Embedding Health Equity in Research
February 24, 2023
Brisa Hernandez, PhD; Wm. Jahmal Miller, MHA, DHL; Alisahah Jackson, MD
Goals GET INFORMED GET UNCOMFORTABLE GET INSPIRED GET ACTIVATED
Objectives
● Acknowledge the history of racism and inequity in research.
● Describe ways to assess/embed health equity when developing research ideas/questions.
● Discover ways to develop research, clinical and administrative collaboration to implement research.
● Translate research findings to support clinical and operational best practices.
3
History of Racism & Inequity in Research
4
5
Long history of research atrocities committed against people of color (e.g., Tuskegee Study, forced sterilization, intellectual property claims)
• Policy changes: 1993, Congress wrote the NIH inclusion policy into Federal law through a section in the NIH Revitalization Act of 1993 (Public Law 103-43) titled Women and Minorities as Subjects in Clinical Research.
• Important to acknowledge current medical racism (e.g., pharmacy deserts, Dr. Susan Moore’s death due to COVID, prison experimentation).
• Research studies tend to:
• Deemphasize the perceptions, thoughts, and interests of people of color, widening disparities in research outcomes and impacts. (e.g researchers of color or with lived experience
All this continues to influence the lack of trust in medicine and research (e.g. COVID-19 vaccine hesitancy)
6 •
Developing Research Questions with a Health Equity Lens
7
● Data sharing and integration drives decisions in diverse sectors- government and health care
● Supports understanding needs, improving services and systems, informing policies and interventions
● Must acknowledge the larger historical social and political context that often includes legacies of racist policies and inequitable resource allocation
● Acknowledge the racial bias in system and data design
Source: https://www.aecf.org/resources/a-toolkit-for-centering-racial-equity-within-data-integration and https://weallcount.com
8
Community Based Participatory Research
“...collaborative approach to research, [CBPR] equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community with the aim of combining knowledge and action for social change to improve community health and eliminate health disparities.”
(Minkler & Wallerstein, 2003, p. 4)
9
Community-Based Participatory Research to Understand the Social and Environmental Determinants Associated with Childhood Overweight. Gibson Village, Concord, NC 2019
Developing multi-sector collaboration
10
● A multisector collaboration is the partnership that results when government, non-profit, private, and public organizations, community groups, and individual community members come together to solve problems that affect the whole community.
● Based on cooperation rather than competition.
● Need to take the time to learn to work together cooperatively
● Establish trust and build safeguards into the collaborative process, therefore more likely to look out for one another's interests.
Utilize same principles to collaborate internally across departments & divisions
11
Collaboration in Action Examples
● Covid-19 Vaccine Outreach Program, funded by Deloitte Health Equity Institute
● Understanding gaps in Peripheral Arterial Disease (PAD)
Screening with a Focus on Equity, funding pending- Janssen Pharmaceutical Companies of Johnson & Johnson
Health System
Agreement execution, National operations, Communication, Dissemination
Local Physician Champions
Local operations, Data, Engagement, Reporting, Communication
● Scalability & Sustainability
Technology/ Data
Digital tool, Data Science, IRB oversight, Reporting, Dissemination
Funder Funding, Advisement, Communication, Dissemination
● Importance of collaboration and coordination in order to transcend walls of our organizations
12
de Hernandez, B. U., Díaz, M., Foster, D., Grey, M., Jackson, A., Thong, J., ... & Burton, C. (2022). A Health System's Approach to Using CBPR Principles with Multi-sector Collaboration to Design and Implement a COVID-19 Vaccine Outreach Program. Journal of Health Care for the Poor and Underserved, 33(5), 234-242.
Translating research to clinical and operational best practices
13
National Example
● Developed in response to The IOM Report Crossing the Quality Chasm,
● AREHQ identifies specific areas for quality improvement and reports on the progress of initiatives addressing disparities at Mass General
● Key components include:
○ Data Sourcing and Segmentation
○ Identify opportunities to improve
○ Implement operational changes
SOURCE: https://www.mghdisparitiessolutions.org/equity-in-health-care-quality
14
Local Examples
Colorectal Cancer Screening Intervention
15
Or ACEs
Thank you!
