Role of Health Information Technology in Addressing Health Disparities: Patient, Clinician, and System Perspectives.

Over the last decade, health information technology (IT) has dramatically transformed medical practice in the United States. On May 11-12, 2017, the National Institute on Minority Health and Health Disparities, in partnership with the National Science Foundation and the National Health IT Collaborative for the Underserved, convened a scientific workshop, "Addressing Health Disparities with Health Information Technology," with the goal of ensuring that future research guides potential health IT initiatives to address the needs of health disparities populations. The workshop examined patient, clinician, and system perspectives on the potential role of health IT in addressing health disparities. Attendees were asked to identify and discuss various health IT challenges that confront underserved communities and propose innovative strategies to address them, and to involve these communities in this process. Community engagement, cultural competency, and patient-centered care were highlighted as key to improving health equity, as well as to promoting scalable, sustainable, and effective health IT interventions. Participants noted the need for more research on how health IT can be used to evaluate and address the social determinants of health. Expanding public-private partnerships was emphasized, as was the importance of clinicians and IT developers partnering and using novel methods to learn how to improve health care decision-making. Finally, to advance health IT and promote health equity, it will be necessary to record and capture health disparity data using standardized terminology, and to continuously identify system-level deficiencies and biases.

Racism and the Life Course: Taking Time Seriously.

The adage "time is money" signifies that time itself is a major social resource, but the role of time as a determinant of health inequities remains underappreciated. Time is fundamental to health promotion and human agency, as in having time to exercise and maintain social relationships. Further, scarcity in time is related to stress and illness. Time is also racialized, such that racial/ethnic minorities often have less free time and suffer a time penalty in multiple facets of life. Such penalties manifest in problems such as greater time in prison or more time spent accessing services. We argue that time may be a social determinant of health that is shaped by racism across the life course. We focus on three aspects: time as age, time as exposure, and time as a resource and privilege. We distinguish between chronological age, biological age, and social age. We discuss issues of accelerated aging and potential interconnections with critical periods. We also examine racial inequities in time. By more deeply considering time, we may advance our understanding of racial inequities in health.

Childhood obesity prevention across borders: A National Institutes of Health commentary.

In response to the increasing rates of childhood obesity, the United States and countries across Latin America have invested in research that tests innovative strategies and interventions. Despite this, progress has been slow, uneven, and sporadic, calling for increased knowledge exchange and research collaboration that accelerate the adaptation and implementation of promising childhood obesity interventions. To share research results, challenges, and proven intervention strategies among Latin American and US researchers, particularly those working with Latino and Latin American populations, the National Institutes of Health (NIH) convened researchers from the United States and Latin America to highlight synergies between research conducted in Latin America and among Latino populations in the United States with the goal of catalyzing new relationships and identifying common research questions and strategies. This article highlights the NIH's research and priorities in childhood obesity prevention as well as areas for future direction, including overarching NIH plans and NIH institutes, centers, and offices investments in specific areas related to childhood obesity prevention in Latin America and/or among Latino populations in the United States.

Leveraging Science to Advance Health Equity: A Regional Health Policy Research Center's Approach.

Advancing health equity and reducing disparities through evidence-based policy research requires the expertise, insights, and active participation of various policy stakeholders - particularly those representing vulnerable populations who may be disproportionately affected by such policies. Unfortunately, there are few sustainable settings for these diverse stakeholders to convene, share their knowledge, develop and execute research in a collaborative fashion, and effectively translate evidence-based findings. The development of a health policy-focused center supports the collaborative structure needed to present a unified, multi-disciplinary approach toward informing health policy. The Transdisciplinary Collaborative Center for Health Disparities Research (TCC) at Morehouse School of Medicine (U54MD008173) was funded in 2012 by the National Institute on Minority Health and Health Disparities (NIMHD) as an innovative approach for conducting health policy research and disseminating evidence-based science to diverse stakeholders. This article provides an overview of the research projects, pilot project programs, infrastructure cores, communications, and strategic dissemination activities supported by the TCC.

Food insecurity and obesity: research gaps, opportunities, and challenges.

Food insecurity, defined as a lack of consistent access to enough food for an active, healthy life, is a major public health concern with 11.8% of U.S. households (15.0 million) estimated to be affected at some point in 2017 according to the United States Department of Agriculture Economic Research Service. While the link between food insecurity, diet quality, and obesity is well documented in the literature, additional research and policy considerations are needed to better understand underlying mechanisms, associated risks, and effective strategies to mitigate the adverse impact of obesity related food insecurity on health. With its Strategic Plan for NIH Obesity Research, the NIH has invested in a broad spectrum of obesity research over the past 10 years to understand the multifaceted factors that contribute to the disease. The issue of food insecurity, obesity and nutrition is cross-cutting and relates to many activities and research priorities of the institutes and centers within the NIH. Several research gaps exist, including the mechanisms and pathways that underscore the complex relationship between food insecurity, diet, and weight outcomes, the impacts on pregnant and lactating women, children, and other vulnerable populations, its cumulative impact over the life course, and the development of effective multi-level intervention strategies to address this critical social determinant of health. Challenges and barriers such as the episodic nature of food insecurity and the inconsistencies of how food insecurity is measured in different studies also remain. Overall, food insecurity research aligns with the upcoming release of the Strategic Plan for NIH Nutrition Research and will continue to be prioritized in order to enhance health, lengthen life, reduce illness and disability and health disparities.

Prevención transfronteriza de la obesidad infantil: comentario de los National Institutes of Health.

En respuesta al aumento de las tasas de obesidad infantil, Estados Unidos y algunos países de Latinoamérica han financiado numerosos estudios que analizan estrategias e intervenciones innovadoras. A pesar de ello, los avances han sido lentos, irregulares y esporádicos, lo cual demuestra la necesidad de intensificar el intercambio de conocimientos y la colaboración en la investigación para acelerar la adaptación e implementación de intervenciones prometedoras en el campo de la obesidad infantil. Con la intención de compartir resultados de estudios, problemas y estrategias de intervención de probada eficacia entre los investigadores latinoamericanos y estadounidenses (especialmente los que trabajan con poblaciones latinas y latinoamericanas), los National Institutes of Health (NIH) reunieron a investigadores de Estados Unidos y Latinoamérica para destacar las sinergias entre los estudios de Latinoamérica y los realizados en poblaciones latinas de Estados Unidos. El fin último de esta iniciativa fue catalizar nuevas relaciones e identificar preguntas y estrategias comunes para la investigación. Este artículo se centra en la investigación y las prioridades de los NIH en materia de prevención de la obesidad infantil, así como en las áreas para futuras acciones, incluidos los planes generales de los NIH y las inversiones de sus institutos, centros y oficinas en áreas concretas relacionadas con la prevención de la obesidad infantil en Latinoamérica y en las poblaciones latinas de Estados Unidos.