Health is a human right. Equity in health implies that ideally everyone should have a fair opportunity to attain their full health potential and, more pragmatically, that no one should be disadvantaged from achieving this potential. Addressing the multi-faceted health needs of ethnically and culturally diverse individuals in the United States is a complex issue that requires inventive strategies to reduce risk factors and buttress protective factors to promote greater well-being among individuals, families, and communities. With growing diversity concerning various ethnicities and nationalities; and with significant changes in the constellation of multiple of risk factors that can influence health outcomes, it is imperative that we delineate strategic efforts that encourage better access to primary care, focused community-based programs, multi-disciplinary clinical and translational research methodologies, and health policy advocacy initiatives that may improve individuals’ longevity and quality of life.

Glenda Wrenn, MD, MSHP; Fatima Kasiah, MD; Allyson Belton, MPH; Sheena Dorvil, MPH; Kristin Roberts, MPH; Brian McGregor, PhD; Kisha Holden, PhD Pe

St. Lucia is an island nation in the Eastern Caribbean, with a population of 179,000 people, where chronic health conditions, such as hypertension and diabetes, are significant. The purpose of this pilot study is to create a model for community health education, tracking, and monitoring of these health conditions, research training, and policy interventions in St. Lucia, which may apply to other Caribbean populations, including those in the U.S. This paper reports on phase one of the study, which utilized a mixed method analytic approach. Adult clients at risk for, or diagnosed with, diabetes (n = 157), and health care providers/clinic administrators (n = 42), were recruited from five healthcare facilities in St. Lucia to assess their views on health status, health services, and improving health equity. Preliminary content analyses indicated that patients and providers acknowledge the relatively high prevalence of diabetes and other chronic illnesses, recognize the impact that socioeconomic status has on health outcomes, and desire improved access to healthcare and improvements to healthcare infrastructures. These findings could inform strategies, such as community education and workforce development, which may help improve health outcomes among St. Lucians with chronic health conditions, and inform similar efforts among other selected populations.

This chapter details an established community-based participatory research (CBPR) model designed to reduce risk for cardiovascular disease (CVD) and type 2 diabetes mellitus (DMII) among underserved and vulnerable African Americans through policy, systems, and environmental improvement in a Metropolitan Atlanta community. This model employed lessons learned over a fifteen-year collaboration led by a community-majority board and included a mixed-method community health needs assessment led by community residents. To move beyond mapping and documenting health disparities, the results were prioritized toward the identification of community- and evidence-based initiatives in response. Reducing the future burden of DMII and CVD depends on the success of both “top-down” national/state initiatives and “bottom-up” targeted CBPR approaches that bring together transdisciplinary teams that not only address health disparities but also employ policy, systems, and environment changes that advance health equity.