Research Towards the Elimination of Health Disparities Yvonne T. Maddox, Ph.D. Deputy Director National Institute of Child Health and Human Development National Institutes of Health

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. Thompson Secretary Department of Health and Human Services

The National Institutes of Health

NIH Mission To improve the health of the Nation through Biomedical Research and Research Training

Advancing Clinical Research Delaying the onset of Alzheimer’s Disease Improving treatment for Parkinson’s Disease Conquering diabetes Improving treatments for spinal cord injury Making AIDS treatment safer, easier and better Improving outcome for cancer and heart disease patients

Changing Profile of the Nation Life Expectancy Racial Breakdown of Population Social Economic Status

Racial breakdown of population

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

There are Racial and Ethnic Differences in many Diseases and Conditions

Cancer Death rate from stomach cancer is substantially higher among Asian and Pacific Islanders, including Native Hawaiians, than among other populations.

Diabetes Native 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.

Hispanics/Latinos are twice as likely to have diabetes than whites African-Americans are 1.7 times more likely to have diabetes than whites Hispanics/Latinos are twice as likely to have diabetes than whites Diabetes has reached epidemic proportions among Native Americans, among the Pimas of Arizona, prevalence is 50% Source: American Diabetes Association

Asthma Asthma is 26 percent more prevalent in African-American children than in white children Among 5 to 24 year olds, African-Americans are 4 to 6 times more likely to die from asthma than whites The hospital discharge rate for asthma is 3.7 times higher for African-Americans than for whites Source: CDC, American Lung Association

Growing Mortality Disparity for American Indians Compared to U. S Growing Mortality Disparity for American Indians Compared to U.S. All Races 1994-1996 Rates Pneumonia and influenza – 71% greater Homicide – 63% greater Gastrointestinal disease – 42% greater Infant mortality – 22% greater Heart disease – 13% greater

Growing Mortality Disparity for American Indians Compared to U. S Growing Mortality Disparity for American Indians Compared to U.S. All Races 1994-1996 Rates Alcoholism - 627% greater Tuberculosis – 533% greater Diabetes – 250% greater Injuries – 230% greater Suicide – 72% greater

DHHS Initiative to Eliminate Racial and Ethnic Disparities in Health Infant Mortality Cancer Management Cardiovascular Disease Diabetes HIV/AIDS Immunizations

Historical Perspective DHHS Response to the President’s Race Initiative “Eliminating Racial and Ethnic Disparities in Health in six areas by the year 2010 (Infant Mortality, Cancer Screening and Management, Cardiovascular Disease, Diabetes, HIV/AIDS, and Immunizations”

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

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.

Trans-NIH Initiative: Addressing Health Disparities

NIH Plan of Action (Goals) Develop a Five-Year Strategic Research Agenda Recruit and Train Minority Investigators Advance Community Outreach Activities Form Partnerships Define, Code, Track, Analyze, and Evaluate Progress Enhance Public Awareness

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

Research Objectives (2) Develop new or improved approaches for detecting or diagnosing the onset or progression of disease and disabilities that contribute to health disparities Develop new or improved approaches for preventing or delaying the onset or progression of disease or disabilities that contribute to health disparities Develop new or improved approaches for treating diseases and disabilities that contribute to health disparities

Research Infrastructure Objectives Support research training and career development Provide support for institutional resources

Public Information, Outreach, and Education Develop research-based information resources Communicate research-based information to increase public awareness Transfer knowledge to health care providers

NICHD Plan to Eliminate Health Disparities

Provisions That the Projects are of Benefit to the Community

Infant Mortality Rate (By Race and Hispanic Origin, Selected Years 1983-99)

Sudden Infant Death Syndrome (SIDS) Leading Causes of Infant Mortality – 1992 Congenital anomalies (21%) Sudden Infant Death Syndrome ( 15%) Low birth weight (11%) Respiratory Distress Syndrome (7%) Maternal complications (4%)

Theories of SIDS Cause circa Bronchospasm Adrenal Insufficiency Chromaffin deficiency Maternal “overlay” Gastric aspiration Poisoning Inborn error of metabolism Parathyroid insufficiency Anaphylactic shock Endotoxemia Bacterial sepsis Viral infection Status thymicolymphaticus (with venous or atrial compression) Mechanical suffocation Vagal reflex, etc. Hypogammaglobulinemia Mucous obstruction of trachea Hypocalcemia with laryngospasm Cardiac arrhythmia Hypersensitivity

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.

Launch of Back to Sleep Campaign BTS Campaign Partners BACK TO SLEEP CAMPAIGN LAUNCHED NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT Launch of Back to Sleep Campaign Press conference, June 1994, Surgeon General BTS Campaign Partners American Academy of Pediatrics SIDS Alliance Association of SIDS and Infant Mortality Programs National Heart, Lung, and Blood Institute, NIH Maternal and Child Health Bureau, HRSA The 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.

Campaign Components Media Materials (radio, TV, print) Video Posters Crib Stickers Magnets

Pre-AAP recommendation Post-AAP BTS Campaign Sleep Position Source: NICHD Household Survey SIDS Rate Source: National Center for Health Statistics, CDC

Sudden Infant Death Syndrome (SIDS) Leading Causes of Infant Mortality Congenital anomalies Short gestation/low-birth weight Sudden Infant Death Syndrome

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 population Black mothers are twice as likely as white mothers to place their babies on their stomachs to sleep Success of the Back to Sleep campaign demonstrates that a focused campaign can increase back sleeping and reduce the risk of SIDS

Reducing SIDS in African American Communities Institute makes strong commitment to eliminating disparity in rates of SIDS between white and minority populations NICHD’s SIDS Strategic Plan

Newest Campaign Literature

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.

Community Participation Campaign strategies targeted to the particular minority group “ Input from the people” Provide the resource materials for health fairs and community events Give progress reports on results

Disparities Research Plan: The NIH Health Disparities Research Plan: Where Do We Go From Here?

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 Authority Special Research and Research Training Opportunities

Strategies to Eliminate Health Disparities Communicate evidenced-based results Increase access to care for low income and minority populations Improve quality and outcomes in the health care system Develop preventive approaches at the community level Build a knowledge base to understand the connection between SES, race, prevention, and health

Cultural Competency What is it? Establishing and Promoting Cultural Education Curricula Creating a Health Delivery Process that Supports an Environment for its Culturally Diverse Clients

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

http://healthdisparities.nih.gov/