Dear Community:

February is Black History Month, a time to honor the resilience, brilliance, and leadership of Black communities, past and present. It's also a reminder that the fight for equity continues today, especially in health, where racial disparities still shape outcomes and opportunities for far too many of our neighbors. At the Center for Closing the Health Gap, we carry this legacy forward through advocacy, education, and community-driven action.

I’m also honored to share that I will be participating in a panel discussion for International Women’s Day on March 8, hosted by the GRAIL. I hope you’ll join us for an inspiring conversation about leadership, justice, and collective impact. (Learn more at grail-us.org.)

And on March 10, I encourage you to attend the Woman’s City Club National Speaker Forum featuring Gina Belafonte – actress, producer, activist, and Executive Director of Sankofa – continuing her father Harry Belafonte’s legacy of art and transformational change.



Wishing you a safe and healthy week ahead, as we continue building a healthier, more just future together.



Renee Mahaffey Harris

President & CEO

Rethinking how health research is done

ReACH is a federally funded training program to support doctoral students in studying science grounded in how people actually live, work and access care using advanced, people-centered research methods. This research is aimed at better results for all groups of people.

The need for that focus is not new. More than 20 years ago, national experts warned that health disparities were deeply embedded in the U.S. health care system. According to program lead Professor Leigh Ann Simmons, the data today look much the same. "That’s why we really can’t shy away from having dedicated training programs in this topic area," Simmons said.

This type of research asks different questions — not only about outcomes, but about context. Research consistently shows that social and structural factors such as housing, income, environmental exposure and neighborhood conditions play a major role in health outcomes. Communities that have faced decades of disinvestment often experience higher rates of chronic illness, worse maternal health outcomes and shorter life expectancy.

Diminishing Returns Among Black Patients With Cancer: The Intersection of Race and Neighborhood Socioeconomic Status

Despite narrowing racial gaps, disparities persist across cancer types and socioeconomic levels. The diminishing returns hypothesis suggests that economic advantage yields fewer health benefits for Black individuals but is largely unexplored in the context of cancer. We examined the diminishing returns among Black and White individuals across cancer types using a nationally representative study population.

Methods

The study analyzed cancer-specific survival among 5.3 million non-Hispanic Black and White adults diagnosed with primary cancer (2006-2020) using SEER-22. We assessed how race and neighborhood socioeconomic status (SES) jointly affects survival across 21 cancer types.The main outcome was cancer-specific death. Diminishing returns were defined quantitively and qualitatively as worse survival for Black individuals even at higher SES. Cox models adjusted for demographics and clinical factors, with multiple imputation for missing data. Social gradients were also evaluated.

Results

Black women showed strong evidence of diminishing returns overall and for seven cancers, especially uterine and breast cancers. A social gradient was also evident in cancers with diminishing returns, except uterine cancer. For Black men, diminishing returns were not observed across all cancers combined but was present in eight cancers—including prostate and colorectal cancers. Most cancers among men exhibited a strong social gradient. Findings were consistent by time period and upon restricting to localized and regional disease in sensitivity analyses.

Advancing the Science and Scholarship of Health Equity

Health equity research has advanced substantially during the past 2 decades and has emerged as a foundational element of population health science and scholarship. JAMA Health Forum has embraced this evolution as part of its core mission and has been committed to publishing health equity science and scholarship that not only informs but also challenges and inspires change. As the field advances it becomes important to pause and to ask: where is the field headed? How can we ensure that the scholarship we publish is advancing health equity?

To address the questions we raised at the outset, it may be important to consider what elements of health policy science and scholarship may be most challenging in the health equity field today. We suggest that there are 4 features that challenge the field: limited methodological transparency, unclear definitions of key social constructs, narrow contextual framing, and overstatement of policy relevance. This is not to suggest that these challenges are unique to health equity–focused research compared with other domains. Rather, it involves additional dimensions of value that expand the conventional understanding of rigor.

ECRI Provides Insight into Advancing Health Equity in Clinical Guidelines

Health inequities across racial and ethnic groups are well documented but often overlooked during clinical guideline development. ECRI is helping to close that gap, with the goal of improving patient care and health outcomes.

ECRI’s Clinical Evidence team contributed to a series of articles examining how systematic reviews and evidence-based clinical practice guidelines address health equity. Kelley Tipton, MPH, ECRI Associate Director for Clinical Evidence Contracts, is first author on one of the articles, which reviewed the ECRI Guidelines Trust to determine to what extent the guidelines note health disparities, embed equity considerations into the methods or recommendations, and incorporate racially or ethnically diverse patient perspectives.

Mahaffey Harris Participating in Panel Discussion at International Women's Day Event on March 8

Learn more at https://www.grail-us.org.