when considering healthcare\u003c/p\u003e\n \u003cp\u003esystem performance.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eHealthcare system performance \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eLevac\u0026rsquo;s [. \u0026nbsp;] scoping review approach was used to locate relevant articles and develop a protocol. The peer-reviewed articles included were published between 2015 to 2020, Oral health and clinical training were excluded.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eOf the 16 studies included, six were from North America, six from Europe and one each from Africa, Australia, China and India. Quantitative or qualitative studies centered on: indicators; equity policies; evaluating the equitability\u003c/p\u003e\n \u003cp\u003eof healthcare systems; creating and/or testing equity tools; and using patients\u0026rsquo; sociodemographic characteristics to examine healthcare system performance. The definitions of equity varied widely, ranging from no definition to distributional fairness of healthcare services to populations with differing levels of disadvantage. All papers acknowledged that social determinants of health affected patients\u0026rsquo; health and their outcomes in various healthcare settings.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eMore research is needed to better understand the lack of consensus and how to ensure researchers are truly assessing the state of equity\u003c/p\u003e\n \u003cp\u003ein their respective healthcare systems. More research should also be conducted to see if the impact of racism is being captured when assessing healthcare system performance. Additional resources are needed to address many of the social determinants of health that healthcare systems may have the capacity to address\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMarcus, Monga Nakra N and Pollack Porter KM (2024)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCharacterizing organizational health equity capacity assessments for public health organizations: a scoping review [21]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo identify and\u003c/p\u003e\n \u003cp\u003echaracterize existing\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eorganizational health equity capacity assessments (OCAs).\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eHealth equity performance assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eThe standard scoping study framework was used: identifying the research question and relevant\u003c/p\u003e\n \u003cp\u003estudies; selecting studies; charting the data; collating and summarizing the results; and validating the findings with\u003c/p\u003e\n \u003cp\u003epractitioners.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e17 OCAs were included. Most aimed to provide considerations or strategies to increase organizational\u003c/p\u003e\n \u003cp\u003ehealth equity capacity or readiness and can be used repeatedly to monitor progress.\u003c/p\u003e\n \u003cp\u003eMany OCAs lack specific definitions of organizational\u003c/p\u003e\n \u003cp\u003ehealth equity capacity.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eFuture publications and case studies should include data related to OCA implementation, including capacity findings, implementation lessons learned, and resources required, where possible.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eContextual information should be included in OCA publications, if possible.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eThornton et al (2023)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAddressing population health inequities: investing\u003c/p\u003e\n \u003cp\u003ein the social determinants of health for children\u003c/p\u003e\n \u003cp\u003eand families to advance child health equity [17]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo provide a critical assessment of recent pediatric population health research with a specific\u003c/p\u003e\n \u003cp\u003efocus on child health equity, and to address the role of the healthcare sector in addressing\u003c/p\u003e\n \u003cp\u003efundamental social drivers of health.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eAddressing the SDOH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eOverview without a defined methodology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eThe overall emphasis in the SDOH literature in pediatric populations focuses on\u003c/p\u003e\n \u003cp\u003ethe processes surrounding implementation: screening,\u003c/p\u003e\n \u003cp\u003euptake, response, and referral. What is less clear\u003c/p\u003e\n \u003cp\u003eis whether screening accurately identifies social\u003c/p\u003e\n \u003cp\u003eneeds or improves overall health outcomes. Healthcare system efforts to identify and address individual needs are important but approaches\u003c/p\u003e\n \u003cp\u003ecentered on the individual level put the burden on patients and caregivers to disclose unmet needs in healthcare setting.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eScreening and responding\u003c/p\u003e\n \u003cp\u003eto urgent health related social needs and changing the\u003c/p\u003e\n \u003cp\u003esocial conditions that impact population health require a closer examination of systemic factors that produce certain patterns of disparities within the overall population.\u003c/p\u003e\n \u003cp\u003eSocial needs interventions\u003c/p\u003e\n \u003cp\u003eneed to pay attention to systems and structures and to explicitly recognize race and racism as key social determinants of health.\u003c/p\u003e\n \u003cp\u003eSignificant investments are needed in affordable housing, early childhood and universal pre-school programs, mental\u003c/p\u003e\n \u003cp\u003ehealth support, and other upstream contributors to health outcomes. Researchers should\u003c/p\u003e\n \u003cp\u003epartner with community\u003c/p\u003e\n \u003cp\u003eorganizations and policymakers to address root causes of health inequities. Value-based payment innovation to address SDOH has the potential to move investments upstream.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eReichman et al (2021)\u003c/p\u003e\n \u003cp\u003eUsing rising tides to lift all boats: Equity-focused quality improvement as a tool to reduce neonatal health disparities [24]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo provide a broad overview of neonatal health disparities scholarship, review the potential impact of Quality Improvement (QI) work on health disparities, and provide a framework for centering\u003c/p\u003e\n \u003cp\u003eneonatal QI endeavors around equity.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eImprovement of quality of care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eOverview without a defined methodology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eInfants of color experience significantly higher rates of low birthweight, preterm birth, and neonatal mortality compared to White infants. Geographic location also plays a role, with disparities in mortality and neonatal care quality observed between urban and rural areas, and even within different neighborhoods of the same city. The quality of care varies significantly between hospitals, contributing to disparities. Black and Hispanic infants are more likely to receive care in lower-quality hospitals, which exacerbates outcomes. There are also significant differences in neonatal mortality rates among different Asian subgroups and Hispanic subgroups, which are often overlooked. Other parental attributes may also contribute to disparities but are under-researched in neonatal care. QI methodologies can inadvertently exacerbate disparities if not explicitly designed to focus on equity.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eEight foundational concepts for designing and executing Equity Focused Quality Improvement (EF-QI) projects:\u003c/p\u003e\n \u003cp\u003e1. Foster a culture of equity\u003c/p\u003e\n \u003cp\u003e2. Identify the disparities\u003c/p\u003e\n \u003cp\u003e3. Incorporate equity in QI design\u003c/p\u003e\n \u003cp\u003e4. Involve families and community partners\u003c/p\u003e\n \u003cp\u003e5. Consider alternative comparator groups\u003c/p\u003e\n \u003cp\u003e6. Focus on root causes\u003c/p\u003e\n \u003cp\u003e7. Adapt data visualization tools\u003c/p\u003e\n \u003cp\u003e8. Disseminate data with equity in mind.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003ePlamondon et al (2019) Connecting knowledge with action for health equity: a critical interpretive synthesis of promising practices [14]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo critically examine promising and\u003c/p\u003e\n \u003cp\u003eempirically-derived strategies for advancing productive action on the root causes of health inequities.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eMulti-disciplinary practices\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eA critical interpretive synthesis of empirical studies and literature reviews published whose authors framed health inequities as having known causes.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e16 papers were included. Four groups of promising practices were identified: (re) structuring systems, working relationally, doing research, and\u003c/p\u003e\n \u003cp\u003ecarrying out knowledge translation. Restructuring systems involves the explicit analysis of power. Deploying social determinants of health nurses within the healthcare system was a key determinant of the efficacy and direction of the health equity work. Working relationally means fostering inclusion and connectedness, and mitigating power imbalances. In research, a promising practice was identified as embracing complexity in health equity work. Regarding knowledge translation, blending numbers with human experience was deemed promising. However, there were few studies examining how to advance health equity at an institutional or societal level.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eCross-sectoral partnerships are needed since many structural determinants of health lie outside the health sector. Such partnerships also need to be studied: there is a gap in the literature.\u003c/p\u003e\n \u003cp\u003eThere is a need for capacity to recognize how societal structures, including dominant social values such as individualism and bio-behaviourism can promote actions that are directly in conflict with the evidence about root causes of health inequities.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eJensen, Kelly and Avendano (2022). Health equity and health system strengthening \u0026ndash; Time for a WHO re-think [20]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1) To provide a critical reading of key policy documents and secondary literature to trace the conceptual and normative development of health equity as a guiding principle of WHO; 2) To highlight the limitations in the current conceptualization of equity in the framework of health system strengthening at the WHO.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eThe concept and practice of health equity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eAn overview without a defined methodology\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eThe authors argue for the importance of re-considering what health equity implies in the context of health systems strengthening (HSS). Tracing the conception of equity at key periods in WHO\u0026rsquo;s history, they cautioned against increasingly unidimensional conceptions of equity; as being a problem of either unequal access to specific healthcare services, or the differential health impacts of specific health interventions. They argue that a HSS agenda that focuses predominantly on improving health service delivery falls short of considering the structural political, social and economic dimensions that drive and sustain ill health and health inequities worldwide.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eThe authors point to potential avenues of interrogation:\u003c/p\u003e\n \u003cp\u003e1.The need to replace simplistic standardised frameworks to measure equity with broadened frameworks that identify intersecting forms of social disadvantage in particular contexts.\u003c/p\u003e\n \u003cp\u003e2. A first step in rethinking equity could involve addressing the equity questions that arise in relation to health workers in the context of HSS.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3. The need to re-focus attention onto the imbalances in resources and power and forms of oppression that undergird health inequities \u0026ndash; and shape the global health field itself.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eSumah, Baatiema and Abimbola (2016) The impacts of decentralisation on health-related equity: A systematic review of the evidence [22]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo review \u0026nbsp; \u0026nbsp; the implications of decentralised governance of health care on equity in health, health care and health financing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eEquity in health and healthcare\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eA systematic search of reviews that examined entire health systems and the relationship between implementing decentralised governance and health-related equity. The quality of reporting of the included studies was assessed.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eOnly 9 papers (out of 808) met the inclusion criteria. The included studies were mostly explorative and used a range of quantitative techniques to analyse the relationship between variables of interest. The impact of decentralisation on inequities in health and health care depends on pre-existing socio-economic disparities and financial barriers to access. While decentralisation can lead to inequities in health financing between sub-national jurisdictions, this is minimised with substantial central government transfers and cross subsidisation. The effect of decentralisation on health-related equity can be best characterised as mixed.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eThe need for central coordination in decentralised health systems is paramount to define health system goals and outline the broad framework for their achievement when designing policy interventions. Equally important is the need for mechanisms to redistribute income to assuage disparity in financing health care between regions. Further research should look at comparative country study of decentralised and centralised national health systems.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBurstr\u0026ouml;m et al (2017). Equity aspects of the Primary Health Care Choice Reform in Sweden -- a scoping review. [23]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo review the existing evidence of the impact of a recent Primary Health Care (PHC) Choice Reform on health equity, and to\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eIdentify the gaps in the current literature.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003ePHC policy reform\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eA scoping review to evaluate the equity aspects of the PHC reform in Sweden,\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eThe studies to date indicate that the PHC Choice Reform, as implemented, increased access to PHC and increased the average number of visits to PHC, but seems to have particularly\u0026nbsp;benefited those in more affluent groups and with lower health care needs.\u003c/p\u003e\n \u003cp\u003eThe PHC Choice Reform has made integrated care for those with complex needs more difficult.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eThe PHC Choice Reform may have damaged equity of primary health care provision, contrary to the tenets of the Swedish Health and Medical Service Act. This situation needs to be carefully monitored. Further studies are needed to follow up on the long-term impacts of the reform on the structure, process, and outcomes of PHC in Sweden and how different types of reimbursement systems may modulate these impacts.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eSpitzer-Shohat and Chin \u0026nbsp;(2019) The \u0026ldquo;Waze\u0026rdquo; of Inequity Reduction Frameworks for Organizations: a Scoping Review [25]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo identify existing frameworks focused on reducing inequities in patient care and outcomes;\u003c/p\u003e\n \u003cp\u003eTo assess to what extent the frameworks address key organizational change elements.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eTools for organizations to become more equitable\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eA scoping review to evaluate the implementation of frameworks that guide organizations to make care and outcomes more equitable for patients. The analyses were conducted on context, processes, outcomes and time, that is, the four constructs of organizational change.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e14 frameworks and models were analyzed, all of them from rich countries. They were developed by governments, healthcare associations, not-for-profit associations, and academia. Most frameworks did not guide the translation of equity across multiple organizational departments and levels. Existing equity intervention frameworks often lack specific guidance for implementing organizational change. Most frameworks primarily focused on the organization\u0026rsquo;s outer context through the analysis of data on race and ethnicity. \u0026nbsp;Two frameworks recognize the importance of existing culture: the CLAS (Culturally and Linguistically Appropriate Services Standards), and the Disparity Leadership Program. \u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMost frameworks address the implementation process at the macro level, but the Roadmap to Reduce Disparities model offers change directives not only on the macro level, but also the meso and micro levels. Regarding outcomes, the Achieving Health Equity framework suggests measuring performance for individual\u0026nbsp;socio demographic attributes. The measurements are combined into a summary index, which is then compared with the best health level among all groups as reference.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eProviding organizations clear, effective, and concrete guidance has great potential from improving health equity. Frameworks should include guidelines on assessment of inner organization context parameters such as readiness for change. Organizations also require specific guidance on how to implement equity within and across all organizational levels. Guidance for institutionalization and sustainability are crucial. Future frameworks should assess the inner organizational context to guide the translation of programs across different organizational departments and levels and provide specific guidelines on institutionalization and sustainability of interventions.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e2. \u0026nbsp; Information and evidence data\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"1002\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAuthors and title\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTheme/ focus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFindings\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRecommendations by authors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e60. Hirsch\u003csup\u003e\u0026nbsp;\u003c/sup\u003eStevenson \u0026amp; Givens (2023)\u003c/p\u003e\n \u003cp\u003eEvidence clearinghouses as tools to advance health equity: What we know from a systematic scan [26]\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo explore how clearinghouses communicated an intervention\u0026rsquo;s health equity impact and to review their health equity definition and underlying methods.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eInforming on health equity impact\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eA systematic scan, a comprehensive directory of clearinghouses and a comparative analysis of clearinghouses with publicly available health equity impact reviews on their websites.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eThe authors identified 18 clearinghouses that were USA-focused, web-based registries of interventions that assigned an effectiveness rating for improving community health and the social determinants of health. Only 7 clearinghouses summarized an intervention\u0026rsquo;s potential impact on health equity. However, they defined and operationalized equity differently, and most lacked transparency in their review methods. One or more approaches were used to communicate the findings: summarize study findings on differential impact for subpopulations, curate interventions that reduce health disparities, and/or assign a disparity/equity rating to each intervention.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003eAdvancing equity through an evidence- informed approach will require researchers to conduct more equity-focused research and clearinghouses to evolve as practice-oriented tools with health equity impact reviews based on clear and transparent underlying definitions, values and methods\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e62. Hollands et al (2024) Methods used to conceptualize dimensions of health equity impacts of\u003c/p\u003e\n \u003cp\u003epublic health interventions in systematic reviews [27]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1)To identify and summarize methods, frameworks, and tools used as a conceptual basis for investigating\u003c/p\u003e\n \u003cp\u003edimensions of equity impact of public health interventions; 2)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTo document\u003c/p\u003e\n \u003cp\u003echallenges and opportunities encountered in the application of such methods, as reported in the systematic reviews.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eAssessment of health equity impacts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eAn overview of systematic reviews with a focus on the equity impacts of public health interventions.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eElectronic searches of the Cochrane Database of Systematic Reviews, the Database of Promoting Health Effectiveness Reviews (DoPHER), the Finding Accessible Inequalities Research in Public\u003c/p\u003e\n \u003cp\u003eHealth Database, and the automated searches of the Open Alex dataset.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eThe majority of reviews originated from European countries, especially the UK. 37.5% used PROGRESS-Plus. Some reviews adapted PROGRESS-Plus with additional dimensions linked to equity.\u003c/p\u003e\n \u003cp\u003ePlanned methods for conceptualizing equity impacts were fully applied in less than half of the reviews. The primary reasons for the incomplete application were the lack of necessary information in primary studies, a lack of included studies, inadequate study quality, and low heterogeneity by key dimensions.\u003c/p\u003e\n \u003cp\u003eMeasurement issues related to dimensions of equity impact were a notable problem, the primary concern being the difficulty of investigating constructs that lack standardized definitions, operationalization, and ultimately measurement, particularly for socioeconomic status and closely related concepts.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003ePrimary studies need to collect and report equity-related data consistently.\u003c/p\u003e\n \u003cp\u003eSupport from research funders, regulators, and scientific journals is necessary. Standardized guidelines and practical guidance are needed to operationalize and analyze equity dimensions consistently. Broader conceptual frameworks, such as socioecological models, may better capture complex and intersecting pathways of inequities.\u003c/p\u003e\n \u003cp\u003eMore explicitly rationalized and considered approaches to the design, conduct, and reporting of primary research and systematic reviews are necessary to address these challenges.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e64.Hosseinpoor et al (2023)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eStrengthening and expanding health inequality monitoring for the advancement\u003c/p\u003e\n \u003cp\u003eof health equity: a review of WHO resources\u003c/p\u003e\n \u003cp\u003eand contributions [28]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo review WHO\u0026rsquo;s work on health inequality monitoring, and to demonstrate how this multi-\u003c/p\u003e\n \u003cp\u003efaceted\u003c/p\u003e\n \u003cp\u003estrategy and associated resources can accelerate\u003c/p\u003e\n \u003cp\u003ehealth inequality monitoring practices among Member States and raise the profile of global evidence on health\u003c/p\u003e\n \u003cp\u003einequalities.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eHealth\u003c/p\u003e\n \u003cp\u003einequality monitoring\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eA review of various strategies, resources, and tools developed by WHO including the overview of the 2022-2027 Inequality Monitoring and Analysis Strategy, specific goals, activities, and resources: manuals, workbooks, eLearning courses, workshops, and software applications like the Health Equity Assessment Toolkit (HEAT).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eThe Inequality Monitoring and Analysis Strategy has 3 goals: strengthening the capacity for health inequality monitoring; generating and disseminating high-quality evidence on health inequality; and developing and refining health inequality monitoring methods, tools, resources, and best practices\u003c/p\u003e\n \u003cp\u003eGuiding material for health inequality monitoring includes manuals and accompanying workbooks, the Health Inequality Monitoring eLearning channel, and capacity building workshops.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHEAT and HEAT Plus is a free and open-source software application that facilitates the assessment of within-country\u003c/p\u003e\n \u003cp\u003ehealth Inequalities using disaggregated data. The Health Inequality Data Repository is the largest collection of publicly available disaggregated data about health and its determinants.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003eTo use the evidence generated from health inequality monitoring to inform and guide policy changes and program improvements.\u003c/p\u003e\n \u003cp\u003eTo utilize WHO resources and tools to improve data collection, analysis, and reporting.\u003c/p\u003e\n \u003cp\u003eTo use WHO\u0026rsquo;s eLearning courses and workshops for continuous learning and capacity building.\u003c/p\u003e\n \u003cp\u003eTo encourage the integration of health inequality monitoring into routine health information systems and research initiatives.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e114.Pearson et al (2023) Climate Change and Health Equity: A Research Agenda for Psychological Science [33]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo examine the role of climate change as a\u003c/p\u003e\n \u003cp\u003eunique source and magnifier of health inequities,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eand consider mediating psychological processes that\u003c/p\u003e\n \u003cp\u003emay fuel and magnify health inequities\u003c/p\u003e\n \u003cp\u003eConsider the\u003c/p\u003e\n \u003cp\u003einfrastructure needed to speed the development and adoption\u003c/p\u003e\n \u003cp\u003eof science and community-informed solutions, including\u003c/p\u003e\n \u003cp\u003eperspectives of communities.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eClimate change and health inequities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eOverview without a defined methodology. The authors extend on two existing frameworks (social vulnerability, and direct and indirect effects of climate change on health and well-being) to\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eGlobally, small island nations and indigenous communities are among the most affected by climate change. At the same time, these communities play a central role in managing earth\u0026rsquo;s ecosystem Inequities can stem from both adaptation and mitigation policies that\u003c/p\u003e\n \u003cp\u003eare designed without considering or including vulnerable groups. Three systemic factors shape climate health equity: structural racism, segregation and displacement. \u0026nbsp;Misperception of climate health risk and social vulnerability is an additional factor.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003eThe intersection of climate change and health inequities presents\u003c/p\u003e\n \u003cp\u003enew challenges and opportunities for health intervention that\u003c/p\u003e\n \u003cp\u003ewill require new research infrastructure, collaborations, and\u003c/p\u003e\n \u003cp\u003etraining initiatives. Climate interventions\u003c/p\u003e\n \u003cp\u003ethat address existing inequities may be more effective in mitigating climate change than those that fail to take health inequities into account. Highlighting cobenefits of climate measures that improve health outcomes and reduce inequities can\u003c/p\u003e\n \u003cp\u003ehelp secure public support for climate action. A \u0026ldquo;whole-of-science\u0026rdquo; approach is needed to address climate-related health inequities.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e25.Cen\u0026eacute; et al (2023) Racial health equity and social needs interventions\u003c/p\u003e\n \u003cp\u003ea review of a scoping review [30]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo understand how studies of interventions addressing social needs among multiracial\u003c/p\u003e\n \u003cp\u003eor multiethnic populations conceptualize and analyze differential intervention outcomes by race or ethnicity\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eSocial needs interventions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eA rapid review, with specific methodological adjustments: reliance on existing searches for the evidence map; no second review of the risk of bias; single reviewer recheck of data for subgroup or effect modification\u003c/p\u003e\n \u003cp\u003eanalyses; focused data extraction outcomes; no strength of evidence grading; and a primarily narrative or qualitative synthesis. The focus was on studies in multiracial or multiethnic populations to examine differential intervention outcomes by race or ethnicity.\u003c/p\u003e\n \u003cp\u003eThe review developed and applied a simple framework of conceptual thoughtfulness and analytical\u003c/p\u003e\n \u003cp\u003einformativeness to understand how social needs interventions may advance racial health equity.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eAmong 152 studies, 44 (28%) included race or ethnicity in their analyses. Only 9% of the 44 studies were considered conceptually thoughtful, explaining race as a proxy for exposure to racism.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFew studies (21 [14%]) conducted race or ethnicity\u0026ndash;stratified analyses that were considered analytically informative for advancing health equity research, with 14 reporting no differences. Of the 7 that did report differences, 3 had mixed outcomes and 4 found interventions benefited minoritized populations more and provided conceptually thoughtful explanations for race as a proxy for root causes of racial health inequities. Nearly 9 in 10 (86%) of the 152 studies in multiracial or multiethnic populations did not examine whether intervention effects differed by race or ethnicity.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003eContinued education on the need to provide theory-driven conceptualizations of race and ethnicity, the risks of not doing so, and standard guidance on where such descriptions should be provided. Adoption of the authors\u0026rsquo; innovative two-concept framework for assessing a study\u0026rsquo;s contribution to racial health equity \u0026nbsp;(conceptually thoughtful, analytically informative). The proposed framework should be Incorporated into standards for systematic reviews on health equity. Journals should revise instructions to emphasize handling race and racism from conceptualization through data analyses and interpretation.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e48. Garrett et al (2023) Antibias efforts in United States maternity care: A scoping review of the publicly-funded health equity intervention pipeline [31]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo investigate whether recent national public funding reflects the heightened priority of the increase in public and governmental support for antibias and antiracism interventions; to identify and characterize publicly funded interventions designed to reduce bias, racism, and discrimination among maternal healthcare providers in the United States.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eReducing bias and racism in maternal healthcare\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eA community-guided rapid scoping review to\u003c/p\u003e\n \u003cp\u003echaracterize new antibias research.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eThe search for publicly funded grants was conducted in the Dimensions database, a comprehensive registry of federal, public/private, and large philanthropic grantees.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eOnly four of 508 projects met the search criteria, featuring an intervention to reduce bias or racism in maternal healthcare providers. One of the projects proposes a \u0026ldquo;racial equity training\u0026rdquo; for perinatal care clinicians to benefit Black women receiving prenatal care. A second project proposes to deliver antiracism training to medical providers to reduce Black and African American patients\u0026rsquo; experiences of racism or mistreatment and promote respectful maternity care. A third project proposes a five-year, multilevel intervention co-developed with community partners to reduce the rate of maternal morbidity and mortality among Medicaid-insured African American women by intervening at various levels, including antibias training at the provider/ practice level for physicians, midwives, hospital administrators, and front desk staff. The fourth project implements an \u0026ldquo;interactive racial equity training\u0026rdquo; designed to help prenatal clinic staff to recognize their implicit biases and understand how racism affects pregnancy care for patients of color.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003eThe reviewed projects employ promising and innovative components such as community-based participatory research, but there is little material in support of intervening on racial bias. Several gaps were identified, e.g., how best to develop and implement bias training, and what is their impact on patient outcomes. Philanthropically funded and community-grounded work will be important to help bridge this knowledge gap.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eLarge funders should support iterative national reviews of emergent research and convene multiple sectors\u0026mdash;including policymakers, payers, providers, community members, and patients\u0026mdash;to align interventions and policies with new evidence while centering on the needs of Black women, birthing people, and others harmed by bias and racism in the healthcare system.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e124.Ramanadhan et al (2023)\u003c/p\u003e\n \u003cp\u003eUsing participatory\u003c/p\u003e\n \u003cp\u003eimplementation science to\u003c/p\u003e\n \u003cp\u003eadvance health equity [29]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo provide guidance on the principles and practice of participatory implementation science (IS); to introduce readers to the value of participatory approaches for strengthening sustainable\u003c/p\u003e\n \u003cp\u003eimplementation of health-related evidence-based interventions; to provide a framework for applying the\u003c/p\u003e\n \u003cp\u003eprinciples, practices, and lessons from participatory research to IS; and to outline challenges and considerations for optimizing the potential of participatory IS.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eParticipatory approach to implementation science\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eDetailed objectives but no methodology\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eTraditional IS often lacks a focus on health inequities and typically uses a top-down approach, whereas participatory IS emphasizes iterative co-creation of knowledge and action, integrating diverse perspectives, including those from lived experiences. The participatory approach enables researchers, community members, and other relevant actors to work together, generate knowledge and drive change. It also decentralizes dominant perspectives to address health inequities and explicitly engages with issues of power\u003c/p\u003e\n \u003cp\u003eand representation to facilitate the meaningful participation of marginalized groups in creating\u003c/p\u003e\n \u003cp\u003etransformational knowledge and change. It\u0026nbsp;focuses on relevant evidence, deeper understanding of local contexts, and building capacity and solutions for health issues. Additionally, it values the research process and aims to advance justice, inclusion, and equity. Participatory IS moves beyond making EBIs work, deploying implementation efforts to reshape systems and intervention contexts in ways that center equity. However, participatory IS requires time and resources, and engagement.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 218px;\"\u003e\n \u003cp\u003eTo optimize participatory Implementation Science (IS): Assessing team readiness and engaging in critical reflexivity considering how team members\u0026apos; roles and social positions impact research\u0026mdash;is crucial;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNavigating tensions between world views within teams to prevent frictions and misunderstandings;\u003c/p\u003e\n \u003cp\u003eAligning projects with broader perspectives; And\u003c/p\u003e\n \u003cp\u003edeveloping measures to advance the evidence base for participatory IS.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e3. \u0026nbsp; Technologies and Tools\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"1011\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAuthors and title\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTheme/ focus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFindings\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRecommendations by authors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e130.Rojas‑\u003c/p\u003e\n \u003cp\u003eRueda, McAuliffe and Morales-Zamora (2024)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAddressing Health Equity in the Context of Carbon Capture,\u003c/p\u003e\n \u003cp\u003eUtilization, and Sequestration Technologies [41]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo describe the role of health equity in the context of carbon capture, utilization, and sequestration\u003c/p\u003e\n \u003cp\u003e(CCUS) technologies.\u003c/p\u003e\n \u003cp\u003eSpecifically, to identify recent finding related to the implementation of CCUS technologies and their impacts on social determinants of health and discuss the challenges and opportunities related to health equity.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eClimate change technologies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eLiterature review and reports on CCUS technologies. No defined methodology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eCCUS technologies have the potential to both improve and worsen health equity. They could help reduce greenhouse gas emissions, a major contributor to climate change, but they could also have negative health impacts like air and noise pollution.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eEfforts to reduce carbon emissions should prioritize the needs and perspectives of the most vulnerable populations and ensure that the benefits and burdens of carbon reduction policies not only are distributed equitably but also contribute to restoring relationships with and opportunities for historically marginalized groups.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eThe effective deployment of CCUS technologies requires a critical assessment of their potential impacts on public health and environmental equity. Decision-makers\u003c/p\u003e\n \u003cp\u003emust confirm aggressive climate mitigation policies are already in place before considering CCUS as part of a comprehensive emission reduction strategy.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eRabet R et al (2024) Barriers and facilitators to digital primary health care access in immigrant and refugee populations: a scoping review [34]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo identify: 1) The barriers and facilitators for access to digital primary health care among immigrants and refugees\u003c/p\u003e\n \u003cp\u003e2) The primary health care needs addressed through digital modalities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003ePrimary health care access through digital health technology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eScoping review of qualitative studies in high and in low or middle-income countries. Levesque\u0026rsquo;s model [71] was used to examine approachability, acceptability, availability/accommodation, affordability and appropriateness.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e25 papers were included. The flexibility of digital modalities was a facilitator, but older age or limited digital literacy skills were barriers. Social networks (family, community) were important to support this access. Immigration systems play a role by affecting living conditions and financial means of these groups. Privacy and data security are major concerns and can be important \u0026nbsp;barriers for these groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eSocial assistance programs and affordable housing schemes can provide refugees and immigrants with safe living arrangements, income support and digital technologies.\u0026nbsp;Providing digital literacy programs and use of cheaper and accessible forms of technology such as text messaging and audio-calling are also recommended. Research should explore how the personal data of those with precarious status are managed and develop guiding principles for digital health applications among these groups.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e24. Cary et al (2023)\u003c/p\u003e\n \u003cp\u003eMitigating racial and ethnic bias\u003c/p\u003e\n \u003cp\u003eand advancing health equity in clinical algorithms: a scoping\u003c/p\u003e\n \u003cp\u003ereview [42]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo review health care applications, frameworks, reviews and perspectives,\u003c/p\u003e\n \u003cp\u003eand assessment tools that identify and mitigate bias in clinical\u003c/p\u003e\n \u003cp\u003ealgorithms, with a specific focus on racial and ethnic bias.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eDiscrimination and bias\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eComprehensive, multidisciplinary scoping review of tools, frameworks, reviews and perspectives on bias mitigating strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e109 studies were included; reviews and perspectives were the most frequent type. Several mitigation strategies were identified. The technical strategies pertained to various stages of the algorithm development process. The operational strategies included governance, design principles and the engagement of multidisciplinary teams. System-wide strategies included training and education on risk of bias, collaborative platforms, and development of standards. No consensus on a single best practice was found.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eTo ensure professional diversity; To require auditable clinical algorithms; \u0026nbsp;To foster transparent organizational culture; To implement health equity by design; To accelerate research; To establish governance structures; and to amplify patients\u0026rsquo; voices.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFuture research should identify optimal bias mitigation methods for various scenarios, depending on factors such as patient\u003c/p\u003e\n \u003cp\u003epopulation, clinical setting, algorithm design, and types of bias to be addressed.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e45. Fisher et al (2023) Occupational safety and health equity impacts of artificial\u003c/p\u003e\n \u003cp\u003eintelligence: a scoping review [44]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo summarize the recent literature on the way in which Artificial Intelligence (AI) can reduce or exacerbate inequities in occupational safety and health (OSH).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eArtificial intelligence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eScoping review adapting PRISMA and designed around three concepts: artificial intelligence, occupational safety and health (OSH), and\u003c/p\u003e\n \u003cp\u003ehealth equity. Research questions were: How can AI be used to promote OSH equity? How does Ai present barriers and challenges to OSH equity? What are best practices to address emerging OSH equity challenges related to AI?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e112 papers included.\u003c/p\u003e\n \u003cp\u003eCertain communities take on a higher burden of dangerous\u003c/p\u003e\n \u003cp\u003ework and traumatic injuries (in construction, transportation, mining). By reducing exposure to hazardous conditions in these\u003c/p\u003e\n \u003cp\u003eindustries, AI has the potential to reduce occupational health inequities for workers from these communities. Algorithmic integrity in the form of proper systems to curb the\u003c/p\u003e\n \u003cp\u003emishandling and misuse of received data is necessary in order to reduce bias. The digital divide mainly affects individuals from low-resourced communities. Increases in depression, suicide, and alcohol and\u003c/p\u003e\n \u003cp\u003edrug abuse, including opioid-related death, may occur, exacerbating health inequities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eAn ethical code or framework for justice in AI development and implementation\u003c/p\u003e\n \u003cp\u003ewas frequently recommended in the literature, and would facilitate OSH equity. AI\u0026rsquo;s role in OSH equity is vastly understudied. An urgent need exists\u003c/p\u003e\n \u003cp\u003efor multidisciplinary research that addresses where and how AI is being adopted and evaluated\u003c/p\u003e\n \u003cp\u003eand how its use is affecting OSH across industries, wage categories, and sociodemographic groups.\u003c/p\u003e\n \u003cp\u003eOSH professionals can play a significant role in identifying strategies that ensure the benefits of AI in\u003c/p\u003e\n \u003cp\u003epromoting workforce health and wellbeing are equitably distributed.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e116. Petretto et al (2024) Telemedicine, e-health, and digital health equity: a\u003c/p\u003e\n \u003cp\u003escoping review [35]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eThe research questions were: How did previous papers: 1) define and describe digital health equity (DHE) \u0026nbsp;in telemedicine and e-health\u003c/p\u003e\n \u003cp\u003e2) describe barriers and risk factors in the promotion of DHE in those e-environments;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3) describe the advantages of the use of telemedicine and e-health for the promotion of\u003c/p\u003e\n \u003cp\u003eDHE; and\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4) describe ways to improve equity in e-health and telemedicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eDigital health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eA scoping review using the PRISMA-ScR guidelines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e31 papers were included: editorials, commentaries, viewpoints and only a few research papers.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAn interesting one is the distinction of 3 levels of digital divide: lack of access, lack of skills, and lack of possibility to use the tools for one\u0026rsquo;s health. The digital divide or disadvantage is the consequence of the interaction between any person and an environment that is \u0026ldquo;not sufficiently equipped to promote health equity\u0026rdquo;.\u003c/p\u003e\n \u003cp\u003eThe role of\u003c/p\u003e\n \u003cp\u003etelemedicine and e-health in reducing the gap in access\u003c/p\u003e\n \u003cp\u003eto health services\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eis widely recognized. The digital and the social determinants of health interact to increase or reduce digital health equity.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eIt is useful to list the reasons/variables that can\u003c/p\u003e\n \u003cp\u003efacilitate the occurrence of the condition of disadvantage.\u003c/p\u003e\n \u003cp\u003eThere is a need to have an overall and integrated\u003c/p\u003e\n \u003cp\u003epicture of all these variables, a multilevel complex model\u003c/p\u003e\n \u003cp\u003eof \u0026ldquo;telemedicine and e-health ecosystem\u0026rdquo;. Government, scientific societies, stakeholders,\u003c/p\u003e\n \u003cp\u003eand health policymakers may have a central role in planning and implementing specific interventions to\u003c/p\u003e\n \u003cp\u003epromote digital health equity, providing system-level changes according to the chosen multilevel complex model.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e136. Sharrief et al (2023) Telehealth trials to address health equity in stroke survivors [36]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo review the telehealth advantages and barriers for the chronic care of stroke survivors and to discuss strategies\u003c/p\u003e\n \u003cp\u003eto address barriers to telehealth use in stroke patients with adverse social determinants of health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eTelehealth (or tele-medicine) for stroke care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eReview without description of the methods\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eTelestroke has increased access to acute stroke care for populations at risk for poor outcomes. However, the use of telehealth applications for expanding access to other aspects of stroke patient care and for reducing disparities in stroke outcomes has been under-studied. Telehealth for the ambulatory care of various chronic diseases (heart failure, diabetes, Parkinson\u0026rsquo;s disease, neurological diseases) was usually found to be as effective as in-person care. However, the results of telehealth care on health inequities among groups at higher outcome risk has not been studied.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eTelehealth for transitional and chronic care of stroke survivors with a higher proportion of adverse social determinants of health (economic instability, low educational attainment, low health literacy, and low levels of social support) may help to address access- related issues and therefore holds promise for addressing disparities in stroke outcomes. However, the need for a patient to\u003c/p\u003e\n \u003cp\u003eaccess care via telehealth requires digital literacy, consistent telephone and internet access,\u003c/p\u003e\n \u003cp\u003eand increasingly, the ability and willingness to engage with the electronic medical record through patient portals. There are also health system barriers, such as billing restrictions. it is\u003c/p\u003e\n \u003cp\u003eessential that systems be built with health equity in mind.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e151. Vakkalenka et al (2024) Telehealth Use and Health Equity for Mental Health and Substance\u003c/p\u003e\n \u003cp\u003eUse Disorder During the COVID-19 Pandemic:\u003c/p\u003e\n \u003cp\u003eA Systematic Review [38]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo evaluate health equality in clinical effectiveness\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eand utilization measures associated with telehealth for clinical management of mental health disorders and substance use disorders and to identify under-represented groups.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eDigital health for mental disease and drug abuse\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eSystematic review using relevant elements of PRISMA guidelines. Studies on tobacco cessation only or neurocognitive conditions (e.g., dementia, Alzheimer\u0026rsquo;s disease, autism) were excluded. Overall, the most common dimensions captured included race/ethnicity or gender. Risk of bias was also assessed.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e25 studies were included, 20 of which on mental health. All 25 evaluated synchronous, direct-to-consumer video telehealth. These conditions in themselves reflect underserved and marginalized populations. Most studies identified that telehealth implementation suffered from significant and widening disparities for\u003c/p\u003e\n \u003cp\u003edisadvantaged populations, including rural populations, older\u003c/p\u003e\n \u003cp\u003epatients, and racial/ethnic minorities.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eIf the technological\u003c/p\u003e\n \u003cp\u003evehicle used to address inequities further propagates a digital\u0026nbsp;\u003c/p\u003e\n \u003cp\u003edivide, policymakers should examine individual-, innovation-, and system-level implementation processes and policies\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ethat promote or hinder equity in adoption, utilization, and\u003c/p\u003e\n \u003cp\u003eclinical effectiveness. Future efforts should focus on measuring the contribution of utilization disparities on outcomes and strategies to mitigate disparities in implementation.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eCampanozzi et al (2023) The role of digital literacy in achieving health equity in the third millennium society: a literature review [40]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo assess the extent of the impact of digital literacy on access to telemedicine services\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eAccess to digital health services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eReview, with the search covering 2011-2022. Databases for the gray literature were omitted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e37 articles were included. The importance of digital literacy for the equitable distribution of health services in the third millennium is recognized. Ensuring equity of access to digital health must be a priority felt by the various stakeholders. It is essential to develop screening tools that can accurately identify the population groups in need of digital literacy interventions.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eIt is not only important to implement digital education programs that can bridge as much of the \u0026ldquo;digital divide\u0026rdquo; as possible, but it is equally important to plan for evaluation studies of the effectiveness of such programs in the immediate future.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eHynie et al (2023) Access to virtual mental healthcare and support for refugee\u003c/p\u003e\n \u003cp\u003eand immigrant groups: a scoping review [39]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo explore the potential\u003c/p\u003e\n \u003cp\u003eof increased access through virtual mental healthcare services (VMHS) for these populations using the patient-centred model of Levesque [71]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eAccess to virtual mental health care\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eA scoping review from November 2020\u003c/p\u003e\n \u003cp\u003ethrough October 2021.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eThe authors investigated the accessibility (affordability, availability/accommodation, appropriateness, and acceptability) of virtual mental health services for immigrants, refugees, and asylum seekers.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e2561 abstracts were reviewed, and 40 unique interventions identified. Studies include cultural adaptations, feasibility/pilot studies, usability studies, and formative evaluations.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNature of Interventions: primarily mental health interventions, diagnostic assessment studies, screening tools, and user-testing of interventions. Delivery modalities were web/mobile apps primarily, video calls, phone interventions, tablet-based, and text-based.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAccessibility depended on individual (e.g., literacy), program (e.g., computer required) and contextual/ social factors (e.g., housing\u003c/p\u003e\n \u003cp\u003echaracteristics, internet bandwidth). Participation often required financial and technical support, raising important questions about the generalizability and sustainability of VMHS\u0026rsquo; accessibility for immigrant and refugee populations.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eThe importance of more implementation research was highlighted. \u0026nbsp; \u0026nbsp; Unique barriers determined by systemic, contextual, clinical and personal characteristics for immigrant and refugee populations were identified. Such obstacles warrant further attention. It is proposed that working with the intended user population on the planning and delivery of virtual mental health services will help increase accessibility for these populations, both now and in the future.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eBakken et al (2019). Behavioral interventions using consumer information technology as tools to advance health equity [37]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo demonstrate the use of mHealth, telehealth, and social media as behavioral intervention platforms in health disparity populations, to identify challenges to achieving their use, to describe strategies for overcoming the challenges, and to recommend future directions.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eConsumer information technology (CIT) for behaviour change\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eLiterature and case examples are summarized. A substantial number of systematic reviews and meta-analysis assessed the quality of intervention studies and the evidence across studies was synthesized, particularly randomized controlled trials, to advance CIT-enabled interventions.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eThe examples presented suggest that mHealth, telehealth, and social-media-enabled behavioral interventions, particularly the multicomponent interventions, show promise and in some instances influence health outcomes of interest in health disparity populations.\u003c/p\u003e\n \u003cp\u003eThe challenges in the design, implementation and evaluation of CIT-enabled behavioral interventions with health disparity populations are described.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eFuture directions include improved design methods,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eenhanced research reporting. advancement of multilevel interventions, rigorous evaluation, efforts to address privacy concerns, and inclusive design and implementation decisions, and to advance multilevel interventions by linking mHealth and social media-enabled interventions with healthcare delivery system. Also, to evaluate mHealth, telehealth, and social media-based interventions throughout the stages of developing and implementing the CIT-enabled intervention. Furthermore, to make design and implementation decisions that foster the inclusion and sustained engagement of health disparity populations in CIT-enabled intervention studies, and to address user privacy concerns.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eSiddique et al (2024) The Impact of health care algorithms on racial and ethnic disparities: a systematic review [43]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo examine: 1) The evidence on whether and how healthcare algorithms (aggravate, perpetuate, or reduce racial and ethnic disparities in access to healthcare,\u003c/p\u003e\n \u003cp\u003equality of care, and health outcomes; and 2) \u0026nbsp;Strategies that mitigate racial and ethnic bias in the development and use of algorithms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eImpact of healthcare algorithms on racial and ethnic disparities in health\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eSystematic review\u003c/p\u003e\n \u003cp\u003eusing predefined criteria to assess one or both key questions: the effect of algorithms on racial and ethnic disparities in healthcare and outcomes, and the effect of strategies or approaches to mitigate racial and ethnic bias in the development validation, dissemination, and implementation of algorithms.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eThe review includes 63 studies in the USA, out of which 49 pertain to mitigating strategies. The most common algorithms evaluated kidney function and cardiovascular risk. Strategies involved removing, adding, or changing variables.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eThe algorithms can affect racial and ethnic disparities in health care (and outcomes) even if race and ethnicity are explicit inputs. Evidence suggesting that algorithms may reduce disparities, perpetuate or exacerbate them, or not affect them was found. Most studies reported that mitigation strategies reduced racial and ethnic disparities in care. However, there were wide variations in the populations and diseases considered.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eInvesting in further research to assess the real-world effect of algorithms on racial and ethnic disparities before widespread implementation is recommended.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e4. \u0026nbsp; Human resources\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"1021\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAuthors and title\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTheme/ focus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFindings\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRecommendations by authors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2. Adams et al. (2023)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eIntegrating nurse practitioners into primary healthcare to advance health equity through a social justice lens:\u003cbr\u003e\u0026nbsp;An integrative review \u0026nbsp;[45]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo develop a framework to guide the successful integration of nurse practitioners (NPs) into practice settings and, working from a social justice lens, deliver comprehensive primary healthcare which advances health equity\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eWorkforce issues: integrating nurse practitioners (NPs) into primary healthcare (PHC)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eAn integrative review, a method that allows for the combination of diverse review methodologies. \u0026nbsp;PRISMA guidelines were also followed. Data were extracted and thematically analysed using NVivo.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e28 articles were included. Six themes were identified at the individual (micro), local health provider (meso), and national systems and structures (macro) levels of the health sector: (1) autonomy and agency; (2) awareness and visibility; (3) shared vision; (4) leadership; (5) funding and infrastructure; and (6) intentional support and self-care\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eBased on this the authors developed a framework to guide the integration of NPs into PHC.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eThe proposed framework based on the review and the six identified themes is to support the integration of NPs into PHC settings where they can optimize their scope of practice and deliver healthcare services that improve healthcare access and health outcomes to achieve equity. The framework should be tested in practice in a range of settings and adapted to meet the local context, community needs and the NP workforce capabilities.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eWorking with communities and co-designing health service delivery with other health and social agencies is critical if local community health needs are to be met and disparities eliminated.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e52. Graefe et al (2024) Advancing health equity in prelicensure nursing curricula: findings from a critical review [46]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo determine the extent to which health equity concepts are explicitly present in prelicensure undergraduate nursing curricula globally.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eWorkforce related issues: training of nurses\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eCritical review.\u003c/p\u003e\n \u003cp\u003eHealth equity content was categorized based on the Commission on Social Determinants of Health (CSDH) framework categories\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e20 unique studies were included and reviewed.\u003c/p\u003e\n \u003cp\u003eFrequency and quantity of health equity content, concepts and topics, teaching strategies, evaluation strategies, and the overall extent of integration varied widely. Only two papers described overall well‐integrated explicit health equity content, and there was little attention to whether students transferred this learning into practice. A focus on individualism rather than population and community was noted.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eThe findings suggest there is a gap (and need of) health equity content\u0026nbsp;throughout the nursing curriculum. The authors argue that such an intervention could help nursing students understand the root causes of health outcomes beyond the individual and intermediary levels and prepare nurses to enter practice with a critical awareness of social and systemic health barriers (e.g., whiteness) and facilitators (e.g., community strength and healing) that influence health and illness. Additional content related to governance and policy, history and historic context, and cultural and social values is needed. Nursing faculty and program directors should critically review their curriculum, courses, assignments, and clinical placements to identify strengths and opportunities for improvement.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eChandler et al (2022) Training public health students in racial justice and health equity: a systematic review [48]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo identify approaches,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eprograms, pedagogical methods, and curricula that exist to support the training of US public health students in understanding racism as structural determinant of health. The purpose is to address racial disparities in healthcare settings and practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eRacism as a determinant of health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eA systematic review of peer-reviewed literature following the Systematic Reviews and Meta-Analyses (PRISMA) guidelines.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eOnly 11 examples of peer-reviewed articles were found on curricula, lessons and competencies developed to better understand racism as a structural determinant of health. Programs included workshop or seminars, and went from 90-minute workshops to semester-long courses. Materials and resources included in-person presentations, music, artistic material, YouTube videos, a local museum, documentaries, television shows, and toolkits. Six out of the eleven programs included some form of evaluation. However, existing peer-reviewed literature provides little pedagogical guidance to inform schools on how to teach about racism and health equity.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eThere is little consensus on how best to teach about racism. More research on public health pedagogy on structural racism is needed.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSchools and programs of public health must explain the social, political, and economic determinants of health and how they contribute to population health and health inequities.\u003c/p\u003e\n \u003cp\u003eThe article suggests more systematic and rigorous approaches to public health pedagogy, including through the development of competency-based models and learning communities on evidence-based education. More research is needed to document how to educate public health students on the health issues such as racial disparities they will address in their practice.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eAhmed et al (2022)\u003c/p\u003e\n \u003cp\u003eCommunity health workers and health equity in low- and middle-income countries: systematic review and recommend-ations for policy and practice [47]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo synthesize research findings on:\u003c/p\u003e\n \u003cp\u003eEffectiveness of community health workers (CHWs) interventions at reaching more disadvantaged groups in low- and middle-income countries (LMICs);\u003c/p\u003e\n \u003cp\u003eEvidence on whether and how these programs reduce health inequities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eWorkforce: CHW-led programs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eThe \u0026ldquo;equity stratifiers\u0026rdquo; of the PROGRESS framework, such as race, gender, religion, social capital, etc., are used to assess the impact of CHWs\u0026rsquo; interventions on inequities.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e167 studies were included, carried out in 33 LMICs; 72 were qualitative. Only eight studies were high-quality randomized trials.\u003c/p\u003e\n \u003cp\u003eThe results suggest that CHW programmes achieved greater equitability in service delivery than outcomes. Regarding service delivery, pro-equity findings outnumbered anti-equity findings across several stratifiers, but some marginalized groups are still being excluded. Pro-equity outcomes outnumbered the anti-equity ones only for gender and occupation; equitable service delivery did not always translate into improved outcomes.\u003c/p\u003e\n \u003cp\u003eCHW programs may also influence health equity through CHW advocacy, investment of their personal resources, or hiring of CHWs in disadvantaged groups. However, they often have poor working conditions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eTo reduce inequities of access to health services, several recommendations are made according to major equity stratifiers, such as:\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-Place of residence: transportation for CHWs and patients; \u0026nbsp; \u0026nbsp; -Socio-economic status: food parcels as part of CHWs services and financial incentives for those most in need; -Gender: division of tasks between male and female CHW; -Education: the use of illustrated informative material to serve low-education people; -Minority race or ethnic groups: recruiting CHWs within the minority group; -Social capital: CHWs accompanying the patient to the health facility or writing a referral slip; -Occupation: adjusting CHW schedule to fit with those of working patients.\u003c/p\u003e\n \u003cp\u003eIt is important to also consider intersectionality in (for instance, gender intersecting with poverty and rural remoteness),\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eCurtis et al (2019) Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition [49]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eRedefining cultural safety to achieve health equity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eSocial determinants of health (violent\u003c/p\u003e\n \u003cp\u003ecolonial history and current racism) and health systems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eA literature review of 59 international articles on the definition of cultural competency and cultural safety published between 1989 and 2018.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eThis review and analysis were conducted from an Indigenous research position that draws from Kaupapa Māori theoretical and research approaches\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eEquitable care is further compromised by\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ethe paradox of well-intentioned physicians providing inequitable care:\u003c/p\u003e\n \u003cp\u003epoor communication,\u003c/p\u003e\n \u003cp\u003ea lack of partnership via participatory or shared decision-making, a lack of respect, familiarity or affiliation and an overall lack of trust.\u003c/p\u003e\n \u003cp\u003eCultural safety requires health providers to question their own biases, attitudes, assumptions, stereotypes and prejudices that may be contributing to a lower quality of healthcare for some patients.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eHealth practitioners, healthcare organisations and health systems need to be engaged in working towards cultural safety as defined by patients and communities, and critical consciousness rather than narrow cultural competency. The objective of cultural safety activities also needs to be clearly linked to achieving health equity.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCultural safety activities should extend beyond formal training curricula or acquiring knowledge about other cultures. The framing of cultural safety requires a focus on power relationships and inequities within healthcare interactions.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e5. \u0026nbsp; Service delivery\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"1021\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAuthors and title\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTheme/ focus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFindings\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRecommendations by authors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e83. Lopez et al (2023) Achieving health equity in the care of patients with heart failure [50]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo discuss the prevailing racial and ethnic disparities in\u003c/p\u003e\n \u003cp\u003eheart failure (HF) care by identifying barriers to equitable care and proposing\u003c/p\u003e\n \u003cp\u003esolutions for achieving equitable outcomes\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eService delivery, heart failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eThe review method is not described. From prevention to advanced interventions, current efforts are described and recommendation made for improvement.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u0026nbsp;Racial and ethnic disparities prevail throughout the entire spectrum of HF care, from prevention to implementation of guideline-directed medical therapy and advanced interventions. Factors such as differential distribution of risk factors, poor access to care, inadequate representation in clinical trials, and discrimination from healthcare clinicians, among others, contribute\u003c/p\u003e\n \u003cp\u003eto these disparities.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eThis review emphasizes the importance of a multifaceted approach involving policy changes, quality improvement strategies, targeted interventions, and intentional community engagement. The authors proposed a framework integrating equity into routine quality improvement efforts, tailoring interventions to specific populations, and advocating for policy transformation.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e84. Lopez et al (2024) Health equity and policy considerations for pediatric and adult congenital heart disease care among minoritized populations\u003c/p\u003e\n \u003cp\u003ein the United States [51]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo review the existing disparities among marginalized or racially minoritized populations with congenital heart disease in the USA and to propose solutions; To critically\u003c/p\u003e\n \u003cp\u003eexamine multilevel factors and health policies that continue to drive health inequities, including\u003c/p\u003e\n \u003cp\u003evarying social determinants of health (SDOH), systemic inequities, and structural racism.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eService delivery, heart failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eThe precise methodology for this comprehensive review is not described. After documenting the causes of disparities throughout the lifespan of minoritized populations with congenital heart disease in the USA, potential solutions for the various minoritized populations taken separately are exposed. The review addresses\u003c/p\u003e\n \u003cp\u003esystem-level health policies that impact on reimbursement and research funding, as well as institutional policies that impact\u003c/p\u003e\n \u003cp\u003eleadership diversity and representation in the workforce\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eThis review describes the challenges facing various population groups with congenital heart disease: Native, Black, Latino, LGBTQ and persons with disabilities.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eDisparities begin as early as prenatal care, with lower prenatal screening rates and poorer health outcomes among minoritized groups. Insurance status and maternal education play significant roles in these disparities. Disinvestment in marginalized communities leads to poorer education, income, and healthcare access, contributing to higher mortality rates and persistent health disparities in CHD populations. Conditions of reimbursement, including\u003c/p\u003e\n \u003cp\u003elower reimbursement rates for pediatric care exacerbate disparities. Minoritized groups are underrepresented in medicine, particularly in pediatric cardiology, impacting patient care and health outcomes\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eA wealth of solutions are proposed at the system and institutional level. Only those at\u003c/p\u003e\n \u003cp\u003esystem level are mentioned here. Solutions for American Indian/Alaska native (AI/AN) populations include: a policy to encourage Indigenous sovereignty, preserving culture, language, and community, and supporting the funding and structure of programs, including home visitation programs. Potential solutions for non-Hispanic Black populations include: improved neighborhood conditions, food assistance programs, and improved health literacy. Solutions for Hispanic/Latino populations are to expand Medicaid for children and provide translation services. For other groups: prohibit discrimination in health insurance and integrate LGBTQ health content into medical curricula and ensure healthcare accessibility and support insurance coverage for persons with disabilities.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e96. McNeill et al (2023) Uses of social determinants of health data\u003c/p\u003e\n \u003cp\u003eto address cardiovascular disease and\u003c/p\u003e\n \u003cp\u003ehealth equity: a scoping review [53]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo explore what and how social determinants of health data are being used to address cardiovascular disease and improve health equity; To \u0026nbsp;identify gaps in evidence by focusing on the\u003c/p\u003e\n \u003cp\u003eways in which SDOH data have been applied to improve\u003c/p\u003e\n \u003cp\u003eCVD outcomes, largely in the United States but\u003c/p\u003e\n \u003cp\u003ealso in other high-income countries.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eSocial determinants of health\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eA scoping review including studies published between 2014 and 2022, involving adult populations, and containing data related to SDOH and outcomes related to CVD.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eThe review included 50 articles and examined three broad domains of data, social determinants of health, and CVD. Practicing clinicians have called for the\u003c/p\u003e\n \u003cp\u003euse of big data on SDOH to address CVD and health\u003c/p\u003e\n \u003cp\u003eequity. The most common SDOH domain among the studies were healthcare access and quality, followed by the neighborhood and built environment. Few studies focused on economic stability, social and community context, or education access and quality.\u003c/p\u003e\n \u003cp\u003eSDOH data have been used to understand the relationship between the built environment and CVD outcomes in 27 studies. The data were used to describe the prevalence or incidence of CVD risk factors and outcomes, and to create climate vulnerability maps. Other uses of the data were to evaluate social risk scores, and for the development of interventions, including to\u0026nbsp;\u003c/p\u003e\n \u003cp\u003edevelop digital health applications for patient self-management and health literacy.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eHealthcare providers, policymakers, and researchers should consider integrating multiple SDOH domains to develop interventions and improve CVD outcomes, including economic stability and social and community context, as well as the neighborhood and built environment, and education access and quality. More research is needed to measure and examine the role racism plays as a driver of cardiovascular health inequities. Combining a wide array of data sources, including non-health sector data, could provide a more comprehensive understanding of SDOH and CVD outcomes and help limit bias.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e85. Lopez-Suarez et al (2023) A toolkit of health equity strategies in research, clinical care, education and innovation for radiologists [59]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo provide a practical approach to advancing equity through evidence-based strategies in the four pillars (research, clinical care, education, innovation)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eService delivery - radiology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eFor each of the four pillars, an overview of existing barriers and gaps, and of current best practices, are presented with examples, based on the literature\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eIn research, there are under-represented communities such as rural and native populations. \u0026nbsp;Regarding clinical care, disparities in access result from a variety of factors including medical mistrust, varying familiarity with healthcare systems, implicit bias by practitioners or patients, and race-based algorithms. Medical students with increased education on the social determinants of health are more confident when working with underserved populations. Regarding innovations, there is increasing use of AI in radiology but there are potential biases because of incomplete data\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eEfforts to recruit underrepresented groups as research participants; patient navigator programs and community health workers to mitigate barriers to care; more emphasis on social determinants of health in radiology education and recruitment of radiologists among under-represented groups; and enhancing equitable uptake of emerging radiology innovations.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e6. Asnaani (2023)\u003c/p\u003e\n \u003cp\u003eWhat role can (and should) clinical science play in promoting mental health care equity? [63]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo provide a summary of the documented mental health care inequities (across a range of identity markers) and briefly review recent movements to address these inequities, such as social justice and equity\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eMental health equity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eReview without description of the methods , but a detailed outline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eSeveral specific areas of scholarship were reviewed in terms of their contributions to promoting mental health care equity, namely: community-based research and community-driven mental health treatment adaptations, task-shifting efforts in domestic and global settings, utilization of technology innovations to promote such work and increase access, and policy efforts.\u003cbr\u003e\u0026nbsp;Several ongoing structural inequalities related to social determinants of health have been identified as underlying causes of inequitable mental health care, including (but not limited to), language barriers, differential (and lower) financial resources for many historically minoritized groups, immigration complications, and the experience of ongoing racism and discrimination within the health care system. \u0026nbsp; \u0026nbsp; These barriers are in addition to other persisting barriers to mental health care that include stigma toward mental health, a scarcity of treatments that have been tested and validated in minoritized identity groups, and a shortage of culturally responsive treatment providers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eTo examine the effectiveness of culturally adapted and culturally driven interventions, and to investigate why or how such interventions are successful, with an interdisciplinary lens. Otherwise, it will not be possible to engage in important replication work and to fully understand the elements that make such community-based practices most likely to succeed.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOpen science approaches are being encouraged across clinical science to improve adherence to core principles of the discipline, including transparency (with data sharing), ethics, and replicability/reproducibility, all of which are relevant to the study of diverse societies.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eit would serve the field (and our society overall) well to adopt a stance that diversity science truly applies to all psychological science. Clinical psychologists should take on the challenge/responsibility to incorporate the principles reviewed in this article that are central to promoting mental health care equity across all segments of society, across psychological phenomena, and across professional roles.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e157.Washington et al (2024)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eA systematic review of the effectiveness of cervical cancer screening and prevention interventions for African American women: implications for promoting health equity [58]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo evaluate the effectiveness\u003c/p\u003e\n \u003cp\u003eof cervical cancer screening interventions for African\u003c/p\u003e\n \u003cp\u003eAmerican women, and to assess their attention to health equity. Precisely: (1) To describe the characteristics of screening and prevention interventions that target African\u003c/p\u003e\n \u003cp\u003eAmerican women; (2) To compare the effectiveness of these interventions; and (3) To determine whether these studies address\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ehealth equity factors.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003ePrevention: cervical cancer screening\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eThe review protocol was registered with PROSPERO and guided by the PRISMA guidelines.\u003c/p\u003e\n \u003cp\u003eA literature search was conducted on PubMed, Embase, CINAHL, and Scopus. Reference sections of included studies and relevant systematic reviews were also searched for additional articles. Study quality was assessed. The review also used the Healing ARC framework and Ford\u0026rsquo;s Public Health Critical Race (PHCR) praxis [82] for additional health equity assessments. A meta-analysis was conducted\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e23 articles met inclusion\u003c/p\u003e\n \u003cp\u003ecriteria, there was a wide variety of intervention strategies: community health workers, patient navigation, patient reminders, self-sampling collection, and Human papilloma virus (HPV) vaccination. Cultural tailoring and community-based methods were commonly used, with several studies showing increased screening behavior and knowledge.\u003c/p\u003e\n \u003cp\u003eMeta-analysis showed that interventions significantly increased the likelihood of participating in cervical cancer screening (OR: 2.43, 95% CI: 1.47\u0026ndash;4.02). Health equity assessment revealed that approximately half of the studies struggled to address health equity concerns, while others incorporated cultural tailoring or community-based methods effectively. Few studies acknowledged the impact of racism and structural inequities explicitly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eThis review supports the importance of incorporating health equity principles and community-based methods in screening and prevention interventions. Future research and practice should incorporate African American women\u0026rsquo;s perspectives in intervention development and implementation. Two major implications for future research and practice are self-sampling and deep cultural tailoring.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eCykert (2022) A path toward health care equity: system-\u003c/p\u003e\n \u003cp\u003ebased interventions for change [55]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo review recent studies that used system-based interventions to reduce disparities and improve outcomes\u003c/p\u003e\n \u003cp\u003efor everyone in North Carolina, and to outline how clinicians\u003c/p\u003e\n \u003cp\u003ecan apply results to practice.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eService delivery \u0026ndash; chronic disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eOverview of successful systemic strategies to reduce chronic disease treatment and outcome disparities. No clear methodology defined\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eCommunities of color, in particular Black people, have worse health outcomes than white people, in cancer, chronic disease, maternal health and infant mortality. This is due to social determinants of health, (SDOH) but also other factors such as poor patient-clinician communication, mistrust, or clinician implicit bias. According to outcomes, the strategy based on principles of real-time transparency, accountability and enhanced communication was successful in patients with cancer, diabetes and hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eCommunity insights into barriers and solutions are imperative in building systemic solutions. The principles that reduced disparities and improved health care in chronic diseases could also apply to maternal and child health: Transparency through real-time digital data; accountability through quality improvement that is\u003c/p\u003e\n \u003cp\u003emindful of disadvantaged groups; and serial enhanced communication incorporating community voices. To truly achieve health equity, additional efforts on SDOH\u0026mdash;such as access to health insurance, healthy foods, and a living wage\u0026mdash;coupled with interventions to attenuate the physiologic effects of experienced racism, will be needed.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e9. Bell et al (2023) Can evidence drive health equity in the COVID‑19\u003c/p\u003e\n \u003cp\u003epandemic and beyond? [74]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo systematically search,\u003c/p\u003e\n \u003cp\u003eidentify, and collate published, well-described, and policy-relevant approaches in\u003c/p\u003e\n \u003cp\u003ewhich someone has applied epidemiological methods to COVID-19 pandemic inequities\u003c/p\u003e\n \u003cp\u003ein healthcare and health outcomes; and\u003c/p\u003e\n \u003cp\u003eto critically assess the potential of\u003c/p\u003e\n \u003cp\u003eproposals for addressing pandemic-related health inequities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eService delivery, COVID-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eA scoping review in accordance with\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(PRISMA-ScR) guidelines. Eleven\u0026nbsp;\u003c/p\u003e\n \u003cp\u003edatabases were searched for relevant articles published from \u0026nbsp; \u0026nbsp; January 1\u003csup\u003est\u003c/sup\u003e 2020 through February 17 2021 to identify and synthesize\u003c/p\u003e\n \u003cp\u003epublished scientific literature describing policy-relevant and evidence-based\u003c/p\u003e\n \u003cp\u003eapproaches using epidemiological methods to address health inequities related to the COVID-19 pandemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e77 papers were included in the review. Significant health inequities affected infection rates, morbidity, and mortality among different socio-economic and racial groups: Inequitable access to testing and vaccines in marginalized communities; disparities in treatment access particularly for culturally and linguistically diverse groups; exacerbation of existing non-COVID-19 health issues due to disruptions in healthcare services and social determinants of health; and other inequities such as race, socioeconomic status, and gender. Proposed solutions target: the inequity in risk of infection, morbidity, and mortality from COVID‑19; the inequity in access to testing and vaccines for COVID‑19; \u0026nbsp;the inequity in access to treatment for COVID‑19; \u0026nbsp;multiple inequities in COVID‑19; and non‑COVID‑19 morbidity and mortality. Some of the proposed solutions, however, could unintentionally exacerbate health inequities\u003c/p\u003e\n \u003cp\u003e.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eHealth policymakers should co-create, co-design, and co-produce equity-focussed, evidence-based interventions with communities, focussing on those most at risk to protect the population as a whole. They should target structural systems of disadvantage which place entire communities at\u003c/p\u003e\n \u003cp\u003eincreased risk. Policymakers and practitioners need to examine algorithms\u003c/p\u003e\n \u003cp\u003efor potential discrimination from in-built biases in the data or decisions made in their development. Epidemiologists collaborating with people from other relevant disciplines may provide methodological expertise for these processes. There is a need for robust, evidence-based interventions to combat systemic health and social inequities to allow everyone in our communities to thrive.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e12.Boden-Albala et al (2023) Use of community-engaged research approaches in\u003c/p\u003e\n \u003cp\u003eclinical interventions for neurologic disorders in the\u003c/p\u003e\n \u003cp\u003eunited states\u003c/p\u003e\n \u003cp\u003ea scoping review and future directions for improving health equity research [64]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo identify and synthesize\u003c/p\u003e\n \u003cp\u003ethe intervention studies that have actively engaged with the\u003c/p\u003e\n \u003cp\u003ecommunity in the conceptualization and implementation of interventions\u003c/p\u003e\n \u003cp\u003eto reduce disparities in neurologic conditions, and to describe the common community engagement processes used by the studies.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eCommunity engagement\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eA scoping review to describe the frequency and\u003c/p\u003e\n \u003cp\u003emanner in which community engagement strategies have been used as part of intervention strategies to address neurologic conditions.\u003c/p\u003e\n \u003cp\u003eThe scoping review methodology followed Arksey and O\u0026rsquo;Malley\u0026rsquo;s\u003c/p\u003e\n \u003cp\u003e5-stage model: (1) identify the research question; (2) identify relevant studies using a systematic\u003c/p\u003e\n \u003cp\u003esearch strategy; (3) select studies (we used PRISMA guidelines); \u0026nbsp; \u0026nbsp; (4) chart (synthesize, code, and interpret) the data; and (5) collate, summarize, and report the results. The articles were screened and reviewed using Covidence.\u003c/p\u003e\n \u003cp\u003eThe review focused on neurologic conditions such as stroke, Alzheimer disease and related dementia, epilepsy, Parkinson disease, spinal cord injury, and traumatic brain injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eA total of 53 studies were included. Community engagement strategies were integrated into interventions in numerous forms with some studies using multiple approaches. Local organizations as community partners were used by 42% of the studies. Culturally Tailored Materials and Mobile Health (mHealth) were used in 40% of studies to improve accessibility and health promotion. An example is Boden-Albala\u0026apos;s trial, which reduced systolic blood pressure in Hispanic stroke survivors. Community health workers were employed by 32% of the studies, enhancing trust and effective delivery of interventions. Faith-based organizations and local businesses were involved in 28% of interventions. Focus groups/health need assessments were a strategy for 25% of studies.\u003c/p\u003e\n \u003cp\u003eCommunity Advisory Boards were utilized in19% of studies for feedback and feasibility.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePersonnel was recruited from the community/champions in 19% of studies. Finally, caregiver/social support was a strategy used in 15% of studies.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eTo involve the community early and continuously, aligning objectives and expectations with the community through a collaborative process; to\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003ebuild curricula that address challenges to community\u003c/p\u003e\n \u003cp\u003eengagement; to prioritize Inclusion of community engagement reporting in peer-reviewed journals; to prioritize and incentivize research that will identify best practices around community engagement to enhance our understanding of subpopulations who\u003c/p\u003e\n \u003cp\u003eexperience disparities.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e53. Gr\u0026eacute;aux et al (2023) Health equity for persons with disabilities:\u003c/p\u003e\n \u003cp\u003ea global scoping review on barriers\u003c/p\u003e\n \u003cp\u003eand interventions in healthcare services [68]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo provide a comprehensive global overview of access to healthcare\u003c/p\u003e\n \u003cp\u003eservices for persons with disabilities as characterized by\u003c/p\u003e\n \u003cp\u003eboth the barriers they face and the interventions\u003c/p\u003e\n \u003cp\u003ethat have been implemented to remove these barriers.\u003c/p\u003e\n \u003cp\u003eTo provide\u003c/p\u003e\n \u003cp\u003einsights to inform the actions that governments and other key stakeholders can take to\u0026nbsp;\u003c/p\u003e\n \u003cp\u003erespond more efficiently to the requirements of the United Nations Convention on the Rights of Persons with Disabilities\u003c/p\u003e\n \u003cp\u003e(UNCRPD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eAccess to healthcare services\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eA scoping review\u0026nbsp;\u003c/p\u003e\n \u003cp\u003efollowing the methodological framework proposed by Arksey\u003c/p\u003e\n \u003cp\u003eand O\u0026rsquo;Malley. Scholarly databases and the websites of Organizations of Persons with Disabilities, and reviewed evidence\u003c/p\u003e\n \u003cp\u003eshared during WHO-led consultations on the topic of health equity for persons with disabilities. A total of 182 articles (published between 2011 and 2022) were included in the review.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eThe majority of sources\u003c/p\u003e\n \u003cp\u003eoriginated from high-income countries. Barriers were identified worldwide across different levels of the health system and through wider contributing factors of health inequities that expand beyond the health system.\u003c/p\u003e\n \u003cp\u003eHuman resources issues, the lack of reliable disability data in healthcare services, financial issues, lack of leadership and policy alignment, availability and quality of services, lack of accessible or specialized medical and rehabilitation equipment, products, and devices, the lack of disability guidelines and legislation enforcement, and the negative attitudes toward persons with disabilities across all strata of society were major barriers. Socio-cultural discriminatory beliefs about disability, Internalized stigma by persons with disabilities could also impact their access to healthcare services. SDOH factors, lack of opportunities for developing health literacy and limited availability of accessible transport are other problems. Eighteen interventions targeting the negative societal attitudes toward persons with disabilities were identified. However, the interventions to promote equitable access to healthcare services for persons with disabilities were not readily mapped onto the needs, their sources of funding and projected sustainability were often unclear, and few offered targeted approaches to address issues faced by marginalized groups of persons with disabilities with intersectional identities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eHealth needs and priorities of different groups of persons\u003c/p\u003e\n \u003cp\u003ewith disabilities can differ widely and require tailored actions. Addressing the barriers faced by the most marginalized groups of persons with disabilities can foster health equity for everyone. Service providers, policymakers, and stakeholders should consult with persons with disabilities with a wide range of intersectional identities to better understand and address their unique health needs and intersectional mediating and risk factors to improve access to healthcare services.\u003c/p\u003e\n \u003cp\u003eSpecial considerations should be given to the needs of women and girls, sexual and gender minority groups, children and older persons, ethnic minorities, and immigrants and refugees with disabilities. Governments and decision-makers in the health sector should be encouraged\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eto set expectations and establish a collaboration mechanism to work efficiently with Organizations of Persons with Disabilities. Global health decision-makers and funders, in close collaboration with Organizations of Persons with Disabilities have a key role to play in overseeing and coordinating\u003c/p\u003e\n \u003cp\u003ethe distribution of resources, building the capacity\u003c/p\u003e\n \u003cp\u003eof country partners, prioritizing the most disadvantaged,\u003c/p\u003e\n \u003cp\u003eand monitoring progress on health equity for persons\u003c/p\u003e\n \u003cp\u003ewith disabilities worldwide.\u003c/p\u003e\n \u003cp\u003eA global research agenda is needed, and its development requires the close collaboration and engagement of multisectoral partners and research networks to better address the deep and multidimensional roots of health inequities.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e97 Meadows et al (2023)\u003c/p\u003e\n \u003cp\u003eStrategies to promote maternal health equity\u003c/p\u003e\n \u003cp\u003ethe role of perinatal quality collaboratives [60]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo examine the role and\u003c/p\u003e\n \u003cp\u003estrategies of perinatal quality initiatives and collaboratives\u003c/p\u003e\n \u003cp\u003eto deliver safe and equitable maternity care and the\u003c/p\u003e\n \u003cp\u003eevidence of demonstrated success.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eMaternal health equity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eA narrative review exploring the contribution of perinatal quality improvement (QI) projects in hospitals, health systems, public health departments, or state perinatal quality collaboratives\u003c/p\u003e\n \u003cp\u003eto address equity in maternal outcomes.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003ePerinatal quality improvement is a method to increase obstetric safety and promote health equity. The authors identified six equity-promoting QI strategies, provided examples and characterized each using a classification\u003c/p\u003e\n \u003cp\u003esystem based on Bingham\u0026rsquo;s ABCDE\u0026rsquo;S of QI Strategies\u003c/p\u003e\n \u003cp\u003eand Tactics A: Accountability; B: Buy-in (incentives or disincentives); C: Collaboration and Communication; D: data; E: education; and S: structure change\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eTo establish and maintain a culture of equity within healthcare systems. To use data to identify gaps in care and track progress over time.\u003c/p\u003e\n \u003cp\u003eTo engage and collaborate with a diverse set of strategic partners and stakeholders.\u003c/p\u003e\n \u003cp\u003eTo include patients and communities in the design and implementation of QI interventions. To educate clinicians on evidence-based practices and the impact of bias and racism on maternal health outcomes. To implement standardized protocols and safety bundles to minimize variations in practice and improve care quality. In sum, leaders should prioritize maternal equity, acknowledge racism\u0026apos;s impact on health outcomes, and invest in staff education and data systems to improve care quality and equity.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e115. Peek et al (2023) Advancing health equity through social care interventions [75]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo use evidence on addressing racism in social care intervention research to create a framework for advancing health equity for all populations with marginalized\u003c/p\u003e\n \u003cp\u003esocial identities (e.g., race, gender, and sexual orientation);\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTo recommend how the Agency for Healthcare\u003c/p\u003e\n \u003cp\u003eResearch and Quality (AHRQ) could advance health equity for marginalized populations\u003c/p\u003e\n \u003cp\u003ethrough social care research and care delivery.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eSocial care interventions\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eThis commentary is informed by a literature review\u003c/p\u003e\n \u003cp\u003eof social care interventions that were affiliated with healthcare systems, input from\u003c/p\u003e\n \u003cp\u003ehealth equity researchers, policymakers, and community leaders attending the AHRQ\u003c/p\u003e\n \u003cp\u003eHealth Equity Summit; and consensus of the authors.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eGroups with marginalized social identities have disproportionate\u003c/p\u003e\n \u003cp\u003esocial needs (e.g., food insecurity) and negative\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSDOH (e.g., poverty). Payors and healthcare systems are interested in addressing patient\u0026apos;s social needs and\u003c/p\u003e\n \u003cp\u003ecommunity-level social determinants of health as a part of comprehensive healthcare strategies to reduce health inequities.\u003c/p\u003e\n \u003cp\u003eHowever, few social care intervention studies have conceptualized race as a proxy for exposure to racism or examined differential treatment effects of the intervention by race or ethnicity.\u003c/p\u003e\n \u003cp\u003eAddressing specific sociocultural priorities of populations with marginalized social identities\u003c/p\u003e\n \u003cp\u003eis an important strategy to increase the effectiveness of social care interventions.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eThe authors recommend that AHRQ: (1) create an ecosystem that values research on SDOH and the effectiveness and implementation of social care interventions in the healthcare sector; (2) work with other federal agencies to (a) develop position statements with actionable recommendations about racism and other systems that perpetuate marginalization based on social identity and (b) develop aligned, complementary approaches to research and care delivery that address social marginalization;\u003c/p\u003e\n \u003cp\u003e(3) advance both inclusive care delivery and inclusive research teams;\u003c/p\u003e\n \u003cp\u003e(4) advance understanding of racism as a social determinant of health and effective strategies to mitigate its adverse impact on health; (5) advance the creation and scaling of effective strategies for addressing SDOH in healthcare systems, particularly in co-creation with community partners; and (6) require social care intervention researchers to use methods that advance our understanding of social health equity.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e150. Ukke et al (2023) Lifestyle Interventions to prevent type 2 diabetes in women\u003c/p\u003e\n \u003cp\u003ewith a history of gestational diabetes: a systematic review\u003c/p\u003e\n \u003cp\u003eand meta-analysis through the lens of health equity [56]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo assess the prevention of type 2 diabetes in women with prior gestational diabetes (GDM) \u0026nbsp;using population characteristics according to the PROGRESS criteria: place of residence, race /ethnicity/culture/language, occupation, gender/sex, religion, education,\u003c/p\u003e\n \u003cp\u003esocioeconomic status, and social capital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eBehavior change\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eReviews databases were searched for interventional studies of diet, physical activity, or behavioural interventions published up to February 2023. Random effects\u003c/p\u003e\n \u003cp\u003esubgroup meta-analysis was conducted to evaluate the association of population characteristics and\u003c/p\u003e\n \u003cp\u003eintervention effects.\u003c/p\u003e\n \u003cp\u003eRandomized controlled trials, non-randomized controlled trials, and pre-post single-arm studies were included. All studies were conducted in high-or middle-income countries.\u003c/p\u003e\n \u003cp\u003eWere excluded studies combining pharmacological or supplementation components with lifestyle intervention\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eA total of 40 unique studies were included in the systematic review. The meta-analysis included 26 unique studies that reported the primary outcomes using the PROGRESS criteria.\u003c/p\u003e\n \u003cp\u003eTwo-thirds of the studies reported on race/ethnicity and education level. Less than one-third reported on place (urban/rural), occupation, and socioeconomic status. None reported on religion or social capital. Lifestyle interventions from high-income countries showed a greater reduction in bodyweight, a key factor for the prevention of T2DM compared with the studies conducted\u003c/p\u003e\n \u003cp\u003ein middle-income countries for subgroup difference.\u003c/p\u003e\n \u003cp\u003eIn the studies that did report findings based on the PROGRESS criteria, participants were mostly (73.9%) tertiary educated and had a high level of income (61.5%). This review highlights the lack of the inclusion of participants at the highest risk of T2DM. There were no studies in low-income countries in Africa or the Pacific region despite these regions being disproportionately burdened\u003c/p\u003e\n \u003cp\u003ewith T2DM and GDM.\u003c/p\u003e\n \u003cp\u003eVirtually delivered interventions have a better effect than those with both virtual and in-person components, with in-person delivered interventions being the least effective in women with a history of GDM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eSubstantial heterogeneity between studies needs to be considered when interpreting the results of this meta-analysis. The high risk of bias in most studies needs to be considered when applying the results of this meta-analysis.\u003c/p\u003e\n \u003cp\u003eThere are ethnic disparities in the overall prevalence of T2DM as well as in the progression of GDM io T2DM, and an adequate representation of ethnic groups bearing the greater burden of the disease and the disaggregation of data, where feasible, is needed in the research to better understand the effectiveness of interventions in these groups.\u003c/p\u003e\n \u003cp\u003eTo advance the understanding of T2DM prevention in all population subgroups, future researchers and funders need to close the equity research gap in the prevention of T2DM in women with a history of GDM by focusing on the inclusion of disadvantaged groups (or groups which are under-represented) and by collecting and reporting disaggregated data on equity.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eKanengoni‑\u003c/p\u003e\n \u003cp\u003eNyatara et al (2023) Barriers to and recommendations for equitable access to healthcare\u003c/p\u003e\n \u003cp\u003efor migrants and refugees in Aotearoa, New Zealand: an integrative\u003c/p\u003e\n \u003cp\u003ereview [70]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo synthesise the evidence on barriers to accessing healthcare services and where present,\u003c/p\u003e\n \u003cp\u003epropose interventions to improve services in various\u003c/p\u003e\n \u003cp\u003ehealthcare settings for migrants and refugees\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eAccess to healthcare for migrants and refugees\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eAn integrative review of studies published between January 2016 to September 2022 to mirror the adoption of the 2030 Sustainable Development Goals in 2015. The review followed the PRISMA guidelines.\u003c/p\u003e\n \u003cp\u003eData were thematically analyzed using vote counting to identify frequent themes, which were refined through discussion. A narrative synthesis was then used to integrate the findings and highlight relationships among the themes\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eOut of 237 identified studies on migrants and refugees, 13 were included in the review. All except one were qualitative, and the other one used a mixed methodology.\u003c/p\u003e\n \u003cp\u003eMost studies focused on refugees. Participants were from LMICs or non-English speaking countries. Studies predominantly involved women. Attitudinal barriers included the lack of culturally competent healthcare providers, discrimination by healthcare providers, and personal, social, and cultural attributes. Structural barriers referred to policies and frameworks that regulated the accessibility of health services such as the cost of healthcare, accessibility and acceptability of interpreter services, length of allocated appointments and long waiting times for an appointment, difficulties navigating the health system, and logistical barriers.\u003c/p\u003e\n \u003cp\u003eMigrants stated that it took them around two years to understand and navigate\u003c/p\u003e\n \u003cp\u003ethe health system in Aotearoa, with others reporting not being provided with information by their local doctor about services available. Mobility barriers were also reported during COVID-19 lockdowns where participants\u0026rsquo; support services were disrupted. For mothers who could not drive or did not have a car, using public transport to access healthcare was particularly difficult for those who had two or more children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eThe authors recommend:\u003c/p\u003e\n \u003cp\u003e1) Fostering a Sense of Belonging: people from former refugee backgrounds to influence policy makers to recognise the unique individual, social, cultural and historical factors that affect their health and promote a culture of acceptance that celebrates diversity;\u003c/p\u003e\n \u003cp\u003e2) Enabling a Whole-of-Society Approach, with collaboration between healthcare providers and non-governmental organizations, the integration of a gender perspective, and community engagement;\u003c/p\u003e\n \u003cp\u003e3) Government, Organizational Structures, and Policies: Implementation of culturally centered policies, funding for interpreter services, addressing structural barriers, and improving healthcare workforce diversity.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eJackson-Triche, Un\u0026uuml;tzer and Wells (2020) Achieving mental health equity: collaborative care [65]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo review what is known about the impact of integrated care programs on improving health equity, with special emphasis on collaborative care (CC)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eCollaborative care (CC) in mental health / behavioral health\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eRapid literature review of reviews and individual studies\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eThe review gives strong evidence that CC is a model that has the potential to reduce disparities for ethnic minorities and other at-risk populations who are often poorly served by usual primary care systems, and who have lower engagement and health outcomes because of other underlying risk factors. As a systems-based approach, CC has been shown to not only improve access to care but also to improve the quality of care received and health outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eTo fully realize the promise of CC, there is a need for approaches that focus on effective community engagement, coalition building, and cultural adaptation, as well as developing innovative approaches such as addressing social determinants. The authors argue that key first steps are using health equity\u0026ndash;focused strategies when planning and implementing CC and giving careful thought and attention to engaging diverse populations and considering their specific preferences and needs.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eKibakaya and Oyeku (2022) Cultural humility: a critical step in achieving health equity [62]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo identify and discuss research pertaining to cultural sensitivity in pediatric primary care and comment on its role for achieving health equity.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eCultural sensitivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eCommentary/ viewpoint article without any systematic method of analysis. They define culturally sensitive care as \u0026ldquo;the delivery of care within the context of appropriate physician knowledge, understanding, and appreciation of cultural distinctions\u0026rdquo;. An alternative concept is one of cultural humility, which incorporates elements of self-questioning, immersion into an\u003c/p\u003e\n \u003cp\u003eindividual patient\u0026apos;s point of view, active listening and flexibility, which\u003c/p\u003e\n \u003cp\u003eall serve to confront and address personal and cultural biases or\u003c/p\u003e\n \u003cp\u003eassumptions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eThere is scarcity in breadth and depth of existing literature that addresses culturally sensitive interventions in pediatric primary care. There is a notable deficiency of research tackling the array of medical, developmental, social, and emotional issues that primary care providers address daily. One current strategy that health systems and educational institutions are leveraging to reduce health disparities is addressing the role of implicit bias and structural racism. Medical schools in the USA have developed various curricula incorporating elements of cultural competence.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eDemonstrating cultural humility frees health care professionals from having to possess expert knowledge about a myriad of cultural differences and fosters open communication with patients to achieve shared health and developmental outcomes. Physicians, leaders, interprofessional collaborators and health systems must fully participate in the effort to transform current practices. The authors argue that it is imperative that healthcare professionals work in partnership with patients and their families to reduce health disparities. The authors and other researchers posit that cultural sensitivity may improve physician-patient communication and collaboration, increase patient satisfaction, and potentially enhance adherence, improve clinical outcomes and reduce health disparities.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eDoyle et al (2019) Achieving health equity in hypertension management\u003c/p\u003e\n \u003cp\u003ethrough addressing the social determinants of health [54]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo examine recent literature on the social determinants of health as they relate to\u003c/p\u003e\n \u003cp\u003ehypertension and cardiovascular disease and discuss relevance to the practice of emergency medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eHypertension management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eExamples from the literature of the intersection of social determinants of health and hypertension management or outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003ePositive impact on behavior or outcomes was shown in minorities by improving access to resources, behaviour counseling, education, the action of community health workers, and technology.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eThere is a need for innovative methods to modify the factors that affect health upstream (and that can be modified, at variance with race and ethnicity) before the symptoms appear, such as education and neighborhood characteristics. Multidimensional partnerships involving healthcare systems, communities, public health organizations and social welfare entities are important to better prevent and manage hypertension through action on social determinants of health.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eRichard et al (2016) Equity of access to primary healthcare for vulnerable populations: the IMPACT international online survey of innovations [67]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo identify, refine and then trial best practice innovations to improve access\u003c/p\u003e\n \u003cp\u003eto PHC, particularly for vulnerable populations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eAccess to primary health care\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eAs part of IMPACT project, an environmental scan was used to identify the breadth of current innovations from the field. The authors distributed a brief online survey to an international audience of PHC researchers, practitioners, policy makers and stakeholders using a combined email and social media approach. Respondents were\u003c/p\u003e\n \u003cp\u003einvited to describe a program, service, approach or model of care that they considered innovative in helping\u003c/p\u003e\n \u003cp\u003evulnerable populations to get access to PHC.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eWritten descriptions of innovations were mapped against the framework of Levesque et al [71] to identify which access dimensions were involved\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eThe study collected 240 unique examples of innovations, which were Innovations were primarily health sector focused (71.3 %). \u0026nbsp;Almost all innovations were operating at the practice or community level (90.4 %). Most innovations addressed supply-side dimensions of access, with less focus on demand-side dimensions. Few innovations targeted both supply- and demand-side dimensions simultaneously. The study also noted that many innovations were funded by government sources and were primarily implemented in community health settings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eIncreasing efforts are needed to address both supply- and demand-side dimensions of access simultaneously to improving the effectiveness of innovations. More comprehensive and integrated approaches are needed to achieve transformative change in access to PHC for vulnerable populations. More research is needed, in particular for more rigorously undertaken systematic evaluations of initiatives that are developed, considering the particular context in which innovations are implemented and having indicators which cover the broad range of access determinants (health and social) for accurate measurement of the effects of intervention components on specific access dimensions.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eSchneider et al (2021) Increasing equity while improving the quality of care [52]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eHighlighting the efforts to reduce inequities in the quality of cardiovascular care, building on insights from recent scholarship on the effects of structural racism in the broader\u003c/p\u003e\n \u003cp\u003esociety and also within medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eCardio-vascular care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eThe authors adapt a tool frequently used in quality improvement work\u0026mdash;the driver diagram, which maps out a path toward an intended outcome\u0026mdash;to chart likely areas for diagnosing root causes of disparities and developing and testing interventions\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eThere are persistent racial and ethnic disparities in cardiovascular disease (CVD) outcomes, particularly among Black, Latino, Asian, Pacific Islander, and Indigenous populations. In the case of heart failure mortality, disparities have widened over time. \u0026nbsp;Clinical and behavioral risk factors like hypertension, diabetes, diet, and tobacco use partly explain these disparities. Genetic factors play a minimal role.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eThere are persistent disparities in care quality among racial and ethnic groups. The authors developed an equity-centred quality improvement model and a roadmap to advance cardiovascular health equity as guides to improve the measurement and analysis of quality problems and the implementation of\u003c/p\u003e\n \u003cp\u003ecare interventions and policies that reduce racial and ethnic disparities in outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eThe Equity-Centered Quality Improvement Model explicitly maps the many influences within and outside of health care that contribute to inequitable patient outcomes. Reducing discriminatory interactions with patients and families and enhancing access to care can increase the trustworthiness of institutions and professionals.\u003c/p\u003e\n \u003cp\u003ePhysicians, other health professionals, and health care systems can reduce racial and ethnic disparities in cardiovascular mortality and other outcomes if they simultaneously and intentionally address both quality and equity. Designing interventions should take a broader perspective than modifying care for patients while they are in a clinical care setting. Tailoring solutions to patients and their communities may involve actively engaging patients and community health workers in developing and evaluating interventions. The use of geospatial and clinical data is recommended to identify disparities, diagnose their root causes, and design targeted interventions. Engaging patients and community health workers in developing and evaluating culturally tailored interventions is also needed.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e76.Kohler et al (2023)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePopulation‑\u003c/p\u003e\n \u003cp\u003ebased physical activity\u003c/p\u003e\n \u003cp\u003epromotion with a focus on health equity: a review of reviews [32]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo identify current evidence on the effectiveness\u003c/p\u003e\n \u003cp\u003eof population- based physical activity (PA) promotion in the community\u003c/p\u003e\n \u003cp\u003ewith a particular focus on health equity.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003ePrevention, physical activity promotion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eReview of systematic reviews on population- based PA promotion for the period 2015 to 2021.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSix electronic databases were examined. A reference list and grey literature search were also conducted. A quality assessment was conducted for each identified review. All included reviews of population-based approaches for PA promotion with a\u003c/p\u003e\n \u003cp\u003efocus on disadvantaged populations\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eSix reviews were included, and they were all rated as high quality. Mass-media campaigns, point-of-decision prompts, environmental approaches, policy approaches, and community-based multi-component approaches\u003c/p\u003e\n \u003cp\u003ecan promote PA in the general population.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAcross populations with social disadvantages, mass-media campaigns, point-of-decision prompts and policy approaches are likely to be effective if they are tailored. However,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003enone of the reviews on community-based multi-component approaches provided evidence on health equity\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eThe evidence regarding health equity is still sparse and future studies should assess the theoretical basis of these approaches, their differential impact including the potential negative and unintended consequences\u003c/p\u003e\n \u003cp\u003eas well as the long-term\u003c/p\u003e\n \u003cp\u003eimpact on PA promotion and health equity. Tailoring interventions to the needs of disadvantaged populations, and engaging people with\u003c/p\u003e\n \u003cp\u003esocial disadvantages in the development, implementation\u003c/p\u003e\n \u003cp\u003eand evaluation of population-based PA programs for their empowerment are recommended, as well as\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ecommunity-based multi-component approaches combining structural (environment and policy) and behavioural components.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eArsenault et al (2018) Equity in antenatal care quality: an analysis of 91 national household surveys [61]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eIdentifying the reasons for inequitable access of women for antenatal care in LMICs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eAntenatal care based on status of the country\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eA systematic review of antenatal care quality using information from 2007-2016 Demographic and Health Survey (DHS) and Multiple Indicator cluster surveys (MICS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eThe study shows that there are much lower and inequitable levels of quality in many LMICs even though they reached high levels of antenatal care coverage. The wealthiest women were four times more likely to report good quality antenatal care than the poorest. Poorer people mostly live in rural areas where there are poor functioning health systems.\u003c/p\u003e\n \u003cp\u003eOther factors that influence antennal care inequalities include availability of good facilities nearby, cost of diagnostic procedures, provider discrimination or bias, and degree of a patient to seek high-quality care, skills of care providers and equipment available.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eEquity in effective coverage should be used as the new metric to monitor progress towards universal health coverage. However, assessing the social inequalities for different nations is still a challenge. The study suggests that more work is still needed to understand factors responsible for inequities in health-care quality. The article recommends better measurement and systematic improvement in healthcare quality especially in poor and vulnerable populations. In the SDG era, achieving parity in health outcomes between rich people and poor people, within and across countries, will require greater focus on the quality of health services and its equitable distribution.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eDavy C, et al (2016) Access to primary healthcare services for indigenous peoples: A framework synthesis [69]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo identify issues that hinder Indigenous peoples from accessing primary health care and then explore\u003c/p\u003e\n \u003cp\u003ehow these were addressed by Indigenous health care services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eAccess to primary healthcare services for indigenous peoples\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eA thematic analysis of 50 papers/studies with focus on access to primary\u003c/p\u003e\n \u003cp\u003ehealthcare services for indigenous peoples using Levesque\u0026rsquo;s accessibility framework. [71]. These studies were from the United States,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCanada, New Zealand, South America, and Papua New Guinea.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eIssues relating to the cultural and social determinants of health (such as unemployment, poverty, and low levels of education) influence whether Indigenous patients, their families and communities were able to access health care.\u003c/p\u003e\n \u003cp\u003eIndigenous health care services addressed these issues in a number of ways including the provision of transport to and from appointments, a reduction in health care costs for low-income people and close consultation with community members in identifying and then addressing health care needs.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eIndigenous health care services appear to be best placed to overcome both the social and cultural determinants of health which hinder Indigenous peoples from accessing health care. Common factors for successful navigation include\u003c/p\u003e\n \u003cp\u003ethe importance of culturally safe and wherever possible,\u003c/p\u003e\n \u003cp\u003elocally owned Indigenous health care services. Findings also suggest that Levesque and colleague\u0026rsquo;s accessibility framework [71] should be broadened to include factors related to the health care system, such as funding.\u003c/p\u003e\n \u003cp\u003eMainstream services are set up to cater to\u0026nbsp;dominant, often non-Indigenous cultures with a set of socially constructed values and norms which can be at odds with Indigenous communities\u0026rsquo; beliefs and values. The authors acknowledge a need to further explore factors relating to the health care system which facilitate or impede access to Indigenous health care services.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eTao, Agerholm and Burstr\u0026ouml;m (2016) The impact of reimbursement systems on equity in access and quality of primary care: A systematic literature review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo compare the different types of reimbursement system in relation to socioeconomic and racial inequalities in access, utilization and quality of healthcare.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eAccess to, and quality of primary healthcare\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eSystematic literature review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e22 papers on experimental or observational studies conducted in the primary care settings were included. \u0026nbsp;Only studies from high-income countries were included. Schemes considered were fee-for-service, capitation, and pay-for-performance (the Quality and Outcome Framework). Seven studies compared capitation and fee-for-service. Access, uptake and quality of services, and chronic disease management were considered. Little scientific evidence supports an association between reimbursement system and socioeconomic or racial inequity in access, utilization, and quality of primary care.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eThe reimbursement scheme may have a differential impact depending on the outcome under study, the context including various healthcare systems, and social\u0026nbsp;stratifiers other than race or SES. Vertical and horizontal equity were not differentiated. Furthermore, a combination of reimbursement schemes, which was observed, does not allow to isolate the impact of a given scheme. Policies for resource allocation that matches the increased healthcare needs of underserved groups might have a greater impact on health inequalities that the type of reimbursement. Further empirical studies are necessary and recommended.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eMalou et al (2020)\u003c/p\u003e\n \u003cp\u003ePromotion de la sant\u0026eacute; globale et approche socio-\u0026eacute;cologique de l\u0026rsquo;autod\u0026eacute;termi-nation chez les personnes pr\u0026eacute;sentant une d\u0026eacute;ficience intellectuelle: une revue syst\u0026eacute;matique des interventions [66|\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo analyze the\u003c/p\u003e\n \u003cp\u003econtexts and highlight conclusive results of interventions that promote overall health and the place of self-determination among people with intellectual disabilities (ID)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eBehaviour change\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eSystematic review of interventions promoting self-determination and overall health among people with intellectual disabilities. The paper analysed relevant\u0026nbsp;\u003c/p\u003e\n \u003cp\u003einterventions focusing on individuals with ID, on environment, and on both ID and environment.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eSignificant results of both types of interventions were observed from a quantitative and qualitative point of view\u003c/p\u003e\n \u003cp\u003ewhen they considered different factors such as the interaction between individuals and the environment in a\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ebroad sense (material, human, living environment, etc. development of self-determination and improving health literacy)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eFuture actions should further evaluate the improvement of overall health through\u003c/p\u003e\n \u003cp\u003ethe development or strengthening of self-determination both at the individual and environmental level.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eGandhi (2015)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCharting the evolution of approaches employed by the Global Alliance for Vaccines and Immunizations (GAVI) to address inequities in access to immunization: a systematic qualitative review of GAVI policies, strategies and resource allocation mechanisms through an equity lens (1999-2014) [73]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo assess how GAVI\u0026rsquo;s approach to address\u003c/p\u003e\n \u003cp\u003eequity/inequity in immunization has evolved over time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eAccess to immunization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eA systematic qualitative review of the literature on\u003c/p\u003e\n \u003cp\u003ethe evolution of GAVI\u0026rsquo;s focus on reducing inequities in access to vaccines, immunization, and GAVI funds between and within countries.\u003c/p\u003e\n \u003cp\u003eThe review included electronic databases search and a direct review of available GAVI Board papers, policies, and program guidelines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eOver time, GAVI has progressively\u003c/p\u003e\n \u003cp\u003eadded vaccines to its portfolio. This expansion should have addressed inter-country, inter-regional,\u0026nbsp;intergenerational\u003c/p\u003e\n \u003cp\u003eand gender inequities in disease burden. However, evidence is scant with respect to final outcomes.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eA focus on addressing inequities between higher-income countries and lower-income countries may reflect the viewpoint of the Alliance stakeholders. In terms of resource allocation mechanics and\u003c/p\u003e\n \u003cp\u003eprogram policies, GAVI focused almost exclusively on between-country equity concerns.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eBy building on its successes,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eGAVI is well-positioned to bring the benefits of vaccination to previously unreached and underserved communities towards provision of universal health coverage.\u003c/p\u003e\n \u003cp\u003eReliance on national averages makes sense when speaking of vaccines that are generally regarded as highly equitable interventions (e.g. targeting boys and girls alike) and, most\u003c/p\u003e\n \u003cp\u003eimportantly, capable of conferring population-wide herd\u003c/p\u003e\n \u003cp\u003eimmunity benefits against VPDs at high enough levels of\u003c/p\u003e\n \u003cp\u003ecoverage. Future research should illustrate the evolution and quantitative effects of GAVI\u0026rsquo;s efforts to address between- and within-country inequities in access to new vaccines, utilization of immunization services, access to GAVI resources, and impact on vaccines preventable diseases.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eNelson et al (2020) Achieving health equity in preventive services: a systematic review for a national institutes of health pathways to prevention workshop [57]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTo examine effects of barriers that create health disparities in recommended preventive services for adults, and to evaluate effectiveness of interventions to reduce them.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003ePreventive services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eSystematic literature review of preventive services related to cancer, cardiovascular diseases, and diabetes in adults. Articles published between 1996 and 2019; 120 studies synthesized.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eDisadvantaged populations in the USA experience disparities in the use of preventive health services.\u003c/p\u003e\n \u003cp\u003ePatient navigation services increased colorectal, breast, and cervical cancer screening rates. Some patient navigation interventions included additional services such as reminder calls, lay health workers, etc. Telephone calls and prompts improved colorectal cancer screening. Reminders from lay health workers improves breast cancer screening\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eFurther research to address gaps and deficiencies of existing studies, and involving unstudied populations experiencing adverse effects of healthcare disparities: racial and ethnic minorities, socioeconomically disadvantaged populations, underserved rural populations, sexual and gender minority\u003c/p\u003e\n \u003cp\u003epopulations, and others subject to discrimination.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1. \u0026nbsp; Governance and policy action\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of the 13 reviews about governance and policy approaches for health equity, three were outside the health sector. One reviewed the importance of neighborhood policies in the USA to advance health equity through institutions, the physical, and the social environment \u003cstrong\u003e[15]\u003c/strong\u003e . The recommended measures included fair housing laws and strengthening of community-led initiatives to improve material and social conditions. The second one reviewed promising strategies to advance addressing root causes of health inequities, including the analysis of structural power structures to address equity issues \u0026nbsp;\u003cstrong\u003e[16]\u003c/strong\u003e . The third one reviewed policies that perpetuate health disparities in children in the USA \u003cstrong\u003e[17]\u003c/strong\u003e . Several social and structural determinants of health were considered, such as housing as highlighted in Arcaya\u0026rsquo;s review \u003cstrong\u003e[15]\u003c/strong\u003e , the criminal legal system, and immigration. Supporting community organizations, in this case those that support immigrant communities, is recommended. Which social determinants of health the healthcare systems have the capacity to address is an interesting question raised in two review papers on health sector actions \u0026nbsp;\u003cstrong\u003e[18, 19]\u003c/strong\u003e .\u003c/p\u003e\n\u003cp\u003eReviews on health sector actions (N=10) pertained to clinical practice guidelines and their development \u003cstrong\u003e[20, 21]\u003c/strong\u003e , and to various strategies for healthcare systems\u003cstrong\u003e[18, 19, 22\u0026ndash;24]\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding clinical guidelines, health equity promoting practices need to be integrated from the onset of their development, and community organizations must be among the involved stakeholders. Healthcare system strategies include health equity as part of health system performance assessment \u003cstrong\u003e[18]\u003c/strong\u003eand organizational capacity for health equity assessment \u003cstrong\u003e[23]\u003c/strong\u003e or strengthening \u003cstrong\u003e[22]\u003c/strong\u003e. The results of a primary health care (PHC) policy reform in Sweden were assessed, including the impact on health equity \u003cstrong\u003e[25]\u003c/strong\u003e . It was found that while the reform increased access to PHC and the number of visits, the improvements were primarily in affluent areas and among people with lower health needs. The study showed that resources were more influenced by provider location, patient choice and demand than need, which suggested potential damage to health equity. The effect of decentralization on health equity was assessed in a systematic review encompassing a quality assessment of the studies \u0026nbsp;\u003cstrong\u003e[24]\u003c/strong\u003e . The results were mixed, with a risk of increased disparities due to financing; central coordination and redistribution were deemed necessary. One review on neonatal health disparities emphasized the quality of care \u003cstrong\u003e[26]\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eSpitzer-Shohat and Chin \u003cstrong\u003e[27]\u003c/strong\u003e assessed the implementation of guidance frameworks provided to organizations implementing interventions to make care and outcomes more equitable by changing policies and practices. Several models and frameworks were analyzed and most of them concentrated on the organization\u0026rsquo;s external context such as analysis of data on race and ethnicity. Also addressing the inner context such as readiness for change was deemed important. As part of health system strengthening approaches for health equity, Jensen, Kelly and Avendano \u003cstrong\u003e[22]\u003c/strong\u003e concluded on the need for broadened frameworks to measure intersecting forms of social disadvantage. Among the strategies for healthcare systems in the USA to address social determinants of health and improve health equity in the pediatric population, the value-based payment is described as promising \u003cstrong\u003e[19]\u003c/strong\u003e . This system has the goal of supporting pediatricians in intervening on upstream influences on health to reduce long-term cost. Incentives are used to address the social determinants of health through universal screenings, referrals to community-based organizations, and investing in various supports.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. \u0026nbsp; Information and evidence data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeven reviews were classified under this theme. In a systematic scan of 18 USA-focused clearinghouses that assigned an intervention effectiveness rating for improving community health and the social determinants of health \u003cstrong\u003e[28]\u003c/strong\u003e, it was found that less than half provided information on the potential impact on health equity. These clearinghouses defined and operationalized health equity differently. They lacked transparency in their methods and used various approaches to communicate the findings. Clear and transparent definitions, values, and methods would be needed.\u003c/p\u003e\n\u003cp\u003eAction is guided by conceptual frameworks. Hollands et al \u003cstrong\u003e[29]\u003c/strong\u003erecently reviewed methods, frameworks, or tools used as a conceptual basis for investigating dimensions of health equity impact in systematic reviews of public health interventions.\u0026nbsp;In this overview of systematic reviews, planned methods for conceptualizing equity impacts were fully applied in less than half of the reviews. The predominant framework was PROGRESS-Plus, used in more than one-third of the reviews. However, there are conceptual and measurement issues owing in part to the lack of standardized definition, operationalization, and measurement of health equity dimensions. Additionally, the nature of the differential impacts is complex, and dimensions of health equity may interact with each other.\u003c/p\u003e\n\u003cp\u003eWHO has developed several health inequality monitoring resources as part of its 2022\u0026ndash;27 inequality monitoring and analysis strategy; these were reviewed \u0026nbsp;\u003cstrong\u003e[30]\u003c/strong\u003e. The resources include a health inequality data repository, a health equity assessment toolkit (HEAT and HEAT Plus), health inequality monitoring tools and resources including a handbook, step-by-step manuals and statistical codes, and eLearning courses. Health inequality reports focusing on specific health topics or countries are periodically released. The WHO strategy and tools respond to the need for high-quality evidence on health inequalities\u0026nbsp;to advance health equity.\u003c/p\u003e\n\u003cp\u003eParticipatory implementation science may be regarded as a tool or strategy to advance health equity, as shown in an overview with examples from the literature \u003cstrong\u003e[31]\u003c/strong\u003e .It is an iterative approach that offers an inclusive and collaborative perspective on implementing and sustaining evidence-based interventions to advance health equity. With a focus on health equity, participatory implementation science emphasizes processes for, and impacts of, community engagement, dissemination, social action, capacity building, and systems changes. System changes include, for example, assessing power distributions and how they can be shifted to create equity-promoting contexts.\u003c/p\u003e\n\u003cp\u003eFour reviews provided information or evidence data. The review by Cen\u0026eacute; et al \u003cstrong\u003e[32]\u003c/strong\u003e\u0026nbsp; examined how and whether social needs interventions in multiracial or multiethnic populations in the USA advanced health equity. The interesting framework considered whether the studies were \u0026ldquo;conceptually thoughtful\u0026rdquo; in that they helped explain the root causes of racial health inequities, and whether they were \u0026ldquo;analytically informative\u0026rdquo;, that is, they examined if the effects differed by race or ethnicity. Out of 152 studies, less than 10% were conceptually thoughtful and only 14% were analytically informative, and mixed effects on health equity were reported. In a scoping review of publicly funded projects to reduce bias/racism in maternal care in the USA \u003cstrong\u003e[33]\u003c/strong\u003e, only four publicly funded such interventions were identified since 2018, which reveals an evidence gap. These projects are nonetheless promising as they used innovative strategies including participatory research responding to community needs, multi-component and multi-level interventions, and human resource training in three out of four cases. A review of six high-quality reviews on community-based promotion of physical activity showed that mass-media campaigns, point-of-decision prompts, and policy approaches could be effective for socially disadvantaged groups provided the messages were tailored \u003cstrong\u003e[34]\u003c/strong\u003e. However, none of the reviews provided evidence of an impact on health equity. Finally, a review of climate change impact on health inequities and mitigating efforts \u003cstrong\u003e[35]\u003c/strong\u003e concluded on the need for a \u0026lsquo;whole of science\u0026rsquo; approach to address the current climate change and health inequality crisis as climate change magnifies health inequalities. Cross-cutting initiatives are given as examples of integrative approaches, such as the Pathfinder Initiative which draws on case studies to improve planetary health, the Pacific Regional Environmental Program, and the Rockefeller Foundation\u0026rsquo;s 100 climate resilient cities\u0026rsquo; initiative, which develops resilient climate plans. Community-based participatory research, local knowledge, a better understanding of climate inequities, and expanding training opportunities were among promising strategies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. \u0026nbsp; Technologies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDigital health or telemedicine is the topic of seven out of the eleven reviews on technologies and health equity. Such technologies may indeed contribute to more equitable access to health services as the digital divide related to consumer information technologies has diminished. A scoping review on barriers and facilitators for digital primary health care in refugees and immigrants found that flexibility of digital modalities was a facilitator while older age and lack of digital literacy were obstacles \u003cstrong\u003e[36]\u003c/strong\u003e. In another review, the social determinants of health were found to interact to increase or reduce digital equity \u0026nbsp;\u003cstrong\u003e[37]\u003c/strong\u003e \u003cstrong\u003e.\u003c/strong\u003e Three levels of digital divide were identified: lack of access, lack of skills, and lack of possibility to use the tools for one\u0026rsquo;s health. Telehealth for the ambulatory care of various chronic diseases (e.g., heart failure, diabetes, Parkinson\u0026rsquo;s disease, neurological diseases) was usually found to be as effective as in-person care; however, the results on equity among those at higher outcome risk has not been studied \u003cstrong\u003e[38]\u003c/strong\u003e. In a review on the use of consumer information technologies (CITs) for behavioral interventions in health disparity populations \u003cstrong\u003e[39]\u003c/strong\u003e , these technologies, including mobile health, telehealth and social media, showed potential in promoting self-management of chronic diseases, supporting activities like diet and physical activity monitoring, enhancing motivational learning and providing health education. Such technologies also proved useful for the evaluation of interventions. Another application of digital health is for mental health. In a systematic review, most studies (using direct-to-consumer telehealth videos) observed widening disparities for disadvantaged populations, including rural populations, older patients, and racial/ethnic minorities \u003cstrong\u003e[40]\u003c/strong\u003e . The generalizability and sustainability of access to digital mental health services for immigrants and refugees was questioned in another review which showed that participation not only depended on the individual (e.g., literacy), the program (computer and software) and the social context, but also depended on financial and technical support \u003cstrong\u003e[41]\u003c/strong\u003e . Digital literacy is important for the equitable distribution of e-health resources, as confirmed in a review \u0026nbsp;\u003cstrong\u003e[42]\u003c/strong\u003e . Screening to identify population groups in need of digital literacy interventions is important to advance health equity.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCarbon capture, utilization and sequestration technologies are promising to reduce greenhouse gas emissions. These have the potential to worsen or improve health equity. The benefits and burdens must be distributed equitably, and the needs and perspectives of the most vulnerable groups must be prioritized \u003cstrong\u003e[43]\u003c/strong\u003e .\u003c/p\u003e\n\u003cp\u003eClinical algorithms are a technology, in a sense, and they may be biased. Strategies to mitigate these biases were reviewed \u003cstrong\u003e[44]\u003c/strong\u003e . The strategies were technical (e.g., the algorithm development process), operational (e.g., governance) or system-wide (e.g., training on the risk of bias), but no single best practice was identified. How healthcare algorithms impact racial and ethnic disparities was reviewed \u003cstrong\u003e[45]\u003c/strong\u003e . The algorithms tested referred mainly to kidney function and cardiovascular risk. The evaluation strategies consisted in the removal, addition, or modification of variables. The review suggested that that mitigation strategies reduced racial and ethnic disparities in care. Artificial intelligence (AI) is another technology that can contribute to health equity. Its impact is still little studied, but a review summarized existing literature on the way AI has the potential to exacerbate or reduce inequities in occupational safety and health \u003cstrong\u003e[46]\u003c/strong\u003e . AI has the potential to improve occupational safety and health particularly in high-risk industries such as construction and mining. These jobs are mainly filled by workers from racialized ethnic minority groups. AI may also have negative health effects owing to job insecurity, new jobs and income disparities. Social safety nets may improve equity in communities that experience the negative impact of AI integration. Considerable research on both the positive and adverse impacts of AI is direly needed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4. \u0026nbsp; Human resources\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOnly five reviews on health equity focused on human resources, but some reviews on other topics also included training or human resources components. Education has nonetheless emerged as a pivotal factor in promoting health equity. One review is on the integration of nurse practitioners into primary health care as a strategy to deliver comprehensive care and advance equity \u003cstrong\u003e[47]\u003c/strong\u003e \u003cstrong\u003e.\u003c/strong\u003e For their successful integration, six requirements were compiled from the literature, at the micro, meso and macro levels, and provided a framework: (1) autonomy and agency; (2) awareness and visibility; (3) shared vision; (4) leadership; (5) funding and infrastructure; and (6) intentional support and self-care. Another review examined nursing curricula to determine to what extent the principles of health equity are explicit in prelicensure curricula \u003cstrong\u003e[48]\u003c/strong\u003e . Only two papers out of 20 described overall well‐integrated explicit health equity content, and there was little attention to whether students transferred this learning into practice. The conclusion was that there is a gap in the health equity content despite the need. A review evaluating over 150 studies carried out in low- and middle-income countries revealed that community health worker programs were effective in reaching the most disadvantaged populations\u003cstrong\u003e[49]\u003c/strong\u003e . However, such programs achieve better equity in service delivery than outcomes as many individuals still face barriers in adopting health advice and referrals. Another review focused on the teaching of racism as a determinant of health in public health training \u003cstrong\u003e[50]\u003c/strong\u003e . Few examples of peer-reviewed literature were found on curricula, lessons and competencies developed to better understand racism. The review revealed a lack of consensus on the most effective approach to teaching about racism in public health. Cultural competency and safety as essential for health equity is the object of a review centered on indigenous healthcare in New Zealand \u003cstrong\u003e[51]\u003c/strong\u003e . The authors highlighted the significance of cultural safety in addressing racism, power imbalances in healthcare, and historical factors affecting healthcare experiences in marginalized populations. Cultural safety training and monitoring within healthcare organizations was deemed essential.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5. \u0026nbsp; Service delivery\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis includes health equity issues and initiatives in general care, in medical treatment, and in public health interventions. Of a total of 26 reviews, 10 pertained to medical care and three to mental healthcare. Two papers on care of heart disease reviewed the factors of racial and ethnic disparities from prevention to advanced interventions and then discussed existing or recommended strategies to reduce these disparities \u003cstrong\u003e[52, 53]\u003c/strong\u003e . In the USA, the burden of modifiable risk factors for heart disease is higher among Black, Asian, Native, and Hispanic populations. Despite some progress, there are significant gaps in the management of hypertension and diabetes among Black and Hispanic patients because of financial barriers, missed visits, and poor access to prevention. Other factors that drive inequities in treatment include social determinants of health, systemic inequities, and structural racism. Examples of ongoing promising initiatives are American Heart Association\u0026rsquo;s \u0026lsquo;Life\u0026rsquo;s Simple 7\u0026rsquo;, community-level efforts to reduce tobacco consumption and obesity, and pay-for-performance programs for more equitable or better-quality programs. More equity in clinical trials, culturally tailored community interventions, cross-cultural training, enhanced diversity in organizations and recruitment in medicine are among the numerous recommended approaches to improve health equity through the spectrum of care. The review by Schneider et al \u003cstrong\u003e[54]\u003c/strong\u003e also highlights cardiovascular outcome disparities, particularly among Black, Latino, Asian, Pacific Islander, and Indigenous populations. Beyond clinical and behavioral risk factors, the clinical management of cardiovascular disease risk factors also shows significant disparities, which extend to the adoption of new technologies. Another review focusing on cardiovascular disease examined how data on social determinants of health were used to improve health equity \u003cstrong\u003e[55]\u003c/strong\u003e . The social determinants most often considered were healthcare access and quality, followed by the neighborhood and built environment. Few studies focused on economic stability, social and community context, or education access and quality. Data on neighborhoods and built environments were used to determine, for instance, areas with limited access to pharmacies, and to draw maps of cardiovascular disease incidence and climate vulnerability. Similarly, Doyle et al \u003cstrong\u003e[56]\u003c/strong\u003e reviewed the literature on social determinants of health as they related to the management of hypertension and cardiovascular disease. A positive impact on behavior or outcomes was observed in minorities by improving access to resources, behavior counseling, education, the action of community health workers, and technology. In an overview of successful systemic strategies to reduce chronic disease treatment and outcome disparities, Cykert \u0026nbsp;\u003cstrong\u003e[57]\u003c/strong\u003efound that according to outcomes, successful strategies were based on principles of transparency through real-time digital data; accountability through quality improvement that is mindful of disadvantaged groups; and serial enhanced communication incorporating community voices. A systematic review focused on the effectiveness of lifestyle interventions for the prevention of diabetes among women who had had gestational diabetes according to social determinants of health \u003cstrong\u003e[58]\u003c/strong\u003e . The interventions were all carried out in high- or middle-income countries. Studies from high-income countries showed a greater reduction in body weight compared with the studies conducted in middle-income countries. It was noted that a high proportion of participants had higher education or higher income. The conclusion was that the women most at risk may not have been included in the programs. In a systematic review, Nelson et al \u003cstrong\u003e[59]\u003c/strong\u003e explored the barriers contributing to disparities in preventive services and the interventions aimed at reducing these among disadvantaged populations in the USA. It was found that clinician-delivered interventions played a crucial role in smoking cessation while technology-assisted interventions (patient navigations, telephone calls, community engagement) were linked to positive outcomes including improved cancer screening rates.\u003c/p\u003e\n\u003cp\u003eIn a review of cervical cancer screening and equity among African American women \u003cstrong\u003e[60]\u003c/strong\u003e , the meta-analysis showed that interventions significantly increased the likelihood of their participating in cervical cancer screening. A wide variety of intervention strategies were used, that is, community health workers, patient navigation, patient reminders, self-sampling collection, and HPV (human papillomavirus) vaccination.\u003c/p\u003e\n\u003cp\u003eEvidence-based health equity strategies under the pillars of research, clinical care, education and innovation were reviewed for radiologists \u003cstrong\u003e[61]\u003c/strong\u003e , but they would as well apply to other medical specialties. Regarding research, there are under-represented communities such as rural and native populations. \u0026nbsp;In clinical care, disparities in access result from factors such as medical mistrust, implicit bias by practitioners or patients, and race-based algorithms. \u0026nbsp; Medical students with increased education on the social determinants of health are more confident when working with underserved populations. Regarding innovations, there is increasing use of AI in radiology but there are potential biases because of incomplete data.\u003c/p\u003e\n\u003cp\u003eA narrative review explored the contribution of perinatal quality collaboratives on perinatal health equity \u003cstrong\u003e[62]\u003c/strong\u003e . These collaboratives are state-based networks of stakeholders in hospitals, health systems, and public health departments. Their aim is to advance maternal equity through improving the quality of care. \u0026nbsp;All 50 USA states belong to these networks. Six equity-promoting quality improvement strategies were documented in the review and used in the collaboratives (ABCDES): Accountability; Buy-in; Collaboration and communication; Data leverage; Education; and Structural changes. Published papers have highlighted the success of this quality improvement approach to reduce or eliminate racial inequities, based on the occurrence of severe maternal morbidity. A study on the quality of antenatal care in 91 low- and middle-income countries revealed that wealthier women were four times more likely to receive high-quality care compared to poorer women \u0026nbsp;\u003cstrong\u003e[63]\u003c/strong\u003e . The authors advocated using care quality as a key metric to monitor progress in universal health coverage. Another determinant of health equity is cultural sensitivity. In a viewpoint article on cultural sensitivity in pediatric primary care, \u003cstrong\u003e[64]\u003c/strong\u003e\u0026nbsp; noted that the literature on this topic is scarce, whether addressing implicit bias or structural racism, although there are some elements of cultural competency included in medical school curricula.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe identified a few reviews on health equity in mental healthcare and care of neurologic conditions \u0026nbsp;\u003cstrong\u003e[65\u0026ndash;67]\u003c/strong\u003e . Marked inequalities in mental health care in minoritized population groups are widely recognized. Among the contributing factors as reviewed by Asnaani \u003cstrong\u003e[65]\u003c/strong\u003e , social determinants of health are important but other drivers are involved, such as discrimination and racism, stigma regarding mental health, and the lack of treatments tested and validated in minoritized groups. Community-based research and community-driven mental health service adaptations are among the strategies identified, as well as task-shifting efforts in domestic and global settings, utilization of technology innovations to promote such work and increase access, and policy efforts. In their scoping review, Boden-Alba;a et al \u003cstrong\u003e[66]\u003c/strong\u003e\u0026nbsp; identified various community engagement strategies in the management of conditions such as Alzheimer disease, dementia and Parkinson\u0026rsquo;s disease that could also apply to mental health care. The strategies included linking with community partners, employing community health workers, recruiting personnel from the community, and caregiver support. A related study is that of \u003cstrong\u003e[68]\u003c/strong\u003e who analyzed the role of context and self-determination in promoting overall health of people with intellectual disabilities. The review highlighted the importance of self-determination and the role thereupon of education and financial autonomy.\u003c/p\u003e\n\u003cp\u003eA review examined what is known about the impact of integrated care programs on improving mental health equity, with special emphasis on collaborative care \u003cstrong\u003e[67]\u003c/strong\u003e . This review provides evidence that collaborative care is a model that has the potential to reduce disparities for ethnic minority and other at-risk populations who are often poorly served by usual primary care systems, and who have lower engagement and health outcomes because of other underlying risk factors. As a systems-based approach, collaborative care has been shown to also improve the quality of care received and health outcomes. The collaborative care team is led by a primary care provider and includes behavioral health care managers, psychiatrists and frequently other mental health professionals. The team implements measurement-guided care plans based on evidence-based practice guidelines and focuses particular attention on patients not meeting their clinical goals.\u003c/p\u003e\n\u003cp\u003eThe reviews on healthcare access barriers and improvement strategies were general \u003cstrong\u003e[69]\u003c/strong\u003e or they targeted specific groups, persons with disabilities\u003cstrong\u003e[70]\u003c/strong\u003e \u003cstrong\u003e,\u003c/strong\u003e indigenous people\u003cstrong\u003e[71]\u003c/strong\u003e , and migrants and refugees (in New-Zealand) \u003cstrong\u003e[72]\u003c/strong\u003e .Richard et al \u003cstrong\u003e[69]\u003c/strong\u003e carried out an environmental scan using an international brief survey to identify innovations in this area according to researchers, practitioners, policy makers and other stakeholders. Over 200 unique innovations to help people living in vulnerable situations to access healthcare were identified. Most innovations addressed supply-side dimensions of access, such as appropriateness and approachability (according to Levesque\u0026rsquo;s framework\u003cstrong\u003e[73]\u003c/strong\u003e, with less focus on demand-side dimensions. Most innovations were funded by governments and were implemented in the realm of community health. Davy et al \u003cstrong\u003e[71]\u003c/strong\u003e, in their study including high-income countries, South America and Papua-New Guinea, identified numerous barriers that indigenous peoples face in accessing primary health care, including discrimination, high healthcare costs, and broader social determinants of health such as unemployment. The authors highlighted the need for tailored healthcare services, employing staff from local indigenous communities, providing transport facilities and reducing healthcare costs for low-income individuals. A review on the impact of various reimbursement systems on health equity \u003cstrong\u003e[74]\u003c/strong\u003e found that the impact depended on the specific outcomes studied, the context and social factors beyond race or socio-economic status. Designing reimbursement systems that address the greater healthcare needs of underserved populations was recommended. The other reviews on healthcare access \u003cstrong\u003e[70, 72]\u003c/strong\u003e focused primarily on barriers - possibly because improvement initiatives are not well documented. Barriers to access by people with disabilities or by immigrants/refugees are considered structural or related to health systems, they are attitudinal, or else they are attributable to social determinants. Among the structural or social barriers, healthcare and specialized equipment costs, language issues (for immigrants and refugees) and logistics constraints are present. Attitudinal barriers include discrimination, negative attitudes, or lack of cultural competence among health care providers. Other health system-related barriers pertain to leadership and policies, as well as the paucity of disaggregated information.\u003c/p\u003e\n\u003cp\u003eThe role of the Global Alliance for Vaccines and Immunization (GAVI) initiatives in reducing inequities in vaccine access and immunization has been widely praised. A review showed that GAVI had significantly improved immunization coverage in eligible countries through targeted policies and supply strategies \u0026nbsp;\u003cstrong\u003e[75]\u003c/strong\u003e . The paper highlighted, however, that approaches such as tiered pricing have created inequities between GAVI-eligible and ineligible middle-income countries. This was before the COVID-19 pandemic which illustrated inequalities in access to prevention and treatment in a dramatic way. Strategies and proposals to address inequities in testing, vaccines, and treatment for COVID-19 as reviewed by Bell et al\u003cstrong\u003e[76]\u003c/strong\u003e\u0026nbsp; included: mobile testing and vaccination centers; at the global level COVAX and Fair Priority model; linguistically and culturally tailored medical care of COVID-19; telemedicine to limit face-to-face interactions; and addressing structural causes of inequities such as racism through whole-of society approaches. However, the real impact of these measures is not documented. Other groups exposed to health inequities are those with marginalized social identities because of race, gender and sexual orientation. In a commentary informed by a literature review on social interventions and inputs from health equity-involved stakeholders, Peek et al \u003cstrong\u003e[77]\u003c/strong\u003e\u0026nbsp; listed several recommendations for the Agency for Healthcare Research and Quality to advance health equity in such groups, including: research on SDOH and the effectiveness and implementation of social care interventions in the healthcare sector; to work with other federal agencies to develop complementary approaches addressing social marginalization; and to require social care intervention researchers to use methods that advance our understanding of social health equity.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis scoping review of reviews on actions to improve health equity was undertaken to describe the types of actions, to identify knowledge gaps, and to recommend evidence-based approaches integrating health equity into One Health initiatives. We had initially intended to document the links between, and interconnections of, One Health and health equity initiatives, and to make recommendations to integrate the two, but this intersection was not directly addressed in most reviews. Only two reviews addressed the effects of climate change or CO\u003csub\u003e2\u003c/sub\u003e reduction actions on health inequities\u003cstrong\u003e[35, 43]\u003c/strong\u003e . Among the negative impacts of the ongoing climate change and its increasing acceleration, there are changes in food and water supply which hamper nutritional security. Climate and environmental changes induce disproportionate adverse effects on specific populations, which are associated with risks of exacerbating, among others, existing gender and socio-economic inequities. It also affects populations\u0026apos; health outcomes, either directly or indirectly. These range from populations\u0026rsquo; physical and mental health and wellbeing to the emergence and distribution of vector-borne disease patterns. \u0026nbsp;As only reviews are included in the present paper, however, relevant intervention studies may have been missed. Additionally, perhaps with additional search terms such as planetary health, climate justice, or environmental health, additional relevant reviews might have been identified. Notwithstanding, this gap underlines the need for health equity concerns to be integrated into One Health endeavors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe One Health approach and its implementation may be challenging and even more so if one attempts to integrate health equity. Four United Nations technical agencies have developed a joint One Health plan of action for the period 2022-2026 \u003cstrong\u003e[78]\u003c/strong\u003e. The need for equity is stated but not the strategies. The following cross-table was designed to provide broad examples of interventions addressing various dimensions of One Health and health equity (using the WHO building blocks). \u0026nbsp; Evidently, our review only captured initiatives in human health, that is, the first row of the table, where more specific examples based on the review are added. In this table, we use \u0026lsquo;priority populations\u0026rsquo; instead of marginalized, vulnerable, underserved or minoritized groups, as the groups most in need and therefore targeted will depend on the context, and the type of action.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2 Health Equity Actions for One Health\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"699\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eGovernance \u0026amp; policy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eInformation \u0026amp; evidence data\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTechnologies\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eHuman Resources\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eService Delivery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHuman\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eHealth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eUniversal health Insurance\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eInstitutional capacity for health equity assessment and Integration into policy\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTailoring health literacy initiatives with and for priority populations\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eDisaggregated data according to social determinants of health\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCommunity spaces and services with and for priority populations\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eDigital health access for priority populations\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eInclusive and diversified health workforce\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eHealth equity training for health personnel\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTailored screening programs for increased access and effective use by priority populations\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eCommunity-based tailored prevention programs\u003cbr\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnimal Health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRegulation for Standards of Practice for animal health protection with and for priority populations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTailored agriculture and husbandry literacy with and for priority populations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eClean and safe drinking and irrigation water with and for priority populations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;Inclusive and diversified husbandry and harvesting strategies\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTailored community-based animal health services with and for priority populations\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEcosystem Health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;Regulation of heavy polluting industries proximal to population centres and related damaged green space\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eInclusive and diversified environmental outreach initiatives with and for priority populations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;Tailored measures to adapt to adverse climate events with and for priority populations\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003einclusive and diversified strategies to address the intersecting determinants of an ecosystem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTailored community-based monitoring systems for water quality with and for priority populations\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eUsing the WHO building blocks for this matrix, as well as to categorize the reviews we analyzed,\u0026nbsp;helps to better understand key areas for future action and research. For instance, \u0026lsquo;human resources\u0026rsquo; was the area with fewer reviews although the critical role of human resources for the delivery of comprehensive healthcare with a focus on social justice was a strong theme across the reviews. Yet institutional capacity to assess health equity or to integrate health equity into practice guidelines was central to some reviews. Gaps were identified in support of a diverse healthcare workforce, especially in relation to Indigenous communities. Training the next generation of healthcare providers, at various levels of the health system, is essential for embedding equity principles within the One Health framework.\u003c/p\u003e\n\u003cp\u003eOnly a few reviews reported on the impact of interventions on health equity \u003cstrong\u003e[24, 25, 32, 35, 56, 71]\u003c/strong\u003e. Furthermore, multiple definitions of health equity were used, many overlapping, but without real consensus. For instance, health inequities and inequalities are often used interchangeably. We also identified gaps in how healthcare systems currently assess equity, underscoring the need for more robust definitions and tools for measuring and promoting health equity. Braveman\u0026apos;s definition \u003cstrong\u003e[9]\u003c/strong\u003e was identified as a promising approach to addressing health inequities, particularly when applied alongside the One Health framework. It summarizes three overlapping core principles: (1) social justice; (2) removing obstacles to health for disenfranchised, marginalized, and excluded groups; and (3) addressing all determinants of health, not only health care.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMany reviews emphasized the importance of addressing SODH in reducing disparities, notably in managing chronic conditions. The PROGRESS-Plus framework was effective in analyzing social determinants of health inequities. However, its limited assessment of intersectionality, the predominant focus on high-income countries and the omission of, say, structural determinants of health are noted as areas for improvement. Social determinants, but also geopolitical and planetary determinants of health inequities must be increasingly considered\u003cstrong\u003e[79]\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eThere is a need for further exploration of how economic policies, education, and sociocultural contexts shape healthcare access. Multilevel interventions that address structural determinants are crucial for advancing equity.\u003c/p\u003e\n\u003cp\u003e\u0026quot;Diversity science\u0026quot; was introduced as a framework that, alongside \u0026quot;proportionate universalism,\u0026quot; can help bridge the gap between interventions aimed at the general population and those designed for socially disadvantaged groups \u003cstrong\u003e[80]\u003c/strong\u003e \u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eProportionate universalism, which promotes population-wide interventions with additional focus on marginalized communities, is recognized as key to ensuring equitable healthcare access under the One Health framework \u0026nbsp;\u003cstrong\u003e[81]\u003c/strong\u003e .\u003c/p\u003e\n\u003cp\u003eThe increasing role of digital literacy as a new determinant of health, especially in access to healthcare services, was highlighted in several reviews. Similarly, the role of artificial intelligence (AI) in exacerbating or mitigating inequities was reviewed in at least one paper\u003cstrong\u003e[46]\u003c/strong\u003e . AI and its impact on health equity is particularly important in agricultural sectors where One Health interventions are relevant. Reviews demonstrated that a holistic, system-level approach, combined with institutional-level interventions, is necessary to achieve health equity and reduce fragmentation of actions under One Health.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe papers emphasized the importance of addressing power imbalances, engaging with communities, and tackling other root causes of health inequities. Local-level approaches were shown to have the potential for systemic impact, particularly in chronic disease management and prevention. However, long-term outcomes of community engagement and local interventions were not thoroughly explored. The role of participatory implementation science in this regard was emphasized \u003cstrong\u003e[82]\u003c/strong\u003e . Social needs interventions and neighborhood-scale initiatives - often situated outside formal health systems - can play a critical role in advancing health equity. These strategies resonate with One Health principles by recognizing the interconnectedness of human, animal, and environmental health and the importance of localized responses.\u003c/p\u003e\n\u003cp\u003eThe importance of data is stressed in many reviews. Evidence clearinghouses were identified as essential tools for promoting health equity, although challenges remain in ensuring their methods are transparent and equity focused. Disaggregated and context-sensitive health data for identifying and addressing barriers according to specific intersecting demographic factors and social determinants of health such as age, socio-economic and immigration status, sex, gender, and disability are essential, as shown in many of the reviews included in this paper. Disaggregating health data to reveal disparities and tailor policies was seen as vital, though operational barriers, such as data privacy concerns and technological limitations, hinder widespread implementation. Systematic disaggregation of health data is critical for creating evidence-based policies that directly address inequities, aligning with One Health\u0026rsquo;s integrated, cross-sectoral approach.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe also noted that the number of health equity-focused reviews has increased over the last recent years, indicating a growing concern about health inequities which may partly result from the COVID-19 pandemic, even if only one review dealt with inequities in the prevention and treatment of COVID-19 \u003cstrong\u003e[76]\u003c/strong\u003e . Most papers were from high-income countries, particularly the USA, where yet little progress in health equity is observed \u003cstrong\u003e[83]\u003c/strong\u003e. Only a few reviews included LMICs\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[18, 36, 49, 63, 72]\u003c/strong\u003e, where health inequities are likely even more marked and where more equity-focused action is called for.\u003c/p\u003e\n\u003cp\u003eAt variance with systematic reviews, scoping reviews do not generally include an assessment of the quality of the selected studies, and this is the case for the present review. According to Grant \u003cstrong\u003e[84]\u003c/strong\u003e , this may limit the uptake of the findings into policy and practice. However, the ongoing consultation with stakeholders may confer additional meaning and applicability to the scoping study and indeed, this consultation is considered by Levac, Colquhoun and O\u0026rsquo;Brien \u0026nbsp;\u003cstrong\u003e[14]\u003c/strong\u003e as the last stage of the process and as a knowledge transfer mechanism.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur scoping review of reviews on actions to improve health equity highlights the need for clearer, more nuanced definitions of health equity within One Health contexts. Without empirical evidence, it remains challenging to establish best practices for integrating health equity into One Health interventions. While diversity science and proportionate universalism offer promising frameworks, their practical impact on health equity requires further investigation. The review also underscores the importance of strengthening community engagement, supporting a diverse health workforce, and improving data-driven policy solutions to advance equity. Moreover, addressing the challenges and opportunities posed by digital health, and AI, and particularly their role as potential effect modifiers in health inequities, should be prioritized in future research. By systematically integrating a health equity lens (principles and indicators) within One Health approaches, interventions can more effectively reduce disparities and help achieve the SDGs.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWHO. 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A typology of reviews: an analysis of 14 review types and associated methodologies. \u003cem\u003eHealth Inf Libr J\u003c/em\u003e 2009; 26: 91\u0026ndash;108.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Health equity, One Health, Achieving health equity, One Sustainable Health, Health equity actions","lastPublishedDoi":"10.21203/rs.3.rs-6024650/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6024650/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThe One Sustainable Health for All (OSH) Forum was launched in 2021 to promote a transdisciplinary “One Health / Planetary Health” approach in line with the 2030 Sustainable Development Goals. The ‘One Health’ approach is a holistic and system-based approach that recognizes the interconnection between health of humans, animals and ecosystems. ‘One Sustainable Health \u003cem\u003e\u003cstrong\u003efor all\u003c/strong\u003e\u003c/em\u003e’ implies health equity, that is, fair access of all human beings to quality health-related services and the health outcomes achieved. The OSH Forum leads thematic international working groups (IWGs), and the IWG on health equity undertook a scoping review as part of its mandate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim: \u003c/strong\u003eThe scoping review of reviews focused on actions to achieve health equity in the realm of One Health. The aim was to describe the types of health equity actions, to identify knowledge gaps and to recommend evidence-based approaches to integrate health equity into One Health initiatives.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003e\u0026nbsp;The comprehensive search identified 62 reviews out of 295 action-focused papers. The WHO building blocks were adapted to categorize the lines of action into six key areas: Governance and policy; Information and evidence data; Technologies; Human resources; and Health-related service delivery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003ePredominant actions were within service delivery (26/62 reviews). Health equity was addressed through governance in 13 reviews, evidence data in 7, technologies in 11, and human resources in 5. Refugees, immigrants, and racial/ethnic minorities were the main targeted groups. The intersection of health equity and One Health was not directly addressed except in two reviews. Most reviews were from high-income countries. Few studies assessed the impact of the interventions on health equity. Strong themes across the reviews were: the importance of addressing the social determinants of health; the need for disaggregated data; the critical role of human resources and community engagement; and the need to analyze power imbalances.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The review highlighted a dire need for studies on the impact of interventions on health equity, particularly in LMICs. Given the limited connections made between health equity and One Health, using a health equity lens to assess One Health initiatives appears warranted.\u003c/p\u003e","manuscriptTitle":"Reviews on interventions for health equity with a One Health focus","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-02 05:33:35","doi":"10.21203/rs.3.rs-6024650/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cbff5ff5-d9c9-427c-a72c-25c08beef0f0","owner":[],"postedDate":"July 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-02T05:33:35+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-02 05:33:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6024650","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6024650","identity":"rs-6024650","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}