CAIRHE mapThe locations of CAIRHE's research and engagement efforts continue to expand across Montana. (Map by Kristen Drumheller)


“Health disparities are real.

The evidence base is large and irrefutable. As such, the time is now to shift the research emphasis away from solely documenting the pervasiveness of the health disparities problem and begin focusing on health equity, the highest level of health possible. The focus on health equity research will require investigators to propose projects that develop and evaluate evidence-based solutions to health differences that are driven largely by social, economic, and environmental factors.”

Shobha Srinivasan, Ph.D., and Shanita D. Williams, Ph.D., MPH, APRN
"Transitioning from Health Disparities to a Health Equity Research Agenda: The Time Is Now"
Public Health Reports, Jan.-Feb. 2014; 129 (Suppl 2): 71–76.

Based at Montana State University, the Center for American Indian and Rural Health Equity (CAIRHE) (“Care”) is an official state of Montana research center designated by the Montana University System Board of Regents.

healthy communities

CAIRHE's mission is to reduce significant health disparities in Native and rural communities through community-based participatory research (CBPR) that is considerate of and consistent with their cultural beliefs. CAIRHE serves the people of Montana as a robust, interdisciplinary research center with strong engagement in communities across the state (see map above). Using proven CBPR methods, the Center and its investigators conduct groundbreaking health equity research and interventions that make a profound, sustainable difference in the lives of Montanans. CAIRHE also maintains a growing statewide and national network of research partners, the Health Equity Network, including clinical organizations, public health agencies, foundations, and other centers, as a way to expand collaboration and dissemination of positive research outcomes.

Montana is a profoundly rural state in the most sparsely populated region of the United States. More than 34 percent of Montana’s residents live in rural areas, the highest percentage of any state, and Montana and its neighboring states (Idaho, Wyoming, South Dakota, and North Dakota) have 5 of the 7 lowest population densities in the United States. Rural risk factors for health disparities in Montana include geographic isolation, fewer health care providers, higher rates of health risk behaviors (such as binge drinking, driving under the influence, and unhealthy diets), lower socioeconomic status, and limited employment opportunities. According to the Montana Department of Public Health & Human Services, residents of rural Montana counties have higher mortality rates for 6 of the 10 leading causes of death, including heart disease, diabetes, and chronic liver disease and cirrhosis, compared to residents of more urban counties. Disparities among Native communities are even more stark. American Indians in Montana have higher rates of death for all 10 leading causes compared to non-Native residents.

CAIRHE is working hard to reverse these trends. Building on recent achievements, CAIRHE will continue to serve as the catalyst for original and innovative multidisciplinary research and community collaborations that will have significant impact on health equity in our underserved region.


About CAIRHE Director and Principal Investigator Alexandra Adams, M.D., Ph.D.

Alex Adams photoAlex Adams is Director and PI of the Center for American Indian and Rural Health Equity (CAIRHE), a position she has held since 2016. Previously she was the founding director of the Collaborative Center for Health Equity, an NIH P60 center at the University of Wisconsin (UW) School of Medicine and Public Health. The foundation for all of her leadership and research has been community-based participatory research (CBPR), working in partnership with communities to understand and solve health challenges using both scientific rigor and crucial community knowledge. She has directed multiple clinical trials, including the Healthy Children Strong Families 2 trial in five Native communities nationally, and has more than 60 peer-reviewed publications. She has held K23, U01, R01, P60, and P20 funding from the NIH, as well as more than $10 million in foundation funding. Her mentoring experience includes launching the UW Health Equity Leadership Institute, now in its second decade. This highly successful leadership institute has trained more than 125 under-represented junior faculty and others working in communities in leadership and career advancement, NIH grant writing, CBPR, and health equity research. Many of the HELI scholars are now tenured with independent NIH or other federal funding. She has mentored four T32 postdoctoral scholars and more than 35 undergraduate, MPH, medical, and graduate students. All of her T32 mentees have gone on to faculty positions and are doing community-partnered work. In addition, she has mentored more than 20 UW and MSU junior faculty in CBPR, career advancement, and NIH grant writing. In October 2021, Dr. Adams was elected to membership in the National Academy of Medicine.

CAIRHE is supported by a Centers of Biomedical Research Excellence (COBRE) award from the National Institute of General Medical Sciences of the National Institutes of Health (grant number P20GM104417). CAIRHE was formerly known as the Center for Health Equity in Rural Montana (CHERM), founded in 2014.