An overview of reviews on strategies to reduce health inequalities

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Abstract

Background

Governments are incentivized to develop and implement health action programs focused on equity to ensure progress with effective strategies or interventions.

Objective

Identify and synthesize strategies or interventions that facilitate the reduction of health inequalities.

Methods

A systematic search strategy was carried out up until August 2019 in MEDLINE (Ovid), Embase (Elsevier), Cochrane Database of Systematic Reviews, LILACS, Scopus, Scielo and Epistemonikos. In addition, a snowball strategy was used. Literature reviews (LRs) of experimental and quasi-experimental studies were included. The identified interventions and outcomes were categorized based on the recommendation by the Cochrane group in “ Effective Practice and Organization of Care”. The quality of the included LRs was evaluated using the AMSTAR 2 tool.

Results

Four thousand ninety-five articles were identified, of which 97 were included in the synthesis of evidence. Most of the studies included focused on the general population, vulnerable populations and minority populations. The subjects of general health and healthy lifestyles were the most commonly addressed. According to the classification of the type of intervention, the domain covered most was the delivery arrangements, followed by the domain of implementation strategies. The most frequent group of outcomes was the reported outcome in (clinical) patients, followed by social outcomes.

Conclusion

The strategies that facilitate the reduction of health inequalities must be intersectoral and multidisciplinary in nature, including all sectors of the health system. It is essential to continue generating interventions focused on strengthening health systems in order to achieve adequate universal health coverage, with a process of comprehensive and quality care.

Supplementary information

Supplementary information accompanies this paper at 10.1186/s12939-020-01299-w.

Related collections

Most cited references 55

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Health disparities and health equity: concepts and measurement.

Paula Braveman (2006)

There is little consensus about the meaning of the terms "health disparities," "health inequalities," or "health equity." The definitions can have important practical consequences, determining the measurements that are monitored by governments and international agencies and the activities that will be supported by resources earmarked to address health disparities/inequalities or health equity. This paper aims to clarify the concepts of health disparities/inequalities (used interchangeably here) and health equity, focusing on the implications of different definitions for measurement and hence for accountability. Health disparities/inequalities do not refer to all differences in health. A health disparity/inequality is a particular type of difference in health (or in the most important influences on health that could potentially be shaped by policies); it is a difference in which disadvantaged social groups-such as the poor, racial/ethnic minorities, women, or other groups who have persistently experienced social disadvantage or discrimination-systematically experience worse health or greater health risks than more advantaged social groups. ("Social advantage" refers to one's relative position in a social hierarchy determined by wealth, power, and/or prestige.) Health disparities/inequalities include differences between the most advantaged group in a given category-e.g., the wealthiest, the most powerful racial/ethnic group-and all others, not only between the best- and worst-off groups. Pursuing health equity means pursuing the elimination of such health disparities/inequalities.

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Inequalities in health: definitions, concepts, and theories

Mariana C. Arcaya, Alyssa Arcaya, S. Subramanian (2015)

Individuals from different backgrounds, social groups, and countries enjoy different levels of health. This article defines and distinguishes between unavoidable health inequalities and unjust and preventable health inequities. We describe the dimensions along which health inequalities are commonly examined, including across the global population, between countries or states, and within geographies, by socially relevant groupings such as race/ethnicity, gender, education, caste, income, occupation, and more. Different theories attempt to explain group-level differences in health, including psychosocial, material deprivation, health behavior, environmental, and selection explanations. Concepts of relative versus absolute; dose–response versus threshold; composition versus context; place versus space; the life course perspective on health; causal pathways to health; conditional health effects; and group-level versus individual differences are vital in understanding health inequalities. We close by reflecting on what conditions make health inequalities unjust, and to consider the merits of policies that prioritize the elimination of health disparities versus those that focus on raising the overall standard of health in a population.

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Do Interventions Designed to Support Shared Decision-Making Reduce Health Inequalities? A Systematic Review and Meta-Analysis

Marie-Anne Durand, Lewis Carpenter, Hayley Dolan … (2014)

Background Increasing patient engagement in healthcare has become a health policy priority. However, there has been concern that promoting supported shared decision-making could increase health inequalities. Objective To evaluate the impact of SDM interventions on disadvantaged groups and health inequalities. Design Systematic review and meta-analysis of randomised controlled trials and observational studies. Data Sources CINAHL, the Cochrane Register of Controlled Trials, the Cochrane Database of Systematic Reviews, EMBASE, HMIC, MEDLINE, the NHS Economic Evaluation Database, Open SIGLE, PsycINFO and Web of Knowledge were searched from inception until June 2012. Study Eligibility Criteria We included all studies, without language restriction, that met the following two criteria: (1) assess the effect of shared decision-making interventions on disadvantaged groups and/or health inequalities, (2) include at least 50% of people from disadvantaged groups, except if a separate analysis was conducted for this group. Results We included 19 studies and pooled 10 in a meta-analysis. The meta-analyses showed a moderate positive effect of shared decision-making interventions on disadvantaged patients. The narrative synthesis suggested that, overall, SDM interventions increased knowledge, informed choice, participation in decision-making, decision self-efficacy, preference for collaborative decision making and reduced decisional conflict among disadvantaged patients. Further, 7 out of 19 studies compared the intervention's effect between high and low literacy groups. Overall, SDM interventions seemed to benefit disadvantaged groups (e.g. lower literacy) more than those with higher literacy, education and socioeconomic status. Interventions that were tailored to disadvantaged groups' needs appeared most effective. Conclusion Results indicate that shared decision-making interventions significantly improve outcomes for disadvantaged patients. According to the narrative synthesis, SDM interventions may be more beneficial to disadvantaged groups than higher literacy/socioeconomic status patients. However, given the small sample sizes and variety in the intervention types, study design and quality, those findings should be interpreted with caution.

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Author and article information

Contributors

Nathaly Garzón-Orjuela:

ORCID: http://orcid.org/0000-0001-6181-8154

ngarzono@unal.edu.co

Daniel Felipe Samacá-Samacá: dfsamacas@unal.edu.co

Silvia Catalina Luque Angulo: scluquea@unal.edu.co

Carmen Verônica Mendes Abdala: abdalave@paho.org

Ludovic Reveiz: reveizl@paho.org

Javier Eslava-Schmalbach: jheslavas@unal.edu.co

Journal

Journal ID (nlm-ta): Int J Equity Health

Journal ID (iso-abbrev): Int J Equity Health

Title: International Journal for Equity in Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1475-9276

Publication date (Electronic): 28 October 2020

Publication date PMC-release: 28 October 2020

Publication date Collection: 2020

Volume: 19

Electronic Location Identifier: 192

Affiliations

[1 ]GRID grid.10689.36, ISNI 0000 0001 0286 3748, Grupo de Equidad en Salud, Facultad de Medicina, , Universidad Nacional de Colombia, ; Bogotá, Colombia

[2 ]GRID grid.456559.e, ISNI 0000 0004 0577 4507, Centro Latinoamericano y del Caribe de Información en Ciencias de la Salud, BIREME/OPS/OMS, ; São Paulo, Brazil

[3 ]GRID grid.4437.4, ISNI 0000 0001 0505 4321, Evidence and Intelligence for Action in Health Department, , Pan American Health Organization, ; Washington DC, USA

[4 ]GRID grid.10689.36, ISNI 0000 0001 0286 3748, Hospital Universitario Nacional de Colombia, ; Bogotá, Colombia

Author information

Nathaly Garzón-Orjuela http://orcid.org/0000-0001-6181-8154

Article

Publisher ID: 1299

DOI: 10.1186/s12939-020-01299-w

PMC ID: 7594271

PubMed ID: 33115482

SO-VID: 05aa0386-73ae-403a-a702-871a3cf2939f

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 18 May 2020

Date accepted : 13 October 2020

Funding

Funded by: Pan American Health Organization. Evidence and Intelligence for Action in Health. Washington

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: health equity,strategies,health status disparities,systematic review

Data availability: