Guiding principles for accelerating change through health inequities research and practice: A modified Delphi consensus process

Despite a preponderance of evidence and considerable resources, health and social inequities persist, and in many cases, are widening. These inequities are not simply the result of passive structural and economic conditions but are actively maintained through institutional processes, norms, and ideologies that uphold the status quo. Reform within health inequities research, policy, and health and social care practice is therefore critical to disrupting these entrenched systems and catalysing both bottom-up and top-down change. We aimed to develop agreement for an iterative set of guiding principles underpinning ways of working for a newly formed Health and Social Equity Collective comprising researchers, community leaders, policymakers, and health and care professionals, seeking to address inequity by identifying and engaging the levers of change within and across institutions. The principles aim to inform a more inclusive and translational knowledge base through research practices, tackling entrenched inequalities in education, training, and capacity-building; and centring communities affected by health inequities through engagement and advocacy. We carried out a modified Delphi consensus process between March and September 2022 with Collective members and networks through online workshops and surveys. Out of 24 consensus statements developed and refined over a workshop and three successive survey rounds, we identified eleven key principles agreed upon by a majority of respondents. Two of these were rated high priority by over 75% of respondents, four by over 60% and five by over 50%. These could be grouped into three main topics detailing ways of working and change needed within: ‘Knowledge and framing of health and social inequities, and incorporation into practice’, ‘Community engagement, involvement and peer research’, and ‘Organisational culture change’, respectively. Given the pressing need to address inequities, these principles offer a grounding for future consensus building initiatives which also incorporate a wider diversity of perspectives, and which should be iteratively updated with ongoing learning from health equity initiatives nationally and internationally.