ADMINISTRATIVE CORE

尽管美国实施了几十年的项目和政策来消除不公平的健康差异，但仍然存在

Despite decades of programs and policies to eliminate unjust health differences in the US, there remain significant disparities in health status among racial and ethnic minority populations. Among the leading causes of morbidity and mortality, cardiometabolic disorders such as heart disease, diabetes and obesity, remains a complex and pervasive problem that is strongly associated with lifestyle behaviors, environmental influences and socioeconomic factors.(1-3) Among minority populations such as Native Hawaiians, Pacific Islanders, and other high-risk populations, this context poses both challenges and opportunities for confronting cardiometabolic health disparities and reversing these trends. Recently there has been a growing movement towards participatory research as a means to build trust and to disseminate evidence based treatments into clinical practice. The rapidly evolving concept of participatory research, often referred to as community based participatory research (CBPR) is gaining momentum as an important feature of public funded health sciences research.(4-6) However, the degree of involvement of community partners varies considerably and the concepts of what CBPR is and how it relates to the research enterprise remains fluid and continually evolving.(7) In our Center for Native and Pacific Health Disparities Research (CNPHDR), we have worked collaboratively with many grassroots community organizations and have developed guidelines and processes that have worked well to advance the scientific agenda while sustaining and building trust in our multiple partnerships.(8, 9) Our 9 years of experience in the Center has resulted in a broad array of contexts in which our community partners are involved to varying degrees.(10) For example, our general approach to working with communities for the first time is to allow the community to first identify the level of involvement they are willing and able to participate in. A discussion ensues about the specifics of a research project as it relates to both parties weighing the benefit and burden of working together to conduct scientific research. In other words, it is the community organization that decides how they want to be involved and it is the responsibility of the PI to discuss with the community whether that role/involvement is consistent with the aims and purpose of the research study. In general, our Center has effectively used this process of relationship building and discussion over the last 9+ years and it has been very valuable in working openly with our community partners in Center-related research projects. In fact, a rich resource for how to adapt this approach has been described in a handbook authored by two of our community partners.(11) Yet, there remain research studies undertaken today by investigators in which there is a lack of awareness or willingness to include community members as active participants of the research enterprise rather than just subjects within research studies.(12, 13) Criticisms of CBPR as a valid approach to solving some of the most persistent health disparity problems remain unresolved. However, the field of CBPR and its application to health disparities research remains a viable approach with potential for not only advancing scientific discovery but also for the translation of science to benefit the public's health, which is one of the long term goals of NIH funded research.