Intended for healthcare professionals

Research Methods & Reporting

Assessing equity in systematic reviews: realising the recommendations of the Commission on Social Determinants of Health

BMJ 2010; 341 doi: (Published 13 September 2010) Cite this as: BMJ 2010;341:c4739
  1. Peter Tugwell, professor1,
  2. Mark Petticrew, chair in public health evaluation2,
  3. Elizabeth Kristjansson, associate professor3,
  4. Vivian Welch, research coordinator4,
  5. Erin Ueffing, coordinator5,
  6. Elizabeth Waters, Jack Brockhoff chair of child public health6,
  7. Josiane Bonnefoy, assistant professor7,
  8. Antony Morgan, associate director8,
  9. Emma Doohan, project manager8,
  10. Michael P Kelly, director8
  1. 1Department of Medicine and Institute of Population Health, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  2. 2Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
  3. 3School of Psychology, Institute of Population Health, University of Ottawa
  4. 4Ottawa Hospital Research Institute, Institute of Population Health, University of Ottawa
  5. 5Campbell and Cochrane Equity Methods Group, Institute of Population Health, University of Ottawa
  6. 6The McCaughey Centre, Melbourne School of Population Health, University of Melbourne, Melbourne, Australia
  7. 7School of Public Health, Faculty of Medicine, University of Chile, Santiago, Chile
  8. 8Centre for Public Health Excellence, National Institute for Health and Clinical Excellence, London, UK
  1. Correspondence to: P Tugwell tugwellb{at}
  • Accepted 13 June 2010

A group from the Cochrane Collaboration, Campbell Collaboration, and the World Health Organization Measurement and Evidence Knowledge Network has developed guidance on assessing health equity effects in systematic reviews of healthcare interventions. This guidance is also relevant to primary research

Summary points

  • The Commission on Social Determinants for Health has recommended assessment of health equity effects of public policy decisions

  • This article provides guidance on assessing equity for users and authors of systematic reviews of interventions

  • Particular challenges occur in seven components of such reviews: (1) developing a logic model, (2) defining disadvantage and for whom interventions are intended, (3) deciding on appropriate study design(s), (4) identifying outcomes of interest, (5) process evaluation and understanding context, (6) analysing and presenting data, and (7) judging applicability of results

  • Greater focus on health equity in systematic reviews may improve their relevance for both clinical practice and public policy making

Background to health inequalities and inequities

The terms health inequalities and health inequities are used in different ways in different societies and by different authors.1 We use the term inequity in preference to inequality, following the definitions articulated by Whitehead.2 She describes health inequality as: “measurable differences in health experience and health outcomes between different population groups—according to socioeconomic status, geographical area, age, disability, gender or ethnic group.” She defines health inequity as differences in opportunity for different population groups which result in, for example, unequal life chances, access to health services, nutritious food, adequate housing, etc. These differences may be measurable; they are also judged to be unfair and unjust.2 The World Health Organization’s Commission on the Social Determinants of Health (CSDH) has further defined health equity as “the absence of unfair and avoidable or remediable differences in health among social groups.”3

The need for adequate reporting of health equity effects

The CSDH final report recognised that tackling health inequities requires a firm evidence base. …

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