The Role and Responsibilities of Public Health in Promotion of Health Equity: A Scoping Review

Inequitable health outcomes are by-products of the intersection of myriad factors including race, ethnicity, ability, gender, social class, and place among others. These factors interplay to compromise individual and community capabilities to maximize potential in challenging conditions culminating in poor health and social suffering; with the worst outcomes observed among the socially disadvantaged. Public health strives to realize healthy and productive communities by incorporating principles of health promotion, disease, and injury prevention at the core of its roles and responsibilities. Addressing health inequities, however, requires intentional and systemic interventions directed towards deconstructing the root causes with attention on the social and structural factors. The need to intervene at the root causes makes no single strategy or intervention sufficient in addressing health inequities. Public health thus needs to explicitly address the praxis of health equity within its roles and responsibilities with emphasis on system-level interventions. The purpose of this thesis was to synthesize existing knowledge regarding the uptake of health equity within public health roles and responsibilities. This paper-based thesis has two independent papers and a general findings chapter. Chapter two sets the stage as a paper that uses personal experience and case study to explore if teaching health professionals on social, structural, political, and cultural causation of illness enhances their capacity to implement health advocacy. Chapter four is the findings from the scoping review that used the Arksey and O’Malley (2005) framework to complete a literature search for the years 1980 to 2018 resulting in 85 articles. Four broad themes of governance, collaboration, health equity leadership, and health advocacy relating to the roles of public health in the promotion of health equity were generated. The role of health advocacy emerged as a core link among the different roles of public health. Therefore, chapter five is a paper that explores the role of health advocacy within public health to assess how public health professionals implement health advocacy from within a system. Public health professionals implement health advocacy using six dimensions: health equity issues, barriers, processes, actors, actions, and health equity outcomes. Healthcare professionals including nurses play significant roles in ameliorating social suffering at the individual, population, and community levels by working to provide supportive services and systems. The health services and support systems are constructed and embedded within systems of politics, law, health, and economics, which manifest as power and authority. Ameliorating social suffering to achieve favorable and equitable health outcomes necessitates building consciousness among healthcare professionals on the complex interplays of social and structural forces and encouraging them to work from and within the system by means of health advocacy