Does public health advocacy seek to redress health inequities? A scoping review

Abstract

What is known about this topic• Advocacy is considered a key public health strategy for redressing health inequities.• There is evidence that public health's advocacy role has not been fully realised; the reasons for this are unclear. What this paper adds• A systematic collation and critical analysis of the conceptual and empirical literature on public health advocacy focused on health equity is provided.• Public health is constrained in its health equity advocacy efforts by neoliberal conceptualisations of health problems, and by multiple barriers at the level of individual public health practitioners, institutions and the social environment. AbstractThe public health (PH) sector is ideally situated to take a lead advocacy role in catalysing and guiding multi-sectoral action to address social determinants of health inequities, but evidence suggests that PH's advocacy role has not been fully realised. The purpose of this review was to determine the extent to which the PH advocacy literature addresses the goal of reducing health and social inequities, and to increase understanding of contextual factors shaping the discourse and practice of PH advocacy. We employed scoping review methods to systematically examine and chart peer-reviewed and grey literature on PH advocacy published from January 1, 2000 to June 30, 2015. Databases and search engines used included: PubMed, CINAHL, PsycINFO, Social Sciences Citation Index, Google Scholar, Google, Google Books, ProQuest Dissertations and Theses, Grey Literature Report. A total of 183 documents were charted, and included in the final analysis. Thematic analysis was both inductive and deductive according to the objectives. Although PH advocacy to address root causes of health inequities is supported theoretically and through professional practice standards, the empirical literature does not reflect that this is occurring widely in PH practice. Tensions within the discourse were noted and multiple barriers to engaging in PH advocacy for health equity were identified, including a preoccupation with individual responsibilities for healthy lifestyles and behaviours, consistent with the emergence of neoliberal governance. If the PH sector is to fulfil its advocacy role in catalysing action to reduce health inequities, it will be necessary to address advocacy barriers at multiple levels, promote multi-sectoral efforts that implicate the state and corporations in the production of health inequities, and rally state involvement to redress these injustices.

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“…Health advocacy can therefore be understood as the set of actions that seek to claim rights for the health of individuals and social groups, especially the disadvantaged ones (5)(6) . The concept of health advocacy is part of a theory based on the idea of defense against health inequities.…”

“…The concept of health advocacy is part of a theory based on the idea of defense against health inequities. The term is related to the construction of actions and policies aimed at reducing such iniquities, which are characterized by life conditions related to the unequal distribution of power, income, and resources among countries, social groups, and individuals (5)(6) . It can be a powerful initiative to promote the improvement of living and health conditions, but it requires, from health professionals, an action guided by the principles of justice and equity (5)(6) .…”

“…The term is related to the construction of actions and policies aimed at reducing such iniquities, which are characterized by life conditions related to the unequal distribution of power, income, and resources among countries, social groups, and individuals (5)(6) . It can be a powerful initiative to promote the improvement of living and health conditions, but it requires, from health professionals, an action guided by the principles of justice and equity (5)(6) . Its purpose is to defend and protect the health rights of people and social groups at a disadvantage, as well as to help them get health care by empowerment (5)(6)(7) .…”

“…It can be a powerful initiative to promote the improvement of living and health conditions, but it requires, from health professionals, an action guided by the principles of justice and equity (5)(6) . Its purpose is to defend and protect the health rights of people and social groups at a disadvantage, as well as to help them get health care by empowerment (5)(6)(7) . When searching, in the literature, health advocacy practices for overcoming or minimizing health iniquities, Farrer et al (5) identified six dimensions of advocacy that contribute to promote health equity: 1) producing types of evidence needed to defend the equity in health and ways to transfer this knowledge to other political processes; 2) highlighting the importance of the participation of the various subjects in defense of health equity; 3) conveying health messages to society, as a value and a form of social justice, right of individuals, and state liability; 4) adapting arguments to different political views; 5) identifying barriers and facilitators of the effective defense for health equity; 6) instituting practices and activities that increase the effectiveness of health advocacy.…”

“…It also identified that few publications on this topic refer to the principles of equity and social justice as the main goal of health advocacy in favor of socially disadvantaged groups. Its authors classified advocacy according to the type of action carried out: 1) actions on a given particular cause to protect or promote the health of a given population or social groups; 2) actions to strengthen the capacity of people to act autonomously to improve their own health; 3) actions intended to reduce structural barriers to health; and, finally, 4) actions that use the media to exert influence on public policy initiatives (6) . The main structural barriers related to the protection of public health are related to the biomedical nature of the hegemonic model of health care; to the little argumentation using the concepts of social determination and social inequities in health for the defense of the right to health; to the little involvement of professionals to defend public health; to the little political will; to the low intersectoral involvement; and to the lack of independence of some health sectors for public health advocacy (6) .…”