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Over half of the WHO guidelines published from 2014 to 2019 explicitly considered health equity issues: a cross-sectional survey

  • Omar Dewidar
    Correspondence
    Corresponding author. Tel.: 613 501 0632; fax: 613-501-0632.
    Affiliations
    Bruyère Research Institute, University of Ottawa, 85 Primrose Avenue, Ottawa, Ontario K1R 6M1, Canada

    School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario K1G 5Z3, Canada
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  • Phillip Tsang
    Affiliations
    Bruyère Research Institute, University of Ottawa, 85 Primrose Avenue, Ottawa, Ontario K1R 6M1, Canada
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  • Montserrat León-García
    Affiliations
    Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB Sant Pau), Carrer de Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain
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  • Christine Mathew
    Affiliations
    Bruyère Research Institute, University of Ottawa, 85 Primrose Avenue, Ottawa, Ontario K1R 6M1, Canada
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  • Alba Antequera
    Affiliations
    Biomedical Research Institute Sant Pau (IIB Santpau), Universitat Autònoma de Barcelona, Carrer de Sant Quintí, 77, 08041 Barcelona, Spain
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  • Tejan Baldeh
    Affiliations
    Department of Health Research Methodology, Evidence and Impact (HEI), McMaster University Faculty of Health Sciences, 1280 Main Street, Hamilton, Ontario L8S 4K1, Canada
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  • Elie A. Akl
    Affiliations
    Department of Health Research Methodology, Evidence and Impact (HEI), McMaster University Faculty of Health Sciences, 1280 Main Street, Hamilton, Ontario L8S 4K1, Canada

    Department of Internal Medicine, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
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  • Pablo Alonso-Coello
    Affiliations
    Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB Sant Pau), Carrer de Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain

    CIBER de Epidemiología Clínica y Salud Pública (CIBERESP), Spain
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  • Jennifer Petkovic
    Affiliations
    Bruyère Research Institute, University of Ottawa, 85 Primrose Avenue, Ottawa, Ontario K1R 6M1, Canada
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  • Thomas Piggott
    Affiliations
    Department of Health Research Methodology, Evidence and Impact (HEI), McMaster University Faculty of Health Sciences, 1280 Main Street, Hamilton, Ontario L8S 4K1, Canada
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  • Kevin Pottie
    Affiliations
    School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario K1G 5Z3, Canada

    Department of Family Medicine, University of Ottawa, 600 Peter Morand Crescent Suite 201, Ottawa, Ontario K1G 5Z3, Canada

    Department of Medicine, University of Ottawa Faculty of Medicine, Roger Guindon Hall, 451 Smyth Road #2044, Ottawa, Ontario K1H 8M5, Canada
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  • Holger Schünemann
    Affiliations
    Department of Health Research Methodology, Evidence and Impact (HEI), McMaster University Faculty of Health Sciences, 1280 Main Street, Hamilton, Ontario L8S 4K1, Canada
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  • Peter Tugwell
    Affiliations
    Department of Medicine, University of Ottawa Faculty of Medicine, Roger Guindon Hall, 451 Smyth Road #2044, Ottawa, Ontario K1H 8M5, Canada

    Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada

    WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, 85 Primrose Avenue, Ottawa, Ontario K1R 6M1, Canada
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  • Vivian Welch
    Affiliations
    Bruyère Research Institute, University of Ottawa, 85 Primrose Avenue, Ottawa, Ontario K1R 6M1, Canada

    School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario K1G 5Z3, Canada
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      Abstract

      Objective

      To evaluate how and to what extent health equity considerations are assessed in World Health Organization (WHO) guidelines.

      Study Design and Setting

      We evaluated WHO guidelines published between January 2014 and May 2019. Health equity considerations were assessed in relation to differences in baseline risk, importance of outcomes for socially disadvantaged populations, inclusion of health inequity as an outcome, equity-related subgroup analysis, and indirectness in each recommendation.

      Results

      We identified 111 WHO guidelines, and 54% (60 of 111) of these used the Evidence to Decision (EtD) framework. For the 60 guidelines using an EtD framework, the likely impact on health equity was supported by research evidence in 28% of the recommendations (94 of 332). Research evidence was mostly provided as differences in baseline risk (23%, 78/332). Research evidence less frequently addressed the importance of outcomes for socially disadvantaged populations (11%, 36/332), considered indirectness of the evidence for socially disadvantaged populations (2%, 5/332), considered health inequities as an outcome (2%, 5/332) and considered differences in the magnitude of effect in relative terms between disadvantaged and more advantaged populations (1%, 3/332).

      Conclusion

      The provision of research evidence to support equity judgements in WHO guidelines is still suboptimal, suggesting the need for better guidance and more training.

      Keywords

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