The ELPH program of research employs complexity theory, intersectionality, and critical social justice theories as theoretical foundations for research [23, 24]. In this study, we used complexity theory to guide our analytical process about what is needed for effective prioritization within complex health systems. We drew on Walby’s framework for theorizing about the intersections of social relations and institutional structures and the implications of this for supporting system responses to increase prioritization of health equity at multiple levels of the health system [27–29]. Within this understanding of complexity, we considered the implementation of a health equity lens to be an event inserted into the health system, and examined the resulting responses within various programs and levels of the system [10, 12, 30]. We conceptualized health systems as complex adaptive systems, in which system responses to enactment of a policy will depend on the multiple interactions and relationships that occur in that system as a result of that policy [10, 11, 30–32]. Thus, while change within a system will be influenced by formal organizational documents and policies, the system response that emerges will also reflect the informal organization that emerges through created structures, groups and processes [10, 12]. Anderson highlights the importance of understanding both these formal and informal aspects of a system, and the interactions between them, to gain insight into the way a system is functioning as a whole as well as to understand the specific system properties that influence change [10]. We aimed to understand how these formal and informal aspects, and their interactions, vary within different parts of the system, and the potential impact of this on the system response. This included identifying critical elements that facilitate prioritization of health equity within the health system, and the relationships among these elements.

This study is part of The Equity Lens in Public Health (ELPH) program of research that commenced in 2011 to study the application of a health equity lens in BC health authorities [23]. As part of the broader program of research, we conducted a qualitative analysis ‘Assessing Health Equity Priorities’, which included a baseline examination of senior leaders’ perspectives on prioritization of health equity in the BC health system in 2013/2014. Our collaborative research team included public health systems leaders from Fraser Health Authority, Interior Health Authority, Island Health Authority, Northern Health Authority, and Vancouver Coastal Health Authority, the Provincial Health Services Authority, and the Ministry of Health. Ethical approval for this study (H11–03359) was provided by the University of Victoria, the University of British Columbia, the University of Saskatchewan, Fraser Health Authority, Interior Health Authority, Island Health Authority, Northern Health Authority, and Vancouver Coastal Health Authority research ethics review boards.We used a participatory process in which health authority partners and academic researchers worked collaboratively throughout the entire research process from developing the research questions, through planning the research design, to analyzing and interpreting the findings [25, 26]. Such participatory approaches are reflexive, dialectic process to better align research and theory with practice, and include stakeholders in knowledge generation that is relevant and useful; participatory approaches are aligned with integrated knowledge translation and exchange processes. We developed working groups and held meetings with partners for feedback for each stage of the research process including the development of the research questions, planning the research design, developing the interview guides, and analyzing and interpreting the data. This contributed to relevance and rigour of the research.

What is the primary goal of the "One Health" initiative?

Though the concept of one health is not new, its integration and implementation in health programs has been slow. How do you think we could quicken the acceptance of the concept to the many stakeholders involved in health, to ensure we achieve equity in human, animal, and environmental health?

How does the World Health Organization (WHO) define health?

According to __________ theory, only the richest people in capitalist societies are able to have excellent health because they are better able than poorer people to afford medical care.A.feministB.social-conflictC.structural-functionalD.symbolic-interaction