Clinical practice guideline recommendations can promote or undermine health equity

Abstract

While clinical practice guideline makers and methodologists signal the importance of considering inequities, recommendations often have little or nothing to do with fairness. Since inequities are, by definition avoidable, guidance on clinical practice is a prime opportunity to make health care more fair. Equity should be a central consideration when deciding who to involve in the guideline process, the guideline's scope, the type of information to consider, how to make recommendations and how to share recommendations. Guideline producers should select topics where guidance can actually address inequities and then use information about disparities to make helpful recommendations. Funders and journal editors should insist that guidelines explain how panels were formed and why new guidance on the topic is needed. Changes to clinical practice guidelines will not be enough to promote health equity, but guidelines can be part of the solution if they are thoughtfully produced and acted on by clinicians and by governments.