funding to address the needs of ethnic minority and medically underserved populations is inadequate.

In addition, the committee believes that NCI and NIH should improve the accuracy of their assessment of the amount of resources allocated to addressing the needs of ethnic minority and medically underserved groups. NIH calculates the amount of money allocated to research on minority health programs on the basis of the percentage of ethnic minority individuals in NIH study populations. While the committee wishes to encourage NIH to continue to support the inclusion of diverse study populations in all the research it sponsors, such "percent relevancy" accounting methods are inappropriate as means of indicating overall expenditures for research on ethnic minority health. Diverse study populations do not, in and of themselves, address the research needs of ethnic minority and medically underserved populations unless meaningful research questions relevant to these groups can be posed a priori and answered based on the appropriateness (i.e., diversity and generality) of the study population. Estimates of expenditures on minority health research should therefore be determined by summing research expenditures associated with studies that address a priori research questions focused on the particular needs of ethnic minority and medically underserved communities. Therefore, while NCI reports that $124 million was allocated to research and training programs relevant to ethnic minority and medically underserved populations in fiscal year 1997 (based on percent relevancy accounting methods), the committee believes that the actual figure allocated for these groups is only slightly more than $24 million, or approximately 1 percent of the total NCI budget. Funds allocated to cancer-related minority health research and training programs by other NIH ICs are also small relative to their respective overall budgets. The committee finds these resources are insufficient relative to the burden of disease among ethnic minority and medically underserved communities, the changing U.S. demographics, and the scientific opportunities inherent in the study of diverse populations. Moreover, the committee found no evidence that NIH calculates total expenditures for research on medically underserved groups, apart from calculations derived from data for ethnic minority populations.

Although the committee found evidence that NCI sponsors significant behavioral and social science research aimed at examining the range of behavioral, psychosocial, dietary, and other factors that enhance or decrease the risk for cancer or poor cancer survival among ethnic minority and medically undeserved groups, behavioral and social science research should be expanded, particularly with respect to prevention and outreach efforts. The agenda for such research should be based on an analysis of the prevalence of particular cancers in these populations and their preventability. Particularly for ethnic minority populations, research is needed

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