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Table 1 Exemplar systematic reviews

From: Health equity: evidence synthesis and knowledge translation methods

Systematic reviews with a major focus on health equity

Example exemplar review

How equity was considered

(1) Assess effects of interventions in disadvantaged population(s)

School feeding for improving the physical and psychosocial health of disadvantaged students [19]

This review included only studies in which the intervention was target at ’predominantly disadvantaged’ children (e.g., living in a rural area or village, or an urban area and described as socioeconomically disadvantaged, from poor areas, if 30% of more of the children in the sample were underweight, or stunted or the average weight, height and body mass index (BMI) were low, or if the studies were implicitly or explicitly aimed at disadvantaged children (and indicators of disadvantage were provided) [19]

Interventions to reduce the prevalence of female genital mutilation/cutting in African countries [22]

Female genital mutilation/cutting (FGM/C) is practiced mainly on young girls and has many potential adverse effects. In addition to ethnic, cultural and religious beliefs, there are socioeconomic beliefs that FGM/C is required for marriage or an economic necessity when women are dependent on men. This review examined intervention features and contextual factors that reduce the prevalence of FGM/C [22]

 

What is the impact of microfinance on poor people? A systematic review of evidence from Sub-Saharan Africa [23]

This review aimed to determine the impact of microfinance interventions on incomes of the poor, on wider poverty/wealth of the poor and on non-financial outcomes, such as health and food security. The authors found that microfinance had inconclusive effects on savings and income but positive effects on health outcomes [23]

(2) Assess effects of interventions aimed at reducing social gradients across populations

Population tobacco control interventions and their effects on social inequalities in smoking: systematic review [20]

This systematic review applied an “equity lens” to population level interventions to reduce inequalities in smoking rates and extracted outcome, process and implementation data stratified by PROGRESS-Plus. Certain interventions, such as smoking restrictions in schools, restricting sales to minors and increasing the price of tobacco, are more effective in reducing smoking among lower-income adults and those with manual occupations. Other interventions had no effect on reducing social inequalities in smoking [20]

Working for health? Evidence from systematic reviews on the effects of health and health inequalities of organizational changes on the psychosocial work environment [24]

The psychosocial work environment has a strong gradient that influences inequalities in health. This umbrella review examined the impacts of interventions on inequalities in health by socioeconomic status, age, gender and ethnicity and found that some organizational workplace interventions can reduce health inequalities in those who are employed, especially between men and women, and socioeconomic groups [24]

 

Socioeconomic differences in lung cancer incidence: a systematic review and meta-analysis [25]

The socioeconomic gradient in lung cancer results from differences in exposures and risk factors, such as smoking, occupational/environmental exposure to inhaled carcinogens and air pollution. This meta-analysis found that lung cancer risk was highest among those in the lowest socioeconomic categories for education, occupation and income [25]

(3) Assess effects of interventions not aimed at reducing inequity but where it is important to understand the effects of the intervention on equity, either positively or negatively

Interventions for preventing obesity in children [21]

This review extracted data on intervention implementation, cost, equity and outcomes. The authors used PROGRESS-Plus to extract equity-relevant data from the studies and examined equity effects for each age group [21]

Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases [26]

This review included studies conducted in any country with any population as long as the intervention was delivered by lay health workers and intended to improve maternal and child health. Many of the included studies focused on low income populations and found that lay health workers can improve access to health care for low income groups and, if extrapolated to other settings, may contribute to reducing inequities [26]

 

Built environment interventions for increasing physical activity in adults and children (Protocol) [27]

This review aims to examine the effectiveness of all built environment interventions to increase physical activity. If sufficient data are available, the authors plan to conduct subgroup analyses to explore whether there is likely to be a relationship of effect to disadvantage and whether an equity gradient is present by assessing studies that have included subgroup analyses by ethnicity, occupation, gender, education, socioeconomic status and disability (including individuals with specific morbidities) [27]