I study racial disparities in health. So much of my work is — or rather, was — supported by federal grants that have now been unceremoniously suspended or eliminated thanks to the Trump administration’s ever-expanding war on diversity, equity and inclusion. So it might seem surprising for me to say that while I believe these funding freezes and cuts at the National Institutes of Health are, on the whole, detrimental for the country, they also present a long-overdue chance for us to rethink how we approach health disparities research.
Racial minorities, especially Black, Latino and Indigenous people, routinely have worse health than white people. Though there are variations among racial and ethnic groups, generally speaking, minorities have higher rates of pretty much every major health problem you can think of, including diabetes, hypertension, stroke, obesity, psychotic disorders and most major cancers. These disparities are far from new. And though progress has been made in some areas, they continue to persist, cost the United States $451 billion in 2018 and will likely worsen in Mr. Trump’s second term amid cuts to federal research and programs including Medicaid.
Last summer, a National Academies of Sciences, Engineering and Medicine report revealed something that should’ve shaken every health disparities researcher: “The U.S. has made little progress in advancing health care equity over the past two decades.”
It’s true. In 2023, I published an article in the journal Social Science and Medicine about what I call the “health disparities research industrial complex” — the entrenched system of researchers, institutions, publications and funders that produces an endless churn of studies on health disparities without meaningfully reducing inequities. Health disparities research is an expensive parrot squawking the same things heard for years, telling us where disparities exist and why, but not much else. The new head of the N.I.H., Dr. Jay Bhattacharya, seems to agree.
The first step to dismantling this research industrial complex and tangibly improving all Americans’ lives is understanding that many studies greenlit by the N.I.H. have been charged simply with identifying and explaining the existence of health disparities; comparatively fewer have studied how to solve them. This made sense years ago when we didn’t yet know that factors such as family structure, environment and education were major influences on the health outcomes of racial minorities. We now understand how and why health disparities arise — yet I continue to see researchers pitch studies that are little more than proverbial bridges to nowhere.
Part of this is money-related. Some scientists studying health disparities are likely to propose studies that are more observational but easily funded instead of investigations that may actually close these gaps.
Publication expectations intensify the cycle. Thousands of articles on health disparities get published each year in scientific journals. Being published is critical for researchers to advance their careers, and scientists can frequently count on journals to accept papers that simply identify the causes and consequences of health disparities even if they don’t also offer a meaningful solution to resolving them.
There are examples of health disparities research that can lead to action, such as the study of disproportionate deaths among minorities from Covid-19, which informed development of education and outreach interventions to shrink deep racial gaps in vaccinations. But as a rule, even when specific health conditions improve across all target populations, disparities among certain groups linger.
The crux of this problem is that the scientific community has been without a nuanced vision for what research to prioritize, fueling the research sprawl. A disproportionately higher rate of N.I.H. grants have been awarded to white researchers compared to Black researchers (a problem the agency has acknowledged and has said it would work to address). For health disparities research, this means the mostly white principal investigators may have trouble recruiting and retaining study participants from minority groups.
Dismantling the health disparities research industrial complex requires establishing common-sense research priorities, something that might finally be possible if the new leadership at the N.I.H. is willing. The Centers for Disease Control and Prevention posts an annual list of the leading causes of death, illuminating the minority populations where those deaths may be especially high. Funding priorities should concentrate on studies that test interventions seeking to reduce the disproportionate suffering these high-risk groups endure. Such experimental projects have, for example, delivered fresh fruit and vegetables to those living in food deserts, and increased local grocers’ inventory of healthy foods to combat low-income communities’ struggles with malnutrition and chronic disease.
The N.I.H. and other federal agencies should aggressively push researchers toward more studies like these and others that expand access to health care, employment, early education and healthy foods. Amid growing concerns about ideology in American science, these moves may help to further demonstrate that scientists are motivated by measurable data to find and test solutions.
We’ve seen over and over that solutions to health disparities aren’t solely about making tweaks to individual behavior. The Trump administration, may want to ignore discrimination and bias, but eliminating them is essential to closing health disparities, and that begins with breaking the cycle where research identifies disparities but does not close the racial inequity gap. We finally have an opportunity now to do so — let’s not let it slip away from us.
Jerel Ezell is a visiting professor at the University of Chicago department of medicine, where he studies environmental health disparities.
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