The health equity imperative in mass gathering medicine: A narrative review of global challenges and strategies

Mass gathering medicine, a critical and evolving domain within public health, has traditionally prioritized immediate medical care and disease control while often underemphasizing the essential dimension of health equity. This narrative review critically explores the systemic challenges and opportunities for integrating equity principles into the planning, implementation, and evaluation of mass gatherings worldwide. Such events frequently exacerbate existing socioeconomic, geographic, and demographic disparities, disproportionately affecting vulnerable groups, including low-income populations, the elderly, and displaced persons. Persistent barriers, including inadequate healthcare infrastructure, limited surveillance systems that lack disaggregated data, and sociocultural and communication challenges, further hinder equitable access to care. Lessons from mass gatherings and pandemic underscore the urgency of addressing these inequities through a shift toward proactive, equity-centered strategies. Key recommendations include the development of explicit equity frameworks, meaningful community engagement, alignment of event preparedness with long-term health system strengthening, and enhanced international collaboration. Embedding health equity as an explicit, foundational principle is essential not only to safeguard the safety and ethical integrity of mass gatherings but also to advance global health security and resilience.