Advancing equity is a key action area identified in Canada’s youth policy and the first State of Youth Report [1,2]. This action area is reflected in national research agendas such as the Canadian Institutes of Health Research (CIHR) Inspiring Healthy Futures report, which highlights the need for knowledge and action that put youth and families from diverse backgrounds at the center to reduce health inequities [3]. The Inspiring Healthy Futures report identifies the importance of collaboration, youth and family participation, and health equity in guiding collective action toward measurable improvement in the health and well-being of young people.

The basis for the goal of health equity is the growing body of evidence that links social and economic disadvantage to avoidable illness, disability, and premature death [4] and the recognition that these disadvantages can be addressed through social policies (such as those aimed at eliminating discrimination based on race, gender, disability, etc). There is mounting evidence indicating strong associations between social factors and health outcomes (eg, inequities based on racial identity [5-8]). Young people who experience social disadvantages due to structural determinants also experience greater burden of health inequities [9]. Chronic health conditions can increase health care needs that can exacerbate the impacts of these determinants [10]. This is important amid growing calls to address health equity and foreground youth perspectives to enhance the relevance and impact of health equity work [1].

The World Health Organization (WHO) Commission on Social Determinants of Health describes health inequities as “killing people on a grand scale” [11]. Health inequities are systemic differences in health that are caused by the uneven distribution of wealth, resources, and power in society; these differences in health are avoidable, unnecessary, and unjust [12]. Health inequities have been a public health challenge for decades, exacerbated by disadvantages such as housing precarity, food insecurity, social disconnection, and discrimination, which are key social and structural health determinants. According to the WHO World Report on Social Determinants of Health Equity, these inequities are most evident internationally in relation to economic inequality, structural discrimination, climate change, and digitalization [13].

In Canada, inequities in health and health care result from the intersecting impacts of social and structural determinants of health, including but not limited to income, racism, and colonialism [14]. For example, injuries and death are higher among young people in neighborhoods composed mostly of low-income, immigrant, and racialized populations [15]. It is also known that suicide rates are higher among First Nations, Inuit, and Métis youth in Canada [16,17]. Research suggests that youth who are disproportionately affected by health and social inequities are also more likely to be underrepresented in health promotion programs and report poorer access to care [3]. This evidence points to significant challenges in moving toward health equity, which refers to no youth being denied the possibility to be healthy due to belonging to a group that is economically and/or socially disadvantaged.

Action toward health equity requires responsiveness to the needs of groups who are at greater risk of poor health based on social conditions while also striving for optimal health for all people [18]. Equity work is grounded in a commitment to reduce disparities in health through addressing social determinants [19]. As a societal goal, health equity focuses attention on social determinants of health (SDoH) to monitor and address health inequities at the population level [20]. Central to discussions of health equity is the question of what constitutes evidence that health equity has been advanced and how the principle can be operationalized for measurement. There is a noted need for innovation in applying a health equity lens to a specific scope of work, communicating about health equity in ways that can be understood within and beyond public health, and gathering support for integrating health equity amid competing priorities and maintaining commitment and resources [5].

Internationally, specific gaps in policy and action include addressing economic inequality by funding universal public services, expanding coverage of universal social protection systems for all, and evaluating the commercial determinants of health [13]. To address structural discrimination, actions include identifying discrimination embedded in policies, laws, institutions, and social norms; redressing the impacts of colonization; and safeguarding the SDoH equity during migration, emergencies, and conflict. Importantly, the WHO recommends new governance approaches to bring about change, including supporting community engagement in local policy processes and creating the enabling conditions that maximize the capabilities of inclusive civil society to address the SDoH equity. This study responds to these recommendations by creating enabling conditions that support the engagement of youth in addressing the SDoH equity.

Definitions of health equity vary, and although youth-focused organizations are foregrounding policies and strategic plans in terms of health equity and SDoH, there is a need to identify priority areas toward translating these plans into meaningful action. Furthermore, research on youth perspectives on and experiences of health equity and inequity need to inform priority-setting research and initiatives. Importantly, the mobilization of knowledge into action must be in collaboration with youth and predicated on their rights to express their perspectives and engage in issues affecting their health [21]. Youth perspectives provide critical information about health needs, historical and persistent facilitators and barriers, and dynamic understandings of health equity, which are all deeply linked to sociopolitical contexts. However, the perspectives of young people are often missing in prevailing approaches to identifying and setting priorities for action, knowledge mobilization, and research.

Identifying health equity priorities requires meaningful engagement with young people living in that context as well as with groups who strive to recognize and address the health needs of youth. In Canada, youth-led priority setting is currently lacking in existing health equity research, particularly in work focusing on knowledge mobilization. Furthermore, there is limited cross-provincial work in this area, which would foster critical dialogues based on youth-identified priorities.

To address these knowledge gaps, our study objectives are (1) to elicit the perspectives of youth on their experiences related to health equity and inequity, including priority areas of need; and (2) to collaboratively identify health equity priority areas with diverse youth, as well as parents, caregivers, and service providers. The study uses affinity-based focus groups and group concept mapping (GCM) methods, which are designed for group engagement, dialogue, and consensus building and are well suited to address the research gaps. This novel project will generate knowledge on experiences of health equity and inequity among youth in Canada and apply those insights in collaboratively identifying priority areas in health equity research and knowledge mobilization.

The conceptual framework used in designing the study draws on the concept of health equity as “the principle underlying a commitment to reduce—and, ultimately, eliminate—disparities in health and in its determinants, including social determinants” [19]. The study is guided by social ecological theory, which draws attention to multiple, nested levels of influence and determinants that interact to shape health outcomes at various levels [22,23]. A social ecological model of health framework will inform the conceptualization and presentation of multiple levels of influence and actions in relation to SDoH during data analysis, data interpretation, and knowledge mobilization (Figure 1). In addition, the study design is informed by critical social theoretical perspectives that position health inequities within power dynamics that are embedded in economic, political, and historical contexts and attend to health outcomes as well as access to health care and health-promoting resources for health at a collective level [24,25].

This multi-methods study has a 2-phase design, with knowledge mobilization integrated into the second phase and in end-of-grant activities. The first phase of the study used a qualitative descriptive approach and reflexive thematic analysis (RTA). The second phase used GCM, a mixed methods approach combining qualitative and quantitative research methods. The data gathered from phase 1 were used to inform phase 2 (Figure 2). The specific methods are detailed within each phase.

The study protocols of the current study have been approved by the research ethics boards of all participating institutions: UBC (H24-00786), Dalhousie University (2024-7364), MacEwan University (102,350), Toronto Metropolitan University (2024-309), and University of Calgary (H24-00786). Written informed consent was required from all participants before taking part in the study. Participants were instructed to use pseudonyms during data collection sessions. Raw audio data will be permanently deleted after the transcriptions are verified. Transcripts will be further deidentified during transcription. Information collected for distributing participant compensation was stored separately from the research data and password protected. All documents were stored in research folders on the UBC Microsoft OneDrive service, with access restricted to key research team members. Participants were offered CAD $40 (CAD $1=US $0.72 as of August 13, 2026) in the form of an electronic gift card for taking part in a focus group. Participants of GCM sessions received a CAD $50 e-gift card for each session attended up to a maximum of CAD $150 per participant.

Knowledge translation and exchange is embedded in our research design. The research team includes youth leaders who were involved in the conceptualization and design of the study and as principal investigators on the project. Youth are also engaged as research trainees in the project and will be engaged in focus group qualitative data interpretation and theme development and in the analysis and interpretation of the concept maps. Aligned with the knowledge translation planning primer, we will use GCM as an integrated knowledge translation strategy to (1) identify and translate research findings into key messages; (2) engage end users; and (3) develop tailored outputs, including a research agenda that will be shared and tailored for different audience groups. Knowledge mobilization outputs will include social media posts and infographics targeted for youth, brief lay reports and webinars streamed through live social media broadcasts tailored for parents and caregivers and youth-serving organizations, and scientific presentations and academic publications for academic audiences. In assisting with the creation of knowledge mobilization outputs, youth research trainees will provide a youth perspective on the framing of key messages.

The overall goal of our study is to advance youth health equity in Canada by identifying and prioritizing knowledge mobilization and research foci that will advance equity-oriented health services, health system change, and long-term sustained action toward improving youth health outcomes. According to the most recent United Nations Children’s Fund report on child well-being, Canada “barely received a passing grade” on child and youth health, with Canadian youth ranking 19th out of 36 comparable countries on overall health and well-being [50]. The report found greater health risks among youth marginalized by income, indigeneity, race, gender, and disability, along with other SDoH. A recent study assessed Canada’s success in reducing socioeconomic and health inequities in 7 areas to address SDoH, including investments in sexual and reproductive health and family planning, early learning and childcare, education, and universal health care, as well as investments to reduce child poverty, ensure sustainable economic development, and control health hazards [51]. The study found that Canada’s successes have been in reducing socioeconomic inequalities in early learning and childcare and reproductive health, and the least successful outcomes were found in relation to health hazard control and child poverty.

Drawing on our previous research on social determinants of youth health, health services [32,52-55], and minoritized groups [33,56-60], the study recognizes the diversity of youth in Canada and the importance of understanding the unique social and structural conditions that shape their health and well-being. In this vein, the study aims to intentionally engage diverse youth, including those from groups that may be underrepresented in research, programs, and policy and especially those who are minoritized due to SDoH. Importantly, this research engages youth in priority setting, which is currently lacking in extant health equity research, particularly in work focusing on knowledge mobilization.

This study centers youth health, voices, and experiences and embeds equity, diversity, and inclusion into the project design. Insights from youth perspectives will inform broader discussions with youth, parents, service providers, and others engaged in youth health and, through a structured approach, inform the generation of ideas related to health equity priority areas, which will be rated and analyzed to generate context-relevant recommendations. The expected outcomes of this study are (1) advancement of inclusive research methodology in engaging systematically marginalized and equity-deserving youth, (2) mobilization of cross-sectoral stakeholders to engage in committed research collaboration, (3) inclusive and meaningful engagement of racialized and systematically marginalized communities in cogeneration of knowledge and research priorities, (4) effective knowledge mobilization using data visualizations, and (5) trust building and leadership sharing in health research. The study aligns with national research strategic plans in Canada and its core focus on empowered youth [61]. The knowledge generated by the study can be applied in community-based and public health responses to strengthen efforts in addressing health inequities that affect the lives of young people in Canada and can inform the development and/or adaptation of health equity interventions that are context relevant and evidence based.

The dissemination of findings in our study reflects the complexity of youth health equity by using approaches that are accessible and inclusive to the needs of various audiences. Consistent with the methods used in the study design, dissemination will prioritize communication strategies that focus on engaging multiple channels [62]. As such, the findings from this work will be tailored to its various interest holders, including youth, families and caregivers, youth-serving organizations, health care systems, and academic audiences.

Knowledge mobilization is embedded throughout this study, particularly within the GCM process, wherein participants are invited to reflect on data from the focus groups and share these insights within their own communities. This process supported early dissemination and interpretation. Dissemination will continue through targeted activities. These activities will take place across multiple audience levels and formats. At a public awareness and engagement level, findings will be shared through online platforms and social media to increase accessibility and reach, with the intention of engaging youth, caregivers, and organizations. Participants who expressed interest in receiving study results will also be provided with plain-language summaries, which may also support further sharing within their personal and professional networks. Professional engagement will include the development of brief lay reports and webinars designed for community- and practice-based audiences. Additionally, academic dissemination will include conference presentations, academic publications, and a research agenda, ensuring that findings contribute to broader conversations on youth health equity. Importantly, all dissemination activities will continue to be informed through youth engagement so that messaging remains relevant and impactful. This approach reinforces the study’s commitment to not only sharing knowledge but also supporting its application in ways that reflect the priorities and experiences of youth.

Notable strengths include the multi-methods, multiphase design. By integrating qualitative descriptive methods with GCM, this study offers a multi-methods approach to engaging with youth and understanding their experiences of health equity and inequities. Youth engagement was further supported through intentional strategies to promote safety, such as self-selection into affinity groups and the prioritization of participation among youth from equity-deserving groups. Where possible, affinity focus groups were facilitated by individuals who shared similar identities. Additionally, cross-provincial engagement strengthened the relevance of this work across the Canadian context, supporting the transferability of findings. However, engagement from one site was limited, and the study only focused on 4 provinces in Canada. As a result, this study may not fully capture the perspectives and experiences of all youth in Canada, particularly those in the Atlantic provinces. Similarly, due to the virtual nature of data collection, individuals without reliable access to devices or internet connection may have been unable to participate, potentially limiting representation. Challenges were also encountered in online recruitment and verification processes. To address this, several measures were taken to reduce the risk of falsely identifying participants, including identity verification at the start of focus group sessions and advance screening procedures for GCM sessions. Despite these limitations, this study is driven by the perspectives of youth and those who serve them across Canada.

In conclusion, it is essential that youth health equity is addressed in ways that are meaningful and responsive to the lived experiences of youth. Doing so can promote lifelong health and expand access to care, enabling individuals to experience fewer inequities across the life course. Insights from this study will inform future research agendas and support the development of health system changes that better meet the needs of youth both now and as they transition into adulthood. Ultimately, this work reinforces the recognition that achieving health equity requires ongoing engagement with those most affected, ensuring that approaches are informed by youth and lead to meaningful change.