Wallerstein et al. Respond

Abstract

We would like to thank Edelstein for highlighting the importance of public health nurses in health disparities research and practice, and for the author's interest in having students combine knowledge of social determinants with community-partnered and engaged interventions. We appreciate the growing role of interprofessional collaborations within Academic Health Centers for reducing health disparities1 and are gratified to note Edelstein's attention to teaching future health professionals. Our article originated as an update to Wallerstein's 1992 article on empowerment and powerlessness, because of that article's continued inclusion in course syllabi.2 Thus, it was a natural evolution to focus the growing lens of transdisciplinary science on powerlessness and empowerment and other current disparities-related constructs (i.e., resources vs demands, context, role of community participation, and power and policy).3 The Association for Academic Health Centers recently cohosted with the universities of California Davis and New Mexico an invitational social determinants conference (http://hsc.unm.edu/vision2020/socialdeterminants) for leaders in medicine, nursing, public health, pharmacy, and teaching hospitals to promote a comprehensive reorientation of Academic Health Centers toward health disparities.4 For health professionals to more effectively conduct their research and practice, and thereby improve health equity, we need to reorient our institutional policies and research resources toward community priorities, as well as address the national policy context. Institutional reorientation could include adopting new bidirectional models such as the Health Extension Rural Offices at the University of New Mexico5; funding pilot social determinants research directly such as studying food pantries within schools in food-desert areas; and changing university policies to support partnership development through community coprincipal investigators and allowing funds for travel and food at community research gatherings. Increasingly, interdisciplinary community-based participatory research has been documenting successes in intervention and policy research to challenge unhealthy social determinants, and should continue to receive high-level funding from the National Institute of Health.6,7,8 Ultimately, transdisciplinary research should be applied at the regional and national level by bringing together integrated studies of how macroeconomic factors are both determinants of ill health as well as targets of change; these are therefore critical to address for protecting our broad public health, prevention, and health care access agenda. Only if the local can be joined with the national level can we turn around the current trend of growing inequities and improve the nation's health.