From rhetoric to reality: organisational practices of health equity in Switzerland

Abstract Despite growing international consensus on the importance of addressing health inequities, the concept of health equity continues to evolve in its definition, relevance, and application across global contexts. While its prominence in international discourse and strategic frameworks has grown, the ways in which health equity is interpreted, prioritised, and operationalised within health-related organisations remain uneven and insufficiently examined. We conducted a qualitative exploratory study, using in-depth semi-structured interviews with representatives ( n = 16) from public health authorities, non-governmental organisations, and academic institutions in Switzerland to explore divergent understandings, current initiatives, perceived challenges, and success measures related to health equity. We conducted Thematic Analysis (TA), supported by NVivo software. We identified four overarching themes: conceptual understandings of health equity, framing health equity in organisational discourse and strategy, challenges in operationalising health equity, and strategies to better implement health equity. The main findings reinforce that advancing health equity is not merely a technical challenge but a deeply political and relational one. Shared language should be accompanied by structural alignment; measurement should be enabled by meaningful data; and vision should be grounded in long-term, collaborative practice. Institutions that succeed in health equity do so not because of isolated actions, but because of a consistent, system-wide commitment. Operationalising health equity requires continuous professional reflexivity and strong local networks to address structural barriers and evolving disparities with flexible, ongoing action. In the absence of political continuity, robust metrics, and actionable data, health equity risks tend to be deprioritised. Embedding equity into routine practice and making its impact visible is critical to sustained progress.