Scientific Goals, Research Strategies, and Priority Areas

There are challenges measuring health disparities, including identifying how to measure the health disparity and selecting appropriate benchmark populations. The following scientific goals and research strategies focus on measurement to provide solutions to these obstacles and advance minority health and health disparities research.

• Goal 1: Promote research to understand and to improve the health of racial/ethnic minority populations
• Goal 2: Advance scientific understanding of the causes of health disparities
• Goal 3: Develop and test interventions to reduce health disparities
• Goal 4: Create and improve scientific methods, metrics, measures, and tools that support health disparities research

Goal 1: Promote research to understand and to improve the health of racial/ethnic minority populations

This goal advances the understanding of health determinants that contribute to the health status of minority populations, including subpopulations. Scientific knowledge generated should span the life course and address sociocultural variations and within-group differences. As the understanding of the interplay between biology and environment advances, better interventions can continue to be developed to improve the health of minority groups. In addition, research into the determinants that impact minority health may lead to new knowledge about the health differences experienced by minority groups.

Strategy 1.1: Examine health determinants that underlie resilience or susceptibility to diseases and conditions experienced by racial/ethnic minority populations.

Action Priority Areas

Starting Line:

• Expand support for large-scale observational, epidemiologic, and longitudinal cohort studies focused on multiple co-occurring chronic diseases and conditions in minority populations.
• Support ancillary etiologic studies using existing cohorts to examine the interplay between biological, behavioral, socioecological, sociocultural, and environmental health determinants in minority populations, as well as interactions with health care and public health systems.
• Support interdisciplinary minority health studies to delineate mechanisms of embodiment of social, cultural, and environmental factors experienced over the life course to better understand how those factors influence individual early development, physiology, cognitive processes, biopsychosocial processes and behavior, and disease trajectories.

Building Momentum:

• Support research, including international research, to identify genomic factors that contribute to U.S. racial and ethnic differences in health outcomes.
• Support research to identify key developmental origins or stages of susceptibility to common diseases and conditions or exposures where interventions would most likely have the greatest effect.
• Expand research efforts to delineate risk factors for developing obesity in early childhood and adolescence as well as identify opportunities for developing more effective and contextually tailored interventions.
• Accelerate efforts to define the critical contributions of oral health to overall health and disease in minority populations through studies to identify genetic and genomic risk or protective factors that contribute to racial and ethnic differences in health outcomes, and mediating or moderating influences of the microbiome, diet and nutrition, access to preventive dental and health care across the life course, and co-occurring chronic diseases and conditions.
• Expand support for research to identify sociocultural factors and other positive resources that promote population health and contribute to resiliency at the individual, family, and community levels.
• Support oversampling of racial/ethnic minority participants in population-based and patient-oriented studies to increase power to detect hypothesized racial/ethnic differences and enable analysis and comparison of racial/ethnic subpopulations.

Strategy 1.2: Develop and assess interventions to improve the health status of minority populations.

Action Priority Areas

Starting Line:

• Develop and implement individual-, family-, peer group-, and community-level health promotion and disease prevention interventions tailored to address the specific needs and cultural contexts of minority populations.
• Develop and implement evidence-based health care system interventions that reduce socioecological barriers to care and promote coordination and integration of preventive care, primary care, and behavioral health services.
• Support secondary data analyses of ongoing cohort studies and public use surveys, as well as other approaches such as simulation modeling, to determine whether minority health differences observed in population studies reflect health disparities arising from social, economic, and/or environmental disadvantages based on group characteristics historically linked to discrimination or exclusion.

Building Momentum:

• Establish a national consortium to develop, validate, and implement assessment tools that can be used in primary care settings for early detection and diagnosis of cognitive impairment and decline, as well as Alzheimer’s disease and related dementias, which are frequently underdiagnosed in aging minority populations, often due to cultural and logistic barriers.
• Expand research to improve access to and coordination of health care services across specialties through innovative care delivery models and the use of health information technology, including research on the use of electronic health records (EHRs) and e-prescribing databases to address potential risks of adverse drug reactions and drug–drug interactions in minority patient populations.
• Support rigorous research on patient–clinician communication factors in primary care and specialty settings that lead to an increase or decrease in health disparities in patient outcomes.
• Support rigorous evaluation of community-engaged interventions to address gaps and improve implementation of evidence-based interventions in community settings and to better understand factors that influence intervention effectiveness and adaptability.
• Support innovative research incorporating strengths-based approaches, behavioral economics principles, and multilevel intervention strategies to promote overall health in disadvantaged minority populations and reduce the incidence of preventable diseases and conditions in early childhood, such as dental decay and overweight/obesity.
• Expand local, regional, and national efforts to assess the impact of policies and policy changes on racial/ethnic minority population health and delineate specific mechanisms by which policies or policy changes mitigate or exacerbate social, economic, and environmental disadvantages.
• Strengthen the capacity of community members, health professionals, policy makers, and community organizations to assess and utilize research findings to effect positive, systemic changes to reduce health disparities.

Goal 2: Advance scientific understanding of the causes of health disparities

This goal seeks to examine the etiology of health disparities and the influence of health determinants on various stages of the life course trajectories and across generations, including the intersection of sex, gender, geography, and race and ethnicity. It also seeks to further the scientific understanding of both the individual effects on health disparities and the complex interactions among health determinants that impact health disparities. These health determinants include both studied and unstudied determinants as well as known and unknown determinants. Research is needed to identify and better understand the integrated relationship of these determinants, especially in real-world settings. These complexities often require interdisciplinary systems science approaches to understand interactions among multiple factors and over time. Results from such research should provide a robust foundation for designing effective interventions to reduce health disparities.

Strategy 2.1: Investigate health determinants through basic, behavioral, clinical, and applied research to better understand the contributions to health disparity outcomes.

Action Priority Areas

Starting Line:

• Identify risk factors that act as health determinants in creating and/or sustaining health disparity outcomes for NIH-designated populations experiencing health disparities.

Building Momentum:

• Support research that seeks mechanisms and pathways behind health determinants that confer worse outcomes in populations experiencing health disparities and identify feasible intervention targets for health disparity outcomes.
• Identify disparities in understudied populations experiencing health disparities—for example, sexual and gender minorities (SGMs) and Native Hawaiians and other Pacific Islanders.
• Support research in understudied health conditions and risk factors that impact health, such as comorbidities and/or violence, that disproportionately affect populations experiencing health disparities.

Strategy 2.2: Support research to examine multilevel pathways and dynamic interrelationships of health determinants that impact health disparity outcomes over the life course and across generations.

Action Priority Areas

Starting Line:

Explore associations between established determinants of health disparity outcomes occurring at multiple levels (e.g., environmental, health care, sociocultural, biological) to identify mechanisms and pathways for health disparity outcomes.

Building Momentum:

• Examine how health disparities develop or are sustained over the life course and across generations.
• Replicate mechanistic and pathway analyses of determinants for additional, related health outcomes, populations experiencing health disparities, life course approaches, and/or across generations.
• Support the collection of diverse ancestral backgrounds in NIH-funded and analyzed -omics data sets to achieve representation similar to the U.S. population.

Strategy 2.3: Identify modifiable or reversible determinants of health disparities during relevant critical periods that can serve as feasible targets for health disparity interventions.

Action Priority Areas

Starting Line:

• Link data on environmental, health care, sociocultural, behavioral, and/or biological health determinants in racial, ethnic, socioeconomically, sexual identity, geographically, and ancestrally diverse cohorts to existing systems for specific outcome ascertainment (e.g., hospitalizations, incidence of specific conditions, mortality, emphasizing life course, and age cohort perspectives).

Building Momentum:

• Support research that enables culturally relevant and appropriate interventions to disrupt fundamental determinants at critical periods that produce health disparity outcomes for priority populations.

Goal 3: Develop and test interventions to reduce health disparities

This goal advances the development and testing of population-specific interventions that reduce adverse health differences and poor health outcomes. This research should capitalize on existing evidence on health determinants to develop interventions that are culturally appropriate, as well as develop new evidence, drawing on research from many different scientific disciplines. Health disparities can include biological, behavioral, sociocultural, environmental, and health care system–level factors. The interventions should be intentional about which populations, time points in the life course, and risk or protective factors are targeted for reduction of health disparity outcomes. Implementation science methods should be employed to inform feasibility, generalizability, and validity assessments of efficacious interventions.

Strategy 3.1: Design and test interventions that target known health determinants within the context of specific populations and appropriate life course time points to influence specific health disparity outcomes.

Action Priority Areas

Starting Line:

• Adapt evidence-based interventions for implementation and evaluation within health disparity populations in culturally appropriate ways that consider the role of cultural processes in health disparity outcomes.
• Develop and test interventions that target multiple socioecological levels at appropriate life course time points to improve health disparity outcomes within community-based populations.

Building Momentum:

• Design and test strategies to improve access to and quality of care for populations experiencing health disparities within the health care system.
• Assess the implementation of interventions within clinical system processes and settings, as well as determine the effects on health disparity outcomes and populations.
• Develop and test interventions to improve symptom self-management and health-related quality-of-life outcomes in populations experiencing health disparities experiencing chronic and overlapping health conditions.

Strategy 3.2: Embed implementation science within intervention studies to inform efforts to scale, sustain, and translate efficacious interventions within and across populations and settings.

Action Priority Areas

Starting Line:

• Develop and test practical and sustainable adaptations within routine health care settings to improve health disparity outcomes and enable dissemination of effective practices.
• Incorporate elements of implementation and scalability into the design and testing of interventions to enhance related effectiveness in real-world settings, particularly low-resource clinical and community settings that serve populations experiencing health disparities.

Building Momentum:

• Develop guidance for NIH-supported researchers conducting intervention studies to include analyses of the pathways and mechanisms by which health disparity interventions produce observed effects.
• Use implementation science approaches to understand and promote the adoption of evidence-based interventions to reduce health disparities.
• Expand research in areas of implementation science with emphasis on clinical and public health systems processes for delivering preventive and treatment interventions in populations experiencing health disparities.
• Develop criteria to assess whether interventions have sufficient evidence for demonstrating success, and create and maintain a compendium of evidence-based interventions with demonstrated success in reducing health disparities in the United States.

Strategy 3.3: Promote prevention and evaluate the impact of upstream interventions on distal health disparity outcomes across the lifespan and across generations.

Action Priority Areas

Starting Line:

• Develop, implement, and evaluate participatory multilevel interventions to reduce exposures to environmental factors for which exposures create adverse health effects in disadvantaged populations, and assess the impact on early biomarkers of associated chronic diseases and conditions.
• Develop and evaluate school-based prevention and health promotion interventions related to health behaviors and mental health.

Building Momentum:

• Promote research on the benefits of preventive interventions, including assessments of the long-term impact on direct measures of health, health-related outcomes, and inter-generational transmission of health disparities.
• Review available evidence to identify key gaps in prevention science related to health disparities, and promote targeted research on preventive services with the aim to increase population health equity.
• Develop and evaluate workplace-based prevention and health promotion interventions related to health behaviors and mental health.

Goal 4: Create and improve scientific methods, metrics, measures, and tools that support health disparities research

The science of health disparities is a relatively new discipline, drawing on expertise from many different fields of study. This diversity of thought presents unique opportunities, allowing researchers to bring methodologies from all parts of academia to bear on reducing health disparities. Researchers have access to a variety of powerful methods, metrics, measures, and tools to identify when health disparities exist, what causes a disparity, and when a disparity is impacted. This diversity can present a challenge, however, in understanding health disparities data across the field. Development and adaptation of common indicators, measures, and methods is needed to enable comparisons among populations, to quantify the roles of various health determinants in influencing and impacting a health disparity, and to promote interdisciplinary collaboration. Population-based data systems should include representative samples of minority and populations experiencing health disparities to facilitate methods development and testing.

Strategy 4.1: Identify and test the adoption of common indicators to quantify the status of health disparities across different diseases/conditions and populations.

Action Priority Areas

Starting Line:

• Compile measurement tools (surveys and administered tests) in non-English languages applicable to the region.
• Develop common standards for capturing data on health disparities, including health determinants that encompass social determinants, with support from the National Library of Medicine.

Building Momentum:

• Develop tools to measure health indicators for health disparities research.
• Develop measurement tools in non-English languages that can measure differences in population responses applicable to the region.

Strategy 4.2: Define the continuum from health differences to health disparities, both qualitatively and quantitatively across multiple dimensions, as well as develop contextually informed clinical and statistical measures of disparities reductions.

Action Priority Areas

Starting Line:

• Set priorities and a research agenda around health disparities measures and metrics.
• Determine the metric that can be established to standardize a disparity reduction.

Building Momentum:

• Collect and disseminate longitudinal data about specific health disparity conditions to develop measures of clinical change over time that apply to different subpopulations.

Strategy 4.3: Apply complex systems modeling approaches to identify and predict relationships between health determinants and health disparity outcome measures.

Action Priority Areas

Starting Line:

• Promote interdisciplinary collaboration among health researchers and experts in computational approaches to further the development of modeling- and simulation-based systems science methodologies.

Building Momentum:

• Assess multilevel interventions in the context of these simulation modeling and systems science research projects.
• Develop innovative model systems to advance understanding of disabilities that can lead to disparities and inequities in access and utilization of health care, rehabilitation treatments, and knowledge of preventive measures.

Strategy 4.4: Support movement toward standardization, collection, reporting, and leveraging of measures of health determinants in both existing and emerging data sources, including administrative clinical data, to foster linkages between health, sex and gender, and relevant health determinants data for use in identifying health disparities and underlying causes through emerging techniques found in data science.

Action Priority Areas

Starting Line:

• Promote analysis and publication of research results that include relevant and appropriately sized samples from populations experiencing health disparities.

Building Momentum:

• Sponsor and support workshops that result in technical reports and publications related to specific measurement issues in health disparities research, such as statistical analysis of small samples, self-identified race and ethnicity, and ancestry informative markers.
• Review and compile major papers on measures and metrics in health disparities to create a repository of technical papers, tools, and publications.
• Identify a representative from NIMHD and the NIH-wide Minority Health and Health Disparities Measurement and Methods Committee to collaborate with NIH’s Office of Data Science Strategy (ODSS) to facilitate the inclusivity and external validity of calculations and labels that impact health disparity populations.

Strategy 4.5: Identify and strengthen rigorous quantitative and qualitative methods to enable analysis on small populations and subpopulations.

Action Priority Areas

Starting Line:

• Foster methodologies for conducting small population analyses.

Building Momentum:

• Map the state of the science for qualitative and quantitative studies with small populations and subpopulations.
• Develop research agendas for health disparity measurement in small populations and subpopulations.

Strategy 4.6: Evaluate minority health and health disparities proposals, programs,and policies to assess the effectiveness in improving minority health and/or reducing health disparities.

Action Priority Areas

Starting Line:

• Develop educational materials for program officers, program analysts, evaluators, and policy analysts on measures, metrics, and their use in outcome assessments of health disparity research.

Building Momentum:

• Assess the effects of social policies on minority health and health disparities.
• Assess the impact of previous NIH grants that were identified as focusing on minority health and/or health disparities.

Page updated Jan. 12, 2024