A New InCHIP Grant Investigates Americans’ Perspectives on Health Equity By Beth Krane

A leading U.S. health foundation has enlisted an InCHIP expert to assist in its efforts to help build a national “culture of health.”

The Robert Wood Johnson Foundation approached UConn Associate Professor of Anthropology Sarah Willen to help broaden and strengthen its understanding of Americans’ perspectives on health equity and deservingness. The Foundation’s “culture of health” framework aims to promote health equity and cultivate a sense of health as a shared value.

Sara Willen, PhD (Anthropology)
Sara Willen, PhD (Anthropology)

With help, in part, from an InCHIP Rolling Seed Grant and advice from mentors at both InCHIP and CDC, Willen responded to the Foundation by building an interdisciplinary research team and advisory board, conducting a two-day planning workshop, and preparing a detailed proposal.

The Robert Wood Johnson Foundation awarded Willen and her research team a two-year grant to support a two-phase study, ARCHES (AmeRicans’ Conceptions of Health Equity), which launched last month. The team is beginning by conducting interviews in Cleveland, Ohio, with Americans from diverse socioeconomic, professional, and racial and ethnic backgrounds, and then will use those qualitative findings to develop and conduct a national survey. An additional study component is an ethnographic study of HIP-Cuyahoga, a regional health equity initiative based in Greater Cleveland.

Willen and her team plan to investigate “how Americans think about a question that plays a pivotal, but largely implicit, role in American public discourse about society’s obligations to its members – the question of ‘who deserves what in the health domain, and why,’” she said.

“Often we hear health researchers and folks in public health say things like, ‘Everyone deserves to live the healthiest life possible,’” Willen said. “That’s a bold statement, and we don’t know whether it’s supported by all Americans. In fact, it’s possible some see things quite differently. Our goal is to develop a better understanding of how people’s moral values and personal experiences influence their views and their actions.”

Willen’s focus on health-related deservingness emerged from her research on unauthorized migration and health in different countries, including Israel.

“Health researchers who work on international migration know full well that ideas about who is and who is not deserving of attention or investment vary considerably from one country to the next,” said Willen, who also directs the Research Program on Global Health and Human Rights at UConn’s Human Rights Institute. “Whether we are health officials, policymakers, voters, or researchers, our views are always influenced by moral values and commitments that tend to remain unspoken.”

“Now we want to open up these questions and pursue them more broadly here in the U.S.,” Willen said. “How do people think about what they themselves deserve in the health domain? How do people’s views and experiences influence their ideas about what others deserve? And, moreover, how might these ideas change over time?”

Willen said her group will examine how individuals’ positions on these issues might affect their health behaviors as well as their perspectives on health disparities, sense of social interconnectedness, and level of civic involvement.

Willen’s core research team includes co-investigators Colleen Walsh, an Assistant Professor of Health Sciences at Cleveland State University, and Abigail Fisher Williamson, an Assistant Professor of Political Science and Public Policy & Law at Trinity College, as well as UConn Anthropology PhD Candidate William Tootle, Jr. The project also involves research consultants from Brown University, Case Western Reserve University, Cleveland State University, Syracuse University, and University of South Florida.

The first study phase, in Cleveland, involves interviews with 140 people, including elected officials, public health professionals, community leaders, philanthropists, clergy, and local residents. Half of those interviewed will be active in HIP-Cuyahoga, and half will not. Researchers also will attend HIP-Cuyahoga meetings, observe its events, and track its public messaging.

Willen chose to conduct the study’s first phase in Cleveland because it is similar to many American cities, yet also exhibits some of the country’s greatest disparities in health outcomes by race/ethnicity and class, including indicators like infant mortality, childhood lead exposure, and life expectancy. And HIP-Cuyahoga presents a nationally-recognized model for responding to those health inequities.

The second phase of the study will test the team’s qualitative findings with a national survey of 3,000 Americans.

Willen said InCHIP Director Jeffrey Fisher, InCHIP Associate Director Amy Gorin, and InCHIP PI and Director of the Rudd Center for Food Policy and Obesity Marlene Schwartz, who has worked extensively with the Robert Wood Johnson Foundation, were all instrumental in helping her respond to the Foundation’s initial interest in her research.

In accepting the grant, Willen has committed to a host of deliverable products including academic papers and presentations, a case study and teaching module focusing on HIP-Cuyahoga, blog posts, and op-ed pieces for mainstream media.

“One of the most exciting things about working with RWJF is their challenge to consider the implications of our research from the outset, ” Willen said. “Not only do we need to produce rigorous findings, but we also need to think constantly about the bigger questions that researchers sometimes neglect: Why does this matter? Who should care about our findings, and how can we make our findings accessible to the right people, in the right way? How might our work change minds?”


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