Social sciences: vital to improving our understanding of health equity, policy and systems

Founded by the International Society for Equity in Health 15 years ago, the International Journal for Equity in Health (IJEqH) has from its inception been committed to redressing not just health inequity, but also inequity in the publishing of research on health cb [1]. An editorial marking the society’s 10 anniversary remarked that “In particular the conferences and the journal have both provided a voice to researchers from low and middle income countries, giving life and embodiment to the values of inclusion, action-based research, research-to policy processes, and the vital role of civil society in strengthening action for health equity.” [1]. This commitment to giving voice to diversity was clear to the members of SHAPES (Social science approaches for research and engagement in health policy & systems) a thematic working group of Health Systems Global [2], when, in July 2016, the Journal published an open letter from our members and affiliate group members, critiquing the lack of publishing space given to qualitative research in many academic journals [3]. Our critique focused on how methodological gatekeeping within mainstream publishing privileged certain voices in global health over others, and in so doing, was in effect silencing many researchers in lowand middleincome countries (LMICs) [3]. Such gatekeeping limits the range of publicly accessible knowledge on solutions to health problems experienced in LMIC settings [3] and these inequitable publishing practices contribute to inequitable knowledge distribution about solutions to health problems faced by the most marginalised populations on the globe. Social science approaches are firmly embedded in the field of health policy and systems research (HSPR), where they not only shape our methods of enquiry, but provide key critical theory through which we are better able to understand the people and the processes shaping health systems [4]. The need for a greater emphasis on social science theory and methods as a means to answer some of the core questions in the emerging field of HPSR has been established during the past decade [5]. Finding solutions to contemporary challenges in health systems, to achieving Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs), will indeed not occur through application of traditional quantitative research methods and techniques alone, as these methods do not take into account the perspectives of the people at the forefront of implementation. Research on the SDGs will need to be far more sophisticated than assessing target indicators through numerical measures; instead, this research will have to embrace complexity, and social science approaches are well suited to the task [6]. Because qualitative approaches take into account the experience of policy actors, they may serve to tell the real life stories of the SDG implementation process. Through these stories, we may be better able to understand the mechanisms through which equity is enhanced or inequity is further entrenched [7]. Research methods born out of the positivist paradigm artificially separate the research subject and object [5], which limits our capacity for observations on the dynamic and the interactive processes that occur between patients, providers, managers, policymakers, communities and activists. These interactions are the heart of health systems [5]. Moreover, notions of research objectivity limit the field, especially when it comes to innovative research practice. Participatory research methods, * Correspondence: [email protected] Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa Full list of author information is available at the end of the article