Navigating and reframing tensions within equity-centered learning health systems.

Introduction: Canada recently joined a growing list of countries that are establishing national collaboratives to exchange knowledge on and scale learning health systems (LHSs) across geographies and sectors. The first symposium of the pan-Canadian Learning Health Hub was held in June 2024 and included a keynote presentation and breakout discussions on how to operationalize equity in LHSs. Methods: In preparing for the keynote presentation, we examined the literature, reflected on our experiences building LHSs that have an equity focus, and on discussions we have had with other LHS practitioners on where and how equity manifests within a LHS. Results: Through our preparation, we identified three tensions that are inherent to and result from centering equity in LHSs: (i) Divergent definitions and languages of health equity (the tension of language); (ii) rapid learning versus slow engagement (the tension of pace); and (iii) equity as a driver and an outcome (the tension of dual roles). In this analysis, we present how these tensions manifest in the practice of equity and LHSs alongside strategies for navigating and reframing these tensions to catalyze dynamic learning. Conclusion: For individuals and organizations interested in advancing equity-oriented LHSs, in Canada and other jurisdictions, this paper highlights how and why the goal should not be to avoid these tensions, but rather to navigate the push-pull inherent in our contexts with intention and a commitment to transformative action.