Commentary on Zemore et al. (2018): The Future of Alcohol-Related Health Disparities Research in the United States

Zemore et al. (2018—this issue) seek to contribute to the agenda for alcohol-related health disparities research among U.S. racial and ethnic groups. They draw on 10 reviews of the relevant literature published in the past decade as the basis for developing their recommendations for future research. Although not all would agree that the current body of work is at an early developmental stage, their suggestions align well with the direction in which the science of health disparities is moving. Their focus on identifying the “drivers of” and interventions to address health disparities is congruent with the recommendations of the National Institute on Minority Health and Health Disparities (NIMHD).

Dr. Eliseo Pérez-Stable, Director of the NIMHD, recently clarified the distinction between minority health and health disparities research and described the institute’s new health disparities research priorities (https://www.nimhd.nih.gov/about/legislative-info/clips/nimhd-vision.html). Minority health research focuses on distinctive health characteristics and attributes of minority racial and/or ethnic groups in the United States that can lead to different outcomes for the minority group in comparison with others. When such differences document relatively poorer health outcomes for minorities and other priority populations (e.g., socioeconomically disadvantaged, rural, and sexual minority populations), they are considered health disparities. The NIMHD leadership describes health disparities research as devoted to: “(1) advancing scientific knowledge about defining mechanisms of how health determinants affect disparities; and (2) how this knowledge is translated into interventions to reduce disparities.”

A considerable amount of the current alcohol-related minority health and health disparities literature captured in the 10 recent reviews can be broadly categorized as minority health research in that it has been limited to characterizing the scope and nature of alcohol use and abuse among minority and other priority groups. At times, the literature has included some preliminary theories to account for differences in patterns of alcohol use and possible health disparities. The time has come to harness this epidemiological and basic etiologic knowledge to develop more complex models of the causes of and remedies for alcohol-related health disparities. NIMHD has proposed a framework to conceptualize and develop health disparities research (www.nimhd.nih.gov/images/research-framework-slide.pdf) that will serve as a vehicle for considering the complex, multilevel nature of minority health and health disparities research, modeling the mechanisms leading to health disparities, and suggesting evidence-based interventions to overcome disparities.

The topics set forward as “under-explored areas” in need of research attention, when considered within the NIMHD framework, can help direct our efforts toward developing the multilevel, complex theories that will be required to understand the causes of and solutions to racial/ethnic and other types of health disparities. We must seek to develop a robust science of alcohol-related health disparities, expand our knowledge of the mechanisms that drive these health disparities, and develop promising prevention, treatment, and health services interventions precisely targeting these causes.