Closing gaps in health outcomes

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Dr. Marcell Nunez-Smith (left) and her partners from the Eastern Caribbean at the 2015 GHLI Forum for Change.

The Equity Research and Innovation Center (ERIC) was launched at the Yale School of Medicine in 2014 with a mission to reduce health inequities in the United States and abroad. Led by Dr. Marcella Nunez-Smith, associate professor of medicine and epidemiology, ERIC is a research and resource hub that coordinates a multipronged scientific portfolio and supports several equity-focused research investigators and trainees.

ERIC’s leading global research initiative is the Eastern Caribbean Health Outcomes Research Network (ECHORN), a chronic disease research network that leads research, programmatic, and other activities within the Eastern Caribbean. ECHORN’s flagship research project is a population-based cohort study across the four inaugural sites: Puerto Rico, U.S. Virgin Islands, Barbados, and Trinidad. The cohort has enrolled over 2,500 participants to date.

YaleNews recently spoke to Nunez-Smith about ERIC, ECHORN, and the meaning and future of global health equity research.

How do you define health equity research?

A health inequity is an avoidable difference in health that is explained by social conditioning or social circumstance. Where groups of people are isolated and marginalized, we see poorer health as a result. That’s a health inequity.

A more positive framing is to think about striving toward health equity, which is the process of identifying strategies that mitigate and overcome those social circumstances, eventually resulting in similar health and healthcare outcomes for people regardless of their social standing.

How does ERIC address the most pressing health inequities in the Caribbean?

One of our grounding principles is stakeholder engagement. ERIC values the considerable time investment it takes to build and sustain authentic partnerships for each research project and activity. At ERIC we are committed to this approach in all of our projects, regardless of where our research activities take place.

We lead research projects that contribute to our understanding of health equity and outcomes and that build upon the science in a way that can inform health policy and practice. The “I” in “ERIC” stands for innovation. Part of the innovation is making sure we include stakeholders at the table, from community members to local and global leaders, who help us at each stage of the project to design the research, analyze the findings, and translate those findings into real-world policy change and solutions.

While this approach is not a “method,” we also consider methodology to be an important area of innovation when addressing health inequities. Once we identify a critical gap in our knowledge about health inequities, we think about novel ways we can address it. In addition to answering the research question, we ask ourselves: what we can do methodologically that would provide a unique contribution to the practice of conducting health science research? We really value the richer picture one can get from combining both quantitative and qualitative research methods within a mixed methods framework. ERIC is a resource to the broader Yale community in thinking through the application of those methods in health sciences research. 

How do you envision the research findings being translated in the real world?

Some of our active areas of research in the Caribbean address the steep increase in rates of chronic disease, which is currently a global phenomenon. We’re seeing rates of obesity and hypertension on the rise in countries where resources are limited and there’s limited infrastructure to address this chronic disease epidemic.

Our research in the Caribbean addresses the steep increase in chronic disease, a global phenomenon.

In the work we do, we aim to provide data that are useful to ministers of health, hospitals, and outpatient facilities as they think about resource distribution. We work with individuals and communities who have many assets but face substantial fiscal challenges. Much of our data collection is geared toward uncovering new factors that help provide protection against chronic disease, such as social support from family members and friends when it comes to managing or mitigating health issues, and not just collecting data on known risk factors for chronic disease. These social supports and other protective factors provide resources that individuals can access right away, and we help policy makers and healthcare workers recognize these factors and promote activities that support their utilization. Our research is demonstrating that partnering with stakeholders in this way provides an innovative and effective approach to address chronic disease, which can provide a roadmap to address health equity in other priority areas.

What are some of the long-term benefits ECHORN will have on health equity in the region?

In the Eastern Caribbean, we have both short- and long-term objectives for the resources that ECHORN supports. The short-term goal is to help support and enhance local infrastructures. In Trinidad and Tobago, for example, the ministries of health ask questions such as: “We have hurricanes, and we have patients on dialysis. How many dialysis machine generators do we need?” They need population-level data to figure this out. That’s just one example of short-term healthcare system strengthening that ECHORN supports.

In the long term, we want to facilitate regional collaboration to address the growing burden of chronic disease. We’re looking at small island nations or small island territories, which are very different in terms of both population and resources. Not every island site can afford to have a cancer center; every hospital does not have a cath lab or diagnostic imaging equipment. So how do we begin to think about regional approaches? And that’s the long-term vision: regional collaboration, regional approaches, regional policy, and regional solutions.

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