Breaking the quality-equity cycle when implementing prevention programmes

© Author(s) (or their employer(s)) 2022. No commercial reuse. See rights and permissions. Published by BMJ. Globally, health systems are increasingly investing in the delivery of prevention programmes for chronic diseases such as diabetes, with the goal of improving quality of life, reducing longterm costs of medication, use of healthcare services and lost productivity associated with illness. However, these investments are only effective if they reach the full range of intended populations, including those populations and settings that would benefit the most from the delivery and health impact of such programmes. The expected benefits of prevention programmes are predicated on successful enrolment of and engagement among those at risk of developing the disease. This requires explicitly tracking and continuously monitoring widening health inequities or exacerbation of implementation gaps across all phases of implementation, particularly among populations experiencing numerous structural barriers to health and healthcare access. 3