Prevention Science and Health Equity: A Comprehensive Framework for Preventing Health Inequities and Disparities Associated with Race, Ethnicity, and Social Class

Abstract

The ultimate goal of our public health system is to reduce the incidence of disability and premature death. Evidence suggests that, by this standard, the USA falls behind most other developed countries largely as a function of disparities in health outcomes among significant portions of the US population. We present a framework for addressing these disparities that attributes them, not simply to differences in the behavioral and physical risk factors, but to social, environmental, and structural inequities such as poverty, discrimination, toxic physical setting, and the marketing of harmful products. These inequities result from de facto and instituted public policies. An analysis of the NIH research portfolio indicates a relative lack of investment in experimental evaluations of preventive interventions—especially studies targeting disadvantaged populations. Moreover, experimental research on reducing social inequities is almost entirely lacking. A line of research focusing on the drivers of inequities and their dissolution must include experimental evaluation of strategies for getting policies adopted that will reduce inequities. In conclusion, a summary is provided of the types of research that are needed and the challenges involved in conducting the experimental research that is essential for reducing inequities and disparities and, in turn, prolonging life.

Where’s the BIPOC Blueprint for Healthy Youth Development? The Role of Scientific Omissions in Our Struggle for Science Translation and Racial Equity in the United States

“…Calls for health equity insist that obstacles be removed and resources be provided so that all people have a fair and just opportunity for health (Braveman et al, 2018 ; Boyd et al, 2023 ). Like others (e.g., Alvidrez et al, 2019 ; Barrera et al, 2017 ; Biglan et al, 2023 ; Ford & Airhihenbuwa, 2010 ; Marsiglia & Booth, 2015 ; Jagers et al, 2019 ; Stanley et al, 2020 ), we argue that these obstacles are socially constructed, with some constructed through our very efforts to advance prevention science. We, in the most grand and ubiquitous sense of the term, make omissions at every phase of the prevention research cycle.…”

“…Twenty years later, the racial reckoning of 2020 in the United States has broadened awareness within our communities of scholarship, practice, and policy-making that racism need not be conscious or active in order for our ideals for the healthy development of all youth to be thwarted by the vast omissions we make. Without explicit attention to the experiences of BIPOC and equity, we run the risk of using available science to improve the health of some young people, shifting population level averages, without catalyzing change in the larger, social contexts in which young people develop disparately (Biglan et al, 2012 , 2023 ; Ginwright et al, 2005 ).…”

Revisiting Race and the Benefit of RAS Blockade in Heart Failure

“…In turn, biological explanations have been proposed for these disputed findings, including possible genetic differences . However, groups defined by race are not genetically distinct, and it is now generally accepted that race is a social construct with no basis in genetics . Consistent with this view, no difference was found in the reduction in BP or eGFR between Black patients and non-Black patients randomized to a RAS blocker.…”

Self-understanding, envisioning the future, and prevention: An appreciation and a reflection on the occasion of the 100th anniversary.

“…Dr. Biglan and colleagues have written extensively about the importance of attending to poverty in preventing mental disorders (Biglan et al, 2023). The Academies also issued a report specifically focused on the value of interventions to address poverty and low income situations (National Academies of Sciences, Engineering, and Medicine, 2019c).…”