Pioneers in Health Equity: Lessons from the REACH Communities David Satcher, MD, PhD Despite substantial improvements in life expectancy over the last century, U.S. racial and ethnic disparities in health continue to persist, are well documented, and increasing.1 Communities of color fare far worse than their White counterparts across a range of health indicators including life expectancy, infant mortality, rates of heart disease, diabetes, cancer, and stroke, self-rated health status, insurance coverage and a number of other health indicators.1 Between 2003 and 2006, racial and ethnic disparities in health cost the United States an estimated $1.24 trillion.2 As the nation’s population becomes increasingly diverse—people of color will comprise 54% of the U.S. population by 20501—the likelihood that the nation’s previous improvements in health will continue will be greatly diminished. Over the last 10, years the Centers for Disease Control and Prevention has supported over 40 communities to address racial and ethnic disparities in health through the Racial and Ethnic Approaches to Community Health (REACH) program. REACH uses community engagement and empowerment to develop and tailor interventions to meet the unique needs of communities of color. REACH communities decide the area of health disparities to address (asthma, breast and cervical cancers, diabetes, heart disease and stroke, hepatitis B, , immunizations, infant mortality, and tuberculosis) and the racial and ethnic group (African American, American Indian/Alaska native, Asian, Native Hawaiian/other Pacific Islander, Hispanic) to target. The 12 articles in this special issue of Progress in Community Health Partnerships: Research, Education and Action document how REACH communities have highlighted, implemented, and advocated for evidence and practice-based strategies across the social determinants of health to eliminate racial and ethnic health disparities. These strategies have included creating and sustaining community coalitions, obtaining baseline data to document racial and ethnic health disparities, and implementing and evaluating interventions that address the root causes of disparity. Building strong coalitions includes developing and sustaining a number of partnerships; partnerships between community-based organizations and academic institutions are a key component to building a strong coalition. VanDevanter et al.,3 Kleinman et al.,4 and Trinh-Shevrin et al.5 used mixed-methods approaches including surveys, key informant interviews, and direct observation to evaluate community–academic partnerships. The authors concluded that although the partnerships seemed to be stable over time, there were consistent differences in community and academic perspectives; academic partners were more satisfied with the partnerships than their community counterparts. All three articles stressed the importance of ongoing evaluation of community coalitions in order to enhance and strengthen the relationship between partners. In addition to evaluating coalitions, it is also important to evaluate interventions. Holden et al.6 described how the Brownsville Action Community for Health Equity used data from structured interviews to evaluate their community interventions to reduce high rates of infant mortality among African Americans and Puerto Ricans in Brooklyn New York’s Brownsville community. Factors associated with intervention success included highly capable partners, a strong coalition, internal champions, and an understanding and appreciation of policy and community involvement. For many communities, baseline data highlighting health disparities are lacking. Brega et al.7 described their process of obtaining baseline data related to cardiovascular disease among American Indian/Alaska Natives. [End Page 215] The lack of regular physical activity is an important social determinant of health and cause of health disparities, particularly among young children. Whitt-Glover et al.8 described the impact of the evidence-based school intervention, short recess, which provides children with 10-minute bouts of moderately intense physical activity during the school day. The authors reported that both the school administration and students were enthusiastic about the program but recommended more research related to the long-term impact of the intervention. One highly effective strategy in addressing disparities in the treatment of cervical cancer is enhanced case management. Clarke et al.9 with the Boston REACH community developed a case management intervention for African American women in primary care settings. Case managers provided patient navigation to prompt screenings and follow-up along with referrals to address patient-identified social concerns (e.g., housing, transportation). The authors reported that lack of child...
Search from 250 M+ research papersSearch from 250 M+ research papers
Open Access
Jun 24, 2024
Revathi Ulaganeethi + 5
