Population Health

Amplifying the Voice of Native Hawaiian and Pacific Islander Communities Amid the COVID-19 Crisis

Photo of Dr. Joseph Keawe‘aimoku Kaholokula

Photo of Dr. Joseph Keawe‘aimoku Kaholokula

The coronavirus disease 2019 (COVID-19) pandemic has spotlighted the health inequities of Native Hawaiians and Pacific Islanders (NHPI) and provided the podium from which to amplify their voices.

Historically, the voices of NHPI were drowned out by other numerically larger health-disparate racial/ethnic groups in the U.S. Their unique health concerns are often overlooked because their data has been aggregated—grouped together—with those of Asian Americans, an arbitrary practice that has done a disservice to both groups.1 NHPI know that resources follow the data, which is why they have been voicing their support for disaggregating—separating out—the data for NHPI and Asian Americans for decades, but to little avail.

Along comes COVID-19 to amplify their voices as to why data disaggregation is important. Continue reading “Amplifying the Voice of Native Hawaiian and Pacific Islander Communities Amid the COVID-19 Crisis”

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NIMHD Investigator Forums on the Impact of COVID-19 on Research Communities

NIMHD Co-authors - COVID-19 PI Forum

Jennifer Alvidrez, Ph.D.
Rick Berzon, Dr.P.H., P.A.
Dorothy Castille, Ph.D.
Nancy L. Jones, Ph.D., M.A.
CDR Nadra Tyus, Dr.P.H., M.P.H.
Division of Scientific Programs

The impact of the COVID-19 outbreak has strained daily life for people living in the United States, affecting nearly every sector including biomedical research. The disruption has also disproportionally affected the lives and livelihoods of populations that experience health disparities, which are also the populations that NIMHD’s research addresses.

To provide an opportunity to better understand the impact of COVID-19 on researchers and research funded by the institute, NIMHD hosted four COVID-19 NIMHD Investigator Forums this summer. NIMHD staff who hosted the events were Drs. Jennifer Alvidrez, Rick Berzon, Dorothy Castille, Nancy Jones and Nadra Tyus.  We knew that the COVID-19 pandemic created many challenges for our research community and learned of the creative strategies they developed to navigate these challenges using their extensive connections with health disparity communities.  We structured the forum to hear directly from NIMHD Principal Investigators (PIs) about their observations and thoughts in three areas:

1) Impact of COVID-19 on the communities where research is conducted
2) Strategies to modify recruitment, data collection, and/or intervention protocols
3) Understanding and addressing the impact of the pandemic on study outcomes. Continue reading “NIMHD Investigator Forums on the Impact of COVID-19 on Research Communities”

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National Minority Mental Health Awareness Month Blog Series

July Is the Best Month to Start a
New Year of Working on Mental Health

Harold W. Neighbors, Ph.D.
Division of Intramural Research
National Institute on Minority Health and Health Disparities

Dr. Harold W. Neighbors

Dr. Harold W. Neighbors

When I started graduate school in the mid-1970s, I had just one seemingly simple research question. I wanted to know: “Who had the higher rate of mental illness, Black or White Americans?” I remember the puzzled looks from fellow students, as most of them already knew the answer – “Blacks of course!” Their reasoning made good sense – life was harder for Blacks in the United States, and a life spent fighting against racial discrimination can lead to emotional damage.

So, I began my investigation, uncovering layer after layer of complexity surrounding what I thought was a simple question. My motivations were both professional and personal. Personally, like many families, Black and White, mine had revealed a few semi-private stories about “bad nerves” (the preferred language of emotional distress used to describe mental health problems) that were offered for consumption in the smallest of morsels. And even though my curiosity was never quite satisfied, I instinctively knew not to push for too many details. Professionally, there was my first “big” assignment as a graduate research assistant on a new, innovative study, the “National Survey of Black Americans”1. I wrote my dissertation on one aspect of the subject: help-seeking behavior for mental health problems, using data from the National Survey of Black Americans. My dissertation research told me that Black Americans need to stop, look, listen, and most importantly, tell the truth about our feelings. The key to sound mental health is what people of color decide to do about profound sadness, feelings of helplessness resulting from attacks on our self-esteem, and hopelessness due to unjust institutional impediments that erode aspirations for achieving one’s best life2. My investigation revealed that when feelings become unbearably painful, they are symptoms. Once you are symptomatic, you need to get help. It is just that simple; and difficult; and complicated. Continue reading “National Minority Mental Health Awareness Month Blog Series”

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National Minority Mental Health Awareness Month Blog Series

American Indian/Alaska Native Mental Health: Our Voices, Traditions and Values to Strengthen our Collective Wellness

Victoria M. O’Keefe, Ph.D. (Cherokee/Seminole Nations of Oklahoma)
Mathuram Santosham Endowed Chair in Native American Health, Assistant Professor, Licensed Clinical Psychologist
Associate Director, Center for American Indian Health
Department of International Health, Social & Behavioral Interventions
Johns Hopkins Bloomberg School of Public Health

Dr. Victoria M. O’Keefe

Dr. Victoria M. O’Keefe

 

My late grandma, Virginia Feather Revas, was a Cherokee Nation citizen, a fluent speaker of ᏣᎳᎩ ᎦᏬᏂᎯᏍᏗ (Cherokee language), and a Community Health Representative (CHR) for our tribe. CHRs are embedded within their tribe and serve important roles in health promotion for their communities.1 My grandmother served our tribe proudly and instilled in me the importance of working on behalf of our people. My favorite memories with her, from visits to Oklahoma, were going to our family’s creek to catch ᏥᏍᏛᎾ (crawfish) for dinner, attending stomp dances and pow wows, and admiring her talent for beadwork and quilt making. These memories are important teachings that I value now more than ever.

Continue reading “National Minority Mental Health Awareness Month Blog Series”

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National Minority Mental Health Awareness Month Blog Series

Centering Structural Inequities in Conversations on Mental Health Among People of Color

Margarita Alegría, Ph.D.
Chief, Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Mongan Institute
Professor, Departments of Medicine & Psychiatry, Harvard Medical School

Dr. Margarita Alegría

Dr. Margarita Alegría

There has been tremendous attention brought to mental health as part of the coronavirus pandemic. The good news is that there is now almost universal recognition that when our mental health is precarious, costs are immeasurable. What has become more apparent is how this cost is much higher for people of color. But why is their burden of mental illness so much greater? What can help shed light on how mental illness impacts racial and ethnic minorities so adversely and profoundly, even when they have lower or similar prevalence rates of mental health disorders when compared to White people1? Continue reading “National Minority Mental Health Awareness Month Blog Series”

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Can Paid Maternity Leave Help Address Disparities in Maternal Mortality?

By Rada Dagher, Ph.D., M.P.H.
Program Director
Division of Scientific Programs
Clinical and Health Services Research
National Institute on Minority Health and Health Disparities

Dr. Rada Dagher

Dr. Rada Dagher

Maternal mortality rates in the United States have reached an all-time high. While these rates have dropped globally in the last few decades1, in the United States, they have more than doubled between 1987 and 20152. The picture is even grimmer for racial and ethnic minority communities, where African American and American Indian/Alaska Native women have the highest maternal mortality rates of all racial/ethnic groups2.

While most of the discussions about the maternal mortality crisis focus on the physical causes of death, the relationship between maternal mental health and mortality rates is largely ignored. For example, postpartum depression leads the list of mental health conditions affecting new mothers, and women experiencing this disorder may have suicidal thoughts and thoughts of harming the baby3. The novel coronavirus (SARS-CoV-2) pandemic that is causing COVID-19 disease outbreaks is another factor to consider. Due to social distancing, women have much lower access to the usual support systems (e.g. family, doulas) that promote their mental health during the vulnerable period of transitioning into motherhood. Recently published data from China on the impact of the COVID-19 pandemic suggests increased rates of postpartum depression4 among Chinese women. Moreover, a recent report from a convenience sample of U.S. mothers of children of ages 0-18 months, shows elevated depression (34.1%) and anxiety (34.6%) rates5. Yet, the currently proposed interventions to address maternal mortality do not consider approaches to prevent and/or treat postpartum depression. One such approach is providing paid leave for new mothers. Continue reading “Can Paid Maternity Leave Help Address Disparities in Maternal Mortality?”

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Racism and the Health of Every American

NIMHD Director's statement on racism and the health of every American
NIMHD Director's Statement

By Eliseo J. Pérez-Stable, M.D.
Director, National Institute on Minority Health and Health Disparities

The past few weeks have been an extremely difficult time in the United States. George Floyd’s death was so painful to witness. Even more painful is the knowledge that he was only one in a long, long line of African American men and women who have been killed by police in America. It is a relentless, terrible history, and his death was yet another reminder of injustice in our lives. It is the same injustice that American Indians suffered in colonial times and the 19th century, losing their lands and being victimized by war. It is the same injustice that led to mass deportation of Mexican Americans—people born in the United States—in the 1930s. It is the same injustice that led to the internment of Japanese Americans during World War II. This is our history.

I have watched the protests—at times coupled with violence but mostly peaceful—and been heartened by the Americans of all races who have continued to show up, day after day, to say that Black lives matter and structural racism must end. This is a society that is proud to say that all are created equal, with liberty and justice for all, but the history of injustice is clear. People are not standing for it anymore. Continue reading “Racism and the Health of Every American”

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Rural Health is a Global Issue

By Priscah Mujuru, DrPH, MPH, RN, COHN-S
Scientific Program Officer, Community Health and Population Sciences
National Institute on Minority Health and Health Disparities

Dr. Priscah Mujuru

Dr. Priscah Mujuru

Rural health to me, is a lived experience. I was born in the rural areas of Zimbabwe. In my village, when a pregnant woman couldn’t make it to the hospital, there were no gloves, clean working stations, or sanitized rooms to ensure safe childbirth. A female in labor would be aided in her delivery by other village women who used what they had: hot water, rags, old razors, and even twine made of tree bark to help with the delivery. We never thought we were poor, and in fact we were proud and happy of who we were.

I was fortunate that my father valued education and sent all his children, 6 girls and 4 boys, to primary and secondary schools. He felt that it did not matter if you were a boy or girl, man or woman, everyone should be given an opportunity to get an education. In a small village, to send so many children to school when there was work to be done, was very rare. Continue reading “Rural Health is a Global Issue”

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50 Years After Stonewall, Celebrating Progress and Striving for LGBTQ Health Equity

By Brian Mustanski, Ph.D.
Director, Institute for Sexual and Gender Minority Health and Wellbeing
Co-Director, Third Coast Center for AIDS Research
Co-Director, Center for Prevention Implementation Methodology
Professor, Department of Medical Social Sciences
Northwestern University
Member, National Advisory Council on Minority Health and Health Disparities

Photo of Dr. Brian Mustanski

Dr. Brian Mustanski

In June 1969, the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community led historic riots against discriminatory police raids of the Stonewall Inn, a gay bar in Greenwich Village. The Stonewall riots galvanized the LGBTQ community to come together in a nationwide movement in pursuit of equality.

Growing up as a young gay man in Minnesota, I had no knowledge of Stonewall. With the Internet still in its infancy, there were limited resources to learn about the LGBTQ community. I resorted to secretly reading my high school encyclopedia’s entry on “homosexuality,” which that edition still described as a psychiatric disorder. Media coverage of homosexuality was dominated by the emerging AIDS crisis. I often heard people say, “AIDS is God’s punishment.” With no access to alternative information, it was hard to reject these messages.

Years later, I began pursuing a career in science. My undergraduate faculty mentor warned me not to “come out,” as it could hurt my chances of graduate admission. Evidence is just emerging on how sexual and gender minority (SGM) people experience structural and interpersonal barriers to STEM careers.1 Continue reading “50 Years After Stonewall, Celebrating Progress and Striving for LGBTQ Health Equity”

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Addressing Social Needs and Structural Inequities to Reduce Health Disparities: A Call to Action for Asian American and Pacific Islander Heritage Month

By Marshall H. Chin, M.D., M.P.H.
Richard Parrillo Family Professor of Healthcare Ethics in the Department of Medicine,
University of Chicago
Member, National Advisory Council on Minority Health and Health Disparities

Photo of Dr. Marshall H. Chin

Dr. Marshall H. Chin

When I was a kid, every Saturday my parents would pack my older sister, younger brother, and me into the family station wagon, and we’d drive 40 minutes on Route 2 East from Boston’s western suburbs into Chinatown. There we gathered with aunts, uncles, and cousins in the home of my grandparents, immigrants from Toisan in southern China. The conversations were loud, the play was very lively, and the wonderful aromas of roast chicken, fried noodles, and sizzling stir-fried vegetables filled the air.

An impressionable young child, I watched intently as my uncles played poker, cigar smoke wafting into the nighttime air. They taught me how to play poker at the ripe old age of 8, and I filled in when one had to take a break for a hand or two. Most of my paternal uncles worked in the laundries. My mother’s side was noodles. My uncles were bright men, but the bamboo ceiling—basically, exclusion from good jobs—limited their opportunities. “I don’t have a Chinaman’s chance,” they’d say as they folded a losing hand of cards.1

Running around Chinatown with my cousins, I saw that my uncles weren’t the only ones whose opportunities were limited. Housing was crowded, and the streets were dirty and smelled of garbage. Years later, when I worked part-time at the Federally Qualified Health Center in Boston’s Chinatown, I cared for many non–English speaking immigrants with limited education. They faced uphill battles as they dealt with their chronic health conditions, paid medical bills without health insurance, and attempted to advance in society. Continue reading “Addressing Social Needs and Structural Inequities to Reduce Health Disparities: A Call to Action for Asian American and Pacific Islander Heritage Month”

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