Author: jberry

For the First Time, Healthy People Initiative Focuses on Social Determinants of Health

By Nancy Breen, Ph.D.
Economist, Office of Strategic Planning, Analysis and Reporting, NIMHD and NIMHD Representative to the Healthy People Social Determinants of Health Workgroup

Healthy People Background

The Healthy People initiative is a federal program that provides “science-based, 10-year national objectives for improving the health of all Americans.” For the past 40 years, Healthy People has monitored the health of Americans and set benchmarks for how we can all be healthier. You can read more about Healthy People online at www.healthypeople.gov.

Nancy Breen, Ph.D.

Nancy Breen, Ph.D.

Healthy People provides a national 10-year framework for health promotion and disease prevention, with measurable objectives and goals, and it invites states and localities to use the national framework and objectives for their own plans. While the focus has always been health promotion and disease prevention, the Healthy People 2020 agenda is the first to use social determinants of health (SDOH) to frame the conceptual understanding of health. For 2000, an overarching goal to “reduce health disparities” was introduced, partly in response to the 1985 Report of the Secretary’s Task Force Report on Black and Minority Health (often referred to as the “Heckler Report”).1 For 2010, that goal was strengthened to “eliminate health disparities.” For Healthy People 2020, one of the overarching goals is to “achieve health equity, eliminate disparities, and improve the health of all groups.”2 The graphic from Healthy People 2020 shows that the overarching goals emphasize the determinants of health.

The mission of Healthy People 2020 includes identifying health improvement priorities; increasing public understanding of the determinants of health, disease, and disability; and engaging multiple sectors to identify opportunities for progress. Including health disparities in this framework improves the chances that federal interventions will be able to reduce health disparities and increase health equity for all Americans. The choice to highlight social determinants as a leading health indicator (LHI) is important, because LHIs are used to motivate action on high-priority health issues and challenges at the national, state, and community levels.3

One of the Healthy People initiative’s key roles is to identify research, evaluation, and data needs. The National Center for Health Statistics conducts two assessments for each 10-year initiative. These midcourse and final reviews provide an opportunity to see the initiative’s impact along the way. The 5-year review for Healthy People 2020 was released in January 2017 and can be found on the CDC website, at https://www.cdc.gov/nchs/healthy_people/hp2020/hp2020_midcourse_review.htm.

Healthy People 2020 Framework

Healthy People 2020 Framework. Graphic from www.healthypeople.gov.

Chapter 39 of the Midcourse Review focuses on SDOH, and some of the most important findings are described below. Healthy People 2020 defines SDOH as “conditions and the environment in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”4 The 33 SDOH objectives are organized into five domains:

  1. Economic stability (9 objectives)
  2. Education (5 objectives)
  3. Health and healthcare (6 objectives)
  4. Neighborhood and built environment (10 objectives)
  5. Social and community context (3 objectives)

Highlights from the Midcourse Review

Economic Stability

How much money people spend on housing can have a meaningful impact on their well-being. Economic experts recommend that families spend no more than one third of their income on housing, so that adequate funds are available for other expenditures. Studies show that spending more than half of a family’s income on housing puts householders at high risk of losing their home. The Midcourse Review shows that more people are being affected on both measures, suggesting that, overall, Americans are not doing as well in terms of economic stability as they were 5 years before.

  • From 2007 to 2011, the proportion of households that spent more than 30 percent of their income on housing rose from 35 percent to 38 percent; in 2011, Hispanics/Latinos were the racial/ethnic group most at risk. Householders with less than a high school education, with low family income, with a disability, or who lived in metropolitan areas were also at higher risk.
  • From 2007 to 2011, the proportion of households that spent more than half of their income on housing increased from 16 percent to 18 percent. Householders who were African American had less than a high school education, were poor, or lived in nonmetropolitan areas were at higher risk.

Education

Today, having a college education is important for getting a job and staying employed. The Midcourse Review showed that, unfortunately, the percentage of young people going to college after completing high school is lower than it was a few years ago.

  • Individuals ages 16–24 who had completed high school and enrolled in college the following October decreased from 68 percent to 66 percent between 2010 and 2013. High school completers from low-income families were less likely than completers from high-income families to enroll in college right after high school graduation.

Health and Healthcare

Having health insurance is an important part of making sure that people can afford access to an ongoing source of healthcare when they get sick. The Midcourse Review showed that more people under the age of 65 have insurance now than they did in 2007 and that people of all ages are more likely to have a source of ongoing healthcare. In addition, more people than before say that they can understand their doctor or nurse’s instructions.

  • The proportion of people under age 65 with medical insurance increased from 83 percent in 2008 to 87 percent in 2014, and the proportion of people of all ages with a source of ongoing care increased from 86 percent in 2008 to 88 percent in 2014.
  • The proportion of people age 18 and over who reported that their healthcare providers’ instructions were easy to understand increased from 64 percent in 2011 to 66 percent in 2012.

Neighborhood Context and the Built Environment

Under the well-known “broken windows” theory, an orderly environment signals that an area is monitored and that criminal behavior is not tolerated: Neighborhoods with a strong sense of cohesion assert social responsibility and control by fixing broken windows and other small but visible problems. Air quality and lead levels are important indicators of a clean and safe environment, and crime rates are an indicator of social cohesion.

  • Between 2008 and 2012, there was a decrease in the rate of arrests of minors and young adults ages 10–24 for serious violent crimes (from 444 to 324 per 100,000 population) and serious property crimes (from 1,527 to 1,223 per 100,000 population).
  • Days when the Air Quality Index (AQI) exceeded 100 (weighted by population and AQI) decreased from 2.2 billion to 982 million between 2006–2008 and 2012–2014. Also, lead levels in blood samples among children ages 1–5 years in the 97.5 percentile decreased from 5.8 mcg/dL to 4.3 mcg/dL between 2005–2008 and 2009–2012.

Social and Community Context

Social support is especially critical for children and adolescents, who are in their formative years. New items that may be measured in the final review of Healthy People 2020 include civic participation, incarceration, and discrimination.

  • The proportion of adolescents ages 12–17 who reported having an adult in their lives with whom they could discuss serious problems rose slightly, from 76 percent in 2008 to 78 percent in 2013; however, it is striking that almost a quarter of adolescents did not report having such an adult in their lives.

Overall, the Healthy People 2020 Midcourse Review underscores a basic fact: Improving the social determinants of health and mitigating their adverse impacts on population health is complicated. Even so, trends for 15 of the 25 objectives that have targets are moving toward or have met national targets. The Midcourse Review provides an opportunity to assess progress and identify remaining opportunities for interventions so that more can be accomplished by 2020. Addressing SDOH in localities, states, and the nation is an important step toward reducing health disparities. We have made some progress, especially in healthcare and family communication, but there is still work to be done.

Learn more about NIMHD’s work to eliminate disparities and improve the health of all groups.

 

References

1. National Center for Health Statistics. Chapter 4: Leading Health Indicators. Healthy People 2020 Midcourse Review. Hyattsville, MD. 2016. https://www.cdc.gov/nchs/data/hpdata2020/HP2020MCR-B04-LHI.pdf

2. National Center for Health Statistics. Chapter 39: Social Determinants of Health (SDOH). Healthy People 2020 Midcourse Review. Hyattsville, MD. 2016. https://www.cdc.gov/nchs/data/hpdata2020/HP2020MCR-C39-SDOH.pdf

3. U.S. Department of Health and Human Services. Report of the Secretary’s Task Force on Black and Minority Health. Volume I: Executive Summary. Washington, DC. 1985.

4. National Center for Health Statistics. Chapter 1: Introduction. Healthy People 2020 Midcourse Review. Hyattsville, MD. 2016. https://www.cdc.gov/nchs/data/hpdata2020/HP2020MCR-B01-Introduction.pdf

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Introducing the Language Access Portal

By Kelli Carrington, M.A.
Director, Office of Communications and Public Liaison
National Institute on Minority Health and Health Disparities

NIMHD Office of Communications and Public Liaison Director Kelli Carrington

Kelli Carrington, M.A.

Many of us know what it’s like to feel overwhelmed during a doctor’s visit by information about health conditions, medicines, and behavior recommendations. For patients who don’t speak or understand English fluently, the situation can be more than overwhelming—it can be dangerous. Patients with limited English proficiency (LEP) are nearly three times more likely to have an adverse medical outcome.1

Language is one of the most significant barriers to health literacy, the ability to understand the basic health information needed to make good health decisions. Patients who lack health literacy are often unable to read or understand written health information or to speak with their healthcare providers about their symptoms or concerns. These patients are less likely to follow important health recommendations or be able to give informed consent.2

According to the U.S. Census Bureau, more than 1 in 5 U.S. residents don’t speak English at home. Of that group, about 4 in 10, or 25 million people, have limited English proficiency.3 Many people with limited proficiency also live in households where no one speaks English well, meaning there isn’t a translator readily available to accompany them to doctor’s visits.

The National Institute on Minority Health and Health Disparities (NIMHD) is committed to addressing these language barriers and to improving the health literacy and lives of everyone living in America. We’re excited to announce a new tool, the Language Access Portal, as a resource for the NIMHD research community, public and community health professionals, healthcare providers, and others who work with health disparity populations with LEP. The portal improves access to cross-cultural and linguistically appropriate health information produced by the National Institutes of Health (NIH), NIMHD, and other federal agencies.

The Language Access Portal pulls together health resources from across NIH in selected languages, particularly those languages spoken by populations experiencing significant health disparities. As we launch, the portal includes information in Spanish, Hindi, Tagalog, Korean, Chinese, Japanese, and Vietnamese. The portal currently has language resources for the following areas where health disparities have been identified:

The Language Access Portal is an important tool to help people working with LEP populations provide the information necessary for patients to make important health decisions. The portal will continue to evolve and incorporate new resources from NIMHD, NIH and other government agencies as they become available, so keep checking back. By working together and using tools like the Language Access Portal, we can begin to tackle these communication barriers and improve the health of every resident of this country.

 

References

  1. Divi, C., Koss, R.G., Schmaltz, S.P., Loeb, J.M. (2007) Language Proficiency and Adverse Events in US Hospitals: a pilot study. Int J Qual Health Care. 19 (2): 60-67.
  2. Lee, J.S., Pérez-Stable, E.J., Gregorich, S.E. et al. (2017). Increased Access to Professional Interpreters in the Hospital Improves Informed Consent for Patients with Limited English ProficiencyJ GEN INTERN MED. doi:10.1007/s11606-017-3983-4
  3. U.S. Census Bureau. Table S1601: 2011-2015 American Community Survey 5-Year Estimates.

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Addressing Mental Health in African Americans Through FAITH

By Dr. Tiffany Haynes, Ph.D.
Assistant Professor, Department of Health Behavior and Health Education
Fay W. Boozman College of Public Health
University of Arkansas for Medical Sciences, Little Rock, AR

Rural African Americans are disproportionately exposed to numerous stressors, such as poverty, racism, and discrimination,1–that place them at risk for experiencing elevated levels of depressive symptoms.6 Elevated levels of depressive symptoms can lead to a host of negative outcomes, including poor management of chronic illnesses (e.g., hypertension, diabetes), poor social and occupational functioning, and development of clinical depression.7 Although effective treatments for decreasing depressive symptoms exist, structural barriers (e.g., lack of available services, transportation) and perceptual barriers (e.g., stigma, fear of misdiagnosis) impede the use of traditional mental health services within these communities, resulting in a significant unmet psychiatric need. Failure to develop culturally appropriate strategies to provide adequate, timely care to rural African Americans can result in a significant public health crisis.

Dr. Tiffany Haynes, Ph.D.

Dr. Tiffany Haynes, Ph.D.

African American churches have been identified as potential venues for providing depression education and treatment for rural African Americans.8 Within the African American rural community, churches represent a key portal through which as much as 85% of the community can be reached.9 Churches have been used to address physical health outcomes in those communities, but few have focused primarily on addressing mental health outcomes10-11. Through the NIMHD-funded project entitled “Faith Academic Initiatives to Transform Health (FAITH) in the Delta,” our partnership, consisting of faith community leaders and University of Arkansas for Medical Science researchers, conducted formative work in the Arkansas Delta. Data suggested that community members consider elevated depressive symptoms to be a significant unmet need. Furthermore, community members suggested that attempts to improve depressive symptoms should do the following:

  1. Provide education about depressive symptoms. Recognizing when depressive symptoms become a clinical problem is the first step toward receiving adequate treatment. However, rural African Americans report difficulties in differentiating between normal sadness and clinically significant depressive symptoms. Providing education about depressive symptoms allows rural African Americans to make informed treatment decisions.
  2. Address the role that stress from social inequities plays in the development and maintenance of depressive symptoms. Rural African Americans correctly realize that prolonged exposure to stress caused by social inequities is a significant factor in the development and maintenance of depressive symptoms. Treatments that conceptualize depressive symptoms as normal reactions to stress are more culturally acceptable in rural African American communities.
  3. Find ways to increase social support for those experiencing depressive symptoms. Stigma is a significant concern in rural communities. Rural African Americans experiencing depressive symptoms tend to socially isolate themselves, which, in turn, can worsen depressive symptoms.
  4. Provide mental health interventions in community-based settings. Residents suggest that offering mental health services in community settings, such as churches, would allow residents to receive treatment in less stigmatizing places and improve access to mental health care.

    (from left to right): Pastor Johnny Smith, Community PI; Dr. Tiffany Haynes, Academic PI; Dr. Karen K. Yeary, PhD, Academic Co-PI; and Pastor Jerome Turner, Community PI.

    From left to right: Pastor Johnny Smith, Community PI; Dr. Tiffany Haynes, Academic PI; Dr. Karen K. Yeary, PhD, Academic Co-PI; and Pastor Jerome Turner, Community PI

Using this data as a base, researchers worked closely with the faith community to culturally adapt an evidence-based behavioral activation intervention for use with rural African American churches. This eight-session behavioral activation intervention, REJOICE (Renewed and Empowered for the Journey to Overcome in Christ Everyday), was adapted to include faith-based themes, scripture, and other aspects of the rural African American faith culture (e.g., Bible studies, interweaving faith-based messages throughout the intervention materials).

Currently, we are testing the effectiveness of REJOICE and obtaining pilot data about the best ways to implement this intervention in rural African American churches. Collecting data from this project is the first step in providing timely and appropriate care to high-need and underserved communities.

 

References

  1. Harris, R. P., & Worthen, D. (2003). African Americans in rural America. In D. L. Brown & L. E. Swanson (Eds.), Challenges for rural America in the twenty-first century (pp. 32-42). University Park, PA: The Pennsylvania State University Press.
  2. U.S. Department of Agriculture, Economic Research Service (2016). Rural Poverty and Well-Being: Geography of Poverty. Retrieved from https://www.ers.usda.gov/topics/rural-economy-population/rural-poverty-well-being/
  3. Fitchen, J. M. (1992). On the edge of homelessness: rural poverty and housing insecurity. Rural Sociology, 57, 173-193.
  4. Kusmin, L. (Ed.). (2012). Rural America at a glance, 2012 edition. Washington, DC: U.S. Department of Agriculture, Economic Research Service.
  5. Odom, E. C., & Vernon-Feagans, L. (2010). Buffers of racial discrimination: links with depression among rural African American mothers. Journal of Marriage and the Family, 72, 346-359.
  6. Kusmin, L. (Ed.). (2011). . Rural America at a glance, 2011 edition. Washington, DC: U.S. Department of Agriculture, Economic Research Service.
  7. Mays, V. M., Cochran, S. D., & Barnes, N. W. (2007). Race, race-based discrimination, and health outcomes among African Americans. Annual Review of Psychology, 58, 201-225.
  8. Taylor RJ, Chatters LM, Levin J. Religion in the Lives of African Americans: Social, Psychological, and Health Perspectives. Thousand Oaks, CA: Sage Publications, 2004.
  9. Reeves RR, Adams CE, Dubbert PM, Hickson DA, Wyatt SB. Are Religiosity and Spirituality Associated with Obesity Among African Americans in the Southeastern United States (the Jackson Heart Study)? J Relig Health. 2011.
  10. DeHaven MJ, Hunter IB, Wilder L, Walton JW, Berry J. Health programs in faith-based organizations are they effective? Am J Public Health. 2004; 94(6): 1030-6. 1448385
  11. Hankerson, Sidney H., and Myrna M. Weissman. “Church-based health programs for mental disorders among African Americans: a review.” Psychiatric Services 63.3 (2012): 243-249.
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Apply Now to NIMHD Loan Repayment Programs

UPDATE: Click here to access the Loan Repayment Program Technical Assistance webinar that NIMHD hosted on September 15, 2016.

By Dorothy M. Castille, Ph.D.
Health Scientist Administrator, NIMHD Division of Scientific Programs

Education is the foundation of our nation’s biomedical research enterprise. But a college education is expensive, and a post-graduate education is even more expensive, with the average cost of medical, veterinary, and dental school totaling more than $200,000. In exchange for a commitment to conduct biomedical or behavioral research, the National Institutes of Health (NIH) will repay up to $70,000 of student loan debt (over two years) per two-year contract through the NIH Loan Repayment Programs (LRPs).

If you are a qualified health professional who agrees to engage in NIH mission–relevant research for at least 20 hours per week at a nonprofit or government institution, you may be eligible to apply to one of the five extramural LRPs:

  • Clinical Research Extramural LRP: Patient-oriented research conducted with human subjects
  • Clinical Research for Individuals from Disadvantaged Backgrounds Extramural LRP: Research conducted by clinical investigators from disadvantaged backgrounds
  • Contraception and Infertility Research Extramural LRP: Research on conditions affecting the ability to conceive and bear young
  • Health Disparities Research Extramural LRP: Research that focuses on minority and other health disparity populations
  • Pediatric Research Extramural LRP: Research that is directly related to diseases, disorders, and other conditions in children

The National Institute on Minority Health and Health Disparities (NIMHD) funds two of these LRPs. The objective of the Health Disparities Research Extramural LRP is to recruit and retain highly qualified health professionals for research careers that focus on minority health disparities or other health disparities to engage and promote the development of research and research programs that reflect the variety of issues and problems associated with disparities in health status. This requirement highlights the need for the involvement of a cadre of culturally competent health professionals in minority health disparities and other health disparities research.

The objective of the Clinical Research for Individuals from Disadvantaged Backgrounds Extramural LRP is to recruit and retain highly qualified health professionals from disadvantaged backgrounds for clinical research careers. The emphasis on clinical research and individuals from disadvantaged backgrounds highlights the need for the involvement of a cadre of competent health professionals in clinical research.

Approximately 1,500 scientists benefit from the $70 million that NIH invests each year through the extramural LRPs. On average, nearly 50 percent of all new LRP applications are funded, and these awards are competitively renewable (for a one- or two-year period) until all educational debt is repaid.  The LRPs are unique programs with tremendous benefit to young researchers, so we strongly encourage researchers that were not successful in getting their applications funded to apply again.

dr-castilleTo qualify, an applicant must be a U.S. citizen or a permanent resident, possess a doctoral-level degree (with the exception of the Contraception and Infertility Research LRP), and have educational loan debt equal to or exceeding 20 percent of his/her annual institutional base salary.

Thinking of applying this year? There are a few updates that you should keep in mind:

  • All applicants (new and renewal) are required to have an eRA Commons ID to submit an LRP application. If you don’t have an eRA Commons ID, act quickly, because it could take several weeks to get one! Check with your grants administrator and visit the eRA Commons website for more information.
  • We have a newly redesigned, easier-to-use online application! All applicants (new and renewal) will be required to create a new log-in account. Check out the new application and application guide (online and as a PDF) at lrp.nih.gov.
  • All application components, including the LRP application, recommendations, and institutional support documentation, are due by December 1, 2016.

Please contact any of these NIMHD program staff for assistance with a new application or feedback on a previous application:

Visit www.lrp.nih.gov for more details and to apply. For additional assistance, call or email the LRP Information Center at 866-849-4047 or lrp@nih.gov, Monday–Friday, 9 a.m. to 5 p.m. ET. You can also follow the NIH Division of Loan Repayment on Twitter and Facebook for more information and cycle updates. Get started on your application today!

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NIH Begins Recruitment for Landmark Adolescent Brain Cognitive Development Study

By Eliseo J. Pérez-Stable, M.D.
Director, NIMHD

logo of NIH's adolescent brain cognitive development study

Today I’m delighted to share some exciting news. The National Institutes of Health (NIH) is launching recruitment for the Adolescent Brain Cognitive Development (ABCD) Study. This is the largest long-term study of brain development and child health in the United States. NIMHD is one of eight NIH institutes, centers, and offices along with the Centers for Disease Control and Prevention (CDC) supporting this landmark study.

Adolescence, the transitional stage between childhood and adulthood, is an important period in human development. While major physical and psychological changes are happening, teenagers are testing their independence and exploring their self-identity. All the while, the brain is undergoing dramatic changes in structure and function.

For the ABCD Study, researchers will follow the biological and behavioral development of more than 10,000 children ages 9-10 through adolescence into early adulthood. It is critically important that the participants in this study reflect the U.S. population, as almost half of all children are now from a minority racial or ethnic group. In addition, the study will strive to recruit children from different levels of socioeconomic status and living environments. To accomplish this goal, recruitment will be done through partnerships with public and private schools near 19 research sites in the continental U.S. and Hawaii, as well as through registries of identical and fraternal twins.

Over the next decade, leading researchers in the fields of child development and neuroscience will use extensive baseline interviews, psychological and behavioral testing, and cutting-edge technology in brain imaging, to determine how childhood experiences interact with a child’s changing biology to affect brain development and—ultimately—social, behavioral, academic, and other health outcomes. Experiences such as playing video games, participating in extracurricular activities like organized sports, insufficient sleep or poor sleep habits, cigarette smoking, other use of tobacco products, and drinking alcohol. For example, we know that adequate hours of sleep is essential for normal growth and brain development, yet studies show that children from minority and economically underserved communities are more likely to experience shorter sleep times compared to their White and economically advantaged counterparts. As a result, these children are disproportionately affected by the adverse health and quality of life consequences of poor sleep.

When it comes to physical activity, the overall lifelong health benefits are clear. Yet children who participate in certain sports and recreational activities are exposed to various injury risks. The CDC estimates that 1.6 to 3.8 million concussions occur in sports and recreational activities annually. Understanding the relationships among these experiences and their effects on the growing brain will provide answers that can inform educational practices and policy and, ultimately, may help improve the health and well-being of our youth.

At NIMHD, our mission is to lead scientific research to improve minority health and reduce health disparities. We know that increased diversity in participants of clinical research studies is both a crucial part of achieving health equity and an essential component to advance scientific knowledge. For example, we cannot know if a treatment will be effective for certain race/ethnic minority groups if they are not part of clinical research. Greater diversity allows researchers to identify differences between populations and formulate appropriate treatments and contributes to understanding the interactions of individual behavior and biology with the social and physical environment. Diverse representation among study participants in the ABCD study will help us gain a better understanding of development across all groups and ensures that the study results are relevant for all children.

You can learn more about the ABCD Study at www.ABCDStudy.org. Help us spread the word about this important study so diverse communities will not only be represented, but can share in, and benefit from, the medical advances gained from this critical research.

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Welcome to NIMHD Insights, the New NIMHD Blog

By Eliseo J. Pérez-Stable, M.D.
Director, NIMHD

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.

Visit www.nimhd.nih.gov to learn more about NIMHD and subscribe to our blog.

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