Equity in evidence synthesis: You can't play on broken strings

Abstract

In the 2022 Cochrane Lecture [1], Jimmy Volmink, recognized as a pioneer of evidence-based medicine in Africa, challenged Cochrane to enhance its equity efforts and suggested five ways to do so. We, as members of the Campbell and Cochrane Health Equity Thematic group*, fully agree with his suggestions and have developed an actionable plan, described below. We invite the global community to join us in our efforts to meet the equity gaps in research and practice.

Population health and healthcare delivery should be equitable and the research that guides it equity sensitive. By this, we mean that we need to focus on the distribution of health outcomes in the population not just overall health. That is, people should have equal opportunities for health and are not subjected to systemic discrimination or structural barriers to health. It is an ambitious goal and one that many of us who work in healthcare delivery and health research are striving for.

This includes those of us who work in evidence synthesis. Synthesizers of other researchers' evidence may think that our handling of equity cannot be better than the handling of equity in the research we synthesize. We, as members of the Campbell and Cochrane Health Equity Thematic Group, disagree. To truly address inequity, evidence synthesis must take into account equity considerations in a systematic and explicit manner, regardless of how equity was addressed in the original research. We believe that evidence synthesis should lead the way in promoting equity, rather than simply reflecting the approaches taken in the primary research that is included in our reviews (Box 1).

We fully agree that Cochrane cannot succeed in better addressing health equity in systematic reviews without also addressing inequities in its own organization and governance. As members of the Campbell and Cochrane Health Equity Thematic group, we commit to the following actions.

Tamara Lotfi: Conceptualization, writing—original draft, reviewing and editing. Vivian Welch: Conceptualization, writing—original draft, review & editing. Jordi P. Pardo: Conceptualization, writing—original draft, review & editing. Jennifer Petkovic: Conceptualization, writing—original draft, review & editing. Shaun Treweek: Writing—review & editing. Andrea Darzi: Writing—review & editing. Rebecca Glover: Writing—review & editing. Declan Devane: Writing—review & editing. Meera Viswanathan: Writing—review & editing. Lawrence Mbuagbaw: Writing—review & editing. Kevin Pottie: Writing—review & editing. Elizabeth Kristjansson: Writing—review & editing. Shahab Sayfi: Writing—review & editing. Lara Maxwell: Writing—review & editing. Olivia Magwood: Writing—review & editing. Damian Francis: Writing—review & editing. Dru Riddle: Writing—review & editing. Beverly Shea: Writing—review & editing. Peter Tugwell: Conceptualization, writing—original draft, review & editing.

JPP is a member of the Cochrane Governing Board. The remaining authors declare no conflict of interest.