Translating Research Evidence Into Practice to Reduce Health Disparities: A Social Determinants Approach

摘要

Translating research evidence to reduce health disparities has emerged as a global priority. The 2008 World Health Organization Commission on Social Determinants of Health recently urged that gaps in health attributable to political, social, and economic factors should be closed in a generation. Achieving this goal requires a social determinants approach to create public health systems that translate efficacy documented by research into effectiveness in the community. We review the scope, definitions, and framing of health disparities and explore local, national, and global programs that address specific health disparities. Such efforts translate research evidence into real-world settings and harness collaborative social action for broad-scale, sustainable change. Ideally, all individuals should have an equal opportunity to reach their full potential for health, but reality falls far short of this goal. Because so many individuals lack opportunities for physical and mental well-being, the elimination of health disparities has emerged as a major worldwide public health objective. A 2008 publication of the World Health Organization (WHO) Commission on Social Determinants of Health (CSDH) identifies persistent and widening health inequities as avoidable and calls for closing the health gap in a generation. 1 Several of the 8 United Nations Millennium Development Goals either directly or indirectly address the elimination of health disparities via eradicating extreme poverty and hunger, achieving universal primary education, promoting gender equality, and empowering women. 2 Similarly, in the United States, 2 overarching goals from Healthy People 2010 are to maximize quantity and quality of life and eliminate health disparities. 3 To improve health and prevent disease, the global scientific community has conducted considerable research, generated relevant evidence, and translated research findings into evidence-based guides. In the United States, these include The Guide to Community Preventive Services , 4 the Guide to Clinical Preventive Services , 5 and the Institute of Medicine's Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care . 6 Global examples include the International Agency for Research on Cancer's World Cancer Report 7 and the WHO's Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases . 8 However, the extensive evidence amassed and the many recommendations for disease prevention and treatment have been largely concentrated in public health and academic medicine and could be more strongly linked to other critically related disciplines as well as to practice and advocacy settings. Without such linkage, the compelling evidence and recommendations will fail to stimulate change and the stark health inequalities throughout the United States and the world will continue or grow worse. Eliminating health disparities will require heightened emphasis on translating and disseminating proven interventions in ways that will reach all people, irrespective of social class or racial and ethnic background. It will also require transcending the confines of academia to reach and influence broader real-world settings. Here we review the scope of health disparities, including their current definitions and framing, and explore strategies for eliminating them through an intersectoral, social determinants approach. We highlight several recent US and global initiatives that translated research evidence into real-world settings through collaborative social action, aiming to initiate broad-scale, sustainable elimination of health disparities.