Transcript Research towards the elimination of health disparities

Research Towards the
Elimination of Health
Disparities
Yvonne T. Maddox, Ph.D.
Deputy Director
National Institute of Child Health and
Human Development
National Institutes of Health
“Advances in scientific knowledge have provided
the foundation for improvements in public health
and have led to enhanced health and quality of life
for all Americans. Much of this can be attributed to
the groundbreaking work carried on by, and funded
by, the National Institutes of Health (NIH).”
Tommy G. Thompson
Secretary
Department of Health and Human
Services
The National Institutes of Health
NIH Mission
To improve the health of the
Nation through Biomedical
Research and Research
Training
Differences in Health
Status
Advancing Clinical Research
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Delaying the onset of Alzheimer’s Disease
Improving treatment for Parkinson’s Disease
Conquering diabetes
Improving treatments for spinal cord injury
Making AIDS treatment safer, easier and
better
Improving outcome for cancer and heart
disease patients
Changing Profile of the Nation
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Life Expectancy
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Racial Breakdown of Population
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Social Economic Status
Racial breakdown of population
Child Poverty: Percentage of related children
under 18 living below selected poverty levels by
race (all families)
*Persons of Hispanic origin may be of any race.
Source: America’s Children: Key National Indicators of Well-Being 2000
Cancer
Death rate from stomach
cancer is substantially
higher among Asian and
Pacific Islanders,
including Native
Hawaiians, than among
other populations.
Diabetes
Native Americans, Hispanics, African
Americans, and some Asian Americans
and Pacific Islanders, including Japanese
Americans, Samoans, and Native
Hawaiians, are at particularly high risk
for development of type 2 diabetes.
Diabetes
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African-Americans are 1.7 times more
likely to have diabetes than whites
 Hispanics/Latinos are twice as likely to
have diabetes than whites
 Diabetes has reached epidemic proportions
among Native Americans, among the Pimas
of Arizona, prevalence is 50%
Source: American Diabetes Association
Asthma
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Asthma is 26 percent more prevalent in AfricanAmerican children than in white children
 Among 5 to 24 year olds, African-Americans are 4
to 6 times more likely to die from asthma than
whites
 The hospital discharge rate for asthma is 3.7 times
higher for African-Americans than for whites
Source: CDC, American Lung Association
Growing Mortality Disparity for
American Indians Compared to U.S.
All Races 1994-1996 Rates
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Pneumonia and influenza – 71% greater
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Homicide – 63% greater
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Gastrointestinal disease – 42% greater
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Infant mortality – 22% greater
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Heart disease – 13% greater
Growing Mortality Disparity for
American Indians Compared to U.S.
All Races 1994-1996 Rates
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Alcoholism - 627% greater
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Tuberculosis – 533% greater
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Diabetes – 250% greater
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Injuries – 230% greater
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Suicide – 72% greater
DHHS Initiative to Eliminate Racial
and Ethnic Disparities in Health
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Infant Mortality
 Cancer Management
 Cardiovascular Disease
 Diabetes
 HIV/AIDS
 Immunizations
Historical Perspective
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DHHS Response to the President’s Race
Initiative
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“Eliminating Racial and Ethnic Disparities
in Health in six areas by the year 2010
(Infant Mortality, Cancer Screening and
Management, Cardiovascular Disease,
Diabetes, HIV/AIDS, and Immunizations”
Definition of Health Disparities
“Differences in the incidence, prevalence,
mortality, and burden of diseases and
other adverse health conditions that exist
among specific population groups in the
United States”
First NIH Working
Group on Health
Disparities
Focus of the Initiative
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Initially, NIH will focus on racial/ethnic
minority populations (AfricanAmericans, Asians, Pacific Islanders,
Hispanics and Latinos, Native
Americans, and Native Alaskans)
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Research on health disparities related to
socioeconomic status is also included in
the definition.
Trans-NIH Initiative:
Addressing Health
Disparities
NIH Plan of Action (Goals)
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Develop a Five-Year Strategic Research
Agenda
 Recruit and Train Minority Investigators
 Advance Community Outreach Activities
 Form Partnerships
 Define, Code, Track, Analyze, and
Evaluate Progress
 Enhance Public Awareness
Research Objectives (1)
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Advance the understanding of the
development of diseases and disabilities
that contribute to health disparities
- Epidemiology and Risk Factors
- Environment/Socioeconomic Status
- Mechanisms of Disease
- Genetic Variation
Research Objectives (2)
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Develop new or improved approaches for
detecting or diagnosing the onset or progression
of disease and disabilities that contribute to
health disparities
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Develop new or improved approaches for
preventing or delaying the onset or progression
of disease or disabilities that contribute to
health disparities
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Develop new or improved approaches for
treating diseases and disabilities that contribute
to health disparities
Research Infrastructure
Objectives
 Support
research training and
career development
 Provide
support for institutional
resources
Public Information,
Outreach, and Education
 Develop
research-based information
resources
 Communicate
research-based
information to increase public
awareness
 Transfer knowledge
providers
to health care
NICHD Plan to Eliminate Health Disparities
Provisions That the
Projects are of Benefit
to the Community
Infant Mortality Rate
(By Race and Hispanic Origin, Selected Years 1983-99)
Sudden Infant Death Syndrome
(SIDS)
Leading Causes of Infant Mortality – 1992
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Congenital anomalies (21%)
 Sudden Infant Death Syndrome ( 15%)
 Low birth weight (11%)
 Respiratory Distress Syndrome (7%)
 Maternal complications (4%)
Theories of SIDS Cause circa
•Bacterial sepsis
•Viral infection
•Status thymicolymphaticus (with
venous or atrial compression)
•Bronchospasm Adrenal
Insufficiency
•Chromaffin deficiency
•Maternal “overlay”
•Mechanical suffocation
•Gastric aspiration
•Vagal reflex, etc.
•Poisoning
•Hypogammaglobulinemia
•Inborn error of
metabolism
•Mucous obstruction of trachea
•Hypocalcemia with laryngospasm
•Cardiac arrhythmia
•Hypersensitivity
•Parathyroid insufficiency
•Anaphylactic shock
•Endotoxemia
Impact of the
Back to Sleep
Campaign
A public-private
partnership to
reduce the risk of
Sudden Infant
Death Syndrome.
BACK TO SLEEP CAMPAIGN LAUNCHED
NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT
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Launch of Back to Sleep Campaign
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Press conference, June 1994, Surgeon General
BTS Campaign Partners
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American Academy of Pediatrics
SIDS Alliance
Association of SIDS and Infant Mortality Programs
National Heart, Lung, and Blood Institute, NIH
Maternal and Child Health Bureau, HRSA
Campaign Components
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Media Materials
(radio, TV, print)
Video
Posters
Crib Stickers
Magnets
SIDS Rate and Sleep Position, 1985-2000
(Deaths per 1,000 Live Births)
100
1.3
1.3
SIDS Rate
1.2 1.17
1.03
1
70
74
78
81
85
85
54 0.87
0.74 0.77 0.72
39
0.67
0.62
50
28
0.5
0
0
1985
86
87
88
89
90
Pre-AAP recommendation
91
92
93
94
Post-AAP
Year
Sleep Position Source: NICHD Household Survey
SIDS Rate Source: National Center for Health Statistics, CDC
95
96
97
98
99
BTS Campaign
2000
Percent Back and Side Sleeping
1.5 1.41 1.41
1.37 1.4 1.39
Sudden Infant Death Syndrome
(SIDS)
Leading Causes of Infant Mortality
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Congenital anomalies
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Short gestation/low-birth weight
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Sudden Infant Death Syndrome
SIDS Rates, United States
Deaths per 1,000 live births
3
2.5
2.38
2.4
2.31
2.33
2.19
2.18
1.94
2
1.79
1.65
1.53
1.5
1.4
1.39
1.38
1.3
1
1.32
0.67
0.62
0.53
0.5
1.3
1.2
1.22
1.35
1.17
1.03
1.18
1.11
1.1
0.87
1
0.78
0.97
0.77
0.72
0.85
0.71
0.5
0.63
0.64
0.58
0
1988
1989
1990
1991
1992
1993
Source: National Center for Health Statistics, CDC
Final Data, 2000
1994
1995
1996
1997
Total
1998
White
1999
2000
Black
Back to Sleep
Focus on African American
Communities
 SIDS rate is 2.2 times higher in the black
population than it is in the white population
 Black mothers are twice as likely as white mothers
to place their babies on their stomachs to sleep
 Success of the Back to Sleep campaign
demonstrates that a focused campaign can increase
back sleeping and reduce the risk of SIDS
Reducing SIDS in
African American Communities
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Institute makes
strong commitment
to eliminating
disparity in rates of
SIDS between white
and minority
populations
NICHD’s SIDS Strategic Plan
Newest Campaign Literature
Implementing the Outreach
D.C. Metro Bus Ad
Community Participation
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Campaign strategies targeted to the particular
minority group “ Input from the people”
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Provide the resource materials for health
fairs and community events
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Give progress reports on results
The NIH Health
Disparities Research Plan:
Where Do We Go
From Here?
National Center on Minority Health
and Health Disparities (NCMHD)
• Congress Established December, 2000 as
part of the National Institutes of Health
(NIH)
• Has Research and Research Training
Grant Authority
• Special Research and Research Training
Opportunities
Strategies to Eliminate Health
Disparities
• Communicate evidenced-based results
• Increase access to care for low income and
minority populations
• Improve quality and outcomes in the health
care system
• Develop preventive approaches at the
community level
• Build a knowledge base to understand the
connection between SES, race, prevention, and
health
Cultural Competency
• What is it?
• Establishing and Promoting
Cultural Education Curricula
• Creating a Health Delivery Process
that Supports an Environment for
its Culturally Diverse Clients
“…. we're taking prevention directly to
the people of America. Throughout this
year, we're going to give Americans the
tools, help and encouragement to live
healthier …. we're raising the profile of
prevention.”
TOMMY G. THOMPSON
SECRETARY
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
http://healthdisparities.nih.gov/