A diverse group swimming against a current toward a lighthouse, symbolizing the challenge and hope of health equity work.

Swimming Against the Tide: How Health Equity Leaders Can Drive Change

Lena Voss in Health & Wellness August 2025 • 4 min read.

"A new study reveals the challenges and triumphs of implementing health equity initiatives in public health, offering insights for leaders navigating systemic barriers."

Health equity isn't just a buzzword; it's about ensuring everyone has a fair shot at a healthy life, regardless of their background or circumstances. But making that ideal a reality within complex public health systems is no easy feat. Many organizations are striving to boost their capacity to address the social determinants of health – those economic and social conditions that profoundly impact well-being – but lack clear guidance on how to lead effectively.

A recent Canadian study, published in the International Journal for Equity in Health, sheds light on this challenge. Researchers examined a province-wide initiative in Ontario to integrate Social Determinants of Health Public Health Nurses (SDH-PHNs) into public health units. The goal? To make health equity a core focus of public health activities.

The study's findings offer valuable lessons for public health leaders, practitioners, and policymakers who are committed to creating a more just and equitable healthcare system. It highlights the hurdles, the necessary shifts in organizational thinking, and the leadership qualities that can help drive meaningful change.

Facing the Current: Key Challenges in Implementing Health Equity

A diverse group swimming against a current toward a lighthouse, symbolizing the challenge and hope of health equity work.

The research revealed that implementing the SDH-PHN role wasn't always smooth sailing. The nurses often found themselves 'swimming against the tide' as they encountered:

Ideological Tensions: Many public health professionals still focus on biomedical or behavioral approaches to health, rather than addressing the root causes of health inequities rooted in social conditions.

Lack of clear direction: Many SDH-PHNs had limited guidance or evidence to direct their practice, resulting in initial stress and uncertainty.
Resistance to change: Some colleagues questioned the value of SDH-PHN roles, viewing them as duplicative or beyond the scope of public health.
Structural Barriers: Existing organizational hierarchies and processes sometimes hindered the SDH-PHNs' ability to influence change.

Competency Development: Both PHNs and their PHUs had to dedicate efforts at the outset to planning the role's scope, including essential competency needs. Organizations consulted researchers, academic experts, provincial and national public organizations to ensure SDH and health equity competency development.

Turning the Tide: Lessons for Effective Leadership

Despite the challenges, the study identified key leadership elements that can help public health organizations effectively advance health equity:

<ul> <li>Multi-level engagement: Success hinges on active engagement from individuals, organizations, and the broader system.</li> <li>Strategic Role Placement: Positioning SDH-PHNs in cross-organizational roles, rather than siloed within specific programs, enhances their impact.</li> <li>Supportive organizational culture: Prioritizing health equity, valuing diverse public health roles, and fostering open communication are essential.</li> <li>Bridging the policy-practice gap: Clear communication of expectations, flexibility for local adaptation, and accountability measures are needed to ensure policies translate into action.</li> </ul>

Ultimately, the study underscores that progress toward health equity requires visionary leadership, a commitment to organizational change, and a willingness to challenge the status quo. By learning from the experiences of SDH-PHNs and embracing these key leadership principles, public health organizations can create a more equitable and healthier future for all.

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This article is based on research published under:

DOI-LINK: 10.1186/s12939-016-0419-4, Alternate LINK

Title: Swimming Against The Tide: A Canadian Qualitative Study Examining The Implementation Of A Province-Wide Public Health Initiative To Address Health Equity

Subject: Public Health, Environmental and Occupational Health

Journal: International Journal for Equity in Health

Publisher: Springer Science and Business Media LLC

Authors: Charmaine Mcpherson, Sume Ndumbe-Eyoh, Claire Betker, Dianne Oickle, Nancy Peroff-Johnston

Published: 2016-08-19

Everything You Need To Know

What exactly is health equity, and why is it so important?

Health equity is about ensuring everyone has a fair opportunity to attain their best possible health, irrespective of their background or circumstances. It's a critical goal because it addresses disparities caused by social and economic conditions, ensuring fairness and justice within the healthcare system. This is significant because it moves beyond simply treating illness to proactively addressing the underlying causes of poor health. The implication is a healthier population overall, with reduced inequalities and more equitable resource distribution.

What are the Social Determinants of Health (SDH), and why is it important to address them?

The Social Determinants of Health (SDH) are the economic and social conditions that profoundly impact well-being. These include factors like income, education, housing, and access to resources. It's important to focus on SDH because these factors can either enable or hinder a person's ability to achieve optimal health. SDH are vital because they recognize the complex interplay of societal issues that affect health. Ignoring SDH means failing to address the root causes of health inequalities, which leads to a less healthy community. The implication is a more holistic and effective approach to public health, tackling health issues at their source.

What are ideological tensions in healthcare, and why are they significant?

Ideological tensions in this context refer to the differing approaches to healthcare. Some public health professionals are focused on biomedical or behavioral approaches, while the study indicates that to achieve health equity, the root causes of health inequities rooted in social conditions must be addressed. This is important because focusing solely on biomedical or behavioral factors can overlook the societal and economic conditions that contribute to poor health outcomes. Implications include the need for a shift in perspective within public health, encouraging a more comprehensive approach that considers social determinants of health and challenges to achieve health equity.

Who are the Social Determinants of Health Public Health Nurses (SDH-PHNs), and what role do they play?

The Social Determinants of Health Public Health Nurses (SDH-PHNs) are integrated into public health units to make health equity a core focus. They are important because they represent a specific approach to addressing health disparities and promoting health equity within the community. The implication is that it can lead to more equitable health outcomes and help identify and address health inequities. The study highlighted SDH-PHNs to shed light on the integration of this specific role in a province-wide initiative in Ontario, which provides valuable lessons for public health leaders, practitioners, and policymakers.

What leadership qualities are needed to successfully implement health equity initiatives?

To effectively advance health equity, public health organizations require strong leadership that promotes a clear focus on SDH, supportive organizational structures, and continuous competency development. This is crucial as it creates an environment that prioritizes health equity. The implication of effective leadership in public health is more equitable health outcomes and a more responsive healthcare system. By identifying and addressing challenges, and providing clear direction, public health leaders can drive meaningful change and create a more just and equitable healthcare system.