Multi-level strategy to promote equity through empowerment and participation

Abstract

Introduction: Health inequities are recognised as one of the core challenges faced affecting population health worldwide. The Sustainable Development Goals (SDGs) and their focus on leaving no one behind have put equity at the centre of efforts to pursue development, wellbeing and prosperity. However, greater understanding of what is working to reduce health inequities is needed to move the implementation of health-related rights in complex systems. Description of policy context and objective: We reviewed case studies that used empowerment and participation interventions to address health inequities and extracted the lessons learned to propose a pragmatic multi-level strategy (Health System, Whole of Government and Whole of Society approach). Targeted population: Public health decision makers Highlights: Health System: Health systems can play an active role in boosting empowerment and participation at individual and community level. At individual level, it can enable empowerment and participation by promoting health literacy among citizens, patients and care-givers. These interventions should empower vulnerable and socially disadvantaged groups. At community level, it can raise awareness about the social determinants of health (SDH), and implement specific health promotion activities or anti-stigma programs. Whole of Government: Intersectoral collaboration is essential to enhance health policies and strengthen decision-making processes that give voice to all groups involved to address SDH and health inequities. Therefore, governments must take measures to enable and strengthen citizens participation, and civil society must be empowered in its role and potential leverage. There is no meaningful participatory citizenship without including the participation of hardto- reach groups, and their engagement needs to be fostered through investment in building skills, capacity and trust. Whole of Society: A crucial direction for policies to promote health equity, concerns the activation of civil society and the empowerment of affected communities to participate as active protagonists in shaping their own health and well-being. Within the whole-of-society approach, it must boost participatory activities which encourage the values of democracy, human rights, social cohesion and tolerance and aim to support social integration of hard-toreach groups. Comments on transferability: This multi-level strategy presented feeds off the best practices using empowerment and participation for health equity in different contexts and within real world conditions. The case studies reviewed are from different countries with different health and social systems. Conclusions: The SDG's commitment to leave no one behind requires exploring how to effectively respond to this challenge. We proposed a multi-level strategy to support health equity deployment, an strategy that feeds off the lessons learned from experiences that have been shown to be effective in improving health equity through empowerment and participation. The overall aims of this strategy are to support decision-makers by providing available evidence on best practices at different levels, to advance knowledge of integrated equitable policies, and to facilitate their implementation.