Research Towards the Elimination of Health Disparities
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1 Research Towards the Elimination of Health Disparities Yvonne T. Maddox, Ph.D.Deputy DirectorNational Institute of Child Health andHuman DevelopmentNational Institutes of Health
2 Tommy G. Thompson Secretary Department of Health and Human Services “Advances in scientific knowledge have provided the foundation for improvements in public health and have led to enhanced health and quality of life for all Americans. Much of this can be attributed to the groundbreaking work carried on by, and funded by, the National Institutes of Health (NIH).”Tommy G. ThompsonSecretaryDepartment of Health and Human Services
4 NIH MissionTo improve the health of the Nation through Biomedical Research and Research Training
5 Advancing Clinical Research Delaying the onset of Alzheimer’s DiseaseImproving treatment for Parkinson’s DiseaseConquering diabetesImproving treatments for spinal cord injuryMaking AIDS treatment safer, easier and betterImproving outcome for cancer and heart disease patients
6 Changing Profile of the Nation Life ExpectancyRacial Breakdown of PopulationSocial Economic Status
9 Child Poverty: Percentage of related children under 18 living below selected poverty levels by race (all families)*Persons of Hispanic origin may be of any race.Source: America’s Children: Key National Indicators of Well-Being 2000
10 There are Racial and Ethnic Differences in many Diseases and Conditions
13 CancerDeath rate from stomach cancer is substantially higher among Asian and Pacific Islanders, including Native Hawaiians, than among other populations.
14 DiabetesNative Americans, Hispanics, African Americans, and some Asian Americans and Pacific Islanders, including Japanese Americans, Samoans, and Native Hawaiians, are at particularly high risk for development of type 2 diabetes.
15 Hispanics/Latinos are twice as likely to have diabetes than whites African-Americans are 1.7 times more likely to have diabetes than whitesHispanics/Latinos are twice as likely to have diabetes than whitesDiabetes has reached epidemic proportions among Native Americans, among the Pimas of Arizona, prevalence is 50%Source: American Diabetes Association
21 AsthmaAsthma is 26 percent more prevalent in African-American children than in white childrenAmong 5 to 24 year olds, African-Americans are 4 to 6 times more likely to die from asthma than whitesThe hospital discharge rate for asthma is 3.7 times higher for African-Americans than for whitesSource: CDC, American Lung Association
23 Growing Mortality Disparity for American Indians Compared to U. S Growing Mortality Disparity for American Indians Compared to U.S. All Races RatesPneumonia and influenza – 71% greaterHomicide – 63% greaterGastrointestinal disease – 42% greaterInfant mortality – 22% greaterHeart disease – 13% greater
24 Growing Mortality Disparity for American Indians Compared to U. S Growing Mortality Disparity for American Indians Compared to U.S. All Races RatesAlcoholism % greaterTuberculosis – 533% greaterDiabetes – 250% greaterInjuries – 230% greaterSuicide – 72% greater
25 DHHS Initiative to Eliminate Racial and Ethnic Disparities in Health Infant MortalityCancer ManagementCardiovascular DiseaseDiabetesHIV/AIDSImmunizations
26 Historical Perspective DHHS Response to the President’s Race Initiative“Eliminating Racial and Ethnic Disparities in Health in six areas by the year (Infant Mortality, Cancer Screening and Management, Cardiovascular Disease, Diabetes, HIV/AIDS, and Immunizations”
27 Definition of Health Disparities “Differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States”First NIH Working Group on Health Disparities
28 Focus of the Initiative Initially, NIH will focus on racial/ethnic minority populations (African-Americans, Asians, Pacific Islanders, Hispanics and Latinos, Native Americans, and Native Alaskans)Research on health disparities related to socioeconomic status is also included in the definition.
29 Trans-NIH Initiative: Addressing Health Disparities
30 NIH Plan of Action (Goals) Develop a Five-Year Strategic Research AgendaRecruit and Train Minority InvestigatorsAdvance Community Outreach ActivitiesForm PartnershipsDefine, Code, Track, Analyze, and Evaluate ProgressEnhance Public Awareness
31 Research Objectives (1) Advance the understanding of the development of diseases and disabilities that contribute to health disparities- Epidemiology and Risk Factors- Environment/Socioeconomic Status- Mechanisms of Disease- Genetic Variation
32 Research Objectives (2) Develop new or improved approaches for detecting or diagnosing the onset or progression of disease and disabilities that contribute to health disparitiesDevelop new or improved approaches for preventing or delaying the onset or progression of disease or disabilities that contribute to health disparitiesDevelop new or improved approaches for treating diseases and disabilities that contribute to health disparities
33 Research Infrastructure Objectives Support research training and career developmentProvide support for institutional resources
34 Public Information, Outreach, and Education Develop research-based information resourcesCommunicate research-based information to increase public awarenessTransfer knowledge to health care providers
36 Provisions That the Projects are of Benefit to the Community
37 Infant Mortality Rate (By Race and Hispanic Origin, Selected Years 1983-99)
38 Sudden Infant Death Syndrome (SIDS) Leading Causes of Infant Mortality – 1992Congenital anomalies (21%)Sudden Infant Death Syndrome ( 15%)Low birth weight (11%)Respiratory Distress Syndrome (7%)Maternal complications (4%)
39 Theories of SIDS Cause circa Bronchospasm Adrenal InsufficiencyChromaffin deficiencyMaternal “overlay”Gastric aspirationPoisoningInborn error of metabolismParathyroid insufficiencyAnaphylactic shockEndotoxemiaBacterial sepsisViral infectionStatus thymicolymphaticus (with venous or atrial compression)Mechanical suffocationVagal reflex, etc.HypogammaglobulinemiaMucous obstruction of tracheaHypocalcemia with laryngospasmCardiac arrhythmiaHypersensitivity
41 Impact of the Back to Sleep Campaign A public-private partnership to reduce the risk of Sudden Infant Death Syndrome.The NICHD developed an easy-to-remember slogan, “Back to Sleep” and an appealing logo. The Surgeon General launched the campaign at a highly publicized press conference in June 1994.
42 Launch of Back to Sleep Campaign BTS Campaign Partners BACK TO SLEEP CAMPAIGN LAUNCHED NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENTLaunch of Back to Sleep CampaignPress conference, June 1994, Surgeon GeneralBTS Campaign PartnersAmerican Academy of PediatricsSIDS AllianceAssociation of SIDS and Infant Mortality ProgramsNational Heart, Lung, and Blood Institute, NIHMaternal and Child Health Bureau, HRSAThe NICHD lined up a coalition of partners, including the American Academy of Pediatrics, the SIDS Alliance, and the Association of SIDS and Infant Mortality Programs, the Maternal and Child Health Bureau, and the Public Health Service.
43 Campaign Components Media Materials (radio, TV, print) Video Posters Crib StickersMagnets
44 Pre-AAP recommendation Post-AAP BTS Campaign Sleep Position Source: NICHD Household SurveySIDS Rate Source: National Center for Health Statistics, CDC
45 Sudden Infant Death Syndrome (SIDS) Leading Causes of Infant Mortality Congenital anomaliesShort gestation/low-birth weightSudden Infant Death Syndrome
47 Back to Sleep Focus on African American Communities SIDS rate is 2.2 times higher in the black population than it is in the white populationBlack mothers are twice as likely as white mothers to place their babies on their stomachs to sleepSuccess of the Back to Sleep campaign demonstrates that a focused campaign can increase back sleeping and reduce the risk of SIDS
48 Reducing SIDS in African American Communities Institute makes strong commitment to eliminating disparity in rates of SIDS between white and minority populationsNICHD’s SIDS Strategic Plan
50 Implementing the Outreach D.C. Metro Bus Ad Bus ad developed by NICHD, National Black Child Development Institute, D.C. Department of Health, MCHB, and SIDS Alliance.Displayed on 50 Metrobuses during National SIDS Awareness Month, October 2000.
51 Community Participation Campaign strategies targeted to the particular minority group “ Input from the people”Provide the resource materials for health fairs and community eventsGive progress reports on results
52 Disparities Research Plan: The NIH HealthDisparities Research Plan:Where Do We GoFrom Here?
53 National Center on Minority Health and Health Disparities (NCMHD) Congress Established December, 2000 as part of the National Institutes of Health (NIH)Has Research and Research Training Grant AuthoritySpecial Research and Research Training Opportunities
54 Strategies to Eliminate Health Disparities Communicate evidenced-based resultsIncrease access to care for low income and minority populationsImprove quality and outcomes in the health care systemDevelop preventive approaches at the community levelBuild a knowledge base to understand the connection between SES, race, prevention, and health
55 Cultural Competency What is it? Establishing and Promoting Cultural Education CurriculaCreating a Health Delivery Process that Supports an Environment for its Culturally Diverse Clients
56 TOMMY G. THOMPSON SECRETARY DEPARTMENT OF HEALTH AND HUMAN SERVICES “…. we're taking prevention directly to the people of America. Throughout this year, we're going to give Americans the tools, help and encouragement to live healthier …. we're raising the profile of prevention.”TOMMY G. THOMPSON SECRETARY DEPARTMENT OF HEALTH AND HUMAN SERVICES