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AJPH First Look, published online ahead of print Oct 31, 2006
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December 2006, Vol 96, No. 12 | American Journal of Public Health 2113-2121
© 2006 American Public Health Association
DOI: 10.2105/AJPH.2005.077628

FRAMING HEALTH MATTERS

Advancing Health Disparities Research Within the Health Care System: A Conceptual Framework

Amy M. Kilbourne, PhD, Galen Switzer, PhD, Kelly Hyman, PhD, Megan Crowley-Matoka, PhD and Michael J. Fine, MD, MSc

All authors are with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pa. Amy M. Kilbourne and Galen Switzer are with the Departments of Medicine and Psychiatry, University of Pittsburgh, Pittsburgh, Pa. Megan Crowley-Matoka is with the Departments of Medicine and Anthropology, University of Pittsburgh. Michael J. Fine is with the Department of Medicine, University of Pittsburgh.

Correspondence: Requests for reprints should be sent to Amy M. Kilbourne, PhD, MPH, VA Pittsburgh Center for Health Equity Research and Promotion (151C-U), University Drive C, Pittsburgh, PA 15240, (e-mail: amy.kilbourne{at}va.gov).

We provide a framework for health services–related researchers, practitioners, and policy makers to guide future health disparities research in areas ranging from detecting differences in health and health care to understanding the determinants that underlie disparities to ultimately designing interventions that reduce and eliminate these disparities. To do this, we identified potential selection biases and definitions of vulnerable groups when detecting disparities.

The key factors to understanding disparities were multilevel determinants of health disparities, including individual beliefs and preferences, effective patient–provider communication; and the organizational culture of the health care system. We encourage interventions that yield generalizable data on their effectiveness and that promote further engagement of communities, providers, and policymakers to ultimately enhance the application and the impact of health disparities research.




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