건강 불평등 문제 해결을 위한 활동의 성과와 한계에 대해 리뷰한 논문
옹호 활동을 펴나가는 데 있어 적절한 시기에, 질적이고, 학제적이며 다양한 방법론을 사용한 연구가 도움이 됨
지식 번역 및 전달의 관점에서 “패키지”형태로 제공되는 지식이 효과가 높음
연구자와 정책 담당자의 잦은 만남이 연구의 정책화 가능성을 높임
의료진이나 당사자의 역할이 중요하지만, 연구자들도 활동에 중요한 기여를 할 수 있음
메시지는 옹호 활동에 적합해야 한다
건강 형평을 위한 활동의 장애물은 주변화된 이들의 건강 문제를 개인의 책임으로 돌리는 정치경제적 시대정신, 건강에 대한 생의학적 접근, 정치적 근시안주의 등
장애물 극복을 위해서는 장기적인 관점이 필요
옹호 활동은 전문성과 신뢰성을 보여주고 “기회의 창”을 잘 활용할 필요가 있음
Advocacy for Health Equity: A Synthesis Review
Context
Health inequalities are systematic differences in health among social groups that are caused by unequal exposure to—and distributions of—the social determinants of health (SDH). They are persistent between and within countries despite action to reduce them. Advocacy is a means of promoting policies that improve health equity, but the literature on how to do so effectively is dispersed. The aim of this review is to synthesize the evidence in the academic and gray literature and to provide a body of knowledge for advocates to draw on to inform their efforts.
Methods
This article is a systematic review of the academic literature and a fixed-length systematic search of the gray literature. After applying our inclusion criteria, we analyzed our findings according to our predefined dimensions of advocacy for health equity. Last, we synthesized our findings and made a critical appraisal of the literature.
Findings
The policy world is complex, and scientific evidence is unlikely to be conclusive in making decisions. Timely qualitative, interdisciplinary, and mixed-methods research may be valuable in advocacy efforts. The potential impact of evidence can be increased by “packaging” it as part of knowledge transfer and translation. Increased contact between researchers and policymakers could improve the uptake of research in policy processes. Researchers can play a role in advocacy efforts, although 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 advocacy target. Several barriers hamper advocacy efforts. The most frequently cited in the academic literature are the current political and economic zeitgeist and related public opinion, which tend to blame disadvantaged people for their ill health, even though biomedical approaches to health and political short-termism also act as barriers. These barriers could be tackled through long-term actions to raise public awareness and understanding of the SDH and through training of health professionals in advocacy. Advocates need to take advantage of “windows of opportunity,” which open and close quickly, and demonstrate expertise and credibility.
Conclusions
This article brings together for the first time evidence from the academic and the gray literature and provides a building block for efforts to advocate for health equity. Evidence regarding many of the dimensions is scant, and additional research is merited, particularly concerning the applicability of findings outside the English-speaking world. Advocacy organizations have a central role in advocating for health equity, given the challenges bridging the worlds of civil society, research, and policy.
