Strategies to Promote the Advancement of Health Disparities Science

Health disparities are a substantial burden to society in terms of healthcare costs, lost productivity, and general societal well-being. In 2015, NIMHD began a visioning process to create a scientific vision that will transform minority health and health disparities research. Thirty specific research strategies across the three pillars that guided the science visioning: methods and measurement, etiology, and interventions establish a new paradigm to stimulate research for improving minority health and closing the gaps in health disparities.

The science that will come from advancing these strategies will help enable NIMHD’s vision—an America in which all populations will have an equal opportunity to live long, healthy, and productive lives.

Methods and Measurement

Indicators for Measuring Health Disparities

• Promote adoption of common outcomes to quantify health disparities processes across different diseases and conditions and develop sentinel indicators.
• Develop a set of indicators that reflects the complexity of population characteristics and that can be adjusted to capture changing U.S. demographics.
• Make explicit the assumptions and values that may be implicit in health disparity outcomes.

Methods for Analyzing Health Determinants Contributing to Health Disparities

• Strengthen and promote analytic methods, particularly models, that will enable a better understanding of causes of health disparities.
• Push the limits of systems modeling to increase its ability to predict relationships between health disparities and health determinants, and to assess health disparities interventions.
• Identify and strengthen rigorous quantitative and qualitative methods to enable analysis on small populations and sub-populations.

Evaluating Health Disparities Research

• Evaluate health disparities programs and research, including policy interventions and natural experiments.
• Clarify whether the intent of the evaluation is process or summative and ensure the evaluation design is relevant to the diversity of the population being assessed.

Health Disparities in The Era of Big Data

• Leverage and foster linkages between existing and emerging data sources, including big data, to magnify the data’s analytic capacity and to more swiftly translate health disparities findings into health disparities reductions.
• Develop and define best practices for incorporating and using geographic identifiers in health disparities research to promote place-based research.

Etiology

Social Determinants

• Advance identification and understanding of how protective factors and resilience promote health at the individual, community, and population levels.
• Strengthen the understanding of how racism and discrimination are conceptualized, measured, and contribute to health disparities, with emphasis on internalized and structural racism.
• Elucidate mechanisms for how social determinants influence health behaviors that lead to health disparities.

Environmental Exposures, Biological Pathways and Mechanisms

• Assess how place and neighborhoods structure health disparities geographically.
• Determine the pathways and mechanisms through which environmental, economic, sociocultural, and behavioral factors influence biological systems and pathogenesis that leads to health disparities.

Life Course Approaches

• Integrate life course into health disparities research, including research on biological pathways and mechanisms.
• Identify mechanisms of intergenerational transmission of disease leading to health disparities, which take into account biological, behavioral, social, cultural, and life course perspectives.

Health Services

• Examine the impact of delivery models on population health.
• Identify the mechanisms by which patient-clinician communication and biases affect disparities in health outcomes.
• Determine how to improve diagnostic and medical guidelines, screening criteria, and standards of care through incorporating considerations of patient characteristics.

Interventions

Guiding Principles

• Promote interventions that address the structural drivers of health disparities, as well as consider the interplay with behavioral and biological factors.
• Support interventions that address common modifiable risk factors associated with multiple health conditions and disease outcomes to reduce health disparities.
• Incorporate a life course perspective by intervening at critical windows of malleability and plasticity during the lifespan and determining opportunities for altering the intergenerational transmission of advantage and disadvantage to prevent and reduce health disparities.

Approaches

• Leverage electronic information and communication technologies to deliver and evaluate interventions that have the greatest potential to reduce health disparities by removing accessibility and health literacy barriers, facilitating tailoring and personalization, and decreasing cost.
• Promote interventions that address the social determinants of health within health care systems.

Methods and Evaluation

• Use study designs and intervention research approaches best suited to accommodate the complexity of health disparities research, while upholding principles of validity and rigor.
• Evaluate the effectiveness of community-derived and practice-derived interventions that maintain and improve health or prevent disease.
• Assess the relative and interactive contributions of multi-level intervention components, as well as the mechanisms through which an intervention affects health outcomes.

Dissemination and Implementation (Scalability)

• Examine key dissemination and implementation issues during intervention design, development, and evaluation (e.g., cost, resources, fidelity, adaptation, feasibility, acceptability) to inform subsequent implementation and scaling up in populations experiencing health disparities.
• Build the science of adapting interventions to different contexts including cultures, delivery systems, and social environments.

Page updated Jan. 4, 2024