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  • Images Are Important: An Apology

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    By Eliseo J. Pérez-Stable, M.D.
    Director, National Institute on Minority Health and Health Disparities

    On November 10, NIMHD shared an image through our online channels that was intended to reflect the results of a recent study, which found that police killings are dramatically underreported. Mortality from police violence is more than two times greater than what is reported in the U.S. National Vital Statistics System—and the under-reporting is particularly marked for African American individuals. I was one of the co-authors of this research paper and I am profoundly saddened that so many people die during encounters with police every year.

    The picture chosen was intended to reflect the unfortunate reality that occurs all too often. However, the image was insensitive and deeply disheartening. Our thoughtful research community has made it clear to us that by sharing this image, NIMHD unintentionally retraumatized people who experience the indignities, dangers, violence, and stress of racism every day. We sincerely apologize. We have removed the image and will do better in future postings.

    Improving the health of racial and ethnic minority groups is the everyday work of this Institute. NIMHD is committed to continuing to lead the scientific efforts to develop, implement, and evaluate interventions to manage, reduce, and eliminate structural racism and discrimination.

  • NIMHD Lauds New Awards on Innovative Health Disparities and Health Equity Research

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    By Eliseo J. Pérez-Stable, M.D.
    Director, National Institute on Minority Health and Health Disparities

    We at the National Institute on Minority Health and Health Disparities are excited and proud to be a part of the Transformative Research to Address Health Disparities and Advance Health Equity initiative, a new effort coordinated by the NIH Common Fund. This new set of 11 grants provides roughly $58 million over five years to support innovative, creative translational health disparities research projects across the country. This new initiative speaks directly to NIMHD’s mission to improve minority health, reduce health disparities, and promote health equity, and encourages bold new solutions to solve enduring problems.

    Despite scientific and technological discoveries that have improved the health of the U.S. population overall, racial, and ethnic minority populations, socioeconomically disadvantaged groups, underserved rural populations, and sexual and gender minorities in the U.S. share an unfair burden of diseases such as diabetes, heart and respiratory diseases, HIV, and obesity. The recent COVID-19 pandemic has further underscored how disease can disproportionately affect vulnerable populations the hardest.

    In our work, characterizing the drivers of health inequities demands a better understanding of social determinants of health, complex underlying causes of health disparities, and effective interventions specifically designed to reduce disparities in these populations.

    To attract innovative ideas and perspectives to health disparities research, these new grants encourage a focus on pressing research problems, new approaches, and sizeable, rapid impacts that leverage intersectoral interventions. Each project has an innovative intervention component and focuses on one or more of the NIH-designated populations that experience health disparities in the U.S.

    For example, researchers and community-based research collaborations will

    • Test financial interventions that address structural racism in minority neighborhoods.
    • Provide gender-affirming mental health care and support to reduce suicide and stress-related health disparities in Black transgender and gender diverse youth.
    • Apply maternal-child health and nutrition interventions at the system level to reduce food insecurity and its harmful health consequences in racial and ethnic minority communities in the Southwest.
    • Implement an app-based intervention to help parents and children, particularly in White populations, hold critical and honest conversations about race, and the role that they have in remedying the pervasive legacy of racism and eliminating discrimination and prejudice.
    • Use new technology developed during the COVID-19 pandemic to deliver physical and mental health interventions for diverse populations with and without disabilities.
    • Develop and evaluate a new model of school-based, telehealth-driven preventive care for underserved rural and socioeconomically disadvantaged children.

    There are additional notable grant programs under this initiative, and I encourage readers to learn more about them by viewing the NIH press release. This initiative is expected to increase the competitiveness of investigators and expand the base dedicated to health disparities research at Minority Serving Institutions (MSIs) with less resources, also central to NIMHD’s mission. Through its innovative approaches to health disparities research, and research funding targeted to MSIs, this initiative will support the goals of UNITE, an NIH effort launched in early 2021 to address structural racism and racial inequities throughout the biomedical research enterprise.

    Not least of all, we are thrilled at the opportunity of this NIH-wide initiative to collaborate with NIH partners pursuing the goals of improving minority health, reducing health disparities, and promoting health equity, including the Office of Research on Women’s Health, the Tribal Health Research Office, the National Institute of Nursing Research, the National Institute of Dental and Craniofacial Research, and other Institutes, Centers and Offices.

  • Heartfelt Thanks to the NIMHD Scientific Community in the Time of COVID-19

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    Co-authored by
    Eliseo J. Pérez-Stable, M.D.
    Director, National Institute on Minority Health and Health Disparities

    Monica Webb Hooper, Ph.D.
    Deputy Director, National Institute on Minority Health and Health Disparities

    As leaders of the National Institute on Minority Health and Health Disparities (NIMHD), we want to express our sincerest thanks to the NIMHD scientific community and staff for their efforts as we continue to experience the most challenging public health crisis in over a century. Your rapid-response efforts to document, understand, and address the undue burden of COVID-19 among populations with health disparities—the very groups already dealing with longstanding disparities in life expectancy and overall well-being—have not gone unnoticed. We deeply appreciate your unwavering commitment to research designed to uncover the causes of health disparities, develop interventions to address them, and promote health equity.

    Since March 2020, the COVID-19 pandemic has radically affected us in our daily lives—as individuals, families, and as members of the biomedical research workforce. We have all had to manage unfathomable adjustments and elevated stress both personally and professionally. The pandemic has disproportionately affected the lives and livelihoods of populations that experience health disparities in even more pronounced ways. And these groups—racial and ethnic minority communities, socioeconomically disadvantaged persons, people who live in rural underserved areas and sexual and gender minority persons—are prioritized by NIMHD.

    The COVID-19 pandemic has also laid bare the inequities embedded within systems of health care, public health, and science, as well as employment, housing, and education. We are proud that as the U.S. and the world have grappled with this unprecedented public health crisis, NIMHD and our community have become an essential part of the scientific response. You have undertaken critical and creative efforts to maintain your research programs, staff, and community partnerships. You have continued to engage with participants as they, too, navigated this new and unfortunate reality, often struggling through the distress and pain associated with the pandemic. Below, we outline a few of these efforts, recognizing that they represent only a fraction of what could be shared.

    • Researchers responded to calls from community partners requesting connections to COVID-19 information, resources, and services. As a result, new collaborations and partnerships were formed and priorities shifted to focus on COVID-19 risk mitigation and prevention.
    • As COVID-19 precluded face-to-face interactions with participants, research teams made swift adjustments, working closely with community partners and health systems to develop and implement COVID-safe procedures to facilitate recruitment, data collection, and intervention delivery. They learned that participants generally maintained their interest in study participation, and, at times, had even greater availability to participate in online, virtual, or telephone-administered activities.
    • Researchers also noted and attempted to address barriers to remote participation, underscoring the digital divide that remains in many medically underserved communities, such as lack of (stable) internet access and smart phone costs. Teams also went to extraordinary lengths to collect biological samples (e.g., saliva) via mail, examining the feasibility and utility of doing so, as well as managing delays in sample processing.

    The COVID-19 pandemic continues to affect our lives and those of our community partners, participants, and patients. There is great uncertainty about when, if ever, activities may return to their pre-pandemic state. We recognize that in some cases, research teams have experienced reduced enrollment and missing data, and have had to suspend operations on specific projects. We hope that these conditions improve in the coming months so that your important contributions to communities and the overall body of knowledge will endure. We are confident that our communities will continue to be resilient, rise to the challenge, and adapt to current conditions.

    We would be remiss if we did not convey our deep gratitude to the NIMHD staff. Our leaders, program directors, scientific review administrators, grants management staff, policy, evaluation, and reporting staff, communications staff, and our mission-critical administrative and technological support teams have gone above and beyond to navigate the challenges of institute operations with extraordinary flexibility, teamwork, and action. We feel like work has never been as intense as it has in the time of COVID-19, but none of it would be possible without the dedicated people who work at NIMHD. The goal of making the world better is a potent motivator, and these efforts are meaningful and important.

    Our appreciation and thanks to the entire NIMHD biomedical research enterprise cannot be expressed enough. Let’s continue to take care of ourselves and our families as we work to make positive differences in the lives of the communities we serve.

  • NIH’s Minority Health and Health Disparities Strategic Plan 2021-2025: A Path to the Future

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    By Eliseo J. Pérez-Stable, M.D.
    Director, National Institute on Minority Health and Health Disparities

    The COVID-19 pandemic has brought minority health and health disparities new attention on the national stage. COVID-19 has disproportionately affected African Americans, American Indians and Alaska Natives, Native Hawaiians and Pacific Islanders, and Latinos and Latinas.

    This is a microcosm of the health equity challenge that plagues the U.S.

    As in most conditions with health disparities, the causes are complex. People from some of these groups are less likely to have health insurance than Whites. Inequities in access to quality education and limited economic opportunities for many, mean that many minority groups are disproportionately represented among the ranks of essential workers, such as those who work in farms, grocery stores, and support staff in health care settings and long-term care facilities, and less able to avoid the virus at work than people who work in office jobs.

    In this moment when so many Americans are looking to the biomedical research enterprise for help, we are proud to be able to provide a strategic, concrete plan for advancing minority health and health disparities research, capacity building and outreach. Today, I am proud to share the new NIH-Wide Minority Health and Health Disparities Strategic Plan 2021-2025: Taking the Next Steps.

    Thanks in large part to investment through the NIH, healthier lifestyles, and medical advances have made it possible for Americans to live longer and healthier lives than ever before. However, not all Americans have benefited equally from these advances. Health disparities persist, disproportionately affecting racial and ethnic minority populations, people with less privileged socioeconomic status, underserved people who live in rural areas, and sexual and gender minorities.

    At NIMHD we are working toward a future in which all populations will have an equal opportunity to live long, healthy, and productive lives. Part of how we honor this commitment is through the programs we support directly and the work of our own intramural researchers. But we also have a role that spans the 27 institutes and centers that make up the National Institutes of Health. We at NIMHD are tasked with coordinating NIH’s research related to minority health and health disparities. As part of that we have led the process to develop a strategic plan for research in these vital areas for all of NIH.

    This strategic plan charts the course for NIH to advance research on minority health and health disparities. In the plan, we lay out a focused vision for advancing the field of minority health and health disparities over the next 10 to 15 years.

    The core of minority health science is understanding why a racial or ethnic minority group has specific health outcomes. Minority health research intends to identify factors contributing to health conditions—whether or not a health disparity is identified and including conditions where a minority population has better outcomes.

    Health disparities arise from the relationship of a wide range of factors, from biological and behavioral factors, to the physical environment, to sociocultural factors and to societal policies and practices such as housing and hiring discrimination. These and other determinants of health interact to lead to poor health outcomes. The complex interrelationships between these factors challenge researchers to uncover the mechanisms and develop interventions that may help reduce health disparities.

    The plan encompasses three priority areas: scientific research; research-sustaining activities; and outreach, collaboration, and dissemination of this work. Within each priority area are two to four goals; each goal is supported by strategies, intended to capture ways in which NIH can advance the sciences of minority health and health disparities.

    • For example, in the priority area of scientific research, one of our goals is to improve the methods and tools that support health disparities research, and one of the strategies supporting that goal is to develop common metrics that can be used to measure health disparities across different health conditions and populations.
    • In the research-sustaining activities priority area, one goal relates to increasing the racial and ethnic diversity of the biomedical workforce; one of the strategies that will move us closer to that goal is to promote programs at research-intensive institutions that expand the pool of applicants from health disparity populations.
    • In the area of outreach, collaboration, and dissemination, one goal is to cultivate and expand the community of researchers and advocates in minority health and health disparities. One of our strategies is to promote collaboration across the federal government.

    These are just three examples of the many goals and strategies that are part of our strategic plan. In addition, the Strategic Plan lists specific leap goals linked to topic areas and potentially achievable in the next 5 to 10 years. Together, these make up a concrete, actionable document that will guide NIH’s minority health and health disparities research program for years to come. We have heard from many voices in the process of developing this strategic plan, and we are excited for the future.

    While NIH cannot solve the problem of systemic racism alone, we can apply the science of minority health and health disparities to understand the mechanisms by which discrimination and racism lead to poor health outcomes, then develop and disseminate science-based methods for mitigating these issues, improving the health of minorities, and decreasing health disparities. With the help of this plan, NIH can continue to produce meaningful, measurable improvements in minority health and reductions in health disparities, through the end of the pandemic, over the next five years, and beyond. Through these efforts, we will advance health equity and help ensure a long and healthy life for all Americans.

  • NIMHD Director Statement in Support of NIH Efforts to Address Structural Racism

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    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.