Science Visioning to Advance the Next Generation of Health Disparities Research

The science vision for minority health and health disparities research, led by the National Institute on Minority Health and Health Disparities, in collaboration with other National Institutes of Health institutes and centers, set out to generate a cohesive perspective for advancing the use of distinct novel definitions with specific health outcomes for the next generation of minority health and health disparities research. The timely need for the visioning process was prompted by unsatisfactory progress in reducing health disparities and improving minority health over the past 20 years and the increase in the number of health disparity populations in the United States.

Two different two-day discussions were held in the summer of 2016, with scientific experts from within and outside of the National Institutes of Health contributing to the science vision in three research pillars: (1) methods and measurement, (2) etiology, and (3) interventions. The experts discussed relevant topics that could advance the field and promote minority health and health disparities research as distinct and interrelated fields of study. This editorial will provide an overview of the rationale for a visioning process on health disparities research and a summary of the articles in this supplement by pillar, underscoring the discussions and strategies to advance health disparities research.

VISIONING A NEW PERSPECTIVE

The visioning process was prompted by the need to guide the scientific field to generate studies that distinctly focus on improving minority health or on reducing health disparities. This perspective is important because health of minority populations can be improved, even if a disparity does not exist. The paucity of health research focused on reducing disparities called attention to the new definition and outcomes.¹ This novel method set the platform for the three distinct pillars, or scientific areas of research.

The new health disparities definition sets the need for enhanced metrics and measures to identify and to evaluate health disparity conditions. Several issues emerged, such as common metrics deficit, absolute and relative measures meaning,² percent difference default, weighting interpretations, and benchmark population’s status.³ In addition, big data science advances may create additional health disparities in diagnosis and treatments if health disparity population’s measures are missing in the data system.

A critical area of research, or pillar, is the etiology of health disparities to identify the contributors of the adverse difference. Once determined, these factors become known as the mechanisms in which the causally interacting parts producing the health disparity can be understood and intervened. As health determinants are viewed mechanistically, proxied models reflecting life situations can be developed to enhance the design of targeted interventions.^4,5

Interventions targeting the known health determinants or mechanisms provide a platform for the implementation of research knowledge in real-life settings to benefit the population concerned.⁶ This approach requires different intervention designs that are complex, comprehensive, and realistic to life conditions.⁷ In addition, this area of intervention research, or pillar, must be sustainable, attentive to the underlying causes of health disparities, culturally competent to engage health disparities communities, and inform policy changes.

SCIENCE VISIONING PILLARS

The following summarizes the articles representing the main discussion topics within each pillar proposed for the science vision. The title precedes the intent of the discussion. Each subsequent article in the supplement will contribute enriched points and research strategies to advance the next generation of health disparities research.

Methods and Measurement Pillar

The “Methods and Measurement Science Pillar” discussions focused on key aspects needed to cohesively strengthen scientific methods and measurement in health disparities research. This pillar has five articles presenting key discussions and recommendations for future research and underscoring the various needs: (1) the need for standardized health disparities outcomes in research that align with e-health records and clarify the analytic methods used to determine the magnitude of the health disparity (Duran et al., p. S25); (2) the need to apply novel methods to understand the causes of health disparities, including complex relationships with feedback loops and dynamic properties (Jeffries et al., p. S28); (3) the need for sound methodological research and rigorous appropriate evaluations to guide decision-making to support studies that reduce health disparities (Dye et al., p. S34); and (5) the opportunities and challenges using big data modalities, including ethical considerations in the analysis and interpretation of results that cautions against making broad generalizations before knowing whether data are representative of the population under study (Breen et al., p. S41). These points established a need for enhanced measurement of health disparities that were more reflective of the real world.

Etiology Pillar

The “Etiology Science of Health Disparities Pillar” focused on understanding the causal mechanisms or health determinants that contribute to health disparities by exploring frameworks and models that incorporate the complexity of the multiple, interacting factors influencing health and disparities across the life course. Strategies to advance the science on the etiology of health disparities were incorporated into each discussion topic, which were: (1) discussing the importance of racism as a mechanism that contributes to health disparities and an exploration of areas of needed research to better understand the impact that racism has on population-level health (Gee et al., p. S43); (2) challenging the field to operationalize and test integrative life course models to examine how exposures throughout life, including transgenerational transmission, influence health trajectories that lead to population level health disparities (Jones et al., p. S48); (3) providing an assessment on how the physical, built, and social environments influence health and contributes to chronic disease health disparities by impacting physiological and developmental processes (Bagby et al., p. S56); (4) highlighting the need for research opportunities to better understand how delivery and access to care contribute to health disparities (Wasserman et al., p. S64); and (5) discussing the need to better understand how multifactorial causal pathways influenced by upstream social determinants of health lead to downstream health disparities (Palmer et al., p. S70). Although some of these aspects are known, this pillar stresses the need for research utilizing multilevel, complex, multifactorial approaches that are more reflective of the social and biological interactions that result in health disparities.

Intervention Pillar

The “Intervention Science Pillar” focused on key aspects needed to inform the design and implementation of population health interventions to improve minority health and reduce health disparities by: (1) presenting examples of structural interventions, discussing challenges, and proposing strategies to foster the development of interventions to address structural determinants that systemically lead to and perpetuate health disparities (Brown et al., p. S72); (2) discussing what is known about the use of mHealth, telehealth and social media as approaches for single and multilevel interventions aimed at improving health behaviors and outcomes, identifying challenges to achieving optimum impact, and describing strategies for overcoming the challenges (Bakken et al., p. S79); (3) outlining areas of need to fill existing challenges in the design and assessment of multilevel interventions as well as strategies recommended that address overarching constructs inherent to multilevel interventions to improve minority health and health disparities (Agurs-Collins et al., p. S86); and (4) advocating for an expansion in the emphasis of adaptation research from researcher-led interventions to research that informs practitioner-led adaptations and facilitates successful adaptation and equitable implementation (Alvidrez et al., p. S94).

CONCLUSION

The visioning process conducted by the National Institute on Minority Health and Health Disparities focused on three scientific areas or pillars of minority health and health disparities research to understand mechanisms that provide insights into the etiology of a health disparity, to create efficacious interventions that can impact a health disparity, and to develop better measures and metrics for identify and assessing health disparities. The discussions resulted in recommendations focusing on health disparities research that determines the contributing factors from biological, sociocultural, physical environmental, behavioral, and systems perspectives in a complex real-world setting. To achieve this, health disparities research has to adopt enhanced measures and methods, including common indicators, when identifying contributing factors in etiology research. The factors identified can be used for interventions targeted to mitigate the causes and efficiently reduce the disparity. Researchers need to be clear on the ultimate intent of their project to improve minority health and to reduce a health disparity.