Health Equity is Focus of New Center
What's the best way to combat the childhood obesity that is so prevalent among Wisconsin's Native Americans? How can we explain the high rates of hypertension, asthma and infant death that are so common in African Americans? And why are diabetes and Alzheimer's disease under-recognized and poorly managed in Hispanic populations in the Badger State?
The new Collaborative Center for Health Equity (CCHE) at the University of Wisconsin School of Medicine and Public Health (SMPH) is poised to tackle such complicated questions.
The center will connect partners from Wisconsin's rural, urban, tribal and other diverse communities with university faculty, research staff and trainees so that together they can use or develop educational, training and research resources aimed at improving the health and wellness of Wisconsin's underserved, minority and immigrant populations.
A recently announced National Institutes of Health award of up to $7.5 million will ensure that CCHE staff can begin significant training and community engagement efforts, as well as work on two targeted research projects.
One project, undertaken in collaboration with two Wisconsin tribes, will evaluate vitamin D supplementation in American Indian women. The other project, undertaken with multiple community partner sites in Milwaukee, will examine people's opinions about participating in biomarker research.
The Collaborative Center for Health Equity builds on the school's ongoing commitment to overcoming disparities in health and health outcomes, replacing the former Center for the Study of Cultural Diversity in Healthcare (CDH).
The new center is housed within the Institute for Clinical and Translational Research (ICTR), where the primary goal is facilitating research that rapidly moves health discoveries from academia to Wisconsin communities that need it the most.
Incorporating the CCHE into the institute was a logical decision for many reasons, says ICTR director Marc Drezner, MD, SMPH professor of medicine.
"We greatly value CCHE's focus on populations that are faced with inequities in health care," he says. "All of our ICTR administrative infrastructure and our six cores, including our pilot grant program, support investigators who want to conduct health equity research."
Drezner says that the appointment of Alexandra Adams, MD, PhD, associate professor of family medicine, as the CCHE director makes the creation of the new center even more exciting.
"Dr. Adams has a long history of conducting outstanding, community-based research with American Indian partners," says Drezner, also the SMPH senior associate dean for clinical and translational research. "Her talent and experience addressing health disparities in Native American communities make her an excellent choice to lead this important new initiative at the school."
Building Community-Academic Partnerships
Creating new and lasting partnerships and reinforcing old ones will be a critical focus of the Collaborative Center for Health Equity, says Adams.
"We're looking to partner with communities that have identified research or service projects with specific links to health equity issues," she says. "We are concentrating initially on chronic diseases because many underserved communities have a strong interest in prevention."
The CCHE will build upon several community-academic partnerships that were initiated through the CDH, and it will develop new relationships with emerging partners, particularly in Milwaukee.
Center partners currently include the Urban Indian Wellness Consortium, the Milwaukee Birthing Project, the Center for Urban Population Health, the United Community Center and the House of Peace Community Center. Members of the Wisconsin Department of Health Service's Minority Health Leadership Council are helping to provide guidance on the center's programming priorities.
Adams also brings well-established partnerships with many of Wisconsin's American Indian tribes, including the Oneida, the Menominee, the Bad River and the Lac de Flambeau communities as well as the Great Lakes Intertribal Council (GLITC), a consortium of 11 tribes.
Since 2000, Adams has worked with the tribal communities to design community-based interventions preventing the childhood obesity that is such a significant risk factor for diabetes and cardiovascular disease.
"Our early collaborative research with three Wisconsin tribes and the Great Lakes Intertribal Council indicated a need for additional knowledge and strategic measures to reduce obesity-related risks," Adams explains.
As a result, she and her American Indian collaborators developed the Wisconsin Nutrition and Growth Study, or WINGS. Through their additional data collection and analysis, the researchers determined that alarmingly high numbers of the children were overweight and as many as 25 percent were obese.
Since then, a healthy lifestyles program — the Healthy Children, Strong Families and Supportive Communities Intervention — was designed using WINGS data, community input and scientific evidence. In addition, many of the communities have begun to experiment with interventions, including healthy eating programs in schools as well as community gardens.
"It's important to use evidence-based approaches in these interventions," says Adams. "The CCHE can contribute to the research process by helping in forming and maintaining community partnerships, providing program evaluation and supplying technical assistance in data collection and assessment. But there is so much we can learn from our partners as well-they teach us about their communities and what will work in each situation."
Adams says that, based on her collaborative experiences on the WINGS and Healthy Children projects, she and her CCHE colleagues will strive for a staged approach to community engagement.
"This means beginning with the research, service or education projects that are most useful to the community, aiming for mutually beneficial outcomes and learning to share data and resources," says Adams. "It is essential that results are shared with the community and lead to community benefits early on in the process."
This deliberate process will help establish and maintain long-term, mutually respectful and trusting partnerships, adds Adams.
"Such relationships are essential for successful health equity research to occur," she says.
A Key Component of the Institute for Clinical and Translational Research
In addition to its community engagement and research activities, the CCHE will contribute to research education and career development efforts within ICTR, establishing training initiatives for health equity and health disparity scholars and serving as a critical resource for diverse students and trainees.
CCHE will also link with other ICTR cores that address research implementation barriers campus investigators often encounter. Center leaders plan to concentrate initially on enhancing the administrative research procedures that are a part of conducting research at a large university.
Christine Sorkness, PharmD, serves as the CCHE associate director. She is also the ICTR senior associate director. Sarah Esmond, MS, is the center's administrative director. Lisa Tiger (Muscogee), MA, serves as the CCHE research ambassador and Robbi Strandemo provides administrative support to the center.
By Dian Land
This article appears in the summer 2009 issue of Quarterly.
Date Published: 09/28/2009
