>> Larissa Aviles-Santa: Hello. I am Dr. Larissa Aviles-Santa, Director of Clinical
and Health Services Research at the National Institute
on Minority Health and Health Disparities at the
National Institutes of Health, and welcome to the lecture
on "Health Disparities Research: Better Health
Outcomes for All". In this lecture, I will briefly
describe the concept of health
disparities, illustrate the multi-dimensional
levels of factors that influence health
along the life course, and discuss some examples
of publications on health or health care disparities and the multi-dimensional
factors that could have influenced
or contributed to the findings. What are health
and healthcare disparities? They are differences
in health and healthcare that are linked
with social, economic, and or environmental
disadvantage. They are beyond biological
or genetic differences. They are also created
with challenges or obstacles
to attaining healthcare. They are also associated with
suboptimal quality of healthcare or inadequate access
to optimal healthcare resources. And most, if not all, populations
who confront health disparities have experienced discrimination
or exclusion. Why is it important to study
health disparities? The answer is purpose driven. To ensure that we are
identifying and defining them well, reducing and eliminating them
wherever we find them, implementing and delivering
the best healthcare practices for our patients and the populations
that we serve and represent.
In this diagram
that was published by Dr. Hector Myers in 2009, he depicted the lifespan
biopsychosocial model of cumulative vulnerability that explains
the development of disease in minority groups in the U.S.,
and, very likely, everywhere. He depicted or included elements that pertain to social
demographic factors, genetic or biological factors,
cognitive, psychosocial, cultural,
health behaviors, et cetera. The National Institute
on Minority Health and Health Disparities
expanded on that model and has created
this research framework that includes both domains
and levels of influence that cover individual,
interpersonal, community, and society levels of influence.
It is important to note
that both the previous one that Hector Myers developed, and this one from NIMHD,
both have a component or a very important aspect
which is time, life course. These elements, these factors,
are going to influence health along the life course
of the individual. Inspired by those two models,
I have created this diagram and this multi-dimensional
diagram with factors and levels in clusters
or constellations and how they could relate
or interact with each other.
These interactions, of course,
can change over time. These clusters could also
represent opportunities for interventions
to reduce health disparities. I will refer to this diagram
throughout this lecture. Now, let's take a look at some
examples from publications that examine health
or healthcare disparities. Now, in examining
those publications, the aim is to discuss
the examples and what factors
the publications or the authors addressed, and what factors could also
have played in a role in the outcomes
that they described. In no way the discussion
is about whether the conclusions
were incorrect or correct, or talking about the
methodologies that they used..
