By Eliseo J. Pérez-Stable, M.D.
At the one-year anniversary of my appointment as director of NIMHD, I’m excited to welcome you to our new blog, NIMHD Insights.
NIMHD leads scientific research in two distinct but overlapping areas: minority health and health disparities. But first of all, what do these terms mean?
Minority health concerns the health of the five U.S. racial and ethnic minorities who have historically faced discrimination and social disadvantage. These groups are defined by the U.S. Census and include African Americans/Blacks, Latinos/Hispanics, Asians, American Indians/Alaska Natives, and Native Hawaiians/other Pacific Islanders. All of these populations are usually not included as participants of all types of biomedical research and most are also underrepresented as members of the scientific workforce. At NIMHD, we are committed to addressing health issues within each of the minority groups independent of whether the outcome is worse, better or similar to that of the White comparison group. We value research that emphasizes mechanisms by which health differs within these race/ethnic groups, as well as comparisons to each other and Whites.
Health disparities are differences in health outcomes that negatively affect racial and ethnic minorities, persons of less privileged socioeconomic status, and underserved rural populations. All of these persons have historically been subjected to system and individual discrimination that results in social disadvantage and leads to worse health outcomes. NIMHD is focusing on outcomes that reflect a higher incidence/prevalence of diseases, higher or premature mortality from specific causes, a higher burden of illness as reflected by global measures such as disability-adjusted life years (DALYs) and worse results on standardized measures of function, well-being or symptoms. NIMHD postulates that the mechanisms that lead to these health disparities have determinants in the behavioral, biological, social, environmental, and clinical health care system that results in these worse outcomes. Understanding these mechanisms is precisely what will lead to development of interventions to reduce health disparities.
Although social disadvantage is at the core of factors that result in health disparities, it is not the only cause. Behavior and lifestyle affect individual and social outcomes especially in interactions with the biological factors of each person. For example, stress associated with early life adverse events may trigger biological mechanisms that may lead to chronic diseases in adults and this has great implications of how we attend to the health of children. Known carcinogen exposure such as tobacco smoke has an increased risk of causing lung cancer in some populations by race/ethnic category and may help us understand different factors that cause cancer, which would not be possible if only one race/ethnic group was included. Poor persons living in one urban environment appear to live an average of four years more than poor people in a different urban environment and this emphasizes the importance of place and systems in the wellbeing of the most vulnerable members of society. Treatment outcomes for persons with diabetes varies by socioeconomic status, race/ethnicity, and health literacy; interventions need to be attentive to these differences. Understanding the factors that explain these observations will advance our knowledge of minority health and health disparities. Health disparities research seeks to understand the causes and effects of these differences and to use this knowledge to determine the best approaches to improve health outcomes in affected populations.
NIMHD shares and interprets minority health and health disparities research findings, fosters innovative collaborations and partnerships, spearheads NIH’s efforts to increase the racial and ethnic diversity of the scientific workforce, and promotes the inclusion of minorities in clinical trials and registries. “Inclusion” of minorities in and of itself is not an issue of minority health or health disparities. Rather, it is an issue of social justice and good science that clinical studies need to have diverse populations that represent today’s American demographics.
This blog will feature posts by me and NIMHD research and program staff, along with guest contributors from within and outside NIH who represent the many disciplines that contribute to minority health and health disparities. Topics will look at the Institute’s research priorities and programs, scientific discoveries, and research policies and practices that impact program operations, among other related areas.
I look forward to engaging with you to share new insights and raise intriguing questions that encourage scientific discussion as we work to build an America in which all populations will have an equal opportunity to live long, healthy, productive lives.