More than 20 years of health disparities research has brought me to an important conclusion: the gulf placed between rigorous science and political advocacy must be bridged by health care researchers.

This bridge must be based on rigorous trials and evidence that survive the scrutiny of peer review.

However, to be useful in the hands of those making policy, the bridge needs to be built with more intention than is often appreciated. As an example, I’ll walk through how I came to this conclusion using an article my team and I published in the most recent issue of Health Affairs.

Our nation continues to grapple with how to respond to the death of George Floyd, widespread and systematic racial inequalities, and increasing evidence that already disparate health outcomes continue to diverge following the COVID-19 pandemic.

Though some action has been taken, the primary difference is increased awareness of the importance of social risk factors on health.

Recently, attention has been given to structural racism as being associated with these social risk factors. However, this does not fully capture what is happening in the lives of those experiencing racism every day.

Structural racism is antecedent to the social determinants of health and therefore a key driver of these social risk factors.

Therefore, to change systematic inequalities we see around us, we must incorporate factors influencing the health of individuals at multiple levels. This includes the macro level of societal policy.

A decade ago, my research team and I shifted our emphasis to conducting work rooted in the social ecological framework. This framework captures the concept of multiple levels of influence affecting health, including interpersonal, community, and societal influences.

We find great utility in considering the National Institutes of Health (NIH) National Institute on Minority Health and Health Disparities (NIMHD) research framework. This framework highlights multiple domains of influences across the life course that impact individual, community, and population health.

Importantly, it directly calls out policies and laws, societal structures, and societal norms as influences on population health.

By conducting analyses to understand the impact of social risk factors, we identified different leverage points on which to test interventions.

We also conducted focus groups and interviews with key stakeholders and community members to give context to interventions we developed. Finally, we worked to obtain funding to test the impact of these interventions on the health of adults with diabetes.

It was in this context that we were invited to look at the evidence base for nonmedical interventions to reduce risk for and improve clinical outcomes for type 2 diabetes.

We conducted an extensive review but found few clinical trials that integrated medical and social interventions within the context of adults with diabetes.

Positive impacts were found when combining food supplementation with referral and diabetes support, financial incentives with education and skills training, housing relocation with counseling support, and medical care and social supports through the EMR.

However, much more work is needed developing and testing multicomponent interventions at a large scale and addressing a broader range of social risk factors.

Having completed the review, something else stood out to us.

There were no interventions directly addressing structural racism within the context of type 2 diabetes.

Though evidence from observational research existed, the lack of clinical trials or natural experiments left a hole where normally we would have offered evidence-based policy recommendations.

We saw an opportunity to consider how one could act on upstream social determinants of health given the evidence that did exist.

What resulted was a set of policy levers that may serve as a road map for future interventions given the racialized context of social risk in the United States. We see this work as one way to address the impact of structural racism on the health of the nation.

Some policy opportunities we identified that could improve the health of adults with diabetes include:

Medicaid expansion
Policies that help ameliorate vulnerabilities of our health system in times of systemic shock such as the COVID-19 pandemic
Policies that establish new billing practices for uninsured patients
Policy levers within the labor market targeting social mobility
Expansion of existing Department of Housing and Urban Development programs

While our work is primarily in diabetes, the process we followed is relevant across conditions. A thorough search of the evidence is necessary, followed by actionable strategies.

But we cannot stop at that point.

While individual level interventions need to be conducted, we cannot ignore connecting evidence to policies that change upstream factors outside the control of individuals.

For example, we can provide healthy food vouchers for individuals who experience food insecurity. However, until we address the location of grocery stores and how investments in communities are decided, community health will not change.

Policy matters and health care researchers cannot ignore the hard work that comes after conducting high quality research.

Health care researchers need to go beyond publishing their work. They need to actively put good science in the hands of those making policies with the end goal of changing lives.

We propose that research should be done with the intent of changing inequitable policies. In Milwaukee, we have a team of eight MD and PhD researchers we have named the Health Equity Research Group.

We come from diverse disciplines and have over fifty program staff who work across seven NIH-funded studies focused on addressing inequalities in health.

The sole purpose of our team is to generate evidence that changes policy at the local, regional, and national level.

In addition to interventional work, our team is creating nationally representative databases to build a framework for studying the impact of structural racism and historical redlining on present-day health outcomes.

We believe that multiple teams of this size and scope are needed across the United States.

Poverty is the driver of so many social risk factors impacting health. As a result, teams focused on conducting high quality research that targets structural inequalities in health is relevant across diverse communities.

We hope the work completed in the Health Affairs review spurs on the great work ahead of us. Ultimately, if we are brave enough to create evidence and then use it to change policy, we will bring meaningful change to pass.

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Today in Health Affairs Forefront, Christopher Palmieri and coauthors argue that integrated Medicare-Medicaid programs offer an effective solution to address the challenges facing dually eligible individuals living with behavioral health conditions.

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About Health Affairs

Health Affairs is the leading peer-reviewed journal at the intersection of health, health care, and policy. Published monthly by Project HOPE, the journal is available in print and online. Late-breaking content is also found through healthaffairs.org, Health Affairs Today, and Health Affairs Sunday Update.

Project HOPE is a global health and humanitarian relief organization that places power in the hands of local health care workers to save lives across the globe. Project HOPE has published Health Affairs since 1981.

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