Publication of a qualitative synthesis review: A building block for effective advocacy for health equity, by Linden Farrer

Scientific research in DRIVERS on advocacy for health equity has been published in a leading US health systems journal, the Milbank Quarterly.

Led by EuroHealthNet, this work aimed to consolidate existing knowledge of advocacy for health equity, which is dispersed widely across the academic and grey literature, across disciplines, and is contained in a variety of different kinds of publications. Advocates previously had no synthesis of this knowledge to draw upon to inform their efforts.

As a result, EuroHealthNet carried out a systematic review of the academic literature and fixed-length systematic search of the grey. The results of the search which were analysed and synthesised by using a heuristic representation of advocacy for health equity (the "Six Dimensions of Advocacy for Health Equity"), developed jointly with the European Anti-Poverty Network, Business in the Community and Eurochild.

The review shows that the policy world is complex and that scientific evidence is unlikely to be conclusive in the making of decisions policy. Timely qualitative, interdisciplinary, and mixed-methods research may be particularly valuable in advocacy efforts. The potential impact of evidence can be increased by “packaging” it using methods of knowledge transfer and translation. Increased contact between researchers and policy makers could improve the uptake of research in policy processes. Researchers can play a role in advocacy efforts, though health professionals and disadvantaged people, who have direct contact with - or experience of - hardship, can be particularly persuasive in advocacy efforts. Different types of advocacy messages can accompany evidence, but messages should be tailored to the target group. Advocates need to take advantage of “windows of opportunity”, which open and close quickly, and demonstrate expertise and credibility. For this reason, dedicated advocacy organisations that have the resources and experience required to advocate could play a leading role in advocacy efforts, bridging the ‘worlds’ of science, practice and policy.

One surprise finding was the emphasis on barriers that hamper advocacy efforts in the academic literature. The most frequently cited was the current political and economic zeitgeist (variously termed 'market fundamentalism', 'market justice', 'neo-classical economics' and 'neoliberalism') and related public opinion, which tends to blame disadvantaged people for their ill health. Other barriers identified included biomedical approaches to health, market-led reforms of higher education, academic difficulties or reluctance to advocate and political short-termism. Several papers suggested means of overcoming these barriers, including long-term actions to raise public awareness and understanding of the SDH, training health professionals in advocacy or human rights, and bringing students concerned with the determinants of health into closer contact with those experiencing hardship as part of their studies.

The review provided a useful building block for later research on advocacy within DRIVERS: five case studies on advocacy and development of the toolkit on advocacy for health equity.

In addition, the findings helped inform the how the project disseminated and presented its results.

The paper is available here, and appendices here. The case studies report is available here, and advocacy for health equity toolkit here.