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Executive Summary
ABSTRACT
This report is an assessment of the National Institutes of Health
(NIH) Strategic Research Plan and Budget to Reduce and Ultimately
Eliminate Health Disparities and the adequacy of coordination of the
development and implementation of the Strategic Plan across NIH Insti-
tutes and Centers.
Congressional legislation in 2000 called for the establishment of
the NIH National Center on Minority Health and Health Disparities and
a Strategic Plan to address the continuing poor health states of minori-
ties, those with low income, and people living in rural areas. The plan
includes the strategic plans of 25 Institutes and Centers and 2 Offices
within the Office of the Director. Goals and objectives in research,
research capacity, and communication are expected to form the founda-
tion for the NIH health disparities research program.
The study committee viewed the Strategic Plan in the context of the
need for NIH health disparities research to be conducted as an inte-
grated and inclusive field of study rather than an aggregate of indepen-
dent research plans and activities occurring in separate research do-
mains. Such an approach, for example, would help to further needed
study of social, behavioral, environmental and other root factors inter-
active across diseases, conditions and affected populations. As well,
there would be more assurance that needed areas of research are not
neglected.
1
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2 EXAMINING THE HEALTH DISPARITIES RESEARCH PLAN OF THE NIH
A concerted minority health and health disparities research pro-
gram and its Strategic Plan is a challenging trans-NIH effort because of
the scope and complexity of the research, and the NIH organizational
and functional setting that makes it difficult to manage initiatives across
NIH. Development and implementation of the Strategic Plan presently
lack the central management and coordination necessary to meet the
challenge. Development and revision of the Strategic Plan has been
delayed and incomplete. The Committee did not find organized, collec-
tive involvement of the Institutes and Centers and expertise from outside
of NIH in overall planning. The Plan includes extensive programs in the
Institutes and Centers, without evidence that these efforts are centrally
coordinated, appropriately assessed regarding priorities and outcomes,
or otherwise viewed as part of an overall NIH strategy. Continuous,
effective, and demonstrable trans-NIH coordination and management
with clearly established responsibility and authority should be assured
by the Director of NIH through the Director of the National Center on
Minority Health and Health Disparities, including timely updates of the
Strategic Plan and collective involvement of the Institutes and Centers
in overall planning and implementation, monitoring, and evaluation of
the Strategic Plan and the health disparities research program.
Needed additions to the Strategic Plan include attention to the inte-
gration of research on the multifactorial nature of health disparities;
population research; targeted and timed objectives; collaborative, inte-
grated research on disparate health care; identification of additional
affected populations; access to a registry of conditions for which differ-
ences between populations exist; assessments and evaluations of pro-
grams intended to increase institutional and research-personnel capaci-
ties to conduct health disparities research; and attention to public and
professional communication regarding health disparities as a specific,
trans-NIH program.
The health of racial and ethnic minorities, poor people, and other disadvan-
taged groups in the United States is worse than the health of the overall popula-
tion. National concerns for these differences, termed health disparities, and the
associated excess mortality and morbidity have been expressed as a high priority
in national health status reviews, including Healthy People 2000 and Healthy
People 2010. The National Institutes of Health (NIH) ranks this issue third among
its top five priorities.
Research is fundamental to the understanding and ultimate correction of health
disparities. The needed research is as far-ranging and complex as the disparities.
Involved are biomedical factors that span the entire range of medical specialties and
research domains--and these factors are strongly intertwined with vital social,
behavioral, and population research issues, as well as disparate health care.
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EXECUTIVE SUMMARY 3
As the nation's foremost research agency, NIH plays a leading role in health
disparities research. Although NIH has accomplished much important research
related to health disparities, there has been concern that NIH ensure that research
efforts are optimally marshaled to address health disparities. The Minority Health
and Health Disparities Research and Education Act of 2000 (P.L. 106-525) delin-
eated NIH's role in improving minority health and reducing health disparities.
The legislation called for the establishment of the National Center on Minority
Health and Health Disparities (NCMHD) to administer special grant programs,
coordinate minority health and health disparities research across NIH and lead
the development of an NIH-wide strategic plan on health disparities. Detailed
descriptions of NCMHD's responsibilities and mandates are included in the leg-
islation (see Appendix A). Established in 2000, NCMHD directed development
of the NIH Strategic Research Plan and Budget to Reduce and Ultimately Elimi-
nate Health Disparities, which was completed in 2003.
CHARGE TO THE COMMITTEE
In 2004, the 4th year of the NIH minority health and health disparities initia-
tive, NCMHD asked the Institute of Medicine to:
· Assess the adequacy of the trans-NIH minority health and health dispari-
ties Strategic Plan in achieving the NIH's goals and objectives. Specifically, the
Committee was to evaluate the Strategic Plan with respect to:
Research (e.g., How well does the Strategic Plan advance scientific
understanding of the causes and means to reduce and ultimately eliminate the
disproportionate burden of disease among health disparity groups?),
Research Infrastructure (e.g., Does the Strategic Plan adequately ex-
pand opportunities and the institutional capacity--such as the environment,
leadership, and commitment to health disparities research--for research on
health disparities?),
Public Information and Community Outreach (e.g., How adequately
does the plan address needs for the dissemination and application of research
findings to reduce and ultimately eliminate health disparities?);
· Assess the adequacy of coordination across NIH ICs in helping to develop
and carry out the Strategic Plan and avoid duplication of administrative resources
among ICs and divisions; and
· Identify means, including potential legislative modifications, to help NIH
achieve its minority health and health disparity Strategic Plan objectives.
In its approach, the Committee reviewed the challenges and needs of health
disparities research and analyzed (a) the adequacy of the Strategic Plan as a
document and plan of action, including the ICs' individual strategic plans; (b)
budget information; (c) trans-NIH organization of the efforts; and (d) experiences
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4 EXAMINING THE HEALTH DISPARITIES RESEARCH PLAN OF THE NIH
with implementation, coordination, and monitoring. The process included open
meeting sessions with the directors of NIH and NCMHD, directors and leaders of
several large ICs and Offices within the Office of the Director, and individuals
and representatives of numerous government agencies and private organizations
concerned with health disparities. Commissioned papers and a commissioned
survey were used to further inform the Committee.
HEALTH DISPARITIES:
DEFINITIONS, MEASUREMENT, AND UNDERSTANDING
Understanding and correcting the poorer health of populations in the United
States is complicated by the need for more consensus on definitions, the wide
range of diseases and conditions, a variety of causal factors, and varying mea-
surements of factors and their interactions. Even as research and attention to
correction move ahead, core questions and issues need more focus. NIH should
take leadership in helping to further define, measure, and better understand health
disparities, and also help to guide attention to research needs and opportunities.
Findings:
· Lack of consensus regarding conceptual and operational defini-
tions of disparities and the complexity of measuring health and
health determinants pose challenges for the identification, under-
standing, monitoring and elimination of health disparities.
· There is a continuing need for NIH-funded research to develop,
test, and refine measures and conceptual approaches for assessing
and monitoring health disparities. Research is required to answer
fundamental questions: Which factors are most critical to moni-
tor? How can they best be measured?
· Currently available information does not provide a full and accu-
rate description of disparities between, and within, racial and eth-
nic groups and across the full spectrum of socioeconomic status.
Detailed, accurate data on Hispanic, Asian/Pacific Islander, Afri-
can American, and American Indian/Alaska Native subgroups are
needed, including data on income, education, and occupation. Such
data will provide an important source for research on disparities
and for monitoring progress toward reducing and eliminating dis-
parities across the nation.
· Sophisticated and creative approaches to studying the processes
that cause health disparities are needed. Coordinated, collabora-
tive trans-NIH initiatives, with the active involvement of multiple
ICs, will be needed to understand common backgrounds for mul-
tiple diseases. Coordinated, collaborative trans-agency approaches
will be required to successfully investigate the complex relation-
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EXECUTIVE SUMMARY 5
ships and interactions among race, ethnicity, gender, income, edu-
cation, occupation, immigrant generation, and area of residence.
Recommendation: NIH, through NCMHD and the ICs and, when ap-
propriate, collaborating agencies, should undertake research to further
refine and develop the conceptual, definitional, and methodological is-
sues involved in health disparities research and to further the under-
standing of the causes of disparities.
For such research, priority areas should include, first, the development and
refinement of valid measures of exposures relevant to understanding and evaluat-
ing health disparities. For example:
· Interagency disparity research initiatives to develop valid and reliable
measures of health effects of social factors; genetic risk; stress; racial/ethnic
discrimination; and health care access and quality.
· Disparities research embedded into large studies (molecular, clinical, and
epidemiological), national data sets, and public health monitoring measures
through the greater inclusion of appropriate measures of race, ethnicity, socio-
economic status, and residential characteristics, and of the psychosocial and envi-
ronmental factors that are likely to shape health disparities in the population
being studied at each time point of data collection.
· In population-based studies, the inclusion of information on racial and
ethnic subpopulations and other relevant characteristics, such as immigrant sta-
tus, language preference, and detailed socioeconomic data, should be encour-
aged. Investigators funded by the ICs should be encouraged to gather information
on socioeconomic status and other dimensions of social stratification.
Second, priority areas should include initiatives to further enhance under-
standing of the etiology of health disparities. For example:
· Multidisciplinary initiatives to advance the study of disparities, including
gene-environment interactions and biological mechanisms mediating disparities.
· Trans-NIH disparity research initiatives to elucidate the pathways and
mechanisms by which health disparities occur, including the identification of
common backgrounds for multiple diseases and disease-specific mechanisms that
may facilitate the development of strategies for intervention.
DEVELOPMENT OF THE STRATEGIC PLAN
Creation of the extensive Strategic Plan included the development of indi-
vidual strategic plans by 25 of the 27 ICs and 2 Offices within NIH's Office of the
Director, followed by reviews and approvals, including those of NCMHD and the
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6 EXAMINING THE HEALTH DISPARITIES RESEARCH PLAN OF THE NIH
director of NIH. Although development of the Strategic Plan began before the
legislation and the establishment of NCMHD, the first Strategic Plan, that for
20022006, was not available until 2003. It was expected, both by the legislation
and as described in the initial Strategic Plan, that the Strategic Plan would be
revised and updated annually. The only updated Strategic Plan, that for 2004
2008, was available to the review committee late in Fiscal Year 2005 as an
incomplete, unapproved draft without a budget.
Finding: NIH has not updated the Strategic Plan as intended by the
legislation and the NIH.
Recommendation: The NIH director should assure that the Strategic
Plan is reviewed and revised annually using an established, trans-NIH
process subject to timely review, approval, and dissemination.
THE STRATEGIC RESEARCH PLAN AND BUDGET
Although the only complete and approved Strategic Plan available for re-
view was the 20022006 Strategic Plan, the Committee felt that it would be most
helpful to include a review and assessment of the unapproved Strategic Plan for
20042008.
The Strategic Plan has three goal areas: research, research capacity, and
outreach and communication (see Box 3-1 and Table 3-3 in Chapter 3).
The research goal forms the basis for substantial objectives that properly
address the understanding of diseases and disabilities, detection and diagnosis,
prevention, treatment, and, in the 2004 Strategic Plan, attention to the multifacto-
rial causes of health disparities. Additional research objectives warrant emphasis
and inclusion.
Minority health and health disparities research should include attention to the
nonbiological and biological multifactorial background of disease and disability.
Integration of such aspects of research with activities related to the Strategic Plan
objective dealing with "understanding . . . the development and progression of
diseases and disabilities that contribute to minority health and other disparities"
should be encouraged. The need for information on health disparity populations
should also be an objective of the Strategic Plan. Recognition of the relationship
between health care disparities and disparities in health status is not currently
described in the Strategic Plan. Opportunities for collaborative, interagency re-
search in health care disparities should be fostered by a specific objective.
Finding: The Strategic Plan has placed inadequate emphasis on under-
standing social and behavioral determinants of health and their interac-
tion with biological factors; better understanding of the characteristics
of populations affected by poor health and the characteristics of diseases
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EXECUTIVE SUMMARY 7
and conditions for which disparities exist in those populations; the rela-
tionship between population disparities in health care and differences in
health status; and research opportunities regarding disparities in health
care.
Recommendation: The Strategic Plan research objectives should pro-
mote more integration of research on the multifactorial nature of health
disparities, including nonbiological factors; population research to fur-
ther the understanding of the presence, prevalence, trends, and other
elements of health disparity conditions; and, when opportunity exists,
an understanding of the causes of disparities in health care.
The research capacity goal and the listed objectives were found to be appro-
priate by the Committee. The Committee emphasized the importance and poten-
tials of certain aspects of the objectives--specifically, diversity in the scientific
workforce, the participation of minority individuals in clinical trials, community-
based participatory research, and the need for assessments of programs.
Diversity in the scientific workforce, and an increase in the numbers of
researchers who will engage in health disparities research, are important objec-
tives. During the minority health and health disparities research program and the
implementation of the Strategic Plan (20002004), successes and trends in pro-
viding support for the development of researchers so far have varied with the type
of career-support mechanisms. Minority Research Fellow and Research Career
Awards increased, but Research Training Grants for minorities changed little.
Participation of minority individuals in clinical trials did increase during this
period.
The Strategic Plan's objectives should include assessments of the results and
impacts of research infrastructure programs (including institutional awards) on
the capacity to conduct minority health and health disparities research. This
information is needed to evaluate the effectiveness of programs, identify ap-
proaches in need of modification, set priorities, and make evaluations available
for internal and external reviews.
Community-based participatory research can be a valuable, if challenging,
research approach. The Strategic Plan and the health disparities research program
provide an opportunity to analyze and evaluate community-based participatory
research in health disparities research and to generate experience-based guidance
on its use in future health disparities research efforts. NCMHD can play a central
role in fostering the understanding and application of community-based partici-
patory research in health disparities.
Findings:
· The Strategic Plan does not provide for assessments of the results
of the research capacity and infrastructure programs included as
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8 EXAMINING THE HEALTH DISPARITIES RESEARCH PLAN OF THE NIH
objectives. Such information is needed to evaluate the effectiveness
of these programs, identify approaches in need of modification, set
priorities, and make evaluations available for internal and exter-
nal reviews.
· The inclusion of community-based participatory research as an
objective of the Strategic Plan is appropriate. There is a need for
development of metrics, analysis, assessment and evaluation of
community-based participatory research for a better sense of the
issues and settings for which it is most promising.
Recommendation: The Strategic Plan should include measurable tar-
gets and time periods for the research capacity objectives. NIH, through
NCMHD's oversight, should develop methods of measuring, analyzing
and monitoring the results of programs that address research capacity,
including workforce, institutional, infrastructure, and community-based
participatory health disparity research objectives.
The objectives listed in support of the community outreach, information
dissemination, and public health education goal are reasonable. There are
important areas in which more information is needed to improve public infor-
mation and outreach strategies related to health disparities, including attention
to the complexity, difficulties, and challenges of communication and the need
for an organized, coordinated, trans-NIH approach to the communication
effort.
Finding: The current objectives for outreach and public information
identify target audiences, but attention is needed to issues of inequali-
ties in public communication, including those related to access and use
of, and ability to act on, information. Additional understanding is
needed regarding effective communication with those who provide care
to groups with poor health. Coordination of communication programs
across NIH could help with examination of specific audience needs and
evaluations of programs.
Recommendation: The Strategic Plan's communication programs should
be organized as a specific trans-NIH effort with centralized coordination
with particular attention to the strategic planning, design, prioritiza-
tion, implementation, and evaluation of efforts across NIH. The initiative
should: be informed by advisory expertise; develop a surveillance system
to identify information needs and availability, sources, behaviors, and use
patterns; and promote attention to the issue of inequalities in health com-
munication.
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EXECUTIVE SUMMARY 9
THE STRATEGIC PLANS OF THE ICS
The Strategic Plan's goals and objectives cannot be achieved unless they are
adopted by the ICs and reflected in their objectives and activities. The individual
strategic plans of the ICs contain an impressive array of planned activities related
to the overall Strategic Plan objectives, but some overall objectives appear infre-
quently as intended IC activities. Time-based, targeted research activities would
help with assessments of the results of research programs.
Finding: There is no evidence that the strategic plans of the ICs were
developed as part of a concerted, trans-NIH strategic planning process.
Planned IC activities are not time-based or targeted.
Recommendation:
· The development of updated Strategic Plans should include assess-
ments of the appropriateness of the individual strategic plans of
the ICs, including whether they adequately reflect the overall goals
and objectives of the NIH Strategic Plan.
· Objectives should be time-based and targeted with measurable
outcomes.
HEALTH DISPARITIES AS DEFINED BY THE STRATEGIC PLAN
Although defining health disparities is difficult (see Chapter 2), the Strategic
Plan and the minority health and health disparities research program required
working definitions. The legislation and the Strategic Plan indicate that in addi-
tion to racial and ethnic minorities and low socioeconomic and rural populations
there may be other population groups that warrant inclusion in health disparities
research and the Strategic Plan. As described by the legislation, it is expected that
the director of NCMHD, consulting with the director of the Agency for Healthcare
Research and Quality, will, when appropriate, designate additional groups expe-
riencing diseases and conditions for which there are disparities. Such designa-
tions should be the result of a well-informed process with specific criteria.
Findings:
· Beyond the basic definitions of health disparities indicated by Con-
gress and used by NIH, there are no further criteria for deciding
what constitutes a health disparity group. Understanding the health
impacts of social stratification (e.g., in the education system or the
labor market) presents an additional approach to health disparities
research.
· There is need for a resource that provides updated listings of:
diseases and conditions for which differences exist; affected popu-
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10 EXAMINING THE HEALTH DISPARITIES RESEARCH PLAN OF THE NIH
lations; prevalence data; and other information that would pro-
vide a knowledge base on the scope and impact of disparity condi-
tions. This resource would help in planning health disparity stud-
ies, setting priorities, and assessing research activities.
Recommendation: NCMHD should consider the designation of addi-
tional health disparity groups based on an informed process and devel-
oped criteria. It should promote development of, and access to, a regis-
try of diseases and conditions for which disparities exist with regard to
race, ethnicity, socioeconomic status, geographic locale, and other desig-
nated health disparity populations.
THE STRATEGIC PLAN BUDGET
The first Strategic Plan, for 20022006, and the 2001 Annual Report in-
cluded budgets developed without uniform accounting, coding definitions, and
methodologies for attributing research activities to minority health and health
disparities efforts. The second Strategic Plan (20042008) was available for re-
view as an unapproved draft that did not include a budget. The two subsequent
Annual Reports, for 2002 and 2003, were also incomplete and unapproved.
The enabling legislation recognized the need for incremental funding to be
provided to the NIH and authorized up to $100 million in additional annual
funding for minority health and health disparities research to be added to separate
appropriations for the conduct and support of the health disparities research
program, but the incremental funds were not allocated to the NIH. The committee
expressed concern that the absence of such funding might have impeded the
establishment of new health disparities research programs, which would reason-
ably incur additional research and management costs.
Regarding the ways in which budget information is reported, it would be
helpful to have budget information categorized by funding for each goal area,
along with the funds allocated for each objective under each goal, and individu-
ally for each involved IC and office. Such information would facilitate monitor-
ing and review.
Findings:
· Incremental funding was not provided to NIH for the minority
health and health disparities research program.
· As of July 2005, during the 5th year of the program period, no
complete, standardized, approved budget information was avail-
able from the Strategic Plan or the Annual Reports. The absence
of such information calls into question the validity and efficacy of
the Strategic Plan and Annual Reports as tools for planning and
coordination.
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EXECUTIVE SUMMARY 11
· For more accurate evaluation, detailed information on specific cat-
egories and aspects of the minority health and health disparities
research program and the Strategic Plan would be helpful.
Recommendation: Within NIH, a clear and timely budget process should
be linked to the Strategic Plan, and it should be updated in a timely
manner. Annual budgets should include information for NIH as a whole,
and for each involved IC and Office, and should detail allocations for
the Strategic Plan goal areas and each objective. Trans-NIH budget
information on efforts made in the major categories of research, re-
search capacity, and communication also should be made available.
Based on information provided by the NIH Budget Office, the Committee
attempted to compare funding for minority health research (involving minority
populations) and health disparities research (minority health plus groups with low
socioeconomic status and rural populations) for the years 1998 through 2004,
though (except for 2003 and 2004) the data were not standardized. The application
of new, standardized definitions of minority health and health disparities in Fiscal
Year 2003 apparently changed the reported NIH funding for minority health re-
search, from $2.13 billion to $2.09 billion, and changed the estimate of funding for
health disparities research from $3.16 billion to $2.43 billion. Using the old meth-
odology, the percentage of the NIH total budget attributed to health disparities
research was calculated to be 11 percent in 1999, and 12 percent each year from
2001 to 2003. With the new methodology it was 9 percent for 2003 and 2004. In
comparison, the proportion for minority health research held at around 8 percent
from 1999 to 2004, reflecting the fact that during the period in which the NIH
budget doubled (19982003), spending on minority health research kept pace.
THE NCMHD
The Office of Research on Minority Health, established in 1990, became
NCMHD in 2000 as a result of the legislation (P.L. 106-525). The legislation also
prescribed NCMHD's dual responsibilities: (a) the administration of large, legis-
latively mandated grant programs dealing with research infrastructure and capac-
ity; and (b) service as the hub of responsibility for coordinating and managing the
Strategic Plan. The Committee questioned NCMHD's current resources and ca-
pacity to deal with these responsibilities.
Findings:
· The dual roles of NCMHD as a granting center and as a coordinator
of major trans-NIH efforts are unique. The leadership of NCMHD
and its Advisory Council call attention to the need for increased
administrative staffing for NCMHD.
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12 EXAMINING THE HEALTH DISPARITIES RESEARCH PLAN OF THE NIH
· There is a need for increased science leadership and presence in
NCMHD, particularly for proper management of the trans-NIH
initiative.
Recommendation:
· The NIH director should review and assess the administrative staff-
ing of NCMHD to ensure that it is sufficient to attend to the
Center's responsibilities.
· Increasing the science leadership and presence within NCMHD
should be pursued by the NIH and NCMHD directors. This entails
the appointment of additional eminent scientists, recognized in the
areas of minority health and health disparities, and the establish-
ment by NCMHD of committees and panels with relevant exper-
tise from within and outside NIH.
MANAGEMENT AND COORDINATION OF THE STRATEGIC PLAN
AND MINORITY AND HEALTH DISPARITIES RESEARCH
The breadth and complexity of the health disparities research agenda and the
Strategic Plan present an extraordinary challenge for trans-NIH management. To
best manage these efforts, NIH needs to:
· Ensure concerted involvement of the ICs and Offices to develop and
regularly update the Strategic Plan;
· Ensure that all ICs and pertinent Offices are attentive to the Strategic
Plan's mission, goals, and objectives;
· Avoid gaps, such as populations, conditions, needs, and approaches, that
would otherwise not be identified or addressed by the independent operation of
the ICs;
· Involve the best expertise from across the NIH and from the external
scientific community;
· Avoid duplicating administrative and research efforts;
· Facilitate collaboration and coordinated research approaches;
· Coordinate outreach and communication;
· Create an organized program structure for effective monitoring and re-
search articulation with other government agencies; and
· Devote attention to research and budget priorities.
The potential for conflicting priorities is real. The ICs' budgets reflect com-
mitments, mandates, and priorities resulting from budget presentations to, and
authorizations from, Congress. If there is truly a concerted trans-NIH priority for
minority health and health disparities research, which is stated to be third among
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EXECUTIVE SUMMARY 13
the agency's top five priorities, then this concern should be active in priority
formulations and decisions within the ICs.
Development of the Strategic Plan does not involve the coordinated, con-
certed, and collective participation of the ICs. There is no ongoing, continuous
update process with an established trans-NIH structure involving the ICs and others
to produce planning improvements and results in periodic, meaningful updates and
revisions of the Strategic Plan. There is no evidence of trans-NIH planning of
priorities regarding minority health and health disparities research activities and
resources for the NIH as a whole or with respect to the ICs. In discussions with the
Committee, directors and other leading members of several large ICs with exten-
sive minority health and health disparities programs expressed a very high level of
commitment to and enthusiasm for these activities. However, it was evident that
there had been little to no contact with the NCMHD during the development or
implementation of these projects and programs. Activities and programs were pur-
sued independently of NCMHD, except that some, particularly in the past, had been
co-funded, or sometimes totally funded, by NCMHD.
There is no manifest organizational structure for the trans-NIH Strategic
Plan and health disparities program. Advisory and coordinating committees are
not described or apparent. Experts from scientific, health care, and affected com-
munities are not involved in advising and participating in ongoing planning in
established, structured, predictable ways. The result is a gaping lack of opportu-
nity to properly inform and contribute to the identification of research and related
needs, plans, and strategy.
No results summarizing the monitoring and assessment of minority health
and health disparities research, and related activities for the NIH, or with respect
to the ICs, are evident. Annual reports are late, languish incomplete and unap-
proved, and do not contain evidence of central NIH assessments of research and
program activities. Moreover, budget and finance issues are not addressed by a
centralized entity responsible for the minority health and health disparities re-
search program and the Strategic Plan.
The Committee saw the need to be certain that there is clearly designated
authority to coordinate and manage the Strategic Plan and health disparities re-
search program. Although the legislation indicates that the NCMHD director is
responsible for coordinating all NIH minority health and health disparities research,
the responsibility for monitoring and managing the Strategic Plan and the program
falls on the NIH director, the NCMHD director, and the IC directors. The text of the
approved initial Strategic Plan (20022006) indicates that NCMHD is responsible
for such functions, but it was unclear to the Committee whether this authority is
widely understood.
Finding: The level of trans-NIH coordination needed to effectively imple-
ment the Strategic Plan has not been evident. Instead, the Committee
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14 EXAMINING THE HEALTH DISPARITIES RESEARCH PLAN OF THE NIH
concluded that an uncoordinated, unmonitored, loosely administered
trans-NIH program existed, with substantial commitments and activi-
ties of largely independent ICs, but without the coordinated, concerted
program needed. Clarity regarding the responsibilities and authority
may be a factor in achieving more effective management. The mandates
of the NIH director are key elements in structuring and assuring effec-
tive management.
Recommendation: The NIH director, through the established authority
of the NCMHD director, should ensure continuous, effective coordina-
tion of the health disparities research program across NIH, including:
· Timely development of Strategic Plan revisions;
· Effective, ongoing participation of the ICs in the Strategic Plan
and the health disparities research program;
· Establishment of appropriate committees involving the directors of
the ICs and others to facilitate collaboration and coordinated ap-
proaches to health disparities research and the setting of priorities;
· Fostering of conferences and the use of committees and panels
involving the NIH, extramural scientific communities, and others
to inform and advise on initiatives and directions; and
· Monitoring of the execution of the Strategic Plan to ensure that its
elements are implemented.
Representative terms from entire chapter:
disparities research
