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U.S. Department of Health and Human Services


TB Challenge: Partnering to Eliminate TB
in African Americans

Understanding Culture:
Overcoming Health Disparities-An interview with George W. Roberts, Ph.D., Acting Associate Director for Prevention Partnerships, Division of HIV/AIDS

Michael Fraser, Public Health Advisor, DTBE/FSEB

Michael Fraser: Dr. Roberts, you have extensive training and expertise in the area of human behavior. What are some of the strategies you have employed over the years to understand and address health disparities in African Americans?

George Roberts: I think it is important to understand cultural influences on behavior as the basis for disease risks. I have been involved in that since coming to the agency (Centers for Disease Control and Prevention [CDC]), starting in the Office of the Associate Director for Minority Health, where I was responsible for identifying and articulating the meaning of culturally linked behaviors that could influence risks for a variety of diseases. My focus was on injury and particularly violence prevention; my focus was also on HIV, and a little on mental retardation and developmental disabilities in children. I also did some work on reproductive health, looking at low birth weight outcomes among African-American women. In all of those situations, what I did, at a time when there were not many behavioral scientists here at CDC 8 to 10 years ago, and certainly not many African Americans (maybe three in total) was bring to bear the social and psychological literature on behaviors like smoking, and drinking and diet. I began looking at the role of social factors as well as cultural factors. I distinguish social factors as those factors that involve the influence of the group, and then the larger social and societal environment, versus cultural factors, which are forces that form norms and beliefs that are associated with a particular ethnic group. So, we have to understand the history of particular ethnicities in relation to the society to better understand their actual cultural influences on behavior.

MF: So before one develops a strategy to address health disparities, we must understand cultural and social factors that influence behavior?

GR: Exactly.

MF: What are ways in which HIV and TB division staff can work together, pooling resources to increase the efficacy of their prevention programs, particularly in times when federal TB control funds have been level for the past 5 years?

GR: One thing that we need to do better is have focused policy discussions among senior staff in both divisions [DHAP and DTBE] to discuss the populations that are affected by both HIV and TB (we are talking about Native-American populations, some Asian populations, some Latino populations, particularly in the Southwest around the border, and African-American populations, in some rural areas especially and in some urban communities and correctional facilities) that are certainly experiencing comorbidities involving HIV infection and TB. So, we need more targeted discussions among policy makers. And then at the program level, we need to work together to identify some overlapping activities, certainly in the way of educating communities about the threat of both HIV infection and TB. I remember recently reading about some of your [DTBE's] efforts to educate communities and send out more health communications information. That's the kind of thing we need to be doing more of together and possibly our Office of Communications can help coordinate that.

MF: What are the steps that we can successfully and effectively use to impact African-American communities in closing the health disparities gap?

GR: By developing effective partnerships, engaging people in ways that make sense to them out of their cultural and social experiences. Also, having them inform our science and having our science inform them, so that there is a bidirectional process of exchanging information, knowledge, and technology. Also, doing a better job of communicating the meaning of health information, including data as well as research findings, so that they are meaningful to people. And then I think working with communities in ways such that we both mobilize our resources and bring resources to bear on mutual goals.


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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