Agency-Wide Action Plan Due by June
By Carla Garnett
On the Front Page...
Some disturbing trends have surfaced in the nation's health: Rates for blindness due to glaucoma in African Americans are six times higher than the rates for whites. American Indians and Alaska Natives are nearly three times as likely as whites to have diagnosed diabetes; Hispanics and Latinos are almost twice as likely. African Americans and Native Americans show increased susceptibility to kidney complications of diabetes. Death rates from heart diseases are disproportionately high among blacks. Native Americans have a higher incidence of meningitis due to Haemophilus influenzae B. Stroke, a major health problem for the entire country, disproportionately affects minority citizens particularly African Americans. Sudden infant death syndrome is more prevalent in minority populations two and a half times more prevalent in blacks and three to five times more prevalent in Native Americans. In 1998, blacks were nearly 10 times more likely than whites to be diagnosed with AIDS.
In fact, certain sectors of the nation do not enjoy the same benefits of health and increased life expectancy that the majority of Americans do.
Recognizing these differences commonly called health disparities Secretary of Health and Human Services Donna Shalala launched a department-wide initiative to eliminate or reduce six specific health gaps by 2010. The six areas are cancer screening and management, infant mortality, HIV/AIDS, heart disease, diabetes and immunizations. The initiative, involving every agency in the department, also serves as the DHHS response to President Clinton's Race Initiative.
Last September, NIH director Dr. Harold Varmus answered the secretary's initiative by establishing an NIH-wide working group to develop a strategic plan for tackling health disparities; in January, NIH acting director Dr. Ruth Kirschstein elevated membership on the working group to IC director level, effectively putting the initiative on the fast track and giving it teeth.
"NIH has a central role in eliminating persistent health disparities through medical research, research training, and dissemination of scientifically sound medical information," Kirschstein said, in her opening statement to Congress earlier this year. In fiscal year 2001, NIH will allocate $20 million to establish a new Coordinating Center for Research on Health Disparities within the Office of the Director. In addition, a new trans-NIH working group will develop a strategic plan to eliminate or reduce health disparities among different segments of the American population. The plan will include goals, timetables and ways to track budgets and accomplishments.
Going beyond the six areas identified by the Secretary's initiative, NIH expects each institute to develop its own strategic plan for addressing disparity in the disease areas it studies. These individual plans will help determine the priorities and emphasis areas in the total NIH strategy.
NIH acting deputy director Dr. Yvonne Maddox and NIAID director Dr. Anthony Fauci, who now cochair the trans-NIH working group, recently introduced the initiative, "Addressing Health Disparities: NIH Program of Action," to the agency's Council of Public Representatives (COPR).
"Initially, NIH will focus on racial and ethnic minority populations including African Americans, Asians, Pacific Islanders, Hispanics and Latinos, Native Americans and Native Alaskans," said Maddox, who also represents NIH on the DHHS disparity initiative panel. "Additionally, research on health disparities related to socioeconomic status will be included."
The NIH initiative's goals are to develop a 5-year strategic research agenda encompassing all institutes, improve recruitment and training of minority investigators, expand outreach and communication efforts in target communities, form new partnerships with other federal and private organizations with similar interest in addressing health gaps, and get more minority participants into clinical trials.
Maddox said before the strategy can move forward, it will have to pass muster with NIH associate director for research on minority health Dr. John Ruffin and his advisory committee as well as Kirschstein. Several ICs have had their advisory councils review their individual plans; NIH will also confer on the plan with COPR members. Since Kirschstein put the initiative atop NIH's agenda in January, "individual institutes developed their plans and submitted them to working group cochairs in remarkable response time," Maddox reported.
"If you look carefully," Fauci explained, "virtually every disease that we study has a disparate nature particularly if we are talking about racial and ethnic populations. Now, that disparate nature may not always be something that we here at NIH can do research on. For instance, it may have to do with socioeconomic factors and other aspects. But there are things we can address from a research standpoint and from a research training standpoint. That is what the charge to the individual institutes was. It goes way beyond saying, 'This disease has a health disparity. We are studying this disease, so therefore, we are studying health disparities.' It is much deeper than that."
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