Introduction
Although there has been a remarkable improvement in health care quality, health disparities, especially in chronic disease burden, continue to persist. Interventions to decrease these gaps need to occur at the local level. Community-based research projects can help identify and address the root causes of health disparities, especially in rural America. This paper examines the role of the Federal Collaboration on Health Disparities Research (FCHDR) and identifies the collaborative strategies for reducing these inequities, their implementation, and intervention development challenges.
Federal Collaboration on Health Disparities Research
Efforts by the FCHDR to improve health are evident in its integrated approach to the reduction of health disparities. It has mobilized scientists, federal officials, and state and local stakeholders to establish the built environment workgroup to identify socioeconomic variables linked to poor health outcomes among racial/ethnic minorities (Hutch et al., 2011). Examples of such determinants identified by FCHDR are community factors (housing and food access) and family/individual components (dietary intake).
It has also worked collaboratively with various entities to develop “policies, tools, and practices” for reducing health inequities (Hutch et al., 2011, p. 592). Examples include the Livable Communities Initiative and the Brownfields Cleanup that create pedestrian-friendly communities to improve air quality. Other community-focused strategies include faith-based and school-based provider-led educational programs (Walton-Moss et al., 2014). FCHDR has also worked collaboratively with partners to disseminate evidence-based research addressing issues causing health disparities. An example of such studies is the Irvine-Minnesota inventory.
Strategies in Community and/or Clinical Practice
I have observed the use of community-based participatory research to empower individuals and address health disparities. The strategy entails collaboration among local medical centers, schools, churches, and community organizers, among others, in health education, capacity building, dissemination of findings, and policy enforcement. For example, recently, a public health department of a university started a smoking cessation project using a media intervention. The researchers used local television and radio channels to mobilize support for the program and tackle health inequalities related to behavioral factors (Hutch et al., 2011). Thus, social action can be used to modify risky behaviors in the community, including smoking and dietary habits.
In clinical practice, I have observed clinician-led (community health workers or CHWs) diabetic education to promote four behaviors healthy eating, exercise, awareness, and self-care (Centers for Disease Control and Prevention, 2016). As Betancourt, Duong, and Bondaryk (2012), culturally tailored training on diabetes self-care that is implemented with at-risk minority populations by CHWs has been shown to be effective. This approach can help decrease health disparities in low-resource rural populations with a high chronic disease morbidity and mortality (Warshaw, 2017). It empowers communities to exercise control of their health.
Implementing these Strategies
Successful implementation of community-based participatory research, educational interventions, policies, and practices, among other strategies, would require adequate community engagement from their inception. The aim is to empower populations to lead such initiatives. It would also involve framing health disparities as a matter of social justice to mobilize support and gain buy-in from the community. Leveraging local assets is critical in implementing these strategies.
The Triad of Rural Health Disparities
Diverse economic, cultural, and geographical factors specific to a rural community present a challenge to clinician-led efforts to eliminate health disparities (Thomas, DiClemente, & Snell, 2014). In my view, healthcare practitioners cannot develop broader interventions to reduce these inequities due to health determinants that are beyond their control. For example, wide variations in the socioeconomic status exist in communities in “income, wealth poverty, transportation infrastructure, and the distribution of healthcare resources” (Ricketts, 2011, p. 1). Addressing these root causes requires multi-stakeholder collaboration. Another challenge is developing culturally sensitive interventions. The cultural characteristics of low-resource communities may be wide and varied. Interventions considered respectful and practical must reflect the norms and beliefs of the population to gain acceptance.
Conclusion
To eliminate health disparities, the different determinants of health must be addressed. Empowering communities through community-based participatory research, education, and policy are some strategies for achieving this goal. They address the diverse economic, cultural, and geographical factors that cause wide variations in access, use, and quality of care.
References
Betancourt, J. R., Duong, J. V., & Bondaryk, M. R. (2012). Strategies to reduce diabetes disparities: An update. Current Diabetes Reports, 12(6), 762-768. Web.
Centers for Disease Control and Prevention. (2016). The national program to eliminate diabetes related disparities in vulnerable populations. Web.
Hutch, D. J., Bouye, K. E., Skillen, E., Lee, C., Whithead, L., & Rashid, J. R. (2011). Potential strategies to eliminate built environment disparities for disadvantaged and vulnerable communities. American Journal of Public Health, 101(4), 587-595. Web.
Ricketts, T. C. (2011). Geography and health disparity. Washington, D.C.: Woodrow Wilson International Center for Scholars.
Thomas, T. L., DiClemente, R., & Snell, S. (2014). Overcoming the triad of rural health disparities: How local culture, lack of economic opportunity, and geographic location instigate health disparities. Health Education Journal, 73(3), 285-294. Web.
Walton-Moss, B., Samuel, L., Nguyen, T. H., Commodore-Mensah, Y., Hayat, M. J., & Szanton, S. L. (2014). Community-based cardiovascular health interventions in vulnerable populations. The Journal of Cardiovascular Nursing, 29(4), 293-307. Web.
Warshaw, R. (2017). Health disparities affect millions in rural U.S. AAMCNews. Web.