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Foreword

January 10, 1992, the National Institutes of Health (NIH) published within its Guide for Grants and Contracts, special instructions to applicants regarding implementation of new policies concerning the inclusion of women and minorities in clinical research study populations. Many of the senior authors of chapters in this seminal volume and I were among those who advocated strongly for this, then, new policy. It spoke to the under‐representation of racial and ethnic minorities in the science of the times, and strongly argued for closer attention to their inclusion in NIH‐sponsored research as a means of improving said science. The introductory chapter to this volume chronicles the circumstances that led to this policy change, as well as the ensuing response on the part of the NIH and Department of Health and Human Services to its implementation.

Unfortunately, despite such a remarkable advance, the vigilance necessary to realize the promise embodied in this change waned. Indeed, as a long‐standing member of several established NIH study sections charged with determining the scientific merit of thousands of grant applications submitted for prospective funding, I witnessed firsthand the gradual attenuation of this policy of inclusion. Study sections struggled with its operationalization; we lacked carefully crafted examples of how adherence to this policy could be accomplished in a pragmatic fashion and thus improve our science. As a consequence, reviewers gradually drifted from a rigorous application of the policy to a pro forma determination of the adequacy of including under‐represented racial ethnic minorities, roughly equivalent to whether or not sampling plans assured their representation equal to that characteristic of the settings in which this work was to be conducted. One seldom read arguments, for example, for oversampling special populations in a manner that would truly test the hypotheses underpinning the proposed research, and thereby address race, ethnicity, or disadvantage as possibly important sources of variation in the phenomena under study.

Again, numerous contributors to this volume who also served on NIH study sections shared this concern and lamented the absence of careful attention to the implications for the science. Understanding the original arguments for why, scientifically, such individuals should be included in the work sponsored by NIH gradually faded; inattention diluted the promise of this remarkable policy. Arguments for the inclusion of under‐represented racial and ethnic minorities and the disadvantaged in NIH‐sponsored research eventually shifted from the benefit to science to the underlying importance of health equity and social justice. While the latter are important motives for undertaking such work, they are, in my opinion, necessary, but not sufficient conditions for promoting knowledge acquisition and ensuring the scientific merit of such efforts.

One and one‐half decades later, the now National Academy of Medicine reviewed the NIH's strategic research plan to reduce and ultimately eliminate health disparities. This assessment essentially focused on the impact of the National Center on Minority Health and Health Disparities as of 2006, just prior to elevation to its current Institute status. In the Academy's report, the committee, of which several authors in this volume and I were members, concluded that the unfinished business of the Center and NIH was to revitalize a focus on the relevant science and to offer a coherent thematic framework for its pursuit. An emphasis on the social determinants of health emerged and gained increasing currency in anticipating and focusing this work. As the present volume amply demonstrates, this particular framework has played a critical role in organizing attention to the key domains and related constructs that bear importantly on the science underpinning minority health and health disparities research today.

This volume, and its companion piece in the special issue of the American Journal of Public Health, provide a roadmap to guide the science in this area. The chapters contained herein illustrate the importance and feasibility of systematic, rigorous inquiry for understanding the specifics of minority health and health disparities. They also convey the importance of the lessons learned for science in general: for discovery, for generalizability, for advancing theory, for enhancing measurement, for improving investigative methods, for promoting attention to neglected areas of research, and for diversifying the scientific work workforce. The Science of Health Disparities Research returns us to the spirit of 1992, and conviction, albeit now empirically demonstrable, that work of this nature can be exacting, meritorious, innovative, and broadly relevant. I applaud my colleagues' efforts in this regard and am confident those who follow can more effectively integrate health equity, social justice, and good science in service of improving the health of racial and ethnic minorities, as well as the disadvantaged, and humankind in general.

Spero M. Manson, PhD Distinguished Professor of Public Health and Psychiatry Colorado Trust Chair in American Indian Health Colorado School of Public Health University of Colorado Anschutz Medical Campus