Disparities in health are not merely health-related differences between populations but those that are systematic, avoidable (preventable), and suffered by socially, economically, or environmentally disadvantaged groups.1,2 A distinct yet related concept, health equity, is the goal of eliminating disparities in health by giving focused attention to the needs of those at greatest risk of poor health and addressing underlying causes of disparities such as social inequities.1 Achieving health equity requires new and targeted approaches in which researchers and communities are essential partners in creating long-term population impact.
Health equity-focused efforts have evolved in recent years. To reflect on this evolving era, we interviewed leaders from two national organizations that fund an array of health equity research. Elvan Daniels, MD, MPH is Scientific Director, Cancer Prevention & Control Research, Extramural Research at the American Cancer Society (ACS). Kerry Anne McGeary, PhD is Senior Program Officer, Research-Evaluation-Learning at the Robert Wood Johnson Foundation (RWJF). Below, Drs. Daniels and McGeary share their insights about health equity research trends, grant application tips, and more.
Dr. Daniels: There has been movement from mostly behavioral research to studies focusing on multiple determinants of health and multilevel research using a variety of study designs. Studies range from interventions involving (a) clinical practices and communities, to (b) communities and public health entities, and (c) health services research evaluating the impact of health policy using a variety of large databases. Less prominent are simple explanatory studies.
Dr. McGeary: I have seen a growth in research with a community, not within or for a community. The community based participatory approaches have grown. However, the disparities researchers still dominate the conversation. More and more they are using the term “health equity” to describe their work.
Dr. Daniels: [Promising studies are those] that address root causes of disparities with novel interventions to address barriers or propose unique solutions. These studies typically build upon previous research and involve partnerships with academic and community partners or primary care, specialty care, and community partnerships.
Dr. McGeary: Investigators should be offering a solutions-focused research design, working with a community’s needs at the forefront, and addressing systemic barriers to achieving the best health outcomes.
Dr. Daniels: Common pitfalls are proposing research with a special population [but] failure to frame the research around two or more determinants of health the researchers believe drive the issue of inequity, lack of theory or conceptual framework, and failure to state how the research finding will contribute to achieving health equity.
Dr. McGeary: They are addressing disparities or the reason for disparities, [but] not offering solutions for the systemic barriers that are driving disparities.
Dr. Daniels: [ACS will] continue to require that applicants focus their research on at least two root causes and multilevel interventions involving interdisciplinary teams.
Dr. McGeary: The directions are related to frameworks, methodologies, and measures for improving health equity.
Dr. Daniels: Yes, we are in the process of refreshing our Priority Area for Health Equity which will include a [revised] definition and guideline principles ACS has developed with an Advisory Group to promote health equity across the Society, with support through funding from RWJF.
Dr. McGeary: Keep addressing the root causes that are at the heart of the stark disparities we see today. Do not shy away from the investigation of an area of work because it is outside your research agenda or scope of work.