Current scholars and alumni of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program gathered in May in Bethesda, Md., a Washington, D.C. suburb, for the program’s four-day annual meeting. Consistent with the focus of the program, research related to health disparities was a principal focus of the gathering.
A highlight came on the third day of the conference, when the scholars traveled to the campus of the National Institutes of Health to hear from an international leader in the field of health disparities, Sir Michael Marmot, M.B.B.S., M.P.H., Ph.D., F.R.C.P.
Marmot is the director of the International Institute for Society and Health, and a research professor of epidemiology and public health at University College, London. He has had leadership roles in several internationally recognized studies and reports on health disparities. Perhaps his most notable role was as the chair of the World Health Organization’s Commission on Social Determinants of Health, which issued the landmark report, “Closing the Gap in a Generation.” He was subsequently drafted by the British government to conduct a review of the nation’s health inequalities, and is now at work on a similar assessment of health inequalities across Europe.
Marmot delivered a message to the group that echoed the themes of his recent work, reminding the scholars that “health is a measure of how well we’re doing as a society,” and asserting that “we have the means to close the gap in a generation. The question is ‘Do we have the will?’” Marmot quoted from the Commission on Social Determinants’ 2008 report, which noted that the “unequal distribution of health-damaging experiences is not in any sense a natural phenomenon, but is the result of a toxic combination of poor social policies and programs, unfair economic arrangements and bad politics.”
Joining Marmot at the lectern for the session was John Ruffin, Ph.D., the director of the National Institute of Minority Health & Health Disparities (NIMHD). After welcoming the group to NIH, he described NIMHD’s commitment to supporting the effort to end health disparities, saying it was the Institute’s mission to “lay the groundwork for new initiatives to make disparities and social justice efforts” succeed. Noting that the Institute is working to build “a strong foundation of sound science,” he said it wants to help develop the “scientific evidence to show how the working poor’s living conditions contribute to shorter life expectancy, and how people in poor neighborhoods get sick more often because of their social conditions.”
After Marmot and Ruffin, three Health & Society Scholars alumni presented findings from their own health disparities research. Michelle Frisco, Ph.D., of the inaugural cohort of scholars (2003-2005), described her research into the relationship between obesity and fertility among women. Her work examines both biological and social determinants of fertility. She has found that women who are obese between the ages of 20 and 24 are more likely to be childless over the course of their lives, suggesting that women’s early adult weight has long-term ramifications for child-bearing.
Gina Lovasi, Ph.D., of the 2006-2007 cohort, presented on research on the effects of local urban infrastructure on health and health behaviors, with a particular emphasis on differences across racial, ethnic and socioeconomic lines.
Finally, Wizdom Powell Hammond, Ph.D., of the 2005-2006 cohort, described her examination of health disparities affecting Black men in the United States, focusing on psycho-social factors that prevent them from seeking preventive medical care. She noted that high levels of “medical mistrust” among Black men discouraged them from seeking care, and that the mistrust was related to the men’s personal experiences with racism.
Feedback and Collaboration
Over the course of the four-day conference, each of the current scholars made presentations to their colleagues, addressing a broad scope of research into disparity issues. The presentations gave the scholars a chance not just to share research findings, but to give and gather feedback on each others’ work and network with participants from several cohorts.
In all, more than 40 scholars presented to their colleagues. Among the meeting’s first presenters was Carolyn McAndrews, M.S., M.C.P., a member of the 2010-2012 cohort, who explored disparate death and injury rates in traffic accidents, which claim the lives of 40,000 people per year in the United States. A disproportionate share of the victims are minorities. McAndrews’ research draws on her studies in urban planning, transportation engineering and economics. Later in the day, sociologist Mark Pachucki, M.A., also from the 2010-2012 cohort, presented his ongoing research into the ways that peer socialization affects diet and exercise habits among pre-adolescents and how those habits, in turn, affect health.
Other research presented by scholars during the meeting touched on anti-smoking policies, maternal depression and childhood health inequalities, school discipline policies and their effect on educational outcomes, disparate risks of being murdered, the impact of employment on new mothers’ health, parental hesitancy to have children vaccinated, migrant health care, obesity reduction, gas tax policy and its impact on physical activity, emotional eating and stress, and more.
The Robert Wood Johnson Foundation Health & Society Scholars program is based on the principle that progress in the field of population health depends upon multidisciplinary collaboration and exchange. Its goal is to improve health by training scholars to investigate rigorously the connections among biological, genetic, behavioral, environmental, economic and social determinants of health and develop interventions that integrate and act on these determinants to improve health. The program is intended to produce leaders who will change the questions asked, the methods employed to analyze problems and the range of solutions to reduce population health disparities and improve the health of all Americans.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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