Addressing Power in Local-Level Policies and Programs to Reduce Health Inequities - A Systematic Review.

Abstract

Health inequities are driven by the unequal distribution of resources and power. Local-level actors are closely connected to communities and have the potential to address unfair imbalances in power through health equity interventions. Yet practical strategies on how to do this remain unclear. To address this gap, we conducted a systematic review of five databases, examining how power was addressed in the design and implementation of local-level health equity interventions and their reported impacts. Thirty-eight international studies were analysed using the Health Equity Power Framework and Four Expressions of Power typology. Most articles described community organizing, health education, advocacy, and community funding initiatives. Interventions that strengthened community knowledge, connectedness, and leadership rebalanced power by enhancing individual and collective agency. Shifts in rigid, inequitable structures and institutional processes were observed when interventions activated multiple types of power, across different forms and spaces. Interventions informed by power-centered frameworks and principles, such as empowerment theory and self-determination, helped actors rebalance power dynamics, while entrenched structural and institutional power imbalances moderated efforts to rebalance power. This review underscores the role of local governments, institutions, and community actors in addressing power imbalances and provides practical guidance on strategies to support equitable policymaking.