Navigating and reframing tensions within equity-centered learning health systems.

Area of Science:

• Health Services Research
• Knowledge Translation
• Health Equity Studies

Background:

• Canada is establishing national collaboratives to scale learning health systems (LHSs).
• Operationalizing equity within LHSs is a key focus for these initiatives.
• The pan-Canadian Learning Health Hub's first symposium addressed equity in LHSs.

Purpose of the Study:

• To examine the literature and practitioner experiences regarding equity in LHSs.
• To identify and analyze inherent tensions when centering equity in LHSs.
• To propose strategies for navigating these tensions to foster dynamic learning.

Main Methods:

• Literature review on equity in LHSs.
• Reflection on practical experiences in building equity-focused LHSs.
• Analysis of discussions with LHS practitioners.

Main Results:

• Three core tensions were identified: divergent language of health equity, pace of learning versus engagement, and equity as both a driver and outcome.
• These tensions manifest in the practical implementation of equity within LHSs.
• Strategies for navigating and reframing these tensions were explored.

Conclusions:

• The goal is not to avoid tensions but to navigate them intentionally.
• Commitment to transformative action is essential for advancing equity-oriented LHSs.
• This work provides insights for Canada and other jurisdictions aiming to integrate equity into LHSs.