Directing Research Toward Health Equity: A Health Equity Research Impact Assessment

Castillo, E.G. and Harris, C. 2021. Directing Research Toward Health Equity: A Health Equity Research Impact Assessment. J GEN INTERN MED 36, 2803–2808. 


Despite medical research advancements, inequities persist, as research has enhanced the health of some while leaving many communities untouched. Reforms are needed to direct research toward health equity, both during this pandemic and beyond. All research must currently pass scientific and ethical review processes, but neither may adequately examine a project’s potential impact on inequities and local communities. Research stakeholders need practical tools to help review and examine any given study’s impact on health equity. We articulate a health equity research impact assessment, which draws from existing research impact assessments and health disparities research measures and frameworks. We describe how this tool was developed and how it may be used by research reviewers, researchers, academic institutions, and funding agencies to elevate health equity in medical science. 

This paper is calling for researchers and review committees to consider assessing the potential for a health research study to contribute to reducing health inequities. All research involving human subjects must be submitted to an ethics board for review and approval. Similarly, the authors are proposing a review for health equity to ensure that research will promote health equity. “Pursuing health equity means striving for the highest possible standard of health for all people and giving special attention to the needs of those at greatest risk of poor health, based on social conditions.” They developed and piloted a tool to enable health equity impact assessments. The authors developed the tool, refined it with a nine-member committee (chaired by the two authors) and tested the tool against 30 applications for funding applying to internal UCLA Medical School funds directed to COVID research. 

Why is this relevant to a knowledge mobilization audience? This is an example of ex ante impact assessment. Before the research starts the tool will help assessors determine if there is community engagement and collaboration, knowledge translation/dissemination and impact potential of the research – among other things. This is very knowledge mobilization with a focus on health equity. Check out the tool in Box 1. It has six elements with multiple questions to be answered in each element: 

  1. Community engagement and partnerships 
  1. Recruitment, representatives, and generalizability 
  1. Intervention design 
  1. Interpretation and contextualization 
  1. Dissemination of research findings and community benefit 
  1. Overall impact on health equity 

That is the good news. Now for some challenges I found with this article. 

The authors promote engagement of stakeholders in research. I didn’t see any non-academic stakeholders engaged in this process. The committee members were all academic researchers. Sure, they all had experience working in community settings but this makes the lack of community engagement even more egregious. The stakeholders of note in Box 2 included researchers, peer reviewers and research institutions and funding agencies. Community members are not even considered stakeholders. There is no mention of community engagement in development of a tool that is calling for community engagement! 

The authors note that “community and interdisciplinary research partnerships have been described as critical for shortening the translational research-to-service gap and for addressing the needs of diverse, under-resourced communities”. And they repeatedly point to Black and Latinx communities as being subject to health inequities. It would have been very helpful to know the diversity make up of the authors and the nine-member committee.  If they are not engaging community members, are they working from their own lived/living experience?  

There is no information on how to use the tool. Are the answers yes/no or are the questions scored on some sort of scale? And if yes/no, how many of the 20 questions need to be answered yes in to pass the health equity research impact assessment? Basically, there is no indication of the standards of excellence required to take the tool from a checklist to an actual assessment tool for reviewers.  

The authors used the tool to assess the health equity research impact potential of 30 funding applications. They report refining the tool based on this sample but there is no further description of the results of the assessment. If there were standards of excellence how many applications met these standards? For those who did not fare well in the assessment did they receive feedback and were invited to amend their application and re-apply? 

I think a tool to assess the potential for an application to have a positive impact on health inequities is excellent. This article provides a fine start, but it has a way to go before this tool can be validated (especially by stakeholder communities) and adopted/adapted for use.  

Questions for brokers: 

  1. This is a tool for ex ante impact assessment. What will it take to turn it into a tool to help researchers plan for health equity impact in their research applications? [hint: nothing. Ex ante impact assessment is planning knowledge mobilization activities to drive impact, see this post
  1. This tool is focused on health equity. Can it also be used for other forms of social and economic inequity? Should it be a tool for inequity in general and not specifically health inequity? 
  1. This is yet another example of academic researchers failing to practice what they preach. Discuss. 

Research Impact Canada is producing this journal club series to make evidence on KMb more accessible to knowledge brokers and to create online discussion about research on knowledge mobilization. It is designed for knowledge brokers and other knowledge mobilization stakeholders. Read this open access article. Then come back to this post and join the journal club by posting your comments.