APA President Norine G. Johnson has established a Task Force on Emerging Opportunities in Psychological Science as one of her presidential initiatives. The task force, co-chaired by professors Cheryl Travis of the University of Tennessee and Marlyne Kilbey of Wayne State University, is planning an exciting program for the APA's 2001 Annual Convention in San Francisco in August. In the spirit of President Johnson's charge to the task force, I would like to bring to your attention an emerging area in psychological science that demands the efforts of our most talented scholars if progress is to be made during the Decade of Behavior. This emerging research area is health disparities.
A health disparity involves a greater burden of disease in a specific subpopulation, including the poor and marginalized, than in the majority group. Examples include racial differences in mortality rates associated with certain cancers and morbidity associated with Type-II diabetes, hypertension or depression to name a few. The reasons for these differences in morbidity and mortality across racial and ethnic groups are multifaceted and understanding their causes offers a challenge and an opportunity not just to medical researchers but to behavioral researchers as well. All too often, psychologists think their work is not relevant to health disparities research. End of story. Well, I suggest that psychological science, including research on stigma, racism, culture, discrimination, psychosocial aspects of stress and coping, and many related topics will be at the heart of any national effort to reduce the unequal burden of disease in our society.
Raynard Kington, the energetic new director of the Office of Behavioral and Social Science Research (OBSSR) at the National Institutes of Health (NIH) met with Science Directorate and Science Policy Office staff at the end of the year 2000. During the meeting, he presented a number of interesting thoughts on the challenges facing OBSSR over the next several years, including ways in which to implement the NIH-wide commitment to research on health disparities. He emphasized that health disparities research must be viewed by behavioral and social scientists as a fundamental scientific challenge of the highest order. I'd like to amplify Dr. Kington's formulation and offer some additional thoughts on the role that psychological science must play in this emerging research area.
First, the importance of health disparities research to the national agenda is striking. Each NIH institute has been charged with preparing a strategic plan on health disparities research (reports are available on the institute web sites). In addition, as reported in the January Monitor, President Clinton signed into law on November 22, 2000 the "Minority Health and Health Disparities Research and Education Act of 2000" which, among other things, elevated the NIH Office for Research on Minority Health to the National Center for Research on Minority Health and Health Disparities. This new Center will have an expanded budget and will develop a portfolio of funding in research, training and dissemination of findings.
The various NIH institutes strategic plans outline in compelling fashion the many challenges that need to be addressed by greater investment in health disparities research: these include training a greater number of ethnic minority researchers committed to working in the area of health disparities; working more closely with underrepresented communities to involve participants more fully in research projects and clinical trials; paying greater attention to public outreach and dissemination of research findings relevant to the health concerns of underrepresented populations; and improving access to and use of the health-care system by underrepresented groups.
Your help needed
Many talented researchers are needed to meet these challenges and to effect a reduction in the greater burden of disease among ethnic-minority groups. How can psychological scientists contribute to this national effort? To the extent that health disparities are mediated by differential access to and utilization of health-care resources, by differences in healthy lifestyles, and by differential treatment within the health-care system, then psychologists must play a lead role. Psychological research--both basic and applied--may offer important insights into the ways in which cultural factors impact on health-related behaviors, or how individual and societal expectations and the stigma associated with disease may interact with race and ethnicity. The questions of individual, social and societal behaviors are not new, but addressing them within the health disparities framework offers a new opportunity for psychological scientists. I urge you to consider ways in which you can contribute to a greater understanding of the origins of health disparities through your own research and mentoring efforts or through your work in a clinical setting.