Department of Family Medicine and Community Health, Community Engaged Research Initiative, CTSI, Global Health Institute, Margolis Center for Health Policy, Department of Head and Neck Surgery & Communication Sciences, Duke University, North Carolina, Durham, USA.
Clin Transl Sci. 2023 Feb;16(2):179-183. doi: 10.1111/cts.13443. Epub 2022 Nov 22.
In a context of social inequity, research translation naturally furthers health inequity. As Fundamental Cause Theory (FCT) explains-and an associated empirical literature illustrates-those with more resources benefit earlier and more from scientific innovation than those with fewer resources. Therefore, research translation of its own course creates and widens health disparities based on socioeconomic status and race/ethnicity. Yet, the conversation about research translation has yet to center this critical reality, undermining our efforts to address heath inequity. Moving toward sustainable health equity requires that we build the evidence base for, prioritize, and institutionalize translation approaches that center the needs and assets of low-resource populations (with community engagement helping toward that end). However, even the impact of that approach will be limited if we as a society do not mobilize knowledge to address social inequity and the many ways in which it shapes health. The health research community should engage the FCT paradigm to think critically about resource allocation among different kinds of research and action. Moreover, in our contributions to discussions about the road to health equity, we must be forthcoming about the reality FCT describes and the limitations it indicates for achieving health equity through translation of biomedical, clinical, health services, and health behavior research alone.
在社会不平等的背景下,研究转化自然而然地加剧了健康不平等。正如基础原因理论(FCT)所解释的,以及相关的实证文献所说明的,那些拥有更多资源的人比那些资源较少的人更早、更多地从科学创新中受益。因此,研究翻译本身就在基于社会经济地位和种族/民族造成和扩大健康差距。然而,关于研究翻译的讨论尚未将这一关键现实作为核心,这削弱了我们解决健康不平等的努力。要实现可持续的健康公平,就需要为以低资源人群的需求和资产为中心的翻译方法建立证据基础,优先考虑并将其制度化(社区参与有助于实现这一目标)。然而,如果我们的社会不调动知识来解决社会不平等问题,以及它在多大程度上塑造了健康,那么即使采取这种方法,其影响也将是有限的。健康研究界应该利用 FCT 范式来批判性地思考不同类型的研究和行动之间的资源分配。此外,在我们为实现健康公平的道路的讨论做出贡献时,我们必须坦诚地面对 FCT 所描述的现实,以及仅通过转化生物医学、临床、卫生服务和健康行为研究来实现健康公平所存在的局限性。