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National Center for Chronic Disease Prevention and Health Promotion
Chronic Disease Prevention
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National Center for Chronic Disease Prevention and Health Promotion Chronic Disease Prevention Home | Contact Us |
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CENTERS FOR DISEASE
CONTROL AND PREVENTION Special Focus: Research No One Left Behind: Focusing Research on Health Disparities Health is a basic need of all people, and as we find better ways to prevent and treat illness, no group should be left behind. This conviction is at the heart of public health. For the past century, the good news on the nation’s health is that remarkable improvements have been enjoyed by all, regardless of race, ethnicity, sex, education, income, or geographic location. “The groups with poorer health in 1900 or 1950 have experienced great improvements, as have the groups that started out with better health,” explained James S. Marks, MD, MPH, Director, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). “Every group now has better health. But the disparities remain.” National Health
Agenda Makes Eliminating Disparities a Priority Two of NCCDPHP’s 10 priority research areas involve health disparities: identifying the underlying determinants of health disparities and developing and evaluating interventions to eliminate them. The center’s research in these areas will provide a scientific foundation for community-directed programs that can boost immunization rates and reduce the disproportionately high rates of breast and cervical cancer, cardiovascular disease, diabetes, HIV/AIDS, and infant mortality among low-income and minority populations. Key examples of some of the center’s ongoing disparities research include the activities of the REACH 2010 project, the Preterm Delivery Research Group, and the TRIAD project. |
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REACH 2010 projects have produced valuable baseline data on health disparities. For example, REACH 2010 investigators in Lowell, Massachusetts, were concerned about the high rates of illness and death from cardiovascular disease and diabetes among Cambodian residents of the city. Gaining access to, and trust from, shut-in Cambodian elders allowed them to document that this population has high rates of known risk factors for the conditions: low awareness of hypertension, failure to receive needed medication, low rates of contact with physicians, high-sodium and high-fat diets, and smoking. The Seattle-King County REACH Coalition is also tackling the problem of disparate diabetes rates. But rather than focusing on a single group, the coalition is working with the area’s African Americans, Hispanics, Latinos, and Asians and Pacific Islanders. The resulting multiethnic coalition has helped the project increase communication and trust among diverse stakeholders and create opportunities for them to work together on other community health concerns. “We’re expecting the REACH 2010 programs to develop new, community-driven strategies proven scientifically effective in eliminating health disparities,” said Imani Ma’at, EdD, CDC’s REACH 2010 director. “The strategies will be disseminated widely to communities across the nation.” To help ensure that the coalitions deliver useful results, CDC has developed an evaluation logic model to help guide programs in building capacity, developing targeted interventions, promoting protective behaviors, and improving health outcomes.
Babies who are born preterm (before the 37th week of gestation) are at higher risk for illness, disability, and death than infants born at full term. Despite continuing declines in rates of preterm births among African American women, they are still twice as likely to have preterm deliveries as non-Hispanic white women. Even when studies control for known markers for preterm delivery—such as low socioeconomic status, low prepregnancy weight, smoking, and less than high school education—the causes of this disparity remain unexplained. “The twofold difference is found even among African American women who are college graduates and had received timely prenatal care,” said CDC epidemiologist Cynthia Ferre, MA. In response to this public health puzzle, CDC established the Preterm Delivery Research Group (PDRG). Rather than focus on individual risk factors for preterm delivery, the PDRG supports research that seeks to link risk behaviors with social, cultural, environmental, and psychological factors. These factors can affect how easily a pregnant woman can follow her doctor’s recommendations. For example, “if healthy foods are not sold in her neighborhood markets, or if her neighborhood is not safe, a pregnant woman will have a harder time improving or protecting her health,” explained CDC’s Vijaya Hogan, DrPH, lead epidemiologist for the PDRG. This past fall, the Maternal and Child Health Journal published an entire issue on findings from PRDG-funded studies examining the social context of pregnancy for African American women. “The results from these and other PDRG studies are bringing us closer to identifying what is unique about being an African American woman in America that puts her at higher risk for having a preterm delivery,” said Ms. Ferre. Also published last fall was Stress and Resilience, a book arising from a study conducted by the PRDG-funded Harlem BirthRight project. This community participatory study of women living in Central Harlem included detailed community surveys and 3 years of ethnographic fieldwork. The book documents how economic circumstances, environmental problems, and social conditions expose African American women to the kinds of stress and chronic strain that could be increasing their risk for preterm delivery. TRIAD Study Examines
Diabetes Health Services
“Current science has offered many efficacious treatments for diabetes, but they are not being used as much as they should be,” said Venkat Narayan, MD, CDC’s project leader for this CDC-funded project. “It is our challenge to see that they reach patients as soon as possible.” Because effective diabetes care is a complex process that requires close working relationships between the person with diabetes and a team of health care and support service workers, the environment where this care occurs is important. TRIAD will examine factors that might affect diabetes care and perhaps explain why certain racial and ethnic minority populations have higher diabetes rates. Having collected baseline data on education and income levels of the 10,000 participants, the six TRIAD centers are now gathering data on the participants’ social status, particularly as reflected in where they live, work, and receive care. “The six centers are addressing three research questions,” said CDC visiting scientist Gloria L.A. Beckles, MBBS, MSc. “Are the socioeconomic status and social class of people with diabetes and the ecological features of where they live related to their health status and disease severity? Are observed associations between diabetes care and social position due to differential access, quality of care, or health behaviors? Lastly, what characteristics of individuals, their neighborhoods (such as how safe or attractive they are), and their health care systems mediate those observed associations? Ecological studies like this have been done in Europe, but seldom here, and never for a chronic disease.” The TRIAD study, together with various other CDC-funded investigations, could shed new light on these questions—and could thereby reveal answers to the troubling question of why health disparities between various demographic groups continue to exist.
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Privacy
Policy | Accessibility This page last reviewed August 10, 2004 United
States Department of Health and Human Services |
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