Reviews on interventions for health equity with a One Health focus

Abstract Background: The One Sustainable Health for All (OSH) Forum was launched in 2021 to promote a transdisciplinary “One Health / Planetary Health” approach in line with the 2030 Sustainable Development Goals. The ‘One Health’ approach is a holistic and system-based approach that recognizes the interconnection between health of humans, animals and ecosystems. ‘One Sustainable Health for all’ implies health equity, that is, fair access of all human beings to quality health-related services and the health outcomes achieved. The OSH Forum leads thematic international working groups (IWGs), and the IWG on health equity undertook a scoping review as part of its mandate. Aim: The scoping review of reviews focused on actions to achieve health equity in the realm of One Health. The aim was to describe the types of health equity actions, to identify knowledge gaps and to recommend evidence-based approaches to integrate health equity into One Health initiatives. Methods: The comprehensive search identified 62 reviews out of 295 action-focused papers. The WHO building blocks were adapted to categorize the lines of action into six key areas: Governance and policy; Information and evidence data; Technologies; Human resources; and Health-related service delivery. Results: Predominant actions were within service delivery (26/62 reviews). Health equity was addressed through governance in 13 reviews, evidence data in 7, technologies in 11, and human resources in 5. Refugees, immigrants, and racial/ethnic minorities were the main targeted groups. The intersection of health equity and One Health was not directly addressed except in two reviews. Most reviews were from high-income countries. Few studies assessed the impact of the interventions on health equity. Strong themes across the reviews were: the importance of addressing the social determinants of health; the need for disaggregated data; the critical role of human resources and community engagement; and the need to analyze power imbalances. Conclusion: The review highlighted a dire need for studies on the impact of interventions on health equity, particularly in LMICs. Given the limited connections made between health equity and One Health, using a health equity lens to assess One Health initiatives appears warranted.