138 Following the trail of investments in public health research to trace racial health disparities

Abstract

Public health investments aim to improve health of all people. Hence it is important to assess whether public health investments accurately reflect the public health burden for both white and black Americans. We used potential years of life lost (PYLL) to examine if the investments made in public health funding, publications, and training align with the PYLL burden of white and black Americans. In a cross-sectional study, we compared the PYLLs across 39 causes of death by race using all-cause US mortality data from 2014 and 2015. We also examined the relationship of race with cause-of-death-specific PYLL and key indicators of public health investment: federal funding (National Institute of Health reports), number of publications (Pubmed), and training (course offerings at top five schools of public health) using linear spline models and graphical analysis. We found that homicide was the number one contributor to PYLL among black Americans, and the 12th contributor to PYLL among white Americans. Firearm-related violence accounted for 88% of black homicide PYLL and 71% of white homicide PYLL. Despite its high burden of PYLL, homicide was the focus of few grants or publications. No courses at top public health schools were dedicated solely to firearm-related violence/homicide research training. While Black Americans are disproportionately affected by homicide and the majority of homicide PYLL for both black and white Americans is attributed to firearm-related violence, we see a dramatic under representation of homicide and firearm-related violence research in public health funding, research, and training. In addition to lives lost, large PYLL captures the loss of human potential that can push families into poverty and societies toward heightened inequality. The medical and public health community must do more to address this public health crisis by calling for greater funding and improved training opportunities in homicide and firearm-related violence research.