Training for Equity: Participatory Systems Mapping in Global Health Education

Publication Date:

2025

Citation:

While equity remains a defining goal of global health, perspectives on how to promote fairness in pathways to health have significantly changed over the last decade. Major shocks in health financing, together with calls to decolonize health education, mark a moment to document perspectives on equity in global health.

We conducted a participatory study at the University of Global Health Equity in Rwanda, a university founded to advance a social medicine approach to global health by integrating the humanities, social sciences, biomedical sciences and clinical medicine. We sought to better understand how students reasoned about causal influences on health equity, using an approach known as Fuzzy Cognitive Mapping (FCM). The FCM exercise invited first-year medical students to define health equity and its drivers through a visual and participatory mapping exercise. Two rounds of mapping sessions were conducted with three groups of students, one round at the start and one round at the end of their ‘Foundations in Global Health Equity’ semester, to capture potential shifts in participatory learning and systems thinking.

Students understood health equity as grounded in fairness, responsiveness, and accountability. Their maps identified diverse factors across community influence, governance, the health system, and socioeconomic opportunity. Based on the variables and connections students mapped, we modeled hypothetical scenarios to illustrate potential pathways for change. The analysis indicated that over the course of their semester, students gained confidence in identifying where improvement might occur, with less emphasis on structural barriers and greater attention to influences that could enable system-wide gains. Scenario simulations showed that, from students’ perspectives, strengthening socioeconomic opportunity would have the broadest effects across the system, amplifying the potential impact of other reforms.

This mapping approach has enormous value for participatory learning, systems thinking, and dialogue-building within health-professional education. It enables respondents to visualize components of the health system and how they interact, and to identify potential points of intervention that may address inequity. By engaging students, the next generation of global health practitioners and scholars, this approach brings their voices and perspectives to the forefront of global discussions on health equity.