NIH Perspectives
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Transcript NIH Perspectives
Research and Prevention:
Closing the Chronic Disease Gap in
Minority Populations
NIH Perspectives
Lawrence A. Tabak, DDS, PhD
Principal Deputy Director, NIH
Department of Health and Human Services
Closing the Gap:
The View from NIH
Health Disparities Research
Minority Populations in Clinical Research
Diversity of the Biomedical Workforce
Closing the Gap:
The View from NIH
Health Disparities Research
Minority Populations in Clinical Research
Diversity of the Biomedical Workforce
Health Disparities Research: The Plans
HHS Health
Disparities Action
Plan
NIH Health
Disparities Strategic
Plan and Budget
HHS Disparities Action Plan
Goals, 2010–2015
Transform health care
Strengthen the nation’s Health and Human
Services infrastructure and workforce
Advance the health, safety, and well-being of the
American people
Advance scientific knowledge and innovation
Increase the efficiency, transparency, and
accountability of HHS programs
NIH Health Disparities Strategic Plan
Establishes principles for NIH’s health disparities agenda
Outlines projects to address minority health and health disparities within
each NIH Institute and Center, NIH Office of the Director
Sets three major goals for each NIH IC:
1. Conduct and support intensive research on factors underlying
health disparities
2. Engage in aggressive, proactive, community outreach, information
dissemination, and public health education
3. Expand and enhance research capacity to create a culturally
sensitive and culturally competent workforce
NIH’s Health Disparities Research: Objectives
Advance understanding of the development and progression of
diseases and disabilities that contribute to health disparities
among racial and ethnic minority, low-income, rural, and
medically underserved populations
Develop new or improved approaches for detecting, diagnosing,
preventing, delaying, or treating the onset or progression of
diseases and disabilities that contribute to health disparities
Advance understanding of the causes of health disparities, e.g.,
non-biological bases of disease incidence and progression
Research on Factors Underlying Health
Disparities
Areas of Emphasis
Clinical and Translational Research
Comparative Effectiveness Research
Social Determinants of Health
Health Services Research
Innovative Health Technologies
Genetics and Biological Factors
Behavioral and Social Sciences
NIH Research on Prematurity and Health
Disparities
U.S. rate of preterm births is >12%, far
higher than many other developed nations
In 2009, 13.9% of Black infants were low
birthweight, compared to 7.2% of White infants
NIH’s Maternal Fetal Medicine Units Network
14 clinical research centers
Research includes identifying factors associated with disparities in
quality of obstetric care/outcomes
Significant findings to date:
Weekly progesterone injections for women with previous preterm
delivery reduces risk of preterm birth
Magnesium sulfate before preterm birth provides neuroprotection
Racial Disparities in Cardiovascular
Disease (CVD)
Morehouse and Emory Team up to Eliminate Health
Disparities (META-Health) study
African Americans experience a higher burden of
CVD, while classification schema may
underestimate CVD risk
Study Findings:
African Americans have higher levels of oxidative
stress than whites (even after adjustment for
differences in risk factors)
Racial differences in oxidative stress may play a
key role in racial disparities in CVD
Metab Syndr Relat Disord. 2012 Mar 2. [Epub ahead of print]
Colorectal Cancer Disparities
Observation: Black men and women have higher
incidence and mortality rates compared to white
men and women
Study Design:
Screening sigmoidoscopy offered to study
participants
Subjects with polyps or lesions were referred to
personal physician for follow-up colonoscopy
(cost not covered by the study)
Laiyemo et al, “Race and Colorectal Cancer Disparities: Health-Care Utilization vs Different Cancer Susceptibilities” JNCI 2010
Colorectal Cancer Disparities: Study
Points to Healthcare Utilization Rates
Study Findings:
Blacks and whites equally likely
to need follow-up colonoscopy
after a screening sigmoidoscopy
Blacks less likely to receive the
follow-up colonoscopy
No statistically significant
difference in the risk of colorectal
cancer by race based on
colonoscopy results
Closing the Gap:
The View from NIH
Health Disparities Research
Minority Populations in Clinical Research
Diversity of the Biomedical Workforce
Conclusions: We found very small differences in the
willingness of minorities, most of whom were
African-Americans and Hispanics in the US, to
participate in health research compared to nonHispanic whites. These findings, based on the
research enrollment decisions of over 70,000
individuals, the vast majority from the US, suggest
that racial and ethnic minorities in the US are as
willing as non-Hispanic whites to participate in health
research. Hence, efforts to increase minority
participation in health research should focus on
ensuring access to health research for all groups,
rather than changing minority attitudes.
PLoS Med 3(2): e19. doi:10.1371/journal.pmed.0030019, 2005
Minority Enrollment in NIH Domestic Clinical
Research
Closing the Gap:
The View from NIH
Health Disparities Research
Minority Populations in Clinical Research
Diversity of the Biomedical Workforce
Diversity of the NIH-Funded Research
Workforce
Hispanic or Latino (of any race)
White
American Indian and Alaska Native
Native Hawaiian and other Pacific Islander
Other, unknown, not reported and more
than one race
Asian
Black or African American
2010 US Census
Bureau Report
2010 NIH Principal
Investigators on RPGs
Sources: US Census Report 2010; IMPACII; AAMC
Greater Diversity in Research Workforce
African Americans, Hispanics, and Native
Americans:
Represent 31% of U.S. college age population but only
account for 14% of undergraduates in life sciences
And even fewer in later stages
Greater Diversity in Research Workforce:
NIH Needs to Do More
Greater Diversity in Research Workforce
NIH’s Plan for Action:
Evaluate current training programs
Phase out unsuccessful programs, expand
successful ones
Increase number of early career reviewers,
including those from underrepresented
populations
Examine grant review process for bias and
develop interventions
Improve support for grant applicants
Gather expert advice on additional action steps
ACD Working Group on Diversity in the
Biomedical Research Workforce
Reed Tuckson, M.D., co-chair
UnitedHealth Group
John Ruffin, Ph.D., co-chair
NIH
Lawrence Tabak, D.D.S., Ph.D., co-chair
NIH
Ann Bonham, Ph.D.
AAMC
Jordan Cohen, M.D.
AAMC
José Florez, M.D., Ph.D.
Harvard Medical School
Gary Gibbons, M.D.
Morehouse School of Medicine
Renee Jenkins, M.D.
Howard University
Tuajuanda Jordan, Ph.D.
Lewis and Clark College
Wayne Riley, M.D., M.P.H., M.B.A.
Meharry Medical College
Samuel Silverstein, M.D.
Columbia University Medical Center
Dana Yasu Takagi, Ph.D.
University of California, Santa Cruz
Maria Teresa Velez, Ph.D.
University of Arizona
M. Roy Wilson, M.D., M.S.
NIH
Keith Yamamoto, Ph.D.
University of California, San Francisco
Clyde Yancy, M.D.
Northwestern University
[email protected]
NIH
Turning Discovery into Health