The Transformative Research to Address Health Disparities and Advance Health Equity initiative is soliciting applications to support collaborative investigative teams or individual scientists who propose unusually innovative research projects, which, if successful, would have a major impact in developing, implementing, or disseminating innovative and effective interventions to prevent, reduce, or eliminate health disparities and advance health equity. No preliminary data are required. Projects must clearly demonstrate, based on the strength of the logic, a compelling potential to produce a major impact in addressing health disparities and inequities.
Racial and ethnic minorities and other groups that experience health disparities continue to bear disproportionate burdens of disease and illness, despite scientific and technological discoveries that have improved the health of the U.S. population overall. Social determinants of health—the conditions in which people are born, grow, live, work, and age—shape individual, community, and population health and wellbeing across the life course. Populations that experience health disparities generally have higher levels of cumulative exposure to adverse social and structural factors such as poverty, lower-quality education, less access to healthy food, chronic and acute psychosocial stress, less access to health care resources, and lifelong exposure to discrimination and structural racism, in addition to physical, biological and environmental hazards. Conversely, access to the health promoting aspects of the environment, such as opportunities for health-enhancing physical activity and buffers against hazardous exposures, is often disproportionately lower in these populations. Inequitable distribution of health-promoting social determinants across various populations is understood as a significant contributor to persistent and pervasive health disparities and inequities. A focus on health equity calls for reducing or eliminating factors that put populations experiencing health disparities at a disadvantage, and for increasing factors that increase the likelihood for achieving positive health outcomes.
Tackling the complex drivers of health disparities requires strong partnerships between researchers, community representatives, community organizations, health service providers, public health agencies, policymakers, and other stakeholders to ensure that relevant and culturally/contextually appropriate research is conducted and, just as importantly, that findings can be translated into sustainable community- and system-level changes that promote health equity. In addition to engaging vulnerable populations and/or populations at increased risk through culturally acceptable approaches, interventions and implementation strategies to reduce health disparities must address the life circumstances and social and structural environments that may pose challenges to reducing health risks. Interventions are not likely to produce sustained reductions in population health risk if they are solely focused on individual-level knowledge, attitudes, behaviors, or risk factors. Multilevel intervention components that address two or more levels of influence on health and behavioral outcomes and that involve peers, social networks, partners, family members, school systems, community members, community- or faith-based organizations, healthcare systems, community clinics, and service providers, are strongly encouraged.
For the purposes of this FOA, intervention projects and implementation or dissemination strategies must include a focus on one or more NIH-designated populations that experience health disparities in the US, which include Blacks or African Americans, Hispanics or Latinos, American Indians and Alaska Natives, Asian-Americans, Native Hawaiians and Other Pacific Islanders, socioeconomically disadvantaged populations, underserved rural populations, and sexual and gender minorities (SGM). NIH is especially interested in disparities or inequities demonstrating a compelling public health need (for example, COVID-19-related reductions in life expectancy for Black and Latino populations are 3-4 times larger than for Whites, see Andrasfay and Goldman, 2021; Arias et al., 2021). Projects assessing whether intervention effects differ across populations should incorporate health determinants such as social, institutional, or environmental factors so as to avoid pejorative contrasts and interpretations. Given heterogeneity within health disparity populations, within-group comparisons of intervention effects are encouraged that allow for discovery of health risk and resilience factors overlooked in comparative research. Projects may include populations outside the U.S. if the purpose is to understand intervention mechanisms and/or impact to address health disparities in the U.S.
Projects must document or demonstrate throughout the research process meaningful collaboration and partnership with local community-engaged leaders that represent the communities/populations of focus and that will be essential for development of feasible and acceptable approaches as well as acceptance, uptake, and sustainability of interventions and strategies proposed. Applicants should provide details on the nature and extent of their partnerships, including clearly describing the roles of partners and providing evidence of support from partner organizations.
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