At UMass Amherst, a commitment to health is embedded in all aspects of campus culture—a promise affirmed by UMass in signing the Okanagan Charter: An International Charter for Health Promoting Universities and Colleges.  

UMass faculty and students are putting this value into action through research that aims to improve health—for individuals, communities, and the planet. Furthermore, many UMass researchers are working to address persistent disparities in health outcomes across social groups, creating a more just and equitable society.

There is ample evidence that health and well-being are strongly influenced by social determinants—factors that include access to high-quality housing, education, safe neighborhoods, health care, and healthy foods and living environments. According to Aline Gubrium, professor and program head of community health education in the UMass Amherst School of Public Health & Health Sciences, “Biased public policy that limits access to advantageous social determinants of health have disadvantaged economically and socially marginalized populations for generations, resulting in immense disparities in health and mental health.” As a result, minoritized race and ethnicity, sexual orientation and gender identity, and disability status are all associated with health disparities.

Given the complex factors at play, outside-the-box thinking and innovative approaches are needed to address both longstanding and emerging areas of health and environmental inequities. With this in mind, UMass researchers from diverse disciplines are joining forces to come at these challenges from new angles, with financial support from UMass Amherst’s Large-scale Integrative Research Awards (LIRA) program. Read on to learn about some of the approaches they are taking to build a healthier and more equitable world. 

Uncovering Pathways to Health Disparities

While data shows a strong relationship between social vulnerability and diseases ranging from HIV and STIs to mental health, cardiovascular disease and diabetes to maternal morbidity and mortality, much less is known about the pathways leading to those disparities. A cross-disciplinary team of researchers led by Chaitra Gopalappa, associate professor of mechanical and industrial engineering in the UMass Amherst College of Engineering, seeks to shed light on the mechanisms at play. The team, which also includes collaborators Song Gao, professor of civil and environmental engineering, and Kalpana Poudel-Tandukar, professor in the Elaine Marieb College of Nursing at UMass, conducts both quantitative and qualitative research at the convergence of health, behavioral science, engineering, and artificial intelligence. Ultimately, they plan to develop computational decision support tools to guide the programs, policies, and infrastructure needed to help close these gaps and optimize public health. Ultimately, the researchers—supported by colleagues in schools and colleges across UMass—aim to make the frameworks developed scalable to diverse health outcomes and adaptable to meet the unique needs of different communities.

This approach would be a radical departure from the way disease prevention analysis currently works by considering synergies between diseases and social determinants. As an example, Gopalappa points to efforts to prevent the spread of COVID-19 during the pandemic. Public policy recommendations were guided by analyses that considered things like the optimal frequency of testing, social distancing rules, and business shutdowns or school closures.  

“But the other question we’d want to ask is: What is the probability that we get 100 percent adherence to the recommendations made—such as masking, weekly testing, or staying home from work? And if people do engage in so-called ‘risky behavior’ by not following the guidelines, why is that? Do they lack transportation to testing centers? Are they required to report to work in person to keep their jobs?” says Gopalappa. “We must consider the needs of and constraints on a given population to figure out what mix of guidelines and structural interventions will be most effective.”

“Our goal is really to move away from thinking about diseases as caused by risky behavior and think instead about the social determinants driving those risky behaviors, which we can address to prevent diseases before they occur,” she adds.  

In their approach, the UMass researchers are also considering the synergies between multiple health conditions. “We know there are biological interactions between diseases, such that having one disease makes a person more vulnerable to others,” says Gopalappa. “But we also know there are social determinants that drive behaviors putting individuals at risk for multiple diseases. So instead of looking at diseases in siloes, our interest is in identifying and addressing the social determinants driving those health risks through structural intervention programs.”

This approach will involve coordination of data and information across multiple datasets through collaborations with federal agencies like the Centers for Disease Control and Prevention (CDC) and the Department of Housing and Urban Development (HUD) that work to address social determinants of health, says Gopalappa. In addition, she says, data can only tell us so much. It’s critical to also engage community stakeholders—including health-care providers, organizations, and individual residents—early in the research process to understand their perspectives and the challenges they face.

Finally, a future public health system that approaches prevention and care holistically requires a skilled workforce adept at thinking and working across disciplines. Gopalappa’s team plans to engage students ranging from high school through graduate school in training opportunities.

The LIRA award would facilitate the planning and development of a research and educational plan to achieve these goals, for future submission of grant proposals for external funding. 

Engaging Communities to Address Inequities

Another team of researchers, based in the UMass Amherst School of Public Health & Health Sciences, is also focused on engaging communities to address social determinants that create health disparities.

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According to PI Susan Shaw, professor of community health education, all too often public health interventions focus on individual behavior and lifestyle modifications to close gaps in health outcomes.

“Addressing health equity requires removing obstacles for marginalized groups—including low-income people, minoritized people, and sexual and gender minorities,” she says. “Many of us who conduct health equity research believe the best way to do this is through community-based participatory research to create equitable partnerships.”

Shaw is the director of the Center for Community Health Equity Research (CCHER) at UMass Amherst. With community-based, participatory research, researchers involve community members and organizations as equal partners rather than “target populations” or passive recipients of interventions.  

“Community-based participatory research requires that research partnerships be based on community needs, grounded in understanding the community, and aligned with the mission and goals of the community partner organization,” Shaw explains. “This approach helps rebuild trust in communities that have often experienced extensive research but little investment and can help generate community-led solutions to achieve health equity.”

Now, with funding from a UMass LIRA grant, Shaw and collaborators plan to expand on CCHER’s work by developing a proposal for a National Institutes of Health-supported Center of Excellence in Investigator Development and Community Engagement. Shaw’s collaborators include Kathryn Derose, professor of community health education; Airín Martínez, associate professor of health policy and management; Daniel López-Cevallos, associate professor of community health education; and Linnea Evans, assistant professor of community health education.

The Center of Excellence would provide funding for pilot awards for new investigators—especially those from underrepresented groups—whose research focuses on health equity. The center would also offer hands-on training in participatory approaches; opportunities for individual and peer mentoring; a monthly seminar series and workshops featuring experts on health equity research topics; and opportunities for collaborative research on questions of interest to community members. Participants would learn about proposal development, participatory research approaches, broad dissemination of findings, and how to turn results into community-led action.

“We are excited to move CCHER to the next level, support diverse new investigators, and provide evidence that can guide policies to create a more just society,” says Shaw. 

Harnessing the Power of the Arts

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Another group of UMass Amherst researchers is working to catalyze existing energy and expertise on campus around using Arts-Based Research (ABR) to address inequities in health and the environment.

A fast-growing research methodology, ABR uses the systematic process of artmaking as a primary way of understanding and examining experiences—both of researchers and the people they involve in their studies, who are sometimes one and the same. Various forms of art may be used in collecting and analyzing data and in disseminating research.  

“Arts-based research is a powerful methodology because of its visceral nature, which aligns nicely with the goals of creating on-the-ground research, intervention, and action in health and environmental research,” explains Gubrium, who is leading the project. “Art also communicates sensibilities in ways that can’t always be conveyed through text or numbers. Art is also socially connecting. It channels joy and care.”

Moreover, by having research participants create art as part of the process, the researcher is centering participants’ viewpoints—flipping the traditional research approach on its head. “We want to empower participants to talk about their lives, what well-being means to them, and the challenges they face,” Gubrium says.  

The team includes Marla Miller, distinguished professor of history; Sally Pirie, professor of child and family studies and director of the CBR Lab; Elizabeth Krause, professor of anthropology; Sarah Goff, professor of health promotion and policy; and Sandy Litchfield, associate professor of architecture. They have individually conducted arts-based work on health and environmental topics ranging from reproductive justice, population politics, and LGBTQ+ youth mental health to aging and environmental humanities. Now they aim to nurture a network of faculty from around campus—including those in fields like engineering, chemistry, or veterinary sciences that may not, on their face, appear to lend themselves to ABR—to build community and generate ideas around arts-based approaches to research.

In the 2024–25 academic year, the team will host a zine-making workshop as well as a digital storytelling workshop to bring together potential affiliates and explore common interests. In the longer term, they intend to develop a center focused on harnessing the power of the arts to address health and environmental inequities.

Learn more about arts-based research at UMass in this story on the CBR Lab.