|
Items in cart [0] |
Questions? Call 888-624-8373 |
| Copyright © 2010. National Academy of Sciences. All rights reserved. Terms of Use and Privacy Statement |
Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page R1
Examining the
HEALTH DISPARITIES
RESEARCH PLANof the
NATIONAL INSTITUTES OF HEALTH
Unfinished Business
Committee on the Review and Assessment of the NIH's
Strategic Research Plan and Budget to Reduce
and Ultimately Eliminate Health Disparities
Board on Health Sciences Policy
Gerald E. Thomson, Faith Mitchell, Monique B. Williams, Editors
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu
OCR for page R2
THE NATIONAL ACADEMIES PRESS ˇ 500 Fifth Street, N.W. ˇ Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board of the
National Research Council, whose members are drawn from the councils of the National Academy
of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of
the committee responsible for the report were chosen for their special competences and with regard
for appropriate balance.
This study was supported by Contract No. NO1-OD-4-2139 between the National Academy of
Sciences and National Center on Minority Health and Health Disparities, U.S. Department of
Health & Human Services. Any opinions, findings, conclusions, or recommendations expressed in
this publication are those of the author(s) and do not necessarily reflect the view of the organizations
or agencies that provided support for this project.
Library of Congress Cataloging-in-Publication Data
Examining the health disparities research plan of the National Institutes of Health : unfinished
business / Committee on the Review and Assessment of the NIH's Strategic Research Plan
And Budget to Reduce and Ultimately Eliminate Health Disparities, Board on Health Sciences
Policy ; Gerald E. Thomson, Faith Mitchell, Monique Williams, editors.
p. ; cm.
Includes bibliographical references and index.
ISBN 0-309-10121-2 (hardback) -- ISBN 0-309-65775-X (PDFs)
1. Health services accessibility--United States. 2. Social medicine--United States. 3. Medical
policy--United States. 4. Medical care--United States--Evaluation. I. Thomson, Gerald E.
II. Mitchell, Faith, 1952- . III. Williams, Monique. IV. National Research Council (U.S.).
Committee on the Review and Assessment of the NIH's Strategic Research Plan And Budget to
Reduce and Ultimately Eliminate Health Disparities.
[DNLM: 1. National Institutes of Health (U.S.) 2. Health Services Research--United States.
3. Cultural Diversity--United States. 4. Health Services Accessibility--United States. 5.
Program Development--United States. 6. Research Design--United States. 7. Socioeconomic
Factors--United States. W 84 AA1 E96 2006]
RA418.3.U6E93 2006
362.10425--dc22
2006011067
Additional copies of this report are available for sale from the National Academy Press, 500 Fifth
Street, N.W., Lockbox 285, Washington, D.C. 20055; (800) 624-6242 or (202) 334-3313 (in the
Washington metropolitan area), Internet, http://www.nap.edu.
For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.
Copyright 2006 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America.
The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and
religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute
of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
OCR for page R3
"Knowing is not enough; we must apply.
Willing is not enough; we must do."
--Goethe
Advising the Nation. Improving Health.
OCR for page R4
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of
distinguished scholars engaged in scientific and engineering research, dedicated to the
furtherance of science and technology and to their use for the general welfare. Upon the
authority of the charter granted to it by the Congress in 1863, the Academy has a
mandate that requires it to advise the federal government on scientific and technical
matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of
the National Academy of Sciences, as a parallel organization of outstanding engineers. It
is autonomous in its administration and in the selection of its members, sharing with the
National Academy of Sciences the responsibility for advising the federal government.
The National Academy of Engineering also sponsors engineering programs aimed at
meeting national needs, encourages education and research, and recognizes the superior
achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of
Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences
to secure the services of eminent members of appropriate professions in the examination
of policy matters pertaining to the health of the public. The Institute acts under the
responsibility given to the National Academy of Sciences by its congressional charter to
be an adviser to the federal government and, upon its own initiative, to identify issues of
medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute
of Medicine.
The National Research Council was organized by the National Academy of Sciences in
1916 to associate the broad community of science and technology with the Academy's
purposes of furthering knowledge and advising the federal government. Functioning in
accordance with general policies determined by the Academy, the Council has become
the principal operating agency of both the National Academy of Sciences and the National
Academy of Engineering in providing services to the government, the public, and the
scientific and engineering communities. The Council is administered jointly by both
Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf
are chair and vice chair, respectively, of the National Research Council.
www.national-academies.org
iv
OCR for page R5
COMMITTEE ON THE REVIEW AND ASSESSMENT OF THE NIH'S
STRATEGIC RESEARCH PLAN AND BUDGET TO REDUCE AND
ULTIMATELY ELIMINATE HEALTH DISPARITIES
GERALD E. THOMSON (Chair), Lambert & Sonneborn Professor of Medicine,
Emeritus, Senior Associate Dean, Emeritus, Columbia University Col-
lege of Physicians and Surgeons, New York, NY
JOHN F. ALDERETE, Professor, Department of Microbiology, University
of Texas Health Science Center at San Antonio, San Antonio, TX
MOON CHEN, JR., Professor, Department of Epidemiology and Preven-
tive Medicine, University of California, Davis, School of Medicine,
Associate Director for Cancer Prevention and Control (Population Sci-
ences), University of California, Davis, CA
HARVEY R. COLTEN, Vice President & Senior Associate Dean, Aca-
demic Affairs, Columbia University, Health Sciences and College of
Physicians & Surgeons, New York, NY
ROBERT A. HIATT, Professor, Epidemiology and Biostatistics, UCSF
Comprehensive Cancer Center, Population Sciences, San Francisco, CA
SHERMAN JAMES, Susan B. King Professor of Public Policy, Duke Uni-
versity, Durham, NC
ICHIRO KAWACHI, Professor of Social Epidemiology, Director, Harvard
Center for Society and Health, Harvard School of Public Health, Bos-
ton, MA
CLAUDE LENFANT, President, World Hypertension League, Gaithers-
burg, MD
SPERO M. MANSON, Professor of Psychiatry, Head, American Indian
and Alaska Native Programs, University of Colorado at Denver and
Health Sciences Center, Denver, CO
JEANNE MIRANDA, Professor in Residence, University of California,
Department of Psychiatry and Biobehavioral Science, Los Angeles, CA
KYU RHEE, Medical Director, Upper Cardozo Community Health Center,
Washington, DC
LYNNE D. RICHARDSON, Associate Professor, Emergency Medicine,
Director, Emergency Medicine Residency, Mount Sinai School of Medicine,
Department of Emergency Medicine, New York, NY
ANTONIA M. VILLARRUEL, Professor, Director, Center for Health Pro-
motion, University of Michigan, School of Nursing, Ann Arbor, MI
DAVID WILLIAMS, Harold Cruse Collegiate Professor of Sociology, Se-
nior Research Scientist, Institute for Social Research, University of Michigan,
Ann Arbor, MI
v
OCR for page R6
HEALTH SCIENCES POLICY BOARD LIAISON
MARTHA N. HILL, Dean and Professor, The Johns Hopkins University,
School of Nursing, Baltimore, MD
IOM PROJECT STAFF
FAITH MITCHELL, Senior Program Officer
MONIQUE B. WILLIAMS, Program Officer
THELMA L. COX, Senior Program Assistant
IOM Staff
ANDREW M. POPE, Director, Board on Health Sciences Policy
AMY HAAS, Administrative Assistant
CARLOS GABRIEL, Financial Associate (until May 2005)
DAVID CODREA, Financial Associate
vi
OCR for page R7
Reviewers
This report has been reviewed in draft form by individuals chosen for their
diverse perspectives and technical expertise, in accordance with procedures ap-
proved by the National Research Council's (NRC's) Report Review Committee.
The purpose of this independent review is to provide candid and critical com-
ments that will assist the institution in making its published report as sound as
possible and to ensure that the report meets institutional standards for objectivity,
evidence, and responsiveness to the study charge. The review comments and
draft manuscript remain confidential to protect the integrity of the deliberative
process. We wish to thank the following individuals for their review of this
report:
PAULA A. BRAVEMAN, University of California, San Francisco
H. JACK GEIGER, City University of New York Medical School
BRADFORD GRAY, The Milbank Quarterly, The Urban Institute
RUTH HANFT, James Madison University
ROBERT A. LOWE, Oregon Health & Science University
NICOLE LURIE, The RAND Corporation
JOHN E. MAUPIN, Meharry Medical College
RUBENS J. PAMIES, University of Nebraska Medical Center
TIMOTHY SIZE, Rural Wisconsin Health Cooperative
Although the reviewers listed above have provided many constructive com-
ments and suggestions, they were not asked to endorse the conclusions or recom-
mendations nor did they see the final draft of the report before its release. The
review of this report was overseen by NEAL VANSELOW, Tulane University,
vii
OCR for page R8
viii REVIEWERS
Professor Emeritus, and DAVID KINDIG, Wisconsin Public Health and Health
Policy Institute, University of Wisconsin-Madison.
Appointed by the NRC and Institute of Medicine, they were responsible for
making certain that an independent examination of this report was carried out in
accordance with institutional procedures and that all review comments were care-
fully considered. Responsibility for the final content of this report rests entirely
with the authoring committee and the institution.
OCR for page R9
Preface
Although the overall health of Americans has improved considerably over
the past several decades, the health of racial and ethnic minorities and other
populations continues to lag behind that of whites. For decades, there have been
declarations identifying correction of health disparities as a national priority but
progress has been slow, and the suffering, disability, and death continue. If the
gaps between populations persist and some minority populations continue to
grow disproportionately, within several decades most Americans will be mem-
bers of populations at risk for disparate health.
Improving the situation requires much better understanding of health dispari-
ties. The National Institutes of Health (NIH) has supported and conducted exten-
sive research related to minority health and health disparities. The NIH health
disparities research effort was addressed by Congress with the "Minority Health
and Health Disparities Research and Education Act of 2000." Among its provi-
sions, the legislation called for establishing the National Center on Minority
Health and Health Disparities (NCMHD) with two broad areas of responsibility:
first, administration of extensive grants and awards aimed at strengthening the
country's personnel and institutional capacities to conduct research on minority
health and health disparities; and second, coordination of all health disparities
research across NIH together with oversight of the development and implementa-
tion of an NIH-wide strategic plan for health disparities research. NCMHD was
established in 2000 and, in 2004, asked the Institute of Medicine to assess the
adequacy and coordination of the Strategic Plan that had been developed. The
study committee began the review late in 2004 with completion targeted for late
2005.
The extensive Strategic Plan features three broad research, research capacity,
and outreach goals along with detailed objectives. Included are the individual
plans of 25 of the 27 Institutes and Centers, as well as 2 Offices within the Office
ix
OCR for page R10
x PREFACE
of the Director. As a catalogue of ongoing and intended health disparities re-
search activity across NIH, it is impressive. As a strategy in a health disparities
research campaign, it is a beginning.
To be sure, the effort faces strong challenges. The first is the nature of the
research itself. The range of diseases and conditions for which there are differ-
ences spans virtually all biomedical disciplines. There are complex, interrelated
social, economic, behavioral, health care, and other environmental aspects--and
the differences, their features, and the roles of contributing factors vary among
affected populations and subpopulations.
The review committee sees the opportunity and need for NIH to focus even
more on health disparities as a research entity and move knowledge and under-
standing forward as no other agency or setting can. Along with understanding the
biomedical aspects of diseases and conditions that are the manifestations of health
disparities, there is need to know more about the contributions and interactions of
core conditions and factors that may be common to the genesis of disparate
health. The NIH should take leadership in helping to understand, further define,
and develop methodology regarding health disparities research. As well, given
the particular importance of the translation of new information into best practices
in the care of patients, there is opportunity to better understand, design, and
assess communication of health disparities information to health professionals
and the public as a core NIH effort with much to be learned and applied.
A second challenge has to do with coordination and management of such an
extensive plan and program across NIH where the Institutes and Centers have a
degree of autonomy that can make it difficult to effect concerted programs. The
challenge is an example of other efforts to achieve trans-NIH coordination of
broad interdisciplinary programs, such as those organized for AIDS, obesity, and
neuroscience. The extensive nature of the health disparities research effort re-
quires that there be a well-structured effort with ongoing, continuous improve-
ment of the plan and program that is the result of extensive involvement from
within and from outside of NIH contributing to identification of research needs,
assessments, evaluation and priority determinations. Along with central oversight
and attention to the detailed aspects of the programs, there must be a broader
view and vision and assurance that needed research areas are not neglected. Also,
there is the opportunity to bring together and involve much expertise from across
NIH and from across the nation to inform the NIH program, its planning, evalu-
ation and priorities.
The Strategic Plan and its strategy for health disparities research can be
strengthened as part of an integrated, cohesive, coordinated trans-NIH program,
developed with the best available thought, addressing relevant, prioritized ques-
tions and issues with clearly initiated and evaluated programs, and with the
production of information which allows the NIH, and the nation, to be assured
OCR for page R11
PREFACE xi
that needed research on health disparities is being addressed as effectively and
expeditiously as possible.
Throughout the review, the Committee felt the implications and urgency of
the task and brought to the review the utmost devotion and commitment. We are
grateful for the expertise and efforts of the staff, including Faith Mitchell, the
Project Director, Monique Williams, Program Officer, and Thelma Cox, Senior
Program Assistant.
Dr. Elias Zerhouni, the Director of NIH, Dr. Raynard Kington, Deputy Di-
rector of NIH, and the NIH Office of Budget were forthcoming and most helpful.
We are particularly grateful to the NCMHD and its Director, John Ruffin, and the
staff for their intense devotion, cooperation and assistance and to the Institutes
and Centers which provided valuable information and insights. We are thankful
for the cooperation, responses, testimony and other information provided by the
Institutes and Centers and Offices within the Office of the Director and those
provided by the many distinguished individuals and devoted organizations.
Gerald E. Thomson, M.D., Chair
Committee on the Review and Assessment of the
NIH's Strategic Research Plan and Budget
to Reduce and Ultimately Eliminate Health Disparities
OCR for page R12
Acknowledgments
The editors would like to thank several people for their testimony to the
Committee: Lawrence Agodoa, Duane Alexander, Barbara Alving, Victoria A.
Cargill, Francis D. Chesley, Jr., Gail C. Christopher, Mark Clanton, Gem Daus,
Adolph Falcon, Charles Francis, René González, Garth Graham, Doug Hussey,
Carolyn M. Kane, Raynard Kington, Ronny B. Lancaster, Yvonne Maddox, John
J. McGowan, Vivian W. Pinn, Winston Price, Griffin Rodgers, Leonard S.
Rubenstein, John Ruffin, David Satcher, Allen M. Spiegel, Louis W. Sullivan,
Walter W. Williams, Jerome Wilson, and Elias A. Zerhouni.
We thank Nancy Adler, Neil R. Powe, Kasisomayajula Viswanath, and
Edwina H. Yeung for their background papers that informed the committee's
deliberations.
Among the IOM staff, special thanks are due to Thelma Cox and Andy Pope.
xii
OCR for page R13
Contents
EXECUTIVE SUMMARY 1
1 INTRODUCTION 15
Congressional Legislation: The Minority Health and
Health Disparities Research and Education Act of 2000, 16
Charge to the Committee, 18
Committee Process, 19
Organization of the Report, 20
2 HEALTH DISPARITIES: CONCEPTS, MEASUREMENTS,
AND UNDERSTANDING 21
Defining Health Disparities, 24
Measuring Health Disparities, 26
Understanding Health Disparities, 29
Implications for the NIH Research Agenda, 31
3 DEVELOPMENT AND AVAILABILITY OF THE
STRATEGIC PLAN 34
The 2002 and 2004 Strategic Plans, 37
The Strategic Plans of the ICs, 55
Health Disparities as Defined by the Strategic Plan, 57
4 BUDGET AND FINANCES 60
Availability of Budget Information, 60
Interpretation of Budget Information: Definitions and Methods, 60
Incremental Funding for the NIH Minority Health and Health
Disparities Research Program, 61
NIH Budget Allocations for Health Disparities, 64
xiii
OCR for page R14
xiv CONTENTS
5 THE NATIONAL CENTER ON MINORITY HEALTH AND
HEALTH DISPARITIES 72
The NCMHD as a Center, 72
Responsibilities for the Minority Health and Health Disparities
Research Program and the Strategic Plan, 76
6 MANAGEMENT OF THE STRATEGIC PLAN AND THE
HEALTH DISPARITIES RESEARCH PROGRAM 78
The Challenge of Structuring a Trans-NIH Health Disparities
Research Program and Strategic Plan, 78
Coordination of the Strategic Plan and Minority Health and
Health Disparities Research, 84
REFERENCES 88
APPENDICES
A PUBLIC LAW 106525--NOVEMBER 22, 2000; "Minority
Health and Health Disparities Research and Education
Act of 2000" 95
B Agendas of Open Meetings 112
C List of Participants Providing Testimony or Written Commentary
to the Committee 119
D Overview of Health Disparities, Nancy Adler 121
E Schematic Diagram Showing Differences, Disparities,
and Discrimination in Health Care 175
F National Institutes of Health NIH Health Strategic Plan Fiscal Years
20042008, Volume I [Draft] 176
G Public Communications and Its Role in Reducing and
Eliminating Health Disparities, Kasisomayajula Viswanath 215
H NIH Committee on Minority Health and Health Disparities
Research Definitions and Application Methodology:
Final Report (Revised January 2004) 254
I Acronyms 272
OCR for page R15
CONTENTS xv
J Centers of Excellence Funded by the National Center on
Minority Health and Health Disparities, 2005 274
K NCMHD Endowment Program Awardees 277
L Summary of Recommendations 278
M Committee and Staff Biographies 280
INDEX 291
OCR for page R16
