Last week, the Centers for Disease Control and Prevention (CDC) released its second Health Disparities and Inequalities Report, which highlights differences in disease and death rates for 29 conditions.
While there was some good news, such as an overall drop in teen pregnancy rates, CDC found racial and ethnic health disparities in all 29 areas they reviewed. For example, black infants are twice as likely to die than white infants, and diabetes rates are higher among blacks and Hispanics than among Asians and whites. Cardiovascular disease is the leading cause of death across all Americans, and blacks are at least 50 percent more likely than whites to die of premature heart disease or stroke.
But this is not new news. The first national goals to reduce disparities were set by Dr. Julius B. Richmond, former United States Assistant Secretary for Health and Surgeon General, in 1979 and were subsequently updated for Healthy People 2000, Healthy People 2010, and Healthy People 2020. The wording of the goal for 2020 is to “achieve health equity, eliminate disparities, and improve the health of all population groups.”
So after 30 years of health policy and health services research to document disparities and successive goals to reduce them, the compelling question is this: why is health equity so difficult to achieve? CDC’s report concludes that limited coverage and access are only part of the problem. From a research perspective, economic and environmental factors – social determinants of health - are the strongest predictors of health status.
Communications: Supporting a National Conversation with Language Everyone Can Understand
In its 2013 report Shorter Lives Poorer Health, the Institute of Medicine noted that the American public needs to be better informed about disparities so that a thoughtful national discussion can take place about the social determinants of health and help build a larger constituency that will support policy solutions.
But educating the public has its own challenges.
In taking steps to communicate with and on behalf of its grantees working on social determinants of health, the Robert Wood Johnson Foundation Vulnerable Populations Portfolio began a study in 2009 to inform its own message strategy. The Foundation tested messages about disparities with more than 3000 registered voters and opinion leaders. That study found that the term “social determinants of health” didn’t resonate. The language used to describe the challenge wasn’t working.
In response, the Foundation developed more effective frame about how “health starts where we live, learn, work, and play” and found out that its messages were picked up by media describing Foundation programs and also appeared in academic literature. The new frame is not aligned with any particular political perspective and uses “colloquial, values-driven, emotionally compelling language” to build support for solutions being implemented by grantees.
Focusing Our Resources
Facilitating an effective national discussion will also require a better understanding of where we can have the greatest impact. Yet, we still need more and better data to help focus resources where they can be most effective.
AcademyHealth is contributing to the national discussion by increasing our commitment to diversity, leading the effort to collect data to better understand the current state of the HSR workforce, and identifying ways to improve engagement of underrepresented groups in the field. Our organization is also working through programs like the AcademyHealth/Aetna Foundation Minority Scholars Program to address training and pipeline issues. We believe that improving diversity in the HSR workforce is a critical precondition to embracing important perspectives, asking novel questions, and conducting rigorous science that engages vulnerable sub-populations, broadens perspectives on patient reported outcomes, improves the quality and efficiency of care, and meaningfully improves dissemination and translation of HSR for diverse stakeholders.
To further inform our diversity efforts, AcademyHealth convenes external perspectives through the HSR Workforce Diversity Planning Committee. The Planning Committee is comprised of external partners from government, academia, and the private sector who are committed to working to develop a collaborative approach to HSR training and continuing education to improve diversity and inclusion in the field. With this knowledge, AcademyHealth will be better able to build and enhance programs to meet the needs of the field and explore innovative strategies to increase diversity and inclusion in HSR