Working together, academic and community-based researchers can strengthen the connections across medical, social service, and public health systems to help diminish structural racism.
Editor’s note: This funding opportunity is now closed.
My maternal grandfather had some good fortune in his life. As both a veteran and an employee of the Ford Motor Company in Detroit, he was eligible for health benefits from two sources. That meant that along with traditional medical services, he could readily access dental care, medical devices, and social services that included counseling and housing assistance, if he needed them. He could even ride his motorized scooter to the Veterans Administration hospital and meet up after clinic appointments with buddies who shared many of his life experiences, providing the social connections so essential to wellbeing.
As my career in health administration evolved, I began to realize that such a palette of services is rare. More typically, people feel as if they are living inside a pinball machine, batted incessantly from one corner to the next in their search for help. Because medical, social service, and public health systems have never been well threaded together, the fractured and inequitable distribution of services and support has become commonplace.
To live the healthiest life possible, people need access not only to appropriate providers and treatment but also, at times, help dealing with housing instability, food insecurity, social isolation, financial strain, interpersonal violence, and other social determinants of health. No single system can provide all of that; instead, systems need to work seamlessly together to provide it as best they can.
Consider the consequences when they do not. Traveling to the doctor to be monitored for diabetes becomes a low priority when it means taking time off from work or arranging childcare, or when the required co-payments or deductibles are unaffordable. Lacking a stable address or forced to navigate complicated transportation routes, someone can miss an appointment to determine their eligibility for financial assistance and be cut off from various supports. The health harms of segregated housing, food apartheid, and employment discrimination are intensified by systems that operate independently of one another.
Growing the Evidence for Coordinating Systems
Systems for Action (S4A) is an RWJF research program dedicated to addressing these challenges by aligning medical, social service, and public health systems. We support evidence-based studies that identify innovative ways to diminish fragmentation, rebalance power, and confront the structural racism that is so deeply embedded in many of these systems.
We already have a body of research that tells us how best to design multi-sector initiatives that will advance health equity. Clearly, we should expand the pool of available social services and support—it is not enough to rely on screening and referrals if there aren’t enough services to go around. We also need to reallocate resources so they are not overweighted towards medical care at the expense of social services and public health. Likewise, social service and public health stakeholders need more voice and authority on any team of collaborators.
RWJF’s National Commission to Transform Public Health Data Systems has identified other attributes of invigorated multisector initiatives. Importantly, these include enhancing communication across sectors, recognizing that we can only build bridges when we understand one another’s language. Better use of public health capacities, including the field’s expertise in surveillance, community outreach, and health education, is also key. And an equity-centered approach requires that we disaggregate data in order to understand how race, ethnicity, geography, socioeconomic status, and other demographic characteristics influence outcomes.
Despite all we have learned about cobbling together disconnected systems, significant knowledge gaps remain. Through a Systems for Action funding opportunity, we are soliciting innovative new ideas for alignment, emphasizing strategies to help dismantle the enduring structural racism within many of our systems.
S4A initiatives always emphasize rigorous methodology but we think we can create more interdisciplinary opportunities for those who are fully grounded in community experiences to connect with academic researchers. We know there is a lot of amazing work underway in local communities. But on-the-ground experts are sometimes limited by resource shortfalls—or the many other demands that compete for their attention, which can limit their capacity to apply formal methodological or practice-based knowledge. This CFP gives priority to projects that are defined and initiated within communities for a simple reason: without that voice, we don’t know enough to drive effective change. Rather than make assumptions about what people within communities need, we want them empowered to identify their own concerns and define the outcome measures they care most about.
Toward that goal, we are offering two categories of research awards so that stakeholders within the domains of medicine, social services, and public health can engage with one another on equal footing. Recognizing that theory, rather than practice, sometimes dominates research, the CFP emphasizes the importance of an action plan—we want to know how you will put new scientific knowledge to work in service to health equity.
Developmental studies: Perhaps your organization is already thinking about strategies for aligning systems but has not yet begun to test them. A pilot study will help you assess the feasibility and potential value of your idea—including whether you can readily engage stakeholders across sectors, successfully recruit study participants, and collect and analyze data. This 12-month developmental grant will position you to respond to future S4A proposal solicitations or pursue other funding opportunities.
Impact studies: These three-year awards allow you to measure the impact of a novel strategy to align delivery and/or financing structures across medical, social service, and public health systems. Open only to participants who can document the results of a previous pilot study, your proposal should explain how you will measure health equity and create a model for addressing the structural racism that remains lodged within these three domains.
To live their healthiest lives, people need services similar to what my grandfather enjoyed. It’s why S4A invests in research that examines how linking systems can advance health equity.
Jacquelynn Y. Orr is a program officer in the Research, Evaluation, and Learning unit. As a strategic liaison to RWJF’s efforts to transform health and healthcare systems, she draws upon her extensive skills in physician practice management, medical education, healthcare delivery, public health, and health disparities research.