Over half of the WHO guidelines published from 2014 to 2019 explicitly considered health equity issues: A cross sectional survey

Abstract Objective To evaluate how and to what extent health equity considerations are assessed in WHO guidelines. Study design and Setting We evaluated WHO guidelines published between January 2014 and May 2019. Health equity considerations were assessed in relation to differences in baseline risk, importance of outcomes for socially disadvantaged populations, inclusion of health inequity as an outcome, equity-related subgroup analysis, and indirectness in each recommendation. Results We identified 111 WHO guidelines, and 54% (60/111) of these used the Evidence to Decision (EtD) framework. For the 60 guidelines using an EtD framework, the likely impact on health equity was supported by research evidence in 28% (94/332) of the recommendations. Evidence was mostly provided as differences in baseline risk (23%, 78/332), and least frequently reported as differences in the magnitude of effect in relative terms between disadvantaged and more advantaged populations (0.9%, 3/332). Guidelines considered the importance of outcomes for socially disadvantaged populations in 11% (36/332) of their recommendations. Only 2.0% (5/332) of the guidelines’ recommendations mentioned indirectness of the evidence for socially disadvantaged and 2% (5/332) conducted subgroup analysis. Conclusion The provision of research evidence to support equity judgements is still suboptimal, suggesting the need for better guidance and more training.