Defining advocacy in public health: a scoping review to inform policy, training, and equity-oriented action

Background: Advocacy is widely recognized as a catalyst for equity in health, yet its conceptual foundations, operational forms, and evaluative criteria remain fragmented. In health systems, advocacy is expected to amplify marginalized voices, address structural determinants, and promote participatory governance, but there is limited consensus on its definition and implementation. This scoping review systematically maps how advocacy has been conceptualized, practiced, and evaluated across public health and healthcare domains in democratic societies, with particular attention to its role in advancing equity. Methods: We conducted a scoping review across four databases (PubMed, Scopus, Web of Science, CINAHL) including peerreviewed literature from health, legal, political, and social domains. Eligible studies explicitly addressed advocacy in health and care contexts, providing conceptual definitions, theoretical frameworks, or descriptions of practice, education, and evaluation. Thematic synthesis was applied to identify recurrent dimensions, strategies, and values. Results: A total of 146 documents were included. Advocacy was consistently framed as a deliberate, value-driven practice oriented toward systemic change, social justice, and equity, despite considerable conceptual and operational variability. Applications spanned clinical care, public health promotion, community mobilization, and policy reform. Relational and communicative skills were widely emphasized as enabling factors, but evaluation remained limited: only 6 studies (4%) reported the use of specific measurement instruments, none of which were standardized. From this synthesis, we developed a preliminary blueprint for equity-oriented public health advocacy, structured around six components: normative grounding; multilevel orientation; relational and communicative practices; critical and systemic literacy; reflexive professionalism and civic agency; and evaluation and accountability mechanisms. Conclusions: Advocacy emerges as both a professional competency and a civic practice essential for equity-driven health systems. This review provides a conceptual foundation and a translational framework to guide integration of advocacy into policy, training, and practice. Sustained collaboration between academia, civil society, and health systems is required to institutionalise advocacy as a driver of just and inclusive health governance. Registration: OSF: https://doi.org/10.17605/OSF.IO/MEJHX