Equity-focused knowledge translation: A framework for "reasonable action" on health inequities

Abstract

To identify gaps in procedural approaches to knowledge translation and outline a more relational approach that addresses health inequities based on creating collaborative environments for reasonable action.
A literature review encompassing approaches to critical inquiry of the institutional conditions in which knowledge is created combined with a process for encouraging reflexive professional practice provide the conceptual foundation for our approach, called equity-focused knowledge translation (EqKT).
The EqKT approach creates a matrix through which teams of knowledge stakeholders (researchers, practitioners, and policymakers) can set common ground for taking collaborative action on health inequities.
Our approach can contribute to the call by the WHO Commission on the Social Determinants of Healths for more reasonable action on health inequities by being incorporated into numerous public health settings and processes. Further steps include empirical applications and evaluations of EqKT in real world applications.

Full text

ORIGINAL ARTICLE
Equity-focused knowledge translation: a framework
for ‘‘reasonable action’’ on health inequities
J. R. Masuda •T. Zupancic •E. Crighton •
N. Muhajarine •E. Phipps
Received: 5 March 2013 / Revised: 12 September 2013 / Accepted: 25 September 2013
Swiss School of Public Health 2013
Abstract
Objectives To identify gaps in procedural approaches to
knowledge translation and outline a more relational
approach that addresses health inequities based on creating
collaborative environments for reasonable action.
Methods A literature review encompassing approaches to
critical inquiry of the institutional conditions in which
knowledge is created combined with a process for
encouraging reflexive professional practice provide the
conceptual foundation for our approach, called equity-
focused knowledge translation (EqKT).
Results The EqKT approach creates a matrix through
which teams of knowledge stakeholders (researchers,
practitioners, and policymakers) can set common ground
for taking collaborative action on health inequities.
Conclusions Our approach can contribute to the call by
the WHO Commission on the Social Determinants of
Healths for more reasonable action on health inequities by
being incorporated into numerous public health settings
and processes. Further steps include empirical applications
and evaluations of EqKT in real world applications.
Keywords Health inequities 
Equity-focused knowledge translation Social injustice
Introduction
Health inequities are a major global health priority,
reflecting a longstanding public health agenda connecting
social and environmental injustices to population level
health inequalities. For example, in Canada, recent strate-
gic directives reflect a more ensconced commitment to
health equity in research (CIHR 2009), policy advocacy
(National Collaborating Centre for Determinants of Health
2010), and practice (Ontario Agency for Health Protection
and Promotion 2009; Lemstra and Neudorf 2008; Van-
couver Coastal Health 2006). There is also a concern about
policy inaction as health inequities continue to widen in
many jurisdictions (Friel and Marmot 2011; Goesling and
Firebaugh 2004). According to the WHO Commission on
the Social Determinants of Health (2008), health inequities
persist because of an inability or unwillingness to act on
entrenched social injustices, due to ideology, lack of
leadership, and societal indifference.
To address the injustices at the root of health inequities,
the Commission appeals to reasonable action for global
action on health inequities:
Where systematic differences in health are judged to
be avoidable by reasonable action globally and
within society they are, quite simply, unjust. It is this
that we label health inequity. (p. 26, emphasis added)
While it seems a truism to say that social injustices and
resulting health inequities are unreasonable, it is also evi-
dent that it is not a lack of reason that permits them to exist,
but rather competing rationalizations of their sources and
J. R. Masuda (&)T. Zupancic
Centre for Environmental Health Equity, Winnipeg, MB, Canada
e-mail: jeff_masuda@umanitoba.ca
J. R. Masuda
University of Manitoba, Winnipeg, MB, Canada
E. Crighton
University of Ottawa, Ottawa, ON, Canada
N. Muhajarine
University of Saskatchewan, Saskatoon, SK, Canada
E. Phipps
Canadian Partnership for Children’s Health and Environment,
Ottawa, ON, Canada
Int J Public Health
DOI 10.1007/s00038-013-0520-z
123

continued existence. Such reasons may originate in vested
interests, opaque decision-making processes, and dogmatic
ideologies that are operative within society. For Sen
(2009), of the key to achieving justice is to confront these
forms of bad reasoning head on:
…central to the point in dealing with [injustices] is
that prejudices typically ride on the back of some
kind of reasoning–weak and arbitrary though it might
be. Indeed, even very dogmatic persons tend to have
some kinds of reasons, possibly very crude ones, in
support of their dogmas…There is hope in this, since
bad reasoning can be confronted by better reasoning.
(Sen 2009, p. xviii, emphasis added)
In this sense, the concept of knowledge translation, now
widely embraced among policymakers, researchers, and
practitioners provides one way to consider how to create
conditions for better reasoning within decision-making. In
this paper, we aim to contribute to this effort by outlining a
framework, called equity-focused knowledge translation
(EqKT) that provides a means to move toward better rea-
soning in knowledge translation practice.
The EqKT framework departs from the prevailing pro-
cedural focus in knowledge translation that focuses on the
movement of knowledge objects (e.g., scientific facts,
policy best practices), through better alignment of knowl-
edge production and decision-making domains (Graham
et al. 2006). Instead, EqKT proposes a relational perspec-
tive on knowledge subjects, emphasizing how the
conditions of knowledge production and use influence not
just what we decide to do with knowledge, but what
stakeholders are to be, in terms of how we act within and
through knowledge. This approach recognizes the rela-
tionship between knowledge and power in the institutional,
communicative, and regulatory conditions of knowledge
production and use that are either reasonable (equity pro-
ducing) or not (inequity producing).
The core principle of the EqKT framework is that equity
enhancing decisions (i.e., better reasoning) must attend to
the relationships that we have with knowledge and, by
extension, with each other in collective processes of
knowledge formation and its use toward health equity
objectives. Such relationships can be achieved by a col-
lective commitment to examine and guide what knowledge
to produce, how it should be communicated, and what
impacts it is expected to deliver. To make our case, we first
provide an account of the progress and limitations in
knowledge translation, focusing on prevailing positivism in
the field. Second, we argue for a ‘‘Third Wave’’ in
knowledge translation that reflects a post-positivist turn
from ‘‘Second Wave’’ population health research. Finally,
we set out parameters of an approach that is guided by
critical inquiry and reflexive practice as two necessary
conditions for collective knowledge translation practices
aimed at achieving health equity.
The state of the art in knowledge translation
Knowledge translation stems from a longstanding effort in
dissemination research and practice to address imbalances
between knowledge production and application (Kitson
2008). While the term is widely adopted, its theoretical and
empirical development is nascent, with Graham et al. (2006)
Knowledge-to-Action (KTA) model being the most widely
accepted approach, at least in the Canadian context. The
basic tenet of the KTA model is to guide the complex and
dynamic nature of knowledge-to-action processes, by plac-
ing knowledge production and its application into a cyclical,
iterative process. By aligning producers of research and
decision-makers around the specific ‘‘steps’’ within the
knowledge-to-action cycle, proponents suggest that more
effective and efficient knowledge translation can take place.
But mainstream knowledge translation practice rests
upon two assumptions that may limit its ability to discern
whether action can enhance health equity. First, an implicit
positivism within knowledge translation models depend
upon a ‘‘banking approach’’ to knowledge, implying that if
the ‘right amount’ of the ‘right’ facts (e.g., existence of a
disparity in a measurable population health outcome) can
get to the ‘right’ people (e.g., an agent with authority and
capacity to enact a decision), then health equity will be
enhanced. However, this approach misses a crucial point: it
assumes that health inequities are the result of a knowledge
deficit or a knowledge-to-action gap, rather than due to
intentional priorities, and interests such as productivity,
prosperity, austerity, or competitiveness, common in neo-
liberal approaches to health governance (Coburn 2000,
2004).
A second, assumption in conventional KT practice is
that stakeholders share a common aim, understanding and
ability to work together. This assumption implies that
barriers to knowledge translation arise mainly from pro-
cedural constraints (e.g., organizational obstacles, resource
constraints, or time), as opposed to epistemological dis-
tances or uneven power relations. The remedy is to
improve communication by ‘getting everyone in the same
room’ and using a shared model. But what is not addressed
is, ‘‘who’’ decides what knowledge is, when knowledge is
ready for translation, what participants are necessary to
effectively translate knowledge, which KT model should
be used, and when to know if stakeholders are equally
prepared, willing, and capable to engage in knowledge
translation. A mechanism is needed to respond to differ-
ences, limits, and politics in relation to the power to define
the conditions of knowledge translation, particularly when
J. R. Masuda et al.
123

there is ostensible agreement on a common goal—to
reduce health inequities—but in fact there lacks common
ground on how health inequities are even defined, let alone
acted on.
The need for ‘Third Wave’ knowledge translation
Scientific evidence does not exist in a vacuum, nor is it the
only form of knowledge to account for social injustice.
There are many alternative explanations for social
inequalities in health, each invoking justification for
(in)action, such as economic (e.g., no good cost-benefit
analysis), ideological (e.g., the ‘‘deserving poor’’), or
political (e.g., fixed, short term election cycles). Dis-
agreements even exist among proponents of health-centric
explanations (e.g., blame the system or victim). Thus a
problem of the knowledge deficit model is its limited
account for sources, strategies, and effects of particular
knowledge claims and their effects within a wider arena of
stakeholders, including politicians, lobbyists, the media,
activists, and the general population. There is a need for
critical contextual analysis of how health inequity priorities
are identified or obscured, prioritized or marginalized, and
acted upon or dismissed. By interrogating how priorities
emerge, it becomes possible to identify underlying logics
that create proximate organizational limitations, procedural
antecedents, and ideological leanings that obscure if not
obstruct health equity aims.
Two main traditions of inquiry in population health
research illustrate the difference between evidence of the
existence of health inequalities, and the interrogation of
their sociopolitical antecedents, commonly referred to as
Second and Third Wave research (O
¨stlin et al. 2011, see
Fig. 1
1
). Second Wave research is premised on the use of
quantitative population-based and spatial analysis as the
means to expose the existence and characteristics of social
inequalities in health in relation to geographic and demo-
graphic factors, and thus inform public health interventions
to mitigate them. But, Second Wave research has fallen
short in accounting for the conditions that create social
inequalities in health and allow them to persist over space
and time.
Third Wave research addresses this lacuna by focusing
on explaining the underlying societal arrangements through
which health inequities manifest, and thus informing action
to change such arrangements at the political level. Third
Wave research builds upon decades of theoretical devel-
opment and empirical demonstration within the social
sciences; exploring the historical, psychological, socio-
logical, and geographical dimensions of health inequities as
rooted in political ideology, culture, and economy. Unlike
the bird’s eye view of Second Wave research, social the-
ories of health provide in-depth accounts of health as a
function of and in society, connecting these to systemic
structures to overcome the artificial distinction between
research ‘‘about’’ the world and action ‘‘in’’ the world. In
the sense Third Wave research focuses not just on how
social injustices ‘‘get under the skin’’ to disrupt health, but
also ‘‘getting under our skin’’ in terms of prompting more
critical orientation to our own knowledge work as well as
to others who are complicit in rationalizing social injustice.
Through the contributions of Second and Third Wave
research, we know inequities are becoming more severe
and globally ubiquitous resulting in coalesced advocacy at
all levels to address root causes in social injustice. But
efforts to translate this knowledge into action have been
equivocal—little progress has been made in alleviating
social injustice or reducing inequities. This paradox of a
‘‘normative’’ state of inequity and seemingly insurmount-
able barriers to tackle them suggests we have not learned
how to ‘‘act’’. ‘‘Learning to act’’ is the definition of and
formidable task for, EqKT.
Equity-focused KT: implementing the ‘Third Wave’
We argue that knowledge translation to address health
inequities can be more effective by embodying a Third
Wave paradigm. For each wave of population health
research, it is possible to characterize corresponding
knowledge translation practice. Knowledge translation of
the First Wave, or ‘biomedical’ tradition in research, cen-
tres on evidence-based practice, where scientific insights
on biological mechanisms of disease and interventions are
provided to clinicians to improve the health of individuals.
Similarly, in Second Wave knowledge translation, typified
by Graham et al.’s (2006) KTA model, evidence-based
population health knowledge is scaled up to organizational
and system levels, where best practices are shared among
knowledge translation actors to support desired outcomes.
But how to translate Third Wave research has been
underexplored.
Part of the challenge is that the positivist approach in
knowledge translation (Rycroft-Malone 2007) conforms to
apluralist perspective of policy, which views knowledge
translation as the application of the ‘most accurate’, ‘most
valid’ or ‘most reliable’ facts to move decision-makers
toward better (i.e., more evidence based) health policies and
practices (Raphael et al. 2008). By contrast, Third Wave
health research applies social constructionist epistemology
where objective knowledge by the distant observer (Blaikie
2007) is rejected in favor of a willingness to intervene in the
1
The ‘‘First Wave’’ refers to the biomedical perspective in health
research, which, in its focus on physiological vulnerabilities and
clinical outcomes, has limited relevance to health equities, except
insofar as it takes up the lion’s share of health research funding in
Canada and around the world.
EqKT: a framework for ‘‘reasonable action’’ on health inequities
123

world. A social constructionist approach explores the social,
cultural, economic, ethical, emotional, and intellectual
conditions of knowledge production (Fook 1999). Ample
social science scholarship demonstrates that policies are
enacted as much on the basis of ideologies, party politics,
vested interests, and even outright prejudice as much as on
scientific evidence or expert influence (Fort et al. 2004;
Harvey 2005). This perspective on policy is what Raphael
et al. (2008) describe as the materialist perspective; policies
are proposed and rationalized that align with pre-estab-
lished ideologies which reproduce a particular ‘‘accepted
reality’’ that may not coincide with scientific facts, but
nonetheless advance particular political objectives.
Thus, a Third Wave approach to knowledge translation
would recognize the power relations that underpin policy
decisions that arise when certain ‘‘accepted realities’’ are
promoted over others. EqKT is not about mobilizing ‘‘what
we know’’ (i.e., Second Wave thinking), but introduces a
reasonable process for understanding and shifting ‘‘how
we know’’ so that a more equitable and just reality can be
pursued (i.e., Third Wave acting). Building on Sen’s appeal
for better reasoning we now describe the application of our
EqKT framework to build collaborative knowledge rela-
tionships to promote health equity.
Critical inquiry of knowledge
The first component of EqKT is to conceive of knowledge
translation as the circumstances that enable particular
realities to be accepted, and others to be subordinated or
dismissed. Through this view, knowledge translation
encompasses all of the techniques that mobilize knowledge
and permit it to have effect. Whether formal or informal,
driven or unanticipated, such techniques make particular
realities possible through the conditions in which knowl-
edge is produced, communicated, and acted upon (see
Foucault 1991,2001). To identify such techniques, we ask:
(a) How and where is knowledge produced? Techniques of
knowledge production involve the structures that
enable the creation of knowledge, including ‘‘hard’’
infrastructure (such as universities, funding organiza-
tions, policy units, and think tanks) and also include
‘‘soft’’ infrastructure, including technologies and
resources that provide access to knowledge (for
instance, online databases, courses, newspapers, and
other methods of knowledge storage, aggregation, and
interpretation). Analyzing production techniques
involves examining where knowledge resides and is
channeled within ‘hard’ and ‘soft’ infrastructures, by
scrutinizing the resources and limits placed on knowl-
edge, as well as the methods or institutions that give
certain ways of knowing legitimacy over others.
Concomitantly critical inquiry scrutinizes the methods
by which knowledge confers legitimacy upon institu-
tions, and their spokespersons over others (e.g., the
authority ascribed to universities, conferences, profes-
sors as compared to community groups, street protests,
elders), as well as the implications of such effects.
(b) How is knowledge communicated? Techniques of
knowledge communication refer to the discursive
power of language in authorizing and delineating
boundaries over ways of knowing, including how the
language of ‘science’ elevates certain perspectives
over others. Techniques of communication include
the narratives that reproduce, reinforce, and legiti-
mize particular claims, including who is as an ‘expert’
and how expertise subordinates other perspectives
(e.g., how quantitative and qualitative perspectives
treat people as ‘‘data’’ rather than formidable sources
of knowledge and agency). Critical inquiry into
techniques of communication involves ‘‘thick
description’’ of knowledge claims in order to contex-
tualize the reality claims of the author(s) within their
positions in relation to such reality (i.e., above, or
apart from reality versus below and embedded within
reality).
(c) What does knowledge ‘‘do?’’ Techniques of knowl-
edge governance refer to knowledge put to work at a
distance to influence a population’s health choices
Fig. 1 Three waves in
contemporary health research.
Adapted from O
¨stlin et al
(2011)
J. R. Masuda et al.
123

and behaviors. Techniques of governance are exer-
cised in the management of populations through
norms, routines and values that individuals are
empowered to abide by as ‘good’ or ‘active’ citizens
(Cruikshank 1999). In lifestyle approaches to popu-
lation health, we are motivated to exercise, eat well,
and not smoke in order to be healthy (i.e., a
behavioral imperative). In doing so, we are also
compelled to do our part to produce a healthy
population that is more efficient and less costly (i.e.,
an economic imperative) as opposed to taking polit-
ical action against social injustices that we see
everyday around us and make some of us unhealthy.
Critical inquiry into techniques of governance entails
the interrogation of strategies through which health
discourses encourage personal responsibility for the
health (e.g., by becoming self-managing, and com-
pliant with norms and regulations, or taking direct
action in pursuit of social and political change). The
analysis of techniques of governance makes it possi-
ble to discern who is obliged to act to reduce health
inequities (e.g., individual victims, public health
practitioners, and/or governmental policymakers),
and who benefits from such actions (e.g., presumably
healthier populations, but also the career advancement
of researchers and the institutions that they work in/
for).
Together, these techniques of knowledge inquiry offer
an interpretative lens for critical analysis of knowledge
sources and uses, and provide the basis for reflexive
examination of one’s own capacities and limitations within
knowledge translation practice. Analyzing knowledge
translation through one’s own use of these techniques
illuminates the extent to which we may intervene to sup-
port more equity-focused approaches.
Reflexive practice in knowledge translation
While the substance, boundaries, and functions of accepted
realities can be discerned through critical inquiry, reflexive
practice reveals one’s own influence within these systems.
Locating our own position in reality construction provides
insight into our assumptions, biases, contradictions, and
possibilities for justice (Holland 1999; Jasper 2003). In
EqKT, reflexive practice identifies possible pathways to
overcome poor reasoning, including decisions that prevent
or evade social justice. In our framework, reflexive practice
includes the following process of self-examination:
(a) How do we recognize all perspectives? Inclusivity
involves recognizing that power dynamics are the
norm in knowledge relationships, particularly when
considering the plurality of stakeholders involved in
knowledge translation. Within research, exclusive
power and influence are often created through
specialized institutions, discourses, and practices that
reflect classes of experts. Within knowledge transla-
tion, affected groups may be seen as mere
beneficiaries of research, as opposed to experts whose
experiences and contextual understanding can mobi-
lize more just realities independently of formal
research processes. Inclusivity is the ability to discern
one’s own power to include (or exclude) others and to
identify where and why power is given (e.g., in terms
of social, professional or financial status or
personality).
(b) How can we be transparent about our motivations
and limitations? To be transparent means being open
and flexible about our goals, biases, and limitations in
collective work. In EqKT, transparency means prior-
itizing the access of those most affected by health
inequities to knowledge translation. Being accessible
facilitates questions and critique of our assumptions
and processes. Openly recognizing and discussing
shared limitations provide opportunities to recognize
the potential for group transformation, including
seeking out perspectives, resources, and opportunities
that reveal previously unseen or unacknowledged
realities.
(c) How do we work together toward common goals?
Finally, humility as a reflexive practice invokes the
notion of ‘‘servant leadership’’ in working collectively
(see Morris et al. 2005). Effective leaders work for the
benefit of others, many of whom occupy social
positions with less influence. Humility is a willing-
ness to check one’s own claims to expertise or
authority and to realize that our contributions are no
more important than—and are in fact often predicated
on—the insights and contributions of others, partic-
ularly among those perceived as occupying socially
disadvantaged positions. Thus, through humility, the
locus of action can be as much on transforming one’s
own organizational priorities as it is on a collective
external policy pursuit.
Integrating critical inquiry and reflexive practice
Our EqKT framework places critical inquiry and reflexive
practice on a matrix (Table 1). Working through this
matrix provides individuals and groups with a pathway for
‘‘reasonable action’’. Set in this way, reasonable action
involves working collectively through the questions in the
13 cells (letters ‘‘a’’ through ‘‘m’’). The reflections gener-
ated from this process provide understanding of ‘how we
know’ in terms of the root causes of social injustices, and
EqKT: a framework for ‘‘reasonable action’’ on health inequities
123

in discerning our own and other’s stake within such sys-
tems to identify collective approaches to change. The first
step is for each knowledge stakeholder to situate them-
selves within the production of a particular reality (cells a,
b, and c) which sets a process through which to critique
that reality (cells d through l) and transform it (cell m).
With techniques of production, reflexive practice allows
stakeholders to deconstruct the institutional ‘bricks and
mortar’ from their collective position, including the rela-
tive access to institutions among colleagues and partners,
as well as those institutions that are not typically given
authority. This process allows groups to determine the
origins of inclusionary and exclusionary power (cell ‘d’),
as well as each group member’s possible complicity and
leverage within this field of power (cell ‘e’). Finally, it
allows knowledge subjects to identify the collective power
in working in service to others’ identified aspirations and
accomplishments (cell ‘f’).
Reflexive practice within techniques of communication
examines our use of language and claims to expertise as a
Table 1 A practice-based
framework for equity-focused
knowledge translation
J. R. Masuda et al.
123

basis for exerting authority when making knowledge
claims. It provides an opportunity to reflect on the extent to
which language reflects the perspectives and priorities of
affected people or communities (cell ‘g’) and determines
whether the community’s voice is authentic or co-opted by
the (mis)interpretations of others (cell ‘h’). In seeking
community perspectives, reflexive practice debunks the
assumption that one has more validity than others, sug-
gesting that collective consciousness-raising can lead to a
complete understanding of complex problems as well as
appropriate priorities (cell ‘I’).
Finally, reflexive practice within techniques of gover-
nance questions the aims of stakeholders engaged in EqKT.
It involves reflection upon the extent individual roles and
communities are coordinated or differentiated (cell ‘j’),
both in terms of positions (e.g., researchers/researched
binaries versus knowledge partnerships) as well as the
goals within these roles. Through collective reflexivity, it
becomes possible to discern how roles are limiting or self-
serving (cell ‘k’), and how individually produced or initi-
ated strategies contribute to the problem (cell ‘l’).
Ideally, the matrix in Table 1can be applied continu-
ously and intuitively, by those committed to working
toward common goals. Examples include a research team
engaging with a community to study a particular health
inequity, a knowledge translation workshop by public
health officials to learn how to work together on shared
problems, or in direct community action among community
leaders who seek to build collective action toward a com-
mon solution. In a collective process, each participant
works through the matrix to identify their own knowledge
practices. Individuals share their reflections with others,
thus forming the basis of relationships. Assumptions are
mapped out, with both complementary and distinct per-
spectives juxtaposed and integrated (see Fig. 2). Ideally,
the process continues as an inherent part of people’s rela-
tionships with each other, so assumptions are revisited, and
avenues for inclusivity, transparency, and humility identi-
fied (e.g., gaps closed, collective changes proposed).
Through this cyclical process, gaps, strengths, synergies,
and priorities will become clear, and collective strategies
for reasonable actions will emerge that are better posi-
tioned to advance common equity aims (cell ‘m’).
Conclusion
In this paper, we have outlined a conceptual framework for
EqKT, premised on a notion of knowledge translation as a
collective commitment to critical inquiry and reflexive
practice. Our framework departs from the procedural focus
of more positivist models, arguing for ‘Third Wave’
knowledge translation that focuses on the relational
dimensions of knowledge construction.
The EqKT approach serves three main purposes. First, it
provides a means to critically analyze existing systems
responsible for defining and delineating ‘‘how we know’’
about health inequities. Second, in adopting a reflexive
orientation, our approach scrutinizes prevailing systems
from one’s own position and influence, exposing its flaws,
gaps, and openings in relation to its constituent techniques
of production, communication, and governance. Third,
EqKT provides the opportunity to transform one’s own
relationship to knowledge, so that in knowledge practice
one can learn to work with inclusively, transparently, and
with humility to reveal alternative realities and pathways
for collective action on health inequities.
The outcome of EqKT might entail a resetting of
assumptions of knowledge institutions, discourses, and
aims (e.g., universities and hospitals as main repositories
of health knowledge occupied by scientist ‘heroes’ and
‘progress’; communities as simply beneficiaries or even
disenfranchised victims in need of education or guid-
ance). In opening up alternative possibilities, we may
discover new forms of expertise and leadership, espe-
cially among those worst affected by health inequities.
We may uncover the limitations and possible biases
within the numerical emphasis of scientific approaches to
health equity, which claim to be objective accounts of the
Fig. 2 Cyclical process of EqKT. Through repeating cycles, both
individual and collective ‘positions’ within knowledge systems are
exposed and ultimately acted upon (represented by ‘m’)
EqKT: a framework for ‘‘reasonable action’’ on health inequities
123

truth, in favour of powerful testimonials of social injus-
tice encounters and resiliences that speak truth to power
(Holmes et al. 2006). We may find ourselves opposing
governmental policymakers that are beholden to ideology,
mobilized by vested interests, as much as they are pur-
veyors of ‘evidence’ and of ‘best practices’. Finally, in
mobilizing Third Wave knowledge translation, we may
find that the business of health equity is not exclusive to
research, policy, regulations, and public awareness cam-
paigns, but may include direct action, including civil
disobedience measures communicating anti-poverty, anti-
racism, anti-sexism, and anti-corporate messages such as
we are witnessing in grassroots led actions taking place
around the world.
References
Blaikie N (2007) Classical research paradigms: approaches to social
enquiry. Polity Press, Cambridge
CIHR (Canadian Institutes of Health Research) (2009) Institute of
Population and Public Health Strategic Plan (2009–2014):
Health Equity Matters. CIHR, Ottawa
Coburn D (2000) Income inequality, social cohesion and the health
status of populations: the role of neo-liberalism. Soc Sci Med
51(1):135–146
Coburn D (2004) Beyond the income inequality hypothesis: class,
neo-liberalism, and health inequalities. Soc Sci Med 58(1):41–56
Cruikshank B (1999) The will to empower: democratic citizens and
other subjects. Cornell University Press, New York
CSDH (Commission on the Social Determinants of Health) (2008)
Closing the gap in a generation: health equity through action on
the social determinants of health. Final Report of the Commis-
sion on Social Determinants of Health. World Health
Organization, Geneva
Fook J (1999) Critical reflectivity in education and practice. In: Pease
B, Fook J (eds) Transforming social work practice: postmodern
critical perspectives. Allen and Unwin, St Leonards, pp 195–208
Fort M, Mercer MA, Gish O (2004) Sickness and wealth: the
corporate assault on global health. South End Press, Cambridge
Foucault M (1991) Governmentality. In: Burchell G, Miller P (eds)
The Foucault effect: studies in governmentality with two lectures
by and an interview with Michel Foucault. University of Chicago
Press, Chicago
Foucault M (2001) The subject and power. In: The Essential Works
1954–1984. Power, vol 3. Allen Lane, London
Friel S, Marmot MG (2011) Action on the social determinants of
health and health inequities goes global. Annu Rev Public Health
32:225–236
Goesling B, Firebaugh G (2004) The trend in international health
inequality. Popul Dev Rev 30(1):131–146
Graham I, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W,
Robinson N (2006) Lost in knowledge translation: time for a
map? J Contin Educ Health Prof 26:13–24
Harvey D (2005) A brief history of neoliberalism. Oxford, New York
Holland R (1999) Reflexivity. Hum Relat 52(4):463–484
Holmes D, Murray SJ, Perron A, Rail G (2006) Deconstructing the
evidence-based discourse in health sciences: truth, power and
fascism. Int J Evid Based Healthc 4(3):180–186
Jasper M (2003) Beginning reflective practice. Nelson Thorn,
Cheltenham
Kitson AL (2008) The need for systems change: reflections on
knowledge translation and organizational change. J Adv Nurs
65(1):217–228
Lemstra M, Neudorf C (2008) Health disparity in Saskatoon: analysis
to intervention. Saskatoon Health Region, Saskatoon
Morris JA, Brotheridge CM, Urbanski JC (2005) Bringing humility to
leadership: antecedents and consequences of leader humility.
Hum Relat 58(10):1323–1350
National Collaborating Centre for Determinants of Health (2010)
Integrating social determinants of health and health equity into
Canadian Public Health Practice: environmental scan 2010.
National Collaborating Centre for Determinants of Health, St.
Francis Xavier University, Antigonish
Ontario Agency for Health Protection and Promotion (2009)
2010–2013 Strategic Plan. Ontario Agency for Health Protection
and Promotion, Toronto
O
¨stlin P, Schrecker T, Sadana R, Bonnefoy J, Gilson L et al (2011)
Priorities for research on equity and health: towards an equity-
focused health research agenda. PLOS Med 8(11):e1001115
Raphael D, Curry-Stevens A, Bryant T (2008) Barriers to addressing
the social determinants of health: insights from the Canadian
experience. Health Policy 88:222–235
Rycroft-Malone J (2007) Theory and knowledge translation: setting
some coordinates. Nurs Res 56(4S):S78–S85
Sen A (2009) The idea of justice. Penguin, Toronto
Vancouver Coastal Health (2006) Towards a population health
promotion approach: a framework and recommendations for
action. VCH Primary Health Care Network, Vancouver
J. R. Masuda et al.
123