Smoking rates are higher among adults who live below the poverty level or who never attended college. Wealthy women are more likely to receive screening mammograms than women at other income levels. Adult obesity rates are noticeably higher among African-Americans and Latinos than whites. Why?
The National Institute on Minority Health and Health Disparities, part of the National Institutes of Health, launched two new centers Wednesday that will study those factors and their impact on different health outcomes for certain racial and ethnic groups, people of lower socioeconomic statuses and rural populations—and how to address these disparities.
Under the program, called the Transdisciplinary Collaborative Centers for Health Disparities Research on Chronic Disease Prevention, two centers will study the impact of a person's surrounding environment—the family, local community, healthcare system—on his or her health, rather than homing in on the individual.
“Multilevel interventions that take into account complex interactions between individuals and their environments can better address determinants of health and enhance chronic disease prevention and health promotion for local communities,” said Dr. Eliseo J. Pérez-Stable, director of the National Institute on Minority Health and Health Disparities, in a statement.
The two research centers will serve as regional hubs for community organizations, doctors, nurses and institutions to collaborate on developing and implementing localized health interventions.
One program, based in Pullman, Wash., will focus on understanding and controlling hypertension among American Indians, Alaska Natives, Native Hawaiians and other Pacific Islanders. The other is set to take place in Flint, Mich., where researchers will study the effectiveness of interventions to improve exercise and eating habits, among other issues.
Increasingly, government officials, healthcare administrators, doctors, researchers and others who observe or are involved in healthcare recognize the vast divides in health along racial and socioeconomic lines, disparities that are affected by social determinants like poverty or housing. Understanding how all of them interact, however, is another matter.
"There are so many factors," said Dr. Michael Parks, an orthopedic surgeon at the Hospital for Special Surgery in New York who has researched health disparities in the field of orthopedics. "If we knew every cause and effect for disparities, we'd be able to knock them down one by one."
In some poor neighborhoods, people may have nowhere to exercise, or they might live in food deserts, contributing to the development of chronic diseases, Dr. Parks said.
Some estimates attribute as much as 80% of health disparities to these kinds of social determinants, Cara James, director of the Office of Minority Health at the CMS, told Modern Healthcare in an interview in April. “Race is a very complicated factor,” she added.
“Providers, the healthcare system, have structural barriers to addressing some of those social determinants,” James said. “Those aren't things that are going to be fixed overnight.”