Bridging the Gap Between Knowledge and Health Equity: Future Directions for Community Engaged Research and Practice
Lisa Cooper and Christina Vincent
Over the past few decades, breakthroughs in science have advanced our understanding of human health and disease – yet the benefits of these discoveries have not been fully realized in better health outcomes, and it’s most concerning that groups that have experienced social and economic marginalization are even less likely to benefit from these discoveries. So, while we still need more knowledge about efficacious and effective approaches and basic biomedical therapies, we have an opportunity to bridge the gap between what we know and our progress in addressing health equity. Community engagement is a critical piece of the bridge between knowledge and action.
As we look to the future, we have proposed five steps to guide our efforts. These steps include: (1) operationalizing community engagement, (2) moving partnerships towards true collaboration and shared leadership, (3) building capacity for community-engaged research, (4) fostering local/global bi-directional learning, and (5) moving from engagement to empowerment and equity. Using these steps as a roadmap, we can enhance alignment of efforts by healthcare and public health researchers and practitioners, and the communities they study and serve to advance health equity.
Operationalizing community engagement means to put it into use by making actions that are needed clear, defining all relevant variables, and making these indicators measurable. The Assessing Community Engagement (ACE) Model provides a means to do this effectively by centering the core principles of community engagement and using them to guide processes and activities - propelling strengthened partnerships and alliances, expanded knowledge, improved health and health care programs and policies, and healthier communities. Improvements in these domains and their associated indicators create motion and catalytic action that moves us toward health equity and well-being through transformed systems. To help put these principles into practice, our center has developed guides based on community engagement principles for our researchers and practitioners. To determine how well we are doing in our efforts, we evaluate the characteristics and processes of our partnership on an ongoing basis, through surveys and interviews. Community engagement must occur not only at the level of individuals, but also at the level of institutions. Examples of institutionalized commitments to community engagement include creating mission statements, guiding principles and common definitions that embed a formal infrastructure and framework. This creates the foundation for financial investment in the required resources.
Moving partnerships toward true collaboration and shared leadership is the next step. Intentional engagement with the community involves honest collaboration—one where researchers often consult and involve community members not only in the process but share in the leadership roles to give these individuals to agency to create the change. There must be space to accept a broadly defined community-engaged research continuum. Community members and organizations alike can identify where they are on the continuum, act to promote progress along it, or enter the continuum wherever necessary based on context. Community-based participatory research is the zenith of community engagement, and a cornerstone of research here at the Center for Health Equity.
The third step as we move into the future is building our individual and institutional capacity for community-engaged research. We’ve used the iceberg concept of culture as a visual aide to describe issues that must be navigated in health equity work. Visible to the eye are things we commonly think of when addressing groups impacted by disparities: race, ethnicity, gender, social class, etc. These factors are critical to our understanding of the experiences of these marginalized communities, but are only the tip of the iceberg. The many other facets of that organization or group impacted by health disparities, while less visible, are just as essential to our understanding of how our partners and patients think and behave and how we might work together to achieve health equity. The iceberg also symbolizes risk. Doing health equity work is a risky business – not for the faint of heart. Issues are deep, complex, longstanding, and emotionally charged.
We can address this, and the dissemination of this information through what we can call the three R’s of community engagement capacity: respect, relationships, and resources. Respect for all persons, regardless of background, and for diverse experiences and perspectives, must be cultivated. Building relationships among individuals and groups is also critical and requires investments of time, clear and frequent communication, and trustworthiness (based on integrity, benevolence, and competence). Finally, providing resources through diverse funding, in-kind training, technical support, and capacity-building approaches are highly valued. At the Center for Health Equity daily, we offer training through curricula such as our Massive Open Online Courses (MOOCs) on health equity research, create educational materials for our Community Advisory Board members, issue quarterly community updates, and release regular newsletters like our Health Equity Happenings, and post information on our website. We attend community events and participate in forums hosted by policymakers and community-based organizations.
Enhancing local and global bidirectional learning is the fourth step in community engagement that bridges the gap between knowledge and action. Several of the projects foster local and global bi-directional learning—taking lessons learned from our local research in Maryland and looking at its applications to health equity research across the country and the globe, and vice versa. For instance, our completed projects like Project ReD CHiP, Five Plus Nuts and Beans Trial, Five Plus Nuts and Beans for Kidneys, the ACT Study, RICH LIFE and the Ghana-based project, ADHINCHRA serve as examples of community-engaged clinical trials of interventions that have addressed issues such patient activation, access to healthful foods, integration of social needs in the delivery of health care, and more. We’ve also participated in national networks of health equity academic community partnerships, including the NIH Centers for Population Health and Health Disparities, Community Engagement Alliance (CEAL), RESTORE, and the NIMHD Health Equity Action Network. In adapting these local lessons for national and global applications, we all take a step forward in reaching our collective goal.
The fifth step in bridging the knowledge to action gap is moving from engagement to empowerment and equity. While it is critical for health equity researchers to use their training to move the needle forward, it is even more important for them to help community members take back their power to improve their own health and the health of their communities. Health and healthcare are always on the ballot. In the U.S., from the reversal of Dobbs to the effects of COVID-19, gun violence, mental health, there is much change needed to improve health. Healthcare professionals and researchers can use their knowledge, skills, privilege and power to support their patients, research participants, and community partners in becoming civically engaged and in advocating for themselves. Some of the ways to do this include creating meaningful relationships, expressing concern about what is happening in the community, building collaborations with other social justice professionals to provide more holistic solutions, and encouraging patients and community members to participate in interest, civic, and advocacy groups, to vote, and even to run for political office if needed.
Truly, the Center for Health Equity would not be where it is today without the engagement of our community members. Every person-- in Baltimore, Maryland, the United States, and every nation on this earth—deserves access to opportunities that empower them to create a healthy life, yet no one person or group can accomplish this lofty goal alone. Realizing our vision of health equity will require strong partnerships involving numerous groups and sectors in our society. Health disparities are everyone’s problem, and health equity is our collective responsibility. Here at the Center for Health Equity, we are energized to continue this work. Please join us!