By Eliseo J. Pérez-Stable, M.D.
Director, National Institute on Minority Health and Health Disparities
On March 1, NIH Director Francis S. Collins, M.D., Ph.D., announced the launch of UNITE, a new NIH initiative aimed at bringing an end to structural racism in biomedical research. In his statement, Dr. Collins recalled the agency’s longstanding support of programs to expand the diversity of the scientific workforce, but he acknowledged shortfalls in NIH’s efforts to bring “…diverse perspectives, backgrounds, and skillsets to complex scientific problems.” As the Director of NIMHD, I enthusiastically endorse this newly stated goal for NIH to address, manage and eliminate systemic racism and discrimination embedded in policies and practices in the biomedical research enterprise. Since its beginnings as an Office more than three decades ago, NIMHD has promoted and supported the recruitment and training of a diverse workforce as part of its mission in research and training. We will continue that work while contributing our knowledge, experience, training programs, and tools to our collective goal of ending structural racism and discrimination, by building a biomedical workforce that reflects the populations we serve at all levels of authority within NIH and in our grantee institutions.
Our mission at NIMHD is more important now than ever as the ongoing COVID-19 pandemic underscores the harsh reality of how health disparities shift the burden of illness, disability, and death onto certain segments of our population. The excess case rate, hospitalizations and deaths from COVID-19 among African Americans, Latinos/as, American Indians and Pacific Islanders are two to three times that of White Americans a year into the pandemic. The magnitude of this disparity is truly unparalleled in the past 50 years and the root cause lies in structural inequities that our society has tolerated far too long. Racism and discrimination affect all Americans and no group is left untouched by the structural inequities that perpetuate these. At NIH our currency is scientific innovation and productivity and the time has come for these efforts to address the vexing challenges of racism and discrimination.
Exposure to racism and discrimination on the individual level is often overt, horrifying and destructive. More subtle forms of ongoing interpersonal racist and discriminatory acts are common and according to the Kaiser Family Foundation/CNN Survey of Americans on Race, when asked about their experience with racism and discrimination within the past month 53% of African Americans and 36% of Latinos reported being treated unfairly because of their race. These acts represent a form of chronic cumulative stress that wears on one’s health and may actually intensify among African Americans and Latinos/as they move up the socioeconomic ladder and experience being “the only one in the room”. NIH-funded researchers have examined the effects of interpersonal racism and discrimination and found significant associations on mental health symptoms, substance use behavior, cardiovascular events and overall physical function. However, the consequences reflected in the pandemic are derived from the ingrained racist practices, laws, policies, and social norms that have underpinned American society since the founding of the Republic. No matter what you call it — structural racism, systemic racism, institutional racism — this form of racism and discrimination crushes hopes and limits potential on a daily basis, but it usually lurks just below the surface. Structural racism and discrimination exist to perpetuate the status quo, to create a culture of inferiority among some and elevate barriers to protect those in power.
People who have not experienced the cruel effects of structural racism have acclimated to it, tolerated it, and even benefited from it. The striking inequality revealed by the pandemic and the social unrest events of 2020 have again brought inequities to light. The unfairness can no longer be ignored: We must identify, modify or eradicate policies that support structural racism wherever it exists. As a nation, we need to reverse practices and norms that have blocked people and entire communities from accessing what most of us take for granted: affordable housing, quality public education, access to health care, living wage for all, job and career opportunities, equal police protection, and the ability to live without fear of discrimination, harassment, and violence. As a major funder of research and as an entity that influences policy and public health practices through scientific discovery, NIH has a unique and important responsibility to identify and address structural racism and end racial inequities in the biomedical research enterprise. NIMHD is committed to lead the scientific efforts to develop, implement and evaluate interventions to manage, reduce and eliminate structural racism and discrimination.
NIMHD envisions an America in which all populations will have an equal opportunity to live long, healthy, and productive lives. As the director of NIMHD, I am proud of our Institute’s hard work and accomplishments that are contributing to a more diverse research workforce through outreach, grant opportunities, training resources, and programs such as the Health Disparities Research Institute, Research Centers in Minority Institutions, and Loan Repayment Program. NIMHD’s leaders, including Deputy Director Monica Webb Hooper, Ph.D., and Anna María Nápoles, Ph.D., M.P.H., scientific director of the Division of Intramural Research, have been supporting the UNITE work as co-chairs of two committees.
Through the UNITE initiative, NIH is focusing on ending structural racism in biomedical research, but the work will be neither simple nor quick. Through our long experience in creating a diverse research workforce, we know that more hard work lies ahead. NIH has also issued a Request for Information seeking public input on practical and effective approaches to improve and strengthen racial equity, diversity, and inclusion within NIH and the external community and to expand research to eliminate or lessen health disparities and inequities. We invite you to share your perspective and recommendations by April 23, 2021, as we thoughtfully consider NIH’s approach to address racial and health inequities. Comments can be submitted through the submission website. As Dr. Collins said, “Identifying and dismantling racist components of a system that has been hundreds of years in the making is no easy task.” NIH is taking on this challenge. We must do better. We will do better.
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