In 2006, the DRA Project reviewed the literature on disparities, considered what might be the most important disparity reducing advances, and developed forecasts for key areas related to disparity reducing advances. Then the DRA Project Partners chose several efforts to pursue. Four of these efforts seek to accelerate advances in public health, with four others in health care. These are described below. In addition the DRA Project is promoting tobacco control, following emerging cancer biomonitoring developments, and working to have advances in the biomonitoring field be disparity reducing.
Public Health Efforts
Refocusing on the Social Determinants of Health: The work of the DRA Project has shown the importance of focusing “upstream� on the determinants of health and disparities. You can see our DRA Project Report on the “most important� advances here on the DRA website. The DRA Project has partnered with the Prevention Institute to produce two reports about refocusing on the social determinants of health: The Imperative of Reducing Health Disparities through Prevention: Challenges, Implications, and Opportunities and Laying the Groundwork for a Movement to Reduce Health Disparities. Using the Prevention Institute reports as a focus, the DRA Project stimulated a national design meeting to press forward the movement forward. DRA Partners are also creating awareness of the social determinants of health. For example, the DRA Project is supporting a public impact campaign using the PBS miniseries on health disparities that is currently on the air. You can find out more about the miniseries and the public impact campaign at Unnatural Causes: Is Inequality Making Us Sick?
Lessons from National Healthy Eating and Active Living Programs: Healthy eating and active living (HEAL) are the keys to preventing obesity as well as health disparities in diabetes, heart disease and cancer. The DRA Project worked with The California Endowment’s Healthy Eating Active Communities Program, REACH U.S., Kaiser Permanente’s Community Health Initiatives, The Joint Center’s Health Policy Institute’s program - Place Matters: Addressing the Root Causes of Health Disparities, YMCA Activate America, and the Robert Wood Johnson Foundation’s Active Living by Design to identify and disseminate lessons learned from these programs, particularly in relation to reducing health disparities. The Report, Using Healthy Eating and Active Living Initiatives to Reduce Health Disparities, identifies five key strategic insights for making these initiatives work with low income communities and communities of color.
Obesity Prevention in Schools: Schools are an important setting to encourage good health and to prevent obesity. There are a number of school based efforts working in this area. One is The City Year Detroit Project using teams of AmeriCorps volunteers to work with Detroit’s public schools to enhance their systems for nutrition, physical activity, the health clinic, the physical environment, health of the teachers and staff and involvement of parents. The DRA Project is working to promote awareness of this type of school based wellness or obesity prevention opportunity. In 2008, the DRA Project will also release an illustrative survey of over forty school focused programs in this field.
REACH U.S. Lessons: The Racial and Ethnic Approaches to Community Health (REACH) is CDC’s cornerstone initiative aimed at eliminating disparities in health status experienced by ethnic minority populations. REACH programs have shown that health disparities can be reduced by engaging local leaders, building community partnerships, recognizing cultural influences, creating sustainable programs, leveraging resources, and empowering individuals and communities. The DRA Project is working with CDC to develop and promote the lessons from REACH U.S.
Health Care Focused Efforts
Expanded Care Model: One of the most important ways to reduce health disparities is to have low income and marginalized populations receive quality health care including preventative services. In US health care, among the most significant quality improving activities have been the Health Disparities Collaboratives in health centers sponsored by the Health Resources and Services Administration (HRSA). HRSA is evolving the approach of these efforts and the chronic care model they used from a single disease focus (e.g. diabetes, heart disease or cancer) to a focus on the whole person and the whole systems of the centers in the “expanded care model.� The DRA Project is working with HRSA to elaborate and promote the expanded care model, including the integration of social determinants, community conditions and complementary and alternative care.
Integrative Primary Care: Many low income and minority communities use complementary or alternative approaches (CAM). Many community health centers do provide some CAM services. It is likely that the inclusion of evidence based methods of complementary and alternative care could reduce health disparities by making care more accessible, culturally appropriate and affordable. The DRA Project is working with the Samueli Institute, HRSA and other DRA Partners to look for ways to integrate complementary and alternative methods of care into primary care for low income and minority populations. A major focus will be the role that evidence based CAM options can play in the Expanded Care Model. A Scoping meeting was held in partnership with the Samueli Institute on April 28, 2008.
Patient Navigation: One source of health disparities is the inability of patients to navigate and appropriately access health care treatment, particularly for diseases with complex treatment regimens, such as cancer. In recent years there have been many significant experiments with “navigators� for patients. The DRA Project is working with the many DRA Partners and others currently running patient navigation projects to focus on ways to understand current navigator activity and outcomes, make navigation more sustainable, and consider how emerging information technology, particularly “virtual navigation� can assist patients and navigators to be more effective. The DRA Project has published a Patient Navigation Program Overview.
Biomonitoring: New technology for monitoring patients in their homes and in their daily routines offers promise in conducting research, preventing disease, screening for risk factors and monitoring treatment or progression of disease. Such monitoring, combined with coaching, has been shown to be effective in some low income populations in managing and improving outcomes of chronic disease, including diabetes, heart disease and asthma. The DRA Project will work with community health centers and other providers interested in developing these applications to spread knowledge and increase the usability and effectiveness of these biomonitoring approaches for low income communities and their health care providers. With funding from the Robert Wood Johnson Foundation forecasts were developed for biomonitoring potentials as well as recommendations for making these advances disparity reducing, often by shortening their diffusion time into low income populations and their health care providers (see the BFP Final Report). The DRA Project is working with the Commission to End Health Care Disparities to summarize and promote this technology strategy.
In addition to the eight working efforts listed above, the DRA Project will continue to monitor and promote other disparity reducing advances including tobacco control, and advances in modeling and mapping; and holding Disparities Foresight Briefings on Capitol Hill to inform the policy community of key developments. See the results of our Briefing on Reducing Health Disparities Faster.