This article, titled “Possible connections between health equity and primary health care: a scoping review” by Fernandes et al. and published in BMC Public Health in 2025, investigates the intricate relationship between health equity and primary health care (PHC) within the national and international literature. The study’s primary objective was to understand how health equity is connected with PHC and public health policies, specifically identifying the aspects of equity developed in PHC, challenges to its implementation, targeted populations, theoretical perspectives used, and methods of measurement. The authors also aimed to determine if global equity emerges as a relevant concept when addressing public health policies, with an emphasis on PHC.
To achieve this, the researchers conducted a scoping review using the method proposed by the Joanna Briggs Institute (JBI). Searches were performed in several prominent databases, including SCOPUS, CINAHL, BVS (which includes LILACS), PubMed, and Scielo, using validated descriptors from Health Sciences Descriptors/Medical Subject Headings (DeCS/MeSH). The eligibility criteria were based on the PCC strategy (Population, Concept, Context), encompassing the population in general (P), the concept of health equity (C), and Primary Health Care and Public Health Policies (C). The review included materials published from 1980 onwards, coinciding with the date of the Alma-Ata Declaration, and limited to full-text, free-access materials in Portuguese, English, or Spanish. After a rigorous selection process, involving duplicate identification and blind assessment by two reviewers with conflicts resolved by a third, the study ultimately included 34 materials. The corpus of selected materials primarily consisted of primary research articles (20), with Brazil (13), Australia (5), and Canada (4) being the most frequently focused countries, and the majority of publications in English (51.43%).
The review found that the concept of health equity is often associated with Whitehead’s theoretical conceptions, particularly defining inequities as systematic, unnecessary, preventable, and/or unfair differences in health. It is also frequently understood as fair or equal opportunity. A notable challenge is the consistent association of equity with the equality/inequality binomial, sometimes as a synonym for equality, or as a strategy to overcome inequality, highlighting a lack of consensus in its conceptualization. Many conceptualizations also incorporated the dimension of access, whether as a component of equity itself or as a category like “equity/inequity of access”. Equity meanings were connected to assistance, addressing differences in outcomes, singular health needs, and care experiences, as well as to structure and policies, such as funding, services provision, and intersectorality. Some texts also conceptualized equity based on abstract values and principles like human and social rights, social justice, and universality.
A central finding is that PHC plays a major role in disseminating and operationalizing the principle of health equity. It is considered more effective in achieving health equity because of its focus on people and the community, and its ability to integrate care within the broader healthcare network. The connections between health equity and PHC were observed across three main spheres:
- Micro-processes and Assistance: This includes themes such as access to PHC, equity in healthcare, and the qualification and training of professionals for equitable care.
- Macro-processes and Policies: This sphere encompasses the inclusion of equity in policies, funding and resource allocation based on health need, territorial distribution, organization in networks and regionalization, services coverage, provision and organization of services, intersectorality, and models of care.
- Health Results: This refers to observable impacts like equity in outcomes, PHC quality, and the equitable use of PHC services.
Despite the importance of these connections, the study highlighted significant measurement challenges. Only 16 out of 34 materials (47%) referred to or performed some kind of equity measurement, and four of these did not even define the concept of equity beforehand. Most attempts at measurement focused on access, but none used validated instruments or agreed upon how equity of access should be measured. Other measurements included equity of care, funding based on outcome differences, and differences in outcomes related to morbidity and mortality. While some articles used validated indicators like the Gini Index or Relative Index of Inequality, these were not specifically developed for measuring health equity in the PHC context. This lack of specific, validated instruments and clear conceptualization before measurement makes it difficult to understand precisely what is being measured and to assess the impact of policies and actions on health results.
Regarding targeted populations, 19 materials (55.8%) did not focus on any particular group. However, some texts engaged with Brazilian Ministry of Health Equity Policies, addressing vulnerable populations such as the homeless, countryside, forest, and water communities, indigenous communities, migrants, the LGBTQIA+ population, racial minorities, people of low socioeconomic origin, and those with non-communicable chronic diseases. The review emphasizes the need to overcome the misconception that PHC exclusively targets poor and vulnerable populations, as PHC should ideally be a universal service to avoid fostering dependence or crystallizing prejudices.
In conclusion, the review underscores the need for the development of specific instruments to measure the concept of health equity and for greater clarity in publications on the topic. There is also a call for more focus on assessing the impacts and observed results of health interventions related to equity. Implementing information systems and planning instruments is deemed crucial for building an equitable health system, requiring the adoption of clearer equity measures in PHC. The study’s limitation included its language inclusion criteria, potentially hindering access to relevant literature in other languages.
Reference: Fernandes, A. J. N. L., Ribeiro, L. C., & Ferreira, J. B. B. (2025). Possible connections between health equity and primary health care: a scoping review. BMC Public Health, 25, Article 499. https://doi.org/10.1186/s12889-025-21526-9
