This commentary describes the potential role of public health systems research in providing a unique and comprehensive strategy to reduce health disparities and improve the health of all Americans.
Garth Graham, MD, MPH, is Deputy Assistant Secretary for Minority Health, US Department of Health and Human Services, Washington, District of Columbia.
Corresponding author: Garth Graham, MD, MPH, Office of Minority Health, US Department of Health and Human Services, 1101 Wootton Parkway, Suite 600, Rockville, MD 20852 (e-mail: Christine.Montgomery@hhs.gov or firstname.lastname@example.org).
The reduction of health disparities has been at the forefront of the public health agenda and a cornerstone of the nation's public health roadmap, Healthy People 2010.1 On October 16, 1985, the Department of Health and Human Services released the Secretary's Task Force on Black and Minority Health.2 This report was a major step in establishing agreement on the existence of health disparities and illustrated the conflicting paradigm that existed in the nation's health between minority and nonminority populations. In fulfilling its responsibility, the Task Force not only looked at the role of the federal government but in fact engaged the various facets of the health system including state government, the private sector, and various community-based organizations. Implicit in the report were challenges and recommendations to improve the public health system so as to eliminate disparities. The report looked at, among other things, the funding, organization, and provision of public health services, and how the delivery of these services worked to reduce disparities. Recommendations included improving the delivery and financing of health services to minority population through better efficiency and acceptability and also increasing technical assistance and collaboration by local and community agencies to meet minority-health needs.
As we look back at the 20th anniversary of the Secretary's Report, it is important to understand the potential role of public health systems research in providing a unique and comprehensive strategy to reduce disparities and fulfill one of the key goals of the US Public Health system. This burgeoning area of research does so in a number of ways:
* Public health systems research is a true multidisciplinary approach. Public health systems research breaks down barriers between areas such as finance, epidemiology, and behavioral and social science, and combines them with decision analysis and operations research to focus on how the system as a whole achieves the desired outcome. This is especially important as it applies to health disparities where we now know that the etiology is multifactorial involving not only traditional health factors but also education, environment, and other variables. In addition, the field of public health services research encourages major collaborations between academia and state and federal governments to address a specific problem.3 If we are truly going to make any progress in eliminating health disparities, understanding this multidimensional problem will require a multidisciplinary approach.
* Public health systems research provides evidence for understanding the structural and financial components of an effective strategy. In a time of limited resources, it will be important for us to understand the tenets of an effective strategy dealing with health disparities. Early work in the area of public health systems research has looked at performance and capacity building in attempting to achieve the core functions of public health.4 As mentioned earlier, true capacity building was at the center of the Secretary's Task Force report as an integral function of eliminating health disparities. Future work in this area will allow us better understanding of how structure, including staff and funding, will result in an effective strategy to reduce health disparities.
* Public health systems research provides a vehicle for understanding the impact of current and future health disparities activities. Over the course of the last two decades, since the release of the report, there has been a tremendous amount of resources directed toward the elimination of disparities, yet quantitative data on the true impact of these dollars remain sparse. The medium of public health systems research, through the evaluation of long-term data, allows us the ability to evaluate the effectiveness and impact of our strategies.5 This will be especially important as many public health administrators and policy makers look at developing effective strategies in a resource-sensitive fashion.
Yet the most important lesson that is illustrated in the field of public health systems research is in understanding that the health of our nation, whether minorities or nonminorities, those living in urban areas, or those living in rural areas, is borne by all. We all have a role to play in the fight to eliminating health disparities, from the federal to state government, from academia to community-based groups, and from private industry to nonprofits; we all have our role in improving the health of all Americans.
1. US Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health
. 2nd ed. Washington, DC: Government Printing Office; 2001.
2. Centers for Disease Control and Prevention. Perspectives in disease prevention and health promotion report of the Secretary's Task Force on Black and minority health. Morb Mortal Wkly Rep
3. Gordon AK, Chung K, Handler A, Turnock BJ, Schieve LA, Ippoliti P. Final report on public health practice linkages between schools of public health and state health agencies: 1992–1996. J Public Health Manag Pract
4. Turnock BJ, Handler AS, Miller CA. Core function-related local public health practice effectiveness. J Public Health Manag Pract
5. Dooley SL, Freels SA. Quality assessment of perinatal regionalization by multivariate analysis: Illinois, 1991–1993. Obstet Gynecol