Top 5 Reasons Why Diversity is Important in Research:
Health research is often done with a small proportion of the overall population, with the goal of providing an effective treatment or intervention for the population as a whole. However, without a diverse group of individuals participating in research, scientists will not know if their results can be applied to all people equally. Diversity in research means that people of different ages, different racial and ethnic groups, and both men and women participate in research studies. Here are some specific reasons why diversity in research is important.
Reason 1
Some groups of people suffer more from certain diseases than other groups.
We know that certain minority groups have a higher incidence of diseases, such as diabetes, obesity, asthma, and CVD, than Whites. Scientists can conduct additional research to understand the biological, social, environmental, and other factors that contribute to these disparities in health. Without participation of diverse groups, we would not know these disparities in health exist and we will not know why these disparities exist.
Reason 2
The cause of disease is not the same for all groups of people.
Research suggests that heart failure in Whites is most likely to be caused by coronary artery disease, while the main cause of heart failure in African Americans is hypertension. Therefore, different treatment plans may be needed to successfully manage or prevent heart failure for these two groups. Without research on the cause of disease for different groups, doctors might conclude that one treatment option is the best for everyone.
Source: Yancy CW. Heart failure in African-Americans: a cardiovascular enigma. J Card Fail. 2000; 6: 183–186.
Reason 3
Medical treatments may not be equally effective for all groups of people, and some groups of people may experience more side effects from medications than other groups.
Some medications might not have the same effectiveness for all groups of people. Research into the effectiveness of heart medications revealed that certain combinations worked better for African Americans than for other racial groups . The reason researchers know this is only because the results included large numbers of different racial and ethnic groups for which they could compare results. Some groups of people may be more at risk of having side effects from some drug treatments as compared to other groups. For example, research shows us that sometimes there are variations in the way different racial and ethnic groups metabolize, or break down, different medications. If one group of people metabolizes a drug more slowly than other groups, the individuals in that group may face a higher risk of developing an unsafe accumulation of that drug in their liver or other organs. If a drug is tested on only one type of person, for example only on White men, researchers will not know if other types of people, such as Latina women or Asian American men, will experience the same, different, or more severe side effects.
Source(s): (Carson P, Ziesche S, Johnson G, Cohn JN. Racial differences in response to therapy for heart failure: analysis of the vasodilator-heart failure trials. J Card Fail. 1999; 5: 178–187.; Dries DL, Strong MH, Cooper RS, Drazner MH. Efficacy of angiotensin-converting enzyme inhibition in reducing progression from asymptomatic left ventricular dysfunction to symptomatic heart failure in black and white patients [published correction appears in J Am Coll Cardiol. 2002;40:1019]. J Am Coll Cardiol. 2002; 40: 311–317.; Exner DV, Dries DL, Domanski MJ, Cohn JN. Lesser response to angiotensin-converting-enzyme inhibitor therapy in black as compared with white patients with left ventricular dysfunction. N Engl J Med. 2001; 344: 1351–1357.; Yancy CW, Fowler MB, Colucci WS, Gilbert EM, Bristow MR, Cohn JN, Lukas MA, Young ST, Packer M, US Carvedilol Heart Failure Study Group. Race and the response to adrenergic blockade with carvedilol in patients with chronic heart failure. N Engl J Med. 2001; 344: 1358–1365.)
Reason 4
Individuals within the same racial or ethnic group can respond differently to the same treatment.
Researchers need the participation of many different individuals within a racial or ethnic group to fully understand how different treatments work for that group. For example, while as a whole, Asian Americans may respond differently to a program than Latinos, different subgroups within the Asian American population may also have different responses to that program. For example, an exercise program designed to help Asian Americans lower their body mass index, a key indicator of risk for heart disease and Type 2 diabetes, may not have the same results for a 20 year-old Asian American man and a 65 year-old Asian American woman. Without sufficient numbers of Asian American participants of different ages, genders, socioeconomic positions, geographic locations, etc., scientists cannot identify and understand the differences within this group for this population.
Reason 5
Diversity in genetic samples and databases is needed to guide personalized medicine based on an individual’s genetic makeup.
Doctors are increasingly moving towards individual treatment plans based on an individual’s genetic makeup. The move towards personalized medicine is due in part to the completion of the Human Genome Project in 2003. Completion of the project was possible only with the analysis of many different samples from diverse individuals. This allowed scientists to understand the normal variations that can occur in human genes, as well as which variations are more common in specific racial and ethnic groups. Some genetic variations have no effect. However, when these variations are associated with an increased risk of disease, doctors can recommend screening for early detection or behavioral interventions to prevent or delay the onset of the disease. When the variations are associated with the response to certain drug treatments, doctors can take care to ensure that they prescribe only the safest and most effective medications.
Below are examples of how public health projects have been using research to make a difference in minority health.
The Healthy Black Family Project
The REACH 2010 Initiative
Healthy Children, Strong Families
The Healthy Black Family Project was developed based on the results of a large national research study, the Diabetes Prevention Program (DPP), which was funded by the National Institutes of Health. That research demonstrated that lifestyle behavior change interventions could prevent and/or delay the development of Type 2 diabetes and led to the development of the Group Lifestyle Balance Program.
Established in 2005, the Healthy Black Family ProjectTM (HBFP) was a community-based, culturally-tailored demonstration project that aimed to improve the overall health status of and eliminate health disparities among African American residents of Pittsburgh, PA. Specifically, HBFP utilized the results of the DPP to create a program that provided physical activity, nutrition, stress management, and smoking cessation activities to help participants and their families prevent Type 2 diabetes and hypertension. HBFP was conducted at three local community centers – The Kingsley Association in the East Liberty community, Hosanna House in Wilkinsburg, PA, and the Hill House Association in the Hill District community. The HBFP provided classes free of charge to community members. Participants in the program lost weight, strengthened muscles, and demonstrated overall impact of their activities with reductions in their risk of disease or symptoms of pre-existing disease.
Watch the Healthy Black Family Project video.
Racial and Ethnic Approaches to Community Health (REACH) is a national initiative of the Centers for Disease Control and Prevention (CDC). The goal of REACH is to eliminate racial and ethnic disparities in health by awarding grants to community partners that enable them to develop and evaluate community-based programs and culturally-tailored interventions aimed at addressing chronic diseases, infant mortality, immunization, and other health issues among African Americans, American Indians, Hispanics/Latinos, Asian Americans, Alaska Natives, and Pacific Islanders.
REACH partners include community-based organizations, local and state government, faith-based organizations, and others who use community-based strategies that determine the driving forces behind health issues affecting them, and then design, implement and evaluate programs that fit their specific needs and culture. REACH coalitions draw upon the evidence based on previous research programs to help them design suitable programs for their communities, and by evaluating their specific initiatives, contribute to increasing our knowledge of what works in diverse communities to reduce health disparities.
Watch the REACH 2010 Initiative video.
Source Success Stories From Our Communities. Community Health and Program Services Branch REACH. Center for Disease Control. www.cdc.gov/reach
Healthy Children, Strong Families (HCSF) is a family-focused, early childhood intervention that addresses the growing problem of childhood obesity in American Indian communities. HCSF consists of a collection of 13 “lessons” that are mailed to the homes of families with preschool-aged (2 to 5 years old) children. The lessons come about once a month, which gives a family time to go through it and put its new ideas to work before the next lesson arrives. The topics cover everything from “Fun Family Fitness” to “On Track Snacks” to “Maintaining Harmony,” with many ideas about how to eat healthier, how to find ways to fit more activity into busy days, the importance of getting enough sleep, and how to deal with the stresses of everyday life. Since families are a part of a larger community, the programs stresses the importance of families doing things together in order to create healthier children and healthier communities.
Since obesity rates of American Indian (AI) children are among the highest of any race or ethnic group in the United States, HCSF researchers are working to test the ability of the intervention to increase healthy lifestyle changes (like eating fruits and vegetables and increasing physical activity) and to reduce obesity among preschool-aged American Indian children and their families. As of 2013, this work is being done in six rural and urban American Indian communities across the U.S., but if the intervention is successful, it may be used to help children in many more communities.
Important Question
Why do we need to conduct health research programs with specific groups of people such as African Americans, Latinos, American Indians, and Asian Americans?
