If you committed to do one thing this year to enhance equity in health policy and systems research, what would it be?

This was the question posed to participants at an organised session in the Global Symposium on Health Systems Research (HSR) in Nagasaki[i] last November.

Despite growing calls for equity and inclusivity in health policy and systems research, we noted the ad hoc nature of their actual integration in research processes. We came together to review existing tools and frameworks aiming to enhance equity, raising the challenges we face, and what we can do better.

We started by discussing the 5 core dimensions of social justice needed to transform global health research: power, recognition, harmony, inclusion, and well-being. We heard about two practical tools designed to support researchers: the EquiPar tool which provides research teams with systematic & practical guidance for strengthening their collaborations; and the 8quity tool to support researchers in greater equity integration across a research cycle. We were also introduced to the Witness Seminar, an oral history method that creates a public record of the voices of those who have witnessed important events – which was carried out to understand the powerful and moving history of Argentina’s Gender Identity Law.

The group then discussed the challenges they faced in achieving equity and the potential pathways moving forward.

Challenges in Achieving Equity

Groups highlighted the lack of clarity and practicality in equity-related research tools: many fail to specify how to operationalize equity, especially in multisectoral contexts, and lack accountability mechanisms for measuring community engagement. Power asymmetries are another major barrier. Participants noted that entrenched hierarchies hinder genuine collaboration. While frameworks may acknowledge these dynamics, they rarely offer guidance on recognizing, navigating, or redistributing power.

The research environment itself is misaligned with equity goals. Short funding cycles, lack of institutional incentives, and entrenched norms discourage long-term, equity-focused work (eg. professional development incentives for all researchers to pursue equity goals; pecuniary support to build this in where it is lacking in existing projects?). Structural changes and support such as professional development incentives and extended timelines are required.

Finally, community knowledge representation remains unresolved. Questions persisted around how to ethically acknowledge and respectfully compensate communities for their contributions, especially given legal and cultural complexities. Tools often overlook such nuances; this limits real-world applicability.

Key pathways for moving forward

Participants noted that achieving equity begins with shared understanding and ethical alignment. Underscoring the linkages between ethics, equity and rigour should be part of research training. Rather than relying on rigid frameworks, participants emphasized the value of small steps and adaptable yet specific guidance that could be incorporated as per context.

Diversity and inclusion must go beyond representation to include relationship-building and sustained engagement. Equity should underpin capacity-strengthening efforts, especially for frontline workers. Regular convenings of equity tool creators could help share experiences, avoid duplication, and amplify impactful practices.

Finally, accountability emerged as a key theme. Embedding routine evaluation, mentorship, and publication guidelines could help ensure that equity efforts are implemented, impactful, and improved over time.

Making the Equitree and Further Commitments

A small but powerful activity that sparked reflection during our HSR 2024 session was the EquiTree exercise. In this activity participants shared their own equity-oriented research experiences: on yellow leaves, they described the challenges they faced; on green leaves, they shared strategies and approaches to overcome these challenges; and on pink flowers, they articulated personal commitments to doing things better. Though introduced in our workshop, the Making of the EquiTree is a versatile tool that can be used and adapted independently in diverse settings to foster reflection, dialogue, and action.

Participants committed to transformative action, emphasizing equal partnerships among individuals, governments, donors, and implementers.  They pledged to educate the next generation and ensure that leadership opportunities are available for marginalized groups.  They committed to using self-assessment tools and practical guidance from existing toolkits at project initiation, and to allocating proposal development time to prioritize equity. Participants mentioned establishing a community of practice on equitable partnerships and indicated that policies regarding intellectual property in projects will be discussed openly, and research capacity-strengthening courses will be developed.

Furthermore, they stated that they will attempt to prioritize equity in policy analysis, aiming to move beyond a piecemeal approach and integrate equity tools with urgency across all parts of their organizations.

However, in today’s geopolitical climate, structural barriers to equity such as funding requirements, tight timelines, and limited budgets pose significant challenges to equity-oriented work. In this context, focusing on practical, achievable steps to advance equity becomes both powerful and political.

We are grateful for the insights of all those attending the session. These are initial steps, and we know there is much work still to be done, perhaps in more difficult circumstances. But we hope by acknowledging the importance of equity throughout the research process, at any times, and all times, we may create safe spaces to explore this, so our EquiTrees flourish into forests.

[i] ‘Just Enough: Tools and Processes to enhance equity and fairness in the conduct of HPSR’, Organised Session, 8th Global Symposium on Health Systems Research, Nov 2024, Nagasaki

Authors:

Neymat Chadha is a Research Fellow at the George Institute for Global Health and a final-year doctoral researcher at the Indian Institute of Technology, New Delhi. Her research focuses on equity in research practices, social and community participation in health, illness narratives, and women’s health.

Devaki Nambiar is a health policy and systems researcher at the George Institute for Global Health India. She is deeply committed to advancing health equity, promoting health for all, fostering social participation in health, and upholding public health research ethics.

Catherine Goodman is a health economics and health systems researcher at the London School of Hygiene & Tropical Medicine (LSHTM). Her work centres on improving the stewardship and quality of healthcare in both public and private sectors. She also chairs LSHTM’s Equitable Partnerships Coordinating Group.

Bridget Pratt is the Mater Associate Professor in Healthcare Ethics at the Queensland Bioethics Centre, Australian Catholic University. Her research explores the ethics of global health research and health systems, with a strong emphasis on social, ecological, and global justice.

Carmen Ryan is a lawyer with a master’s in Human Rights and Democratization from UNSAM. With 15 years of experience across civil society, international organizations, and public institutions, she currently leads public advocacy at Fundación Huésped, promoting social participation and equitable healthcare access.

Competing interest: None to declare

Handling Editor: Neha Faruqui