Three Ways to Advance Health Equity Through Research
Jun 8, 2021, 1:45 PM, Posted by Alonzo L. Plough
Learn about how we’re working to strengthen the evidence base that can guide our nation toward a more equitable future.
The pandemic and this past year’s racial reckoning have given us a decisive moment. We have an opportunity to build a movement for positive change and collective healing. Part of the national awakening is recognizing the urgency to improve public health and advance equity. Today, multiple organizations and people across sectors are eager to do their part in creating a better, more equitable future.
My colleagues at the Robert Wood Johnson Foundation and I, too, seek bold and lasting change. We believe our path forward must be rooted in the best available evidence. What we need now, urgently, is research on how to eliminate inequities in health outcomes by addressing structural racism. How do we create evidence-based policies and practices so everyone has fair and just opportunities to thrive?
Long-established biases in our research field have determined who conducts research, and they tend to favor the same institutions and individuals. We also have deeply held beliefs about which types of research are valuable, and too often this constrains innovation.
To advance toward our goal of achieving health equity, we need to expand traditional research approaches to include more perspectives, ideas, and methodologies. When we do, I believe we will enhance our rigor and excellence. Here is what it might look like—and what we are practicing in our own work:
1. Lived Experiences Are Valuable
Individuals who experience in daily life what researchers study as “societal problems” bring essential knowledge to our fields. We should value and encourage those with diverse life experiences to enter the research field because their experiences can help us understand where barriers exist and how to overcome them. We can then apply this additional knowledge into actionable evidence to improve health equity.
Achieving health equity requires that our research truly reflects the country’s demographics. And it’s not just researchers. It should be every institution that touches research, including academia, publishing, and philanthropy. At our foundation, we have made a diversity, equity, and inclusion commitment to recruit leaders and staff from diverse backgrounds, perspectives, expertise, and/or lived experiences. We have worked on this for years, and will continue to strive for fair representation. (You can see our latest demographic report that is inclusive of staff and trustees.) Diversifying who conducts research makes evidence stronger and helps us put that evidence into action.
2. Research Should be Centered in Communities
Academia has long cherished randomized control trials as a gold standard of research (to name one example). But COVID-19 has underscored the need to address nuanced community conditions and dynamics through a broader set of methodologies in order to advance health equity.
That’s why we’re investing in research that either takes place within communities and/or meaningfully engages community members. We welcome eclectic, mixed methodologies connecting quantitative and qualitative data that can produce both authentic community partnerships and solid research evidence as well as actionable policy change.
Research should also be accountable to communities—and not simply extractive. What we learn from community-based research can be applied right back in communities, initiating an evidence-to-action pathway. RWJF invests many of its research dollars through our “For Action Programs,” namely Policies for Action, Evidence for Action, Systems for Action, Health Data for Action, and Health Equity Scholars for Action. I invite you to explore how emerging research from these centers is being applied in real life.
3. Data Needs to be Complex and Nuanced to be Useful
Evidence is only as strong as its data. Yet too often we base evidence on data collection and reporting that itself carries elements of structural racism.
One example is insufficient disaggregation of race and ethnicity in current data systems. Grouping all Asian populations without regard for the different cultures, languages, immigration histories, or wide variations in health, education, and wealth is problematic. Too often, race and ethnicity information for populations is not collected, analyzed, or reported, or it is discounted. Look at data collected for American Indian and Alaska Natives, Middle Eastern and North African peoples, and Native Hawaiian or other Pacific Island populations, for example. The lack of good population-level data on disability is another example. These flaws render populations invisible, mask unique needs, and hide strengths and assets. It leads to poorly informed decisions that affect lives and wellbeing. This lack of disaggregation was clearly part of the problem in our national response to COVID-19.
Another example is siloed data. As the COVID-19 pandemic swept the nation, there was a delay in recognizing its impact on incarcerated populations. We had health data, and we had data on incarcerated people. Yet, criminal justice-related data are not routinely connected to population health data systems. The pandemic response could have been improved with better data interconnectivity and more comprehensive and equity-focused frameworks.
To this end, RWJF has created a National Commission to Transform Public Health Data Systems. The commission will reimagine how data are collected, shared, and used, and identify what’s needed to update our public health data infrastructure to improve health equity.
Toward Bold and Lasting Change
When some groups lack equal opportunity to live to their full potential, our nation cannot achieve its full promise. Through our funding approaches, we are supporting the researchers to further develop action-oriented, mixed-method approaches that address urgent problems that constrain health equity. Here at RWJF, we don’t have all the answers but we are eager to continuously engage, have exploratory conversations, debate openly and, most importantly, to support the work to bring about change. I hope you will help us strengthen and accelerate the evidence that will help our nation achieve better health and equity for all.
About the Author
Alonzo Plough, chief science officer and vice president, Research-Evaluation-Learning, is responsible for aligning all of the Foundation’s work with the best evidence from research and practice and incorporating program evaluations into organizational learning.