Health inequities remain one of the greatest challenges facing health systems globally. They contribute to poorer patient outcomes, reduced workforce wellbeing, inefficient use of healthcare resources, and escalating costs, making health equity a clinical, moral, social, economic, and political imperative. Consequently, governments, healthcare organisations, and professional bodies have identified health equity as a strategic priority and have invested substantially in programs designed to improve access and outcomes for underserved populations.
We propose that sustainable progress requires a shift from implementing isolated health equity initiatives to fostering a culture of health equity across the entire health system. In this culture, advancing health equity becomes routine business and a shared responsibility of policymakers, health service leaders, clinicians, researchers, educators, consumers, and communities. Health equity programs should be co-designed with the right stakeholders to ensure they are contextually relevant, implementable, and scalable. Equally important, governance, funding, workforce capability, care coordination, digital infrastructure, policies, and organisational processes must actively enable equitable care across every level of the system.
To operationalise this concept, we present a Systems Lasagne Model of Health Equity, a whole-of-system framework that illustrates how interconnected layers of the health system work together to create and sustain equitable healthcare. Adapted from the Clinical Oncology Society of Australia's Healthy Workplace Culture Framework and informed by the joint Lancet Oncology, American Society of Clinical Oncology, and European Cancer Organisation statement on healthy workplace cultures, the model emphasises alignment between leadership, enabling systems, models of care, implementation, and continuous quality improvement. By embedding health equity into everyday practice rather than treating it as a standalone initiative, this framework provides a practical roadmap for health systems seeking to achieve equitable, high-quality, and sustainable care for all populations, regardless of geography, socioeconomic status, or background.