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Agency-Wide Action Plan Due by June
Health Disparities Research Tops NIH Agenda

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.

NIH Responds

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.

All Aboard

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).

NIH acting deputy director Dr. Yvonne Maddox and NIAID director Dr. Anthony Fauci, who cochair the trans-NIH working group to develop a strategic plan on health disparities research, recently introduced the initiative to NIH's Council of Public Representatives.

"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.

Next Steps

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."

Getting the Message Out on Health Disparities

Student Symposium and Health Fair Scheduled, June 2-3

NIH will host a 2-day Student Symposium and Health Awareness Fair on June 2-3 to highlight the agency's commitment to closing health gaps in minority and underserved populations. Three key goals of the trans-NIH initiative, "Addressing Health Disparities: NIH Program of Action," are to reach targeted communities with disease prevention messages, to recruit minorities to participate in clinical trials, and to increase training and career development for minority scientists.

On June 2, 30 to 40 invited minority medical and dental students will meet with several NIH branch chiefs at the Fogarty International Center for briefings about the research process here. They will also take part in a grantsmanship workshop and tour campus labs and the Clinical Center.

The fair will be held on June 3 at the Natcher Center from 9 a.m. to 4 p.m. There, the medical and dental students will work side by side with NIH physicians and staff. They will encourage the estimated 500 middle school and high school attendees to consider careers in the health sciences. They will also answer questions about their personal medical school experiences.

"We made children ages 12 to 17 and their parents and teachers the target of the health fair because we believe there are childhood indicators of adult disease," said NIH acting deputy director Dr. Yvonne Maddox, who serves with NIAID director Dr. Anthony Fauci as cochair of the NIH-wide working group to develop the agency's strategic plan to attack health disparities. She has also served as deputy director of the National Institute of Child Health and Human Development since 1995. "We must begin early with youngsters, making them aware of disease prevention strategies," Maddox stated.

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