Pathways to Prevention (P2P) Program

Achieving Health Equity in Preventive Services


Funding Opportunities in Preventive Screening
Two recent Notices of Special Interest (NOT-OD-22-178 and NOT-OD-22-179) encourage research to increase evidence-based screening services in diverse populations and address evidence gaps in preventive screening.

Chronic diseases, such as heart disease, cancer, and diabetes are responsible for seven of every 10 deaths among Americans each year and account for 75% of the nation’s health spending.1 Many of these chronic conditions can be prevented, delayed, or caught and treated early when patients work closely with their primary care providers. Greater use of proven clinical preventive services in the United States could avert the loss of millions of life-years and result in cost savings for individuals and families.2

Evidence-based guidelines recommending certain preventive services are developed by the U.S. Preventive Services Task Force, the Community Preventive Services Task Force, and the Health Resources and Services Administration’s Bright Futures program to help all Americans stay healthy.3,4 Despite the proven value of preventive services such as various screenings, provider counseling, and preventive medications, implementation by providers and uptake by patients of these evidence-based practices varies.5 Demographic and geographic differences in the use of these services are significant and may contribute to disparities in disease burden and life expectancy.6,7,8


It has been well established that social determinants of health, including language barriers and culture, impact the acceptance and use of preventive services among minority populations and in people with low socioeconomic status. However, limitations in the available data, insufficient evidence, and research gaps present challenges to the science of developing recommendations to increase the use of preventive services among specific groups.9 More research is required to understand the root causes of disparities in the use of preventive services, and disparities in patient acceptance of preventive recommendations, and how barriers can be addressed through provider and community interventions. Additional areas for research include the role of health care systems to improve adoption and implementation of preventive services, and prospects for applying new technologies and communication innovations to close disparities gaps.

Workshop Goals

This P2P workshop assessed the available scientific evidence on achieving health equity in the use of clinical preventive services in a health care setting, focusing on three leading causes of death in the United States: cancer, heart disease, and diabetes. Specifically, 10 preventive services for adults were addressed during the workshop:

  • Abnormal blood glucose and type 2 diabetes mellitus screening
  • Aspirin use to prevent cardiovascular disease (CVD) and colorectal cancer: preventive medication
  • Behavioral counseling to promote healthful diet and physical activity for CVD prevention in adults with cardiovascular risk factors
  • Breast cancer screening
  • Cervical cancer screening
  • Colorectal cancer screening
  • High blood pressure screening
  • Lung cancer screening
  • Obesity screening and management
  • Tobacco smoking cessation in adults: behavioral and pharmacotherapy interventions.

The workshop also addressed the following questions:

  • What is the effect of impediments and barriers on the part of providers to the adoption, promotion, and implementation of evidence-based preventive services that contribute to disparities in preventive services? Which of them are most common?
  • What is the effect of impediments and barriers on the part of populations adversely affected by disparities to the adoption, promotion, and implementation of evidence-based preventive services that contribute to disparities in preventive services? Which of them are most common?
  • What is the effectiveness of different approaches and strategies between providers and patients that connect and integrate evidence-based preventive practices for reducing disparities in preventive services?
  • What is the effectiveness of health information technologies and digital enterprises to improve the adoption, implementation and dissemination of evidence-based preventive services in settings that serve populations adversely affected by disparities?
  • What is the effectiveness of interventions that health care organizations and systems implement to serve disparity populations to reduce disparities in preventive services use?

Sponsoring NIH Institutes, Centers, and Offices

The workshop was co-sponsored by:

Continuing education credits are not offered for this workshop.

  1. Centers for Disease Control and Prevention (CDC). Preventive Health Care. Accessed June 2019.
  2. Maciosek MV, Coffield AB, Flottemesch TJ, Edwards NM, Solberg LI. Greater use of preventive services in U.S. health care could save lives at little or no cost. Health Affairs. 2010;29(9):1656–1660.
  3. Fox JB, Shaw FE. Clinical Preventive Services Coverage and the Affordable Care Act. American Journal of Public Health. 2015;105(1):e7–e10.
  4. Seiler N, Malcarney MB, Horton K, Dafflitto S. Coverage of clinical preventive services under the Affordable Care Act: from law to access. Public Health Reports. 2014;129(6):526–532.
  5. Fox JB, Shaw FE. Receipt of Selected Clinical Preventive Services by Adults--United States, 2011-2012. MMWR. Morbidity and Mortality Weekly Report. 2015;64(27):738–742.
  6. Strickland J, Strickland DL. Barriers to preventive health services for minority households in the rural south. The Journal of Rural Health. 1996;12(3):206–217.
  7. Dwyer-Lindgren L, Bertozzi-Villa A, Stubbs RW, et al. Inequalities in life expectancy among us counties, 1980 to 2014: Temporal trends and key drivers. JAMA Internal Medicine. 2017;177(7):1003–1011.
  8. Okoro CA, Zhao G, Fox JB, Eke PI, Greenlund KJ, Town M. Surveillance for Health Care Access and Health Services Use, Adults Aged 18-64 Years—Behavioral Risk Factor Surveillance System, United States, 2014. MMWR. Morbidity and Mortality Weekly Report Surveillance Summaries. 2017;24;66(7):1–42.
  9. Bibbins-Domingo K, Whitlock E, Wolff T, et al. Developing recommendations for evidence-based clinical preventive services for diverse populations: methods of the U.S. Preventive Services Task Force. Annals of Internal Medicine. 2017;166(8):565–571.
Last updated on