Editors' Introduction – Special Issue: Health Equity

The achievement of health equity is an essential component of the pursuit of the Millennium Development goals (Editorial, 2010). However, “the evidence base on health equity, the social determinants of health, and what works to improve them needs further strengthening” (Marmot, 2008, p.1668). This involves investigating complex factors that influence health equity; testing interventions designed to reduce inequities experienced by vulnerable populations; and, examining implications for programs, practice, and policies in health and health-related sectors. Consequently, this special issue was launched to elucidate methodological insights and issues related to investigation of health equity; highlight the relationship between qualitative methodologies and equity; and, promote theoretical and practical integration of health equity issues in qualitative research.

Dr Jennie Popay, Professor at Lancaster University (UK) and lead of the Knowledge Network on Social Inclusion for the World Health Organization Commission on Social Determinants of Health shares important insights from an international perspective. She astutely advises reframing research to focus on pathways linking determinants with health equity outcomes, methodological innovation supporting action and intervention, and engagement of the public through participatory research approaches. Dr Nancy Edwards, Scientific Director of the Canadian Institutes of Health Research Institute of Population and Public Health, offers observations of significant trends and transformations from a national perspective. She wisely calls for investment in multi- level intervention research, theoretical underpinnings based on critical praxis, implementation science, mixed methods designs, multidisciplinary teams, and programmatic research focused on health equity.

The authors of the six papers published in this special issue communicate important insights regarding experiences and understandings of inequity and equity (all articles), ethical challenges (Schneider, Scerri et al., Aluwihare-Samaranayake), societal discourse and social justice (Schneider, Aluwihare-Samaranayake), diverse qualitative methodologies (Pratesi), participatory research approaches (Schneider, Mulcahy), and knowledge mobilization to influence programs, practice and policy (Patterson et al, Scerri et al). Inequities experienced by vulnerable populations including people affected by mental health problems (Schneider), developmental disability (Mulcahy), interpersonal and domestic violence (Scerri et al), same sex parenting and caregiving (Pratesi), poverty (Aluwihare-Samaranayake), and homelessness (Patterson et al) are illuminated. Salient social determinants of health including gender, income, social inclusion, and safe environments are also highlighted (Pratesi, Mulcahy, Schneider).

Diverse methodological strategies applied and analyzed by contributing authors include interpretive phenomenology (Pratesi), narrative interviews (Patterson et al, Mulcahy), open- ended interviews (Schneider), and grounded theory (Scerri et al). The potential of such qualitative strategies to advance inquiry and action in addressing health equity and inequities by the exploration of human experience, intersubjectivity, and social processes is clearly illustrated. The authors reveal the complexities inherent in such research strategies, including some ethical (including relational) and political challenges that can arise when research enables new or suppressed voices to be heard.

The contributing authors of articles and commentaries profile innovative and timely contributions to knowledge creation and translation. However, the gap in intervention research and integrated methods noted by Edwards and Popay persists in these papers, pointing to pertinent future directions in health equity research.