HEALTH EQUITY RESEARCH INTERVIEWS: 1st ROUND TOP-LEVEL RESULTS & NEXT STEPS August 22, 2016 OVERVIEW 6 interviews 11 interviewees (5 dyads, 1 solo) Scott Burris & Laudy Aron Anita Chandra & Tamara Dubowitz Brian Smedley & Naima Wong Croal Paula Braveman & Elaine Arkin Shiriki Kumanyika Rachel Davis & Sheila Savannah Interviews lasted at least 60 minutes Dyads challenging recommend solo interviews for next round A C A D E M Y H E A LT H 3 - G E N E R AT I O N M O D E L Most interviewees acknowledged that these different generations of health equity research exist, BUT:
Linear, sequential model is overly simplified Stages/generations are often overlapping, not occurring one at a time Many referenced the 2011 Annual Rev. Public Health article by Stephen Thomas around fourth 3 - G E N E R AT I O N M O D E L , c o n t i n u e d I think those are useful distinctions to make, what I dont like is the sense that these are the sequences, and you sort of pass from one and then when you grow up you do the other. I dont think you want to imply that at all because youre always going to need all of those. Youre going to need research in all of those. They are overlapping, rather than sequential as portrayed here. [The model] ignores the fact that there
has been intervention research going on for decades. What I find most useful is to think about intervention research happening at different levels of analysis. Much of the early work has been done at the individual level. Slowly that research began to evolve and to more carefully consider social context. More recently, people are beginning to intervene at the level of institutions and structures and systems. This has been important because work is needed at all levels; we need comprehensive approaches to solve health disparities and advance health equity. OTHER TOP-LEVEL THEMES Field is ready to consider solutions Lots of existing research that is ready to be SOLUTION acted upon S AREAS Hard to identify specific areas in health equity to be addressed all seen as important Need for work across multiple areas and multiple disciplines that are interrelated and not distinct
Traditional NIH RCT design does not lend itself well to health equity work need more natural experiments RESEARCH Need to develop distinct standards for health equity research (rather than anything goes DESIGN approach) Many people seeking MPHs are coming from other disciplines, and theyre starting to see the overlap of public health in their work, whether theyre from planning, or education, or healthcare. I think that really leveraging that strength and looking at more interdisciplinary studies so that we are more holistically using the science of public health as part of academic programs across multiple different disciplines would be really important. TOP-LEVEL THEMES, continued
INTNL LESSONS AREAS DEFINING HEALTH EQUITY A sense that other countries (UK, Australia, Canada, etc.) are much more advanced in their health equity research Lesson learned need more longitudinal studies in US that could incorporate health equity outcomes of interest Unanimous agreement that health equity research should be include of all marginalized/oppressed populations (gender identity, rural populations, disabled community, etc.) However, a fear that too much dilution could lead to important resources being directed away from populations most in need COCs and low-income Interviews did not directly address the definition of health equity A sense that we need to define what exactly is entailed by health equity research, and expand what is constituted as health education, residential segregation, etc. could all have health and equity implications If were talking about health equity, what are
we talking about when we talk about health outcomes? Were talking about economic outcomes, all kinds of health outcomes. If were going to talk about health equity, we really need to broaden what were talking about when we talk about health equity research. To me, justice research is health research, transportation research is health research. Everything is health research. H E A LT H E Q U I T Y F U N D E R S Current Funders Robert Wood Johnson Foundation
NIH: NIMHD, NCI, NIEHS, NHLBI Kellogg, Annie E. Casey, Kresge (less so), Ford Foundation (NY), Gates, Hewlett, Packard, California Endowment California Health Foundation Convergence Partnerships SAMHSA Movember Foundation Potential Funders Grantmakers in Health US Chamber of Commerce Foundation Gates, Annie E. Casey, Ford, Kresge, Macarthur Healthcare foundations/Convergence Partnerships City governments
US Department of Education, HUD Community foundations, esp. in South Association groups, like Natl. League of Cities, US Conference of Mayors, etc. Universities and hospitals as anchors NEW INTERVIEW QUESTIONS Added based on feedback from interviewees on guide Added at different points throughout interview period, so not asked of all interviewees Potential to be included in/modified for next round interviews Are there lessons in health equity outside of the United States that have informed your work? There may be a need to transition health equity into other disciples outside of public health. How do you think this might be
accomplished, and what disciplines should be included? What needs to change or evolve in health research training, health practice, etc., to better include health equity? Is there one leading indicator that you think would be a good signal of improving health equity? Questions? Discussion Next Steps
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