The diversity gap in precision medicine research (PMR) participation has led to efforts to boost the inclusion of underrepresented populations. Yet our prior research shows that study teams need greater support to identify key decision-making issues that influence diversity and equity, weigh competing interests and tradeoffs, and make informed research choices. We therefore developed a Diversity Decision Map (DDM) to support the identification of and dialogue about study practices that impact diversity, inclusion, and equity.

The DDM is empirically derived from a qualitative project that included a content analysis of documents, observations of research activities, and interviews with PMR stakeholders. We identified activities that influenced diversity goals and created a visual display of decision-making nodes, their upstream precedents, and downstream consequences. To assess the potential utility of the DDM, we conducted engagements with stakeholder groups (regulatory advisors, researchers, and community advisors).

These engagements indicated that the DDM helped diverse stakeholder groups trace tradeoffs of different study choices for diversity, inclusion, and equity, and suggest paths forward. Stakeholders agreed that the DDM could facilitate discussion of tradeoffs and decision-making about research resources and practices that impact diversity. Stakeholders felt that different groups could use the DDM to raise questions and dilemmas with each other, and shared suggestions to increase the utility of the DDM.

Based on a research life course perspective, and real-world research experiences, we developed a tool to make transparent the tradeoffs of research decisions for diversity, inclusion, and equity in PMR.

Though Health Technology Assessment (HTA) has steadily grown over the past decades, less attention has been paid to the way HTA may prove more responsive to the broader economic, social, and environmental challenges that health systems are facing today. In view of climate change, chronic diseases, an aging population, inequalities, and workforce issues, the HTA community’s unique set of skills nonetheless holds great potential to help decision-makers strengthen many publicly funded health systems around the world.

This article adopts an integrated system-wide perspective guided by the Responsible Innovation in Health (RIH) framework to explore how the HTA community may not only adapt to the speed of innovation but also consider its direction.

Because RIH aims to steer innovation toward a more sustainable pathway, it can help HTA agencies anticipate decision-makers’ informational needs regarding four systemic challenges: (1) equitable access; (2) workforce issues; (3) accountable policy trade-offs; and (4) environmental sustainability. We clarify how key elements of the RIH framework may be used by HTA agencies to: (1) supplement their evaluation process; (2) align their priority-setting or strategic planning activities with their health system challenges; or (3) inform the production of early HTAs, horizon scans, or reports that are broader in scope than a single technology review.

The article concludes with three practical implications that were identified by the Institut National d’Excellence en Santé et Services Sociaux (INESSS) (Québec, Canada) and may inspire other HTA agencies.

Childhood morbidity is a precursor and contributor to under-five child mortality. Community-based primary healthcare programs are culturally responsive and low-cost strategies for delivering maternal and child health services in rural communities.

To evaluate the equity effect of the Ghana Essential Health Intervention Program (GEHIP) – a five-year community-based primary healthcare program – on childhood morbidity.

GEHIP was implemented in the Upper East region of Northern Ghana. Household baseline and end line surveys conducted in 2010/2011 and 2014/2015, respectively, from both intervention and comparison districts were used to assess three childhood morbidity conditions: maternal recall of neonatal illness, the incidence of diarrhoea, and fever. Difference-in-differences analysis, mean comparison test, and multivariate logistic regressions are used to assess the effect of GEHIP exposure on these three childhood morbidity conditions.

Baseline sample data of 2,911 women and end line sample of 2,829 women were included in this analysis. There was generally more reduction in all three childhood morbidity conditions in intervention communities relative to comparison communities. Diarrhoea and fever had a statistically significant treatment effect (AOR = 0.95, p-value<0.01 and AOR = 0.94, p-value<0.001). Results of equity analysis indicate significant mean reductions for both the poor and non-poor for neonatal illness and diarrhea, while only the intervention group had a significant reduction for both poor and non-poor for fever. Regression analysis shows no significant equity/inequity effects of GEHIP on the incidence of diarrhoea and fever. Neonatal illness, however, shows significant effects of wealth within the intervention group.

This study shows that GEHIP contributed significantly to childhood morbidity reduction. This implies that community-based strategies have the potential to improve child health and contribute to the attainment of the United Nations sustainable development goal related to child health. Specific targeted measures are recommended to ensure both the poor and relatively better-off benefit from interventions.

In recent years, there has been a growth in awareness of the importance of equity and community engagement in clinical and translational research. One key limitation of most training programs is that they focus on change at the individual level. While this is important, such an approach is not sufficient to address systemic inequities built into the norms of clinical and translational research. Therefore, it is necessary to provide training that addresses changing scientific norms and culture to ensure inclusivity and health equity in translational research.

We developed, implemented, and assessed a training course that addressed how research norms are based on histories and legacies of white supremacy, colonialism, and patriarchy, ultimately leading to unintentional exclusionary and biased practices in research. Additionally, the course provides resources for trainees to build skills in how to redress this issue and improve the quality and impact of clinical and translational research. In 2022 and 2023, the course was offered to cohorts of pre and postdoctoral scholars in clinical and translational research at a premier health research Institution.

The efficacy and immediate impact of three training modules, based on community engagement, racial diversity in clinical trials, and cancer clusters, were evaluated with data from both participant feedback and assessment from the authors. TL1 scholars indicated increased new knowledge in the field and described potential future actions to integrate community voices in their own research program.

Results indicate that trainings offered new perspectives and knowledge to the scholars.

Ensuring more equitable transformations requires addressing how different contextual dimensions of identity, such as gender and class, hinder equity. However, previous analyses on equity have addressed these dimensions separately. We suggest advancing beyond these methods by integrating intersectional analysis into the distributive, procedural, and recognition aspects of equity when examining social–ecological transformations. A review of 37 studies on social–ecological transformation shows that social–ecological transformation scholars commonly addressed social, spatial, and environmental transformations. In contrast, few studies have gone into depth in analyzing the reasons for power imbalances. We encourage scholars to use critical questions to reflect on social–ecological transformations collectively.

Ensuring equity in social–ecological transformations involves understanding how aspects of identity – such as gender, age, and class – affect experiences on the path to sustainability. Previous studies have often focused on one dimension of difference, but an intersectionality framework is essential for recognizing interconnected identities. In this paper, we review 37 empirical studies on social–ecological transformations, identifying key assets of transformation, including economic, social, cultural, political, spatial, environmental, and knowledge-based assets. We apply an analytical framework based on intersectional equity, incorporating intersectionality in equity analysis, which examines how power dynamics contribute to inequities in distribution, procedure, and recognition. Our findings show that social, spatial, and environmental assets of transformation are the most frequently mentioned in our sampled literature, together with benefits, costs, inclusiveness, and knowledge of equity dimensions. Power imbalances occurred the most often, while different aspects of identity were mentioned only in two-thirds of the studies. We believe an intersectional equity approach will help better conceptualize transformation concerning (in)equity. Based on our reflections, we suggest critical questions encouraging scholars to evaluate them iteratively with an interdisciplinary group.

An intersectional equity approach is key to just social–ecological transformations. We review 37 studies to show why.