Unveiling the disparity divide: Does research fuel health inequity?

Mary Scott is an Epidemiologist at the Public Health Agency of Canada and a Research Associate at the Ottawa Hospital Research Institute. Her research has focused on health services and care for older, vulnerable populations. She is passionate about improving health systems to be transparent, efficient, and effective. She tweets at @marym_scott. Her research paper Building evidence to advance health equity: a systematic review on care-related outcomes for older, minoritised populations in long-term care homes is now published in Age and Ageing journal.

Health equity research tends to centre on minoritised populations, often overshadowing the origins of disparities and their underlying causes. While many studies focus on describing disparities, they sometimes overlook the bigger picture. But what if we could change that? What if we could transform research into a tool for promoting fairness and inclusivity?

Investigating the intersecting layers of inequity is crucial for taking literature from informative to transformative. Equity can only be achieved when we move beyond merely acknowledging poor outcomes to understanding the mechanisms that create and perpetuate disparities.

In our quest for equity, we must explore the structural barriers that hinder marginalised populations from accessing high-quality care. Rather than continually highlighting disparities, we should strive to unearth narratives that inspire solutions. Employing historical context and tools such as frameworks to synthesise literature enables us to pinpoint the root causes of inequality, directing our efforts towards addressing its origins.

Take, for example, our recently published international systematic review on care-related outcomes for minoritised populations living in long-term care homes. Through our synthesis of 34 studies, originating mostly from the United States, we uncovered underlying factors that are often overlooked in existing literature.

Firstly, we found that upon entry to long-term care homes, minoritised populations often have differences in their underlying health characteristics. Secondly, the quality of care within long-term care systems is not uniform and larger proportions of minoritised populations were living in facilities with lower standards. Finally, there's a lack of evidence that considers intersecting identities and how they impact care outcomes.

To ensure the integrity of our findings, our team followed PRISMA-Equity guidelines to assess bias and synthesise studies by both outcome and specific minoritised populations. By applying a conceptual framework to guide our analysis, we were able to critically examine how evidence mapped onto the factors contributing to persistent health disparities.

We delved deeper into the methods used by the included studies, looking for clues on whether they considered system-level differences in their analysis. Unfortunately, most studies focused solely on individual characteristics of minoritised groups, missing the broader systemic factors at play.

It's clear that while the existence of health disparities is well-documented, many studies fall short in their analysis, merely describing disadvantaged groups' health outcomes without digging deeper. Our review builds on the work of scholars who argue research should consider the multiple layers of inequity in how we produce knowledge.

In our pursuit of health equity, it's imperative that we shift our research paradigm from observation to action. By embracing more inclusive methodologies and centring the experiences of marginalised communities, we can pave the way for a future where health disparities are a thing of the past. Let's not just talk about equity – let's make it a reality.