TMHERR: Volume 2
January 2024-March 2024
“Development of a Health Equity Framework for the US Preventive Services Task Force” (Lin, Webber, Bean, and Evans 2024 in JAMA Network Open)
Importance: Clinical practice guidelines are crucial for reducing health inequities, and the US Preventive Services Task Force (USPSTF) aims to integrate health equity and racism considerations into its recommendations.
Objective: The goal is to create a framework for the USPSTF to systematically incorporate health equity throughout its recommendation-making process.
Evidence Review: Frame work development involved mapping existing health equity guidance to USPSTF methods, consulting USPSTF members and staff, and creating a draft health equity framework and checklist. This draft was reviewed by USPSTF’s key partners.
Findings: A comprehensive equity framework was established for all stages of the recommendation process, including:
Topic nomination and prioritization
Work plan development
Evidence review
Evidence deliberation
Recommendation statement development
Recommendation dissemination
The framework includes considerations such as prioritizing health equity, engaging diverse stakeholders early, developing equity-relevant questions, synthesizing evidence with an equity perspective, and addressing gaps in evidence.
Conclusions and Relevance: Implementing this framework will be demanding and resource-intensive but offers valuable guidance for the USPSTF and other guideline entities aiming for a more transparent and equity-focused approach in their recommendations.
Keywords: health equity framework, US Preventive Services Task Force
“Healthcare Workforce Equity for Health Equity: An Overview of its Importance for the Level of Primary Care” (Milicevic, Scotter, Bruno-Tome, Scheerens, and Ellington 2024 The International Journal of Health Planning and Management)
Healthcare workforce crises often arise from inequities affecting healthcare workers. This study reviews key primary healthcare (PHC) workforce policy questions related to health equity and highlights the evidence needed to implement policies that enhance equity in the health workforce and access to PHC services. The authors examined police questions regarding optimal workforce size, equitable distribution, and competencies for equitable healthcare access. Effective policies must include evidence on staffing, training, retention, recruitment, and governance, ensuring alignment with local needs and evidence-based practices. Measuring PHC workforce equity is crucial for improving access and health equity. Using indicators to assess health and workforce equity can enhance recruitment, retention, and responses to workforce crises.
Key words: healthcare workforce, policy, governance
“Instruments for Racial Health Equity: A Scoping Review of Structural Racism Measurement, 2019-2021” (Hing, Chantarat, Fashaw-Walters, Hunt and Hardeman 2024 Epidemiologic Reviews)
Advancing racial health equity requires measuring structural racism, yet the methods for doing so are still debated. Building on the work of Groos et al 2018, this scoping review examines literature from 2019-2021 to identify how epidemiologists and health researchers measured structural racism. Key themes include a focus on anti-Black racism, using residential segregation and other segregation-based proxies, and measuring structural racism as spatial exposures. There is a growing call to consider structural racism as a multidimensional, multi-level determinant of health. Innovations include policy databases and simulated counterfactual approaches to understand structural racism's impact on racial health inequities. However, gaps remain, such as limited measures of antiracism and insufficient research on later life effects. The findings suggest several future steps to enhance the science of structural racism measurement, which is crucial for developing effective antiracism policies.
Keywords: survey of structural racism measures, multidimensional, antiracism
“Synthesizing Best Practices to Promote Health Equity for Older Adults Through Community-Engaged Research” (Epps, Gore, Flatt, Williams, et al. 2024 Research in Gerontological Nursing)
Achieving health equity requires research that captures the diverse experiences of populations affected by age- and race-related disparities. Community-engaged research (CEnR) is a method that enhances the relevance and impact of health and aging studies by involving the community. This review highlights best practices for using CEnR to promote health equity among older adults, covering an overview of CEnR, its benefits, fundamental principles, and three research examples from the authors’ own CEnR projects.
Some Policy Recommendations:
Academic institutions should value CEnR in promotion and tenure decisions, acknowledging that it requires significant community involvement and equitable collaboration. Policies should allocate adequate time and financial resources to build and maintain trust with community partners.
Funding mechanisms should also support the inclusion of community research assistants on boards and at conferences, amplifying the voices of older adults and their families.
Additionally, researchers and organizations must commit to sustaining CEnR collaborations beyond project funding to avoid short-term engagement and ensure long-term impact. Effective CEnR demands transparency and a sustainability plan from the outset.
Institutional Review Boards should also consider incorporating training for community members to enhance their research skills and engagement. This training will empower communities and improve the research's relevance and effectiveness.
Keywords: community engaged research, policy, best practices
“Who is Responsible for Addressing Racial Disparities and Health Equity in Older Adults?” (Martinez 2024 Public Policy & Aging Report)
The U.S. is in a slow-motion public health crisis, preceded and exacerbated by the COVID-19 pandemic. Structural racism, an embedded feature of the nation’s structural systems, unfairly advantages European Americans while disadvantaging people of color, such as African Americans, Latin Americans, and Native Americans. This inequality manifests across various sectors including housing, education, employment, and healthcare, and profoundly impacting health outcomes and contributing significantly to racial health disparities.
These disparities are not confined to younger populations but extend into older adults, who often face compounded effects of both ageism and racism. Ageism, like racism, is a systemic form of oppression that affects individuals across the lifespan and is reinforced by cultural and institutional norms. It contributes to poorer health outcomes, increased social isolation, and lower quality of life among older adults.
Addressing these crises requires a multifaceted approach involving political will, financial resources, and interdisciplinary collaboration. Educational initiatives are crucial to understanding and mitigating racism and ageism. Policies must be developed to rectify past injustices and ensure equitable outcomes moving forward. Institutions must promote inclusion and diversity to foster systemic change and improve health equity for all ages. This comprehensive strategy aims to eliminate racial health inequities and enhance the well-being of older adults, ensuring that the impact of these disparities is effectively addressed.
keywords: ageism, multifaceted approach, multi-sectorial disadvantage
“An Intersectionality Framework for Identifying Relevant Covariates in Health Equity Research” (Simkus, Holtz, and Twombly 2024 Frontiers in Public Health)
Health equity research uses impact evaluations to assess the effect of new interventions on the reduction of health inequities. Research that fails to account for various experiential factors and their interactions, inadvertently perpetuate or worsen health disparities. Therefore, it's crucial to include variables related to the sample's circumstances, conditions, and experiences in evaluations. This review advocates for using intersectionality as a framework to identify important but often overlooked covariates related to the following domains: biological, social, environmental, and economic—that can obscure research findings. The authors provide examples using lupus research, as well as their own evaluations with minority patients, demonstrating how intersectionality can highlight relevant covariates. Using an intersectionality framework can help refine covariate selection, supporting precision prevention and revealing effective solutions for persistent health inequities.
keywords: intersectionality, lupus research, biological domain, social domain, environmental domain, and economic domain