One of many challenges confronting the nation’s health care system is the persistent disparity in health outcomes between various ethnic and racial groups. Why, for example, do Black children die from asthma at a higher rate than White children? And what can be done about it?
Research into such questions was the focus of a recent symposium organized by the Robert Wood Johnson Foundation’s (RWJF’s) New Connections: Increasing Diversity of RWJF program. Its broad mission is to increase the exposure of RWJF to researchers and experts from historically underrepresented research communities. The symposium, which ran from June 17 through 19, focused on advancing research into health disparities.
As RWJF Senior Program Officer Debra Joy Perez, Ph.D., M.P.A., M.A., points out, what gets studied depends on who’s doing the work. A basic disparities research question, she said, might be, “are there differences between African American and white women in terms of breast cancer rates and survival?” But, Perez explains, “an African American researcher might also ask why these differences exist and what specific interventions might work in breast cancer rates and survival among African Americans.”
Perez’s observation was the starting point for the symposium. “You start every research project with a question, and that question is impacted by a researcher whose individual and personal experience defines the research perspective,” she says. Therefore, quality research on health and health care requires inclusion and a diversity of researchers who frame questions from a point of view that reflects their historically underrepresented viewpoints.
Varying Death Rates from Asthma
Marla McDaniel, Ph.D., research associate at The Urban Institute, is a member of the 2008 cohort of New Connections grantees who attended the symposium. Her research illustrates the program’s underlying philosophy. McDaniel has focused on racial and ethnic differences in asthma management in children, studying the extent to which asthmatic minority children receive preventive treatment and asthma education.
“I want to know why it is that Black kids are dying more from asthma,” she said. “It’s a huge issue for me because these mortality differences shouldn’t be. There’s a significant disparity.”
McDaniel’s research reveals that asthmatic African American and Puerto Rican children ages 2 to 17 are less likely to receive preventive medicine and preventive care than their white counterparts—a disparity in treatment that may contribute to their disproportionately higher asthma-related death rates.
“I’ve always been interested in people and the conditions of people and wanting to understand why things are the way they are,” she said. “Being in predominantly White academic settings where I was …wondering why I didn’t see many who looked like me, has really driven me to this type of research.”
McDaniel’s background and commitment to health research disparities made her a prime candidate for a New Connections grant. She attributes her passion for research on disparities to observations she made during her upbringing. As a child she went to church in a community that was low-income and Black, but attended schools where the student population was predominantly White and more affluent. “I saw differences between the lives of many Blacks and Whites early on and I had a lot of questions about race and the disparities I was seeing,” she said. Those questions continued as she trained for her profession, and helped her land a New Connections grant in 2008.
New Connections Makes ‘First Investment’ in Assistant Professor’s Research
Hector Rodriguez, Ph.D., an assistant professor at UCLA, is a 2009 New Connections grantee. Rodriguez is currently investigating racial and cultural issues related to patient experience surveys. He says some racial and ethnic groups appear to have positive reporting tendencies, while others appear to have negative ones. Rodriguez wants to know why.
So he is applying a statistical analysis to try to isolate any systematic biases in the way people of different races, ethnicities and primary languages respond to questions on patient satisfaction surveys. “Given the same experiences as a white person, Asians are less likely to give positive responses,” he says. “Physicians who treat a lot of Asian patients receive lower scores on these surveys and this can create an environment in which certain doctors prefer not to treat certain patients.”
Examining systematic biases across racial lines is important because patient experience surveys are often used to assess a physician’s performance and determine their compensation, he says.
Rodriguez is especially pleased to have been awarded a New Connections grant because it “provides a certain legitimacy” to his research. Assistant professors often have a difficult time obtaining funding for their research projects. But “once an institution makes that first investment in us, a lot of us are more attractive to other funders,” he said. “That first investment is really key and is what enables us to go for other opportunities.” Since being awarded the New Connections grant, Rodriguez has acquired additional research funding from the United States Department of Veterans Affairs’ Center for the Study of Healthcare Provider Behavior.
Symposium a Whirlwind
The 2010 New Connections symposium was the fourth annual event of its kind. This highly-focused, three-day conference featured back-to-back presentations and lectures from prominent published scholars; research training and career development sessions; networking events; a panel discussion on the state of health and health care disparities research; and a “speed mentoring” session—an ever popular part of the program.
William Vega, Ph.D., co-director of the Network for Multicultural Research on Health and Healthcare at U.C.L.A., served as symposium chair. He said the symposium was particularly relevant to researchers interested in social issues affecting health who are looking to create solutions by “unlocking why certain things are happening…. Bringing this type of group together is completely outside of the mainstream of how research is normally done,” he said.
New Connections National Program Director Gerri Spilka, M.A., M.Arch., agrees with Dr. Vega. She said, “I think it really takes people who have an allegiance, a personalized sensitivity and the experience of underserved populations to ask research questions that are a little bit out of the mainstream. You get the same old answers or the same types of problem-solving if you only rely on the same dominant culture to conduct the research.” New Connections annually awards as many as 13 research grants of up to $75,000 each to scholars from historically underrepresented and underserved communities.
The symposium included members of the growing RWJF New Connections program network, which now boasts almost 700 people. A select group of 100 attended this year’s conference, including current grantees and alumni, as well as New Connections applicants who did not receive funding.
“If we want solutions to the social health problems that we are addressing as a Foundation, we know that the people who come to the table with us in search of those solutions have to be representative of the communities we are trying to help,” Perez says. “New Connections brings an untapped talent pool of knowledge, innovation and perspective to the work that each of our teams is doing.”
New Connections: Increasing Diversity of RWJF Programming awards one to two-year grants to early and mid-career researchers and scholars who have been underrepresented in research and evaluation activities supported by RWJF.