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Justice: a key consideration in health policy and systems research ethics
  1. Bridget Pratt1,
  2. Verina Wild2,
  3. Edwine Barasa3,
  4. Dorcas Kamuya3,
  5. Lucy Gilson4,5,
  6. Tereza Hendl2,
  7. Sassy Molyneux3,6
  1. 1Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
  2. 2Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-University, Munich, Germany
  3. 3Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, Kenya
  4. 4Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
  5. 5Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
  6. 6Nuffield Department of Medicine, Oxford University, Oxford, UK
  1. Correspondence to Dr Bridget Pratt; bridget.pratt{at}


Health policy and systems research (HPSR) is increasingly being funded and conducted worldwide. There are currently no specific guidelines or criteria for the ethical review and conduct of HPSR. Academic debates on HPSR ethics in the scholarly literature can inform the development of guidelines. Yet there is a deficiency of academic bioethics work relating to justice in HPSR. This gap is especially problematic for a field like HPSR, which can entail studies that intervene in ways affecting the social and health system delivery structures of society. In this paper, we call for interpreting the principle of justice in a more expansive way in developing and reviewing HPSR studies (relative to biomedical research). The principle requires advancing health equity and social justice at population or systems levels. Drawing on the rich justice literature from political philosophy and public health ethics, we propose a set of essential justice considerations to uphold this principle. These considerations are relevant for research funders, researchers, research ethics committees, policymakers, community organisations and others who are active in the HPSR field.

  • health services research

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  • Handling editor Seye Abimbola

  • Twitter @edwinebarasa, @Lucy_Gilson, @sassy.molyneux

  • Contributors BP, VW and SM conceived of and wrote the first draft of the paper, with BP taking the lead. Each substantially contributed to the analyses presented in the paper. TH, EB, LG and DK each contributed substantially to the intellectual content of the paper and were involved in revising paper. All authors approved the submitted version of the paper.

  • Funding BP is currently supported by an Australian Research Council (ARC) Discovery Early Career Researcher Award (award number DE170100414). The contents of this article are solely the responsibility of the author and do not reflect the views of the ARC. VW and TH are supported by the German Federal Ministry (BMBF, FKZ 01GP1791). SM and DK are supported by a Wellcome Trust Strategic Award to the Global Health Bioethics Network (096527), and SM by a Wellcome Trust Collaborative Award and by Nuffield Department of Medicine funds at the University of Oxford. DK is also funded by the Wellcome Trust Humanities and Social Science (Society and Ethics) (grant number 205419/Z/16/Z).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement There is no data for this article.

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