1. 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

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. Thompson
Secretary
Department of Health and Human Services

3. The National Institutes of Health

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

5. 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

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

8. Racial breakdown of population

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

14. 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.

15. 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

21. 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

23. Growing Mortality Disparity for American Indians Compared to U. S
Growing Mortality Disparity for American Indians Compared to U.S. All Races Rates
Pneumonia and influenza – 71% greater
Homicide – 63% greater
Gastrointestinal disease – 42% greater
Infant mortality – 22% greater
Heart 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 Rates
Alcoholism % greater
Tuberculosis – 533% greater
Diabetes – 250% greater
Injuries – 230% greater
Suicide – 72% greater

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

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 Agenda
Recruit and Train Minority Investigators
Advance Community Outreach Activities
Form Partnerships
Define, Code, Track, Analyze, and Evaluate Progress
Enhance 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 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

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

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

35. NICHD Plan to Eliminate Health Disparities

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 – 1992
Congenital 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 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

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 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.

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

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

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

48. 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

49. Newest Campaign Literature

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 events
Give progress reports on results

52. Disparities Research Plan:
The NIH Health
Disparities Research Plan:
Where Do We Go
From 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 Authority
Special Research and Research Training Opportunities

54. 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

55. 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

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