THE ROLE OF LEADERS IN PREVENTING HEALTH INEQUALITIES

Abstract

The aim of this literature review was to review the evidence for the importance of effective leadership and to identify key features of leadership that promote the reduction of health inequalities within healthcare systems.

Methods: The review used search and MeSh terms related to “leadership” and “health inequalities” and the PubMed search engine. Inclusion criteria were: published in the last 10 years and available in English.

Results: One thousand three hundred and eighty five papers were found, of which 52 papers were identified, by the sole reviewer, as relevant to leadership and health inequalities. The themes focussed on 11key areas of the role of leadership in reducing health inequalities. These included adequate representation amongst leaders to reflect the demographic distributions within populations. Gender inequality amongst leaders was identified as an area that could potentially have an impact of health inequalities within populations. The political impact on the wellbeing and inequalities present within populations highlighted the role of health and social care in partnership with political groups to reduce disparities and the need for collaborative working, from a political global perspective, to have a greater impact on worldwide health inequalities. The literature suggested that Community leaders within populations can empower communities, reduce health inequalities and promote social change. Community leaders can also act as leverage points in the wider public health agenda working with leaders within the health sector. Given that these inequalities are related to health and health outcomes, many papers discussed the role of clinical leadership across health professions and the responsibility to appropriately train and develop clinical leaders and to ensure leadership succession, sustainability and the legacy of programmes to reduce health inequalities. Key issues in the future are the continual change within health services and the need to ensure consistent leadership in relation to reducing inequalities through change, and having an understanding of digital enablers to reduce inequalities.

Conclusions: These results suggest that key features of good leaders are: inter-professional working and networking, political awareness, empowering others and a strong drive and vision with resilience. Drivers for the reduction of health inequalities included, political input and influence, representative workforce and leaders and inequalities within leadership roles, global and local collaboration, involvement of the third sector and community leadership, clinical leadership, succession planning for clinical leaders and a knowledge and understanding of the digital enablers to reduce health inequalities. However some health inequalities are ingrained and built into the health systems. Analysis via institutional theory suggests that leaders are required to promote change at all levels to tackle the underlying causes of health inequalities.