Advancing health equity: Why guideline development must prioritize fairness and justice

Health equity should be regarded as a fundamental principle and a priority for all guideline development organizations. Yet, this principle has not been consistently prioritized in the creation of mainstream guidelines. In this commentary, we examine a real-world example from leprosy management, where the initial lack of integration of health equity considerations in the guideline recommendations did not consider the potential impact of the recommendations on the health of populations most affected by leprosy. We also highlight subsequent changes in the guideline development process that reflect stronger consideration of health equity, addressing some of the previous issues propagated with historical practices. We also draw on other examples from several fields to further illustrate the impact of integrating health equity considerations in guidelines. Building on evaluations of guidelines for health equity and real-world experiences, we highlight some of the common challenges in integrating health equity considerations in the guideline development process. We propose potential solutions using existing tools and frameworks and outlining key research priorities to further advance this goal.