Understanding the organisational relevance and practice of health equity in Switzerland

Abstract Health equity remains a key objective in both global and national health strategies, however its practical implementation across organisational settings varies considerably. The Swiss national health strategy declares the health system is to be based on openness and solidarity, accessible for everyone, independent from language, origin, social and educational status. This study explores how health equity and health equality are defined, understood, and operationalised within different organisational contexts in federalist and decentralised Switzerland. We conducted in-depth qualitative interviews with a wide range of stakeholders n = 16+ interviews (10 finalised, 6 ongoing/scheduled) to explore divergent understandings, current initiatives, perceived challenges, and success measures related to health equity. Data will be analysed using NVivo guided thematic analysis. Preliminary findings reveal a broadly conceptual understanding of health equity, particularly in distinction to health equality- yet practical application remains inconsistent. While public health organisations often embed equity within their strategic frameworks, clinical bodies and academic institutions typically address equity through specific, project-based initiatives. Notably, sustainability challenges and the complexity of participatory approaches were common concerns across all sectors. Stakeholders also highlighted the impact of political changes, with academic participants emphasizing that shifting political priorities often disrupt continuity, leading to fragmented efforts, short-term initiatives, and diminished long-term impact. Issues around measuring progress were also widely recognized. Limited availability of disaggregated demographic data and the absence of formal evaluation frameworks meant that success was frequently assessed through service uptake statistics or internal evaluations, underscoring the need for more comprehensive, systematic assessment approaches. Key messages • Operationalising health equity requires continuous professional reflexivity and strong local networks to address structural barriers and evolving disparities with flexible, ongoing action. • Without political continuity, clear measurement tools, and reliable data, health equity efforts risk losing visibility; embedding equity in daily practice and documenting success is essential.