摘要：Translational, transdisciplinary, and transformational research stands to become a paradigm-shifting mantra for research in health disparities. A windfall of research discoveries using these 3 approaches has increased our understanding of the health disparities in racial, ethnic, and low socioeconomic status groups. These distinct but related research spheres possess unique environments, which, when integrated, can lead to innovation in health disparities science. In this article, we review these approaches and propose integrating them to advance health disparities research through a change in philosophical position and an increased emphasis on community engagement. We argue that a balanced combination of these research approaches is needed to inform evidence-based practice, social action, and effective policy change to improve health in disparity communities. THE FIELD OF HEALTH DISPAR ities science has reached an important crossroad with the need for a paradigm shift. Progress in research to reduce the health disparities gap that exists for racial and ethnic minorities, rural, and low socioeconomic populations has been slow despite significant recent advances in science. But today, high throughput technologies for translational research and the application of genomic and molecular data to facilitate the discovery of new therapies is beginning to offer promise for disparity-reduction efforts. 1 The field of medicine has entered a revolutionary period that offers the unprecedented opportunity to identify risk of disease, based on precise molecular knowledge, and the chance to preempt disease conditions. As a result of the accelerated science discoveries and technological revolution, the potential for eliminating disparities is proliferating. The National Institutes of Health (NIH) is the primary federal agency for conducting and supporting biomedical research to improve health and save lives. In 1999, the NIH identified the reduction of socioeconomic and racial/ethnic disparities in health as a major priority for public health practice and research. 2 The establishment in law of the National Center on Minority Health and Health Disparities (NCMHD) in 2000 has provided a source of ongoing critical support for health disparities research and assures continuous, effective coordination of health disparities research programs across the NIH. 3 Public Law 106-525 gave the NCMHD grant funding authority and broadened its constituency base. Since then, the NIH has made profound changes in health disparities research, embracing approaches that are participatory and cross-disciplinary. Some aspects of these changes represent a deepening of the scientific knowledge process already in motion; other changes represent a growing shift in philosophical view of health disparities as a social justice issue with need for full social engagement. In the last 2 decades we have had an exponential increase in identifying broader determinants of health. 4 , 5 The current landscape of health disparities science includes an understanding of the complex associations between biological and nonbiological determinants of health. 6 – 8 Over the same time period, training and mentoring of new investigators to address health disparities has progressed, creating a larger, multidisciplinary workforce. 9 In his classic book, The Structure of Scientific Revolutions , Kuhn 10 explains that paradigm shifts occur when scientists encounter anomalies that cannot be explained by the universally accepted paradigm in which progress has been made. The paradigm shift, in his view, is not simply the current theory, but full engagement of the world in which the theory exists and features of the landscape of knowledge that scientists can identify around them. When enough significant anomalies have accrued within a current paradigm, the scientific discipline is thrown into a state of crisis , according to Kuhn, and the old ways of making sense of the world are no longer useful. We provide a model for such a paradigm shift through the balance and integration of translational, transformational, and transdisciplinary thematic research. We also attempt to conceptualize these 3 approaches as a guide for advancing the science of health disparities research through a change in philosophical position and community engagement. Translational, transformational, and transdisciplinary thinking are currently important dimensions of “paradigm-shifting” research. We argue that a balanced combination of these research approaches is needed to inform evidence-based practice, social action, and effective policy change to affect change and close the health disparity gap. Figure 1 represents the triad of translational, transformational, and transdisciplinary health disparities research. These 3 spheres of research are often separate and disparate. Sometimes there is overlap where the 2 spheres are linked and working together. There is the rare occasion when all 3 spheres of research are aligned and intersect. We call for an integrated approach for positive transformation in disparities research. Open in a separate window FIGURE 1 The intersections of translational, transformational and transdisciplinary research.
