Research Towards the Elimination of Health Disparities

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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

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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

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The National Institutes of Health
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NIH Mission

• To improve the health of the Nation through
  Biomedical Research and Research Training

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Differences in Health Status
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Advancing Clinical Research

• Delaying the onset of Alzheimers Disease
• Improving treatment for Parkinsons Disease
• Conquering diabetes
• Improving treatments for spinal cord injury
• Making AIDS treatment safer, easier and better
• Improving outcome for cancer and heart disease
  patients

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Changing Profile of the Nation

• Life Expectancy
• Racial Breakdown of Population
• Social Economic Status

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Racial breakdown of population
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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 Americas Children Key National
Indicators of Well-Being 2000
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Cancer
Death rate from stomach cancer is substantially
higher among Asian and Pacific Islanders,
including Native Hawaiians, than among other
populations.
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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.
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Diabetes

• 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
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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
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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

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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

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DHHS Initiative to Eliminate Racial and Ethnic
Disparities in Health

• Infant Mortality
• Cancer Management
• Cardiovascular Disease
• Diabetes
• HIV/AIDS
• Immunizations

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Historical Perspective

• DHHS Response to the Presidents 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

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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
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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.

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• Trans-NIH Initiative
• Addressing Health Disparities

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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

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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

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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

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Research Infrastructure Objectives

• Support research training and career development
• Provide support for institutional resources

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Public Information, Outreach, and Education

• Develop research-based information resources
• Communicate research-based information to
  increase public awareness
• Transfer knowledge to health care providers

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NICHD Plan to Eliminate Health Disparities
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Provisions That the Projects are of Benefit to
the Community
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Infant Mortality Rate (By Race and Hispanic
Origin, Selected Years 1983-99)
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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)

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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

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Impact of the Back to SleepCampaign

• A public-private partnership to reduce the risk
  of Sudden Infant Death Syndrome.

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BACK TO SLEEP CAMPAIGN LAUNCHEDNATIONAL
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

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Campaign Components

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

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Pre-AAP recommendation Post-AAP
BTS Campaign
Sleep Position Source NICHD Household Survey
SIDS Rate Source National Center for Health
Statistics, CDC
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Sudden Infant Death Syndrome (SIDS)Leading
Causes of Infant Mortality

• Congenital anomalies
• Short gestation/low-birth weight
• Sudden Infant Death Syndrome

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Back to SleepFocus 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

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Reducing SIDS in African American Communities

• Institute makes strong commitment to eliminating
  disparity in rates of SIDS between white and
  minority populations

NICHDs SIDS Strategic Plan
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Newest Campaign Literature
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Implementing the OutreachD.C. Metro Bus Ad
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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

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

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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

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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

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. 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. THOMPSONSECRETARYDEPARTMENT OF HEALTH
  AND HUMAN SERVICES

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http//healthdisparities.nih.gov/