107th Congress

Testimony on NIH Role in Eliminating Health Disparities

John Ruffin
Director, National Center on Minority Health and Health Disparities
May 21, 2002

Good Afternoon:

I am honored to join you today as the first Director of the National Center on Minority Health and Health Disparities (NCMHD) for this special hearing on Minority Health Disparities. I am thankful to the Congress for realizing the need, listening to the American people, and helping to enact legislation to create the Center. This is a great opportunity for me to update you on the activities of the NCMHD in light of the recent findings in the Institute of Medicine’s report -- "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care."

As creators of the law, health disparities advocates and health professionals, I need not tell you the statistics and the disproportionate burden of disease and death from cancer, stroke, heart disease and diabetes that confront minority populations. You also recognize that while the United States has made great strides in advancing the health of the nation, not everyone has benefitted equally. These are just some of the influential factors that urged the Congress to pass the Minority Health and Health Disparities Research and Education Act of 2000, in November 2000, to create the NIH's newest Center, the National Center on Minority Health and Health Disparities. The official launching of the Center took effect in January 2001. Now, a little over one year old, I would like to share with you what we have been doing to implement the law and address the elimination of health disparities. For the benefit of those of you who may not be familiar with the law, let me briefly tell you what the Congress has asked us to do.

According to Public Law 106-525, the National Center on Minority Health and Health Disparities is authorized to lead, coordinate, support and assess the NIH effort to reduce and ultimately eliminate health disparities. The law also broadened the scope of the NCMHD's constituency to include other health disparity populations, such as the medically underserved. The Center’s statutory priority must be Minority Health Disparities Research. To carry out these provisions, the Center has to implement three core programs -- a Loan Repayment Program, an Endowment Program and a Centers of Excellence Program, as well as take the lead to develop a trans-NIH Comprehensive Strategic Research Plan and Budget to reduce and ultimately eliminate health disparities.

Many of you are familiar with our predecessor, the Office of Research on Minority Health, which for 10 years served as the foundation within the NIH to systematically address minority health issues. As an Office, we worked with the NIH Institutes and Centers, community organizations and other federal agencies to identify research gaps and then applied our findings to create science. We realized the complexity of the issues and the multi-dimensional approach needed to ensure resolution, and through many of our partnership efforts, we were able to effect positive results which included the establishment of about 100 health-related projects and support to approximately 30 research training programs, such as the “Bridges to the Future” program with the National Institute of General Medical Sciences.

Other partnership projects undertaken with NIH Institutes and Centers include:

• The African-American Study of Kidney Disease and Hypertension and the Minority Organ and Tissue Transplant Program, with the National Institute of Diabetes and Digestive and Kidney Diseases;
• The development of research relationships between minority medical schools and the NCI Comprehensive Cancer Care Centers, in collaboration with the National Cancer Institute; and
• The ORMH collaborative activities expanded beyond the NIH ICs.

The Office also worked with other Department of Health and Human Services agencies, including the Office of Minority Health, the Centers for Disease Control and the Agency for Healthcare Research Quality. With the Office of Minority Health, ORMH supported projects such as:

• The Asian and Pacific Island American Health Forum, and
• The National Medical Association’s Mazique Symposium, as well as programs of
• The Association of Asian Pacific Community Health Organizations,
• The Association of American Indian Physicians,
• Quality Education for Minorities, and
• The National Alliance for Hispanic Health.

The Office succeeded by working collaboratively at various levels to unveil the gaps, develop innovative projects to bridge those gaps, evaluate the outcomes and ultimately translate the outcomes into programs. The Center will continue to build upon these activities and this collaborative philosophy.

Over the past year, the NCMHD has worked diligently with its partners, the other Institutes and Centers (ICs) and Offices at NIH to implement the statute. I am grateful for the extensive support and cooperation that the Center has received from Dr. Ruth Kirschstein, former Acting Director of NIH, and all of the other IC Directors. The help of the other ICs is demonstrated in the Center’s achievements that I will discuss. In FY 2001, we were appropriated a total of $132,044,000.00 to assume our activities. I am pleased to inform you that we have implemented all of our core programs authorized by Congress, developed the draft Trans-NIH Comprehensive Strategic Research Plan and Budget to Reduce and Ultimately Eliminate Health Disparities, solidified our organizational structure, hired new staff, co-sponsored several projects with other NIH Institutes and Centers and created the Center’s website, which can be accessed at www.ncmhd.nih.gov.

NIH Comprehensive Strategic Research Plan and Budget

For the first time in the history of the National Institutes of Health, it will have a comprehensive Strategic Research Plan and Budget that will be a guiding mechanism for the conduct and support of all NIH minority health disparities research and other health disparities research activities. NCMHD was honored to be charged with the development of this plan in collaboration with the Director of NIH and the Directors of the other NIH ICs.

The Plan was developed with substantial input from various stakeholders, including the public, academia and health professionals, representing those populations that disproportionately experience disparities in health. It describes current activities and future plans of the NIH to address the health disparities crisis, to build a culturally competent cadre of biomedical and behavioral investigators and to increase the number of minority clinical and basic medical scientists who are essential to the success of our efforts.

There are three main goals of the plan -- research, research infrastructure and community outreach -- that encompass information dissemination and public health education. Within each goal there are areas of emphasis and objectives to accomplish the priorities identified. Each objective outlines an action plan, time-line, performance measures to monitor and report progress and outcome measures to demonstrate accomplishment and ultimate impact. The Plan will continue to be an evolving document over the next five years. Once finalized, it will be posted on the NCMHD website on a continuing basis, and comments from the public will be welcomed. We will update and revise the Strategic Research Plan and Budget annually with the continued collaborative input of the other NIH ICs, and we will provide annual reports on our progress.

NCMHD Programs Authorized Under P.L. 106-525

One of the new capabilities that the Center welcomes is the opportunity to award grants. The Center’s Advisory Council was recently appointed to offer advice and serve as the second level of review for grant applications. The NCMHD established two grant funding programs in FY 2001 --the Loan Repayment Program and the Endowment Program for Section 736 (Public Health Service Act) Institutions. We have also recently launched another grant funding program -- the Project EXPORT Centers of Excellence Program. None of this would have been possible without the collaborative effort that the other NIH Institutes and Centers extended.

Loan Repayment Program

The National Center on Minority Health and Health Disparities created two loan repayment programs in fiscal year 2001 -- the Loan Repayment Program for Health Disparities Research and the Extramural Clinical Research Loan Repayment Program for individuals from disadvantaged backgrounds. The Loan Repayment Program for Health Disparities Research is aimed at increasing the number of highly qualified health professionals in health disparity research careers, and focuses on basic, clinical, and behavioral research with priority given to biomedical research. The Extramural Clinical Research Program seeks to increase the number of highly qualified health professionals from disadvantaged backgrounds who pursue clinical research careers. Applicants to the loan repayment programs must have a health professions degree, such as a M.D., Ph.D., D.O., D.D.S., or equivalent doctorate degree. Individuals completing their residencies, post-doctoral training, and internships may also apply.

I am pleased to report that the first round of loan repayment awards were made to 45 health professionals in FY 2001, eight months after the Center’s creation. Twenty-eight awards went to the Health Disparities Research Loan Repayment Program, and seventeen awards to the Extramural Clinical Research Loan Repayment Program. Of the total 45 awards, 34 individuals were from a health disparity population, and 11 were Caucasians pursuing health disparities research. Health disparity populations consist of African Americans, Hispanics, Asians, Pacific Islanders, Native Americans, Alaska Natives and the medically underserved. The medically underserved are members of the general population, as well as racial and ethnic minorities who live below the poverty line and live in non-metropolitan rural areas where a high percentage of the counties are designated as health professional shortage areas. The breakdown of the 34 health disparity population awardees are as follows:

The Endowment Program

The Center is fortunate to have had similar success in implementing the Endowment Program for Section 736 Institutions, as authorized by Public Law 106-525. These institutions are Centers of Excellence already established by the Health Resources and Services Administration under Section 736 of the Public Health Service Act. The purpose of this program is to facilitate capacity building for minority health disparities research and other health disparities research at institutions that have a demonstrated commitment to educating and training researchers from minority and health disparity populations. In FY 2001, the NCMHD made the first round of endowment awards to five institutions.

Additionally, the Center is preparing to make endowment awards to two institutions that participated in the FY 2001 competition, per the recommendation of reviewers. The Endowment Program is an on-going priority of the Center. Presently, the Center is accepting applications for the fiscal year 2002 round of competition through June 17, and plans to issue awards in September.

Centers of Excellence Program

The Centers of Excellence in Partnerships for Community Outreach, Research on Health Disparities and Training (Project EXPORT) will be established at academic institutions with a significant number of students from racial and ethnic minority and other health disparity populations. These Centers will:

• Promote the conduct of minority health and/or health disparities research;
• Encourage the participation of members of health disparity groups in biomedical and behavioral research as well as prevention and intervention activities; and
• Build research capacity.

The NCMHD recently concluded a series of technical assistance workshops in Dallas, Texas; Morgantown, West Virginia; Birmingham, Alabama and Seattle, Washington, to inform the community about the program and the application requirements. Workshop presentations are available on the Center’s website for interested constituents who could not attend the workshops. Applications are currently being accepted until May 24th. We plan to announce the FY 2002 awards in September.

Collaborative Projects

As the NCMHD evolves, we remain committed to forging partnerships among disciplines, communities, individuals, and at all levels of our constituency. With the support of our constituents within and beyond the NIH community, we are able to identify the issues and gaps in minority health and explore the approaches that would help to make health disparities a historical phenomenon. The NCMHD envisions an America in which all populations will have an equal opportunity to live long, healthy and productive lives. We will leave no one behind. Examples of recent collaborative project findings include:

• Just last month, the American Academy of Ophthalmology issued a press release on the findings of Project VER, which stands for Vision, Evaluation, and Research Project. This was a joint project of the NCMHD and the National Eye Institute, which revealed that open-angle glaucoma was the leading cause of blindness among a sample group of Hispanic Southern Arizona residents of Mexican descent.
• Last year, the Diabetes Prevention Program that we supported in partnership with the National Institute of Diabetes and Digestive and Kidney Diseases showed that moderate diet and exercise are beneficial in delaying and possibly preventing type 2 diabetes for people who are overweight and at high risk.

Other collaborative projects that the NCMHD supports with other NIH ICs include:

• The Innovative Approaches to the Prevention of Obesity Program with the National Institute of Diabetes and Digestive and Kidney Diseases, which is aimed at evaluating interventions to environmental factors that contribute to inappropriate weight gain in children, adolescents and adults.
• The Overcoming Barriers to Treatment Adherence In Minorities and Persons Living in Poverty Program, in conjunction with the National Heart, Lung, and Blood Institute. The program evaluates interventions to overcome treatment adherence among racial and ethnic minorities and people living in poverty faced with certain diseases.
• The Healthy Aging in Nationally Diverse Longitudinal Samples (HANDLS) program, with the National Institute on Aging, is a community-based research effort designed to evaluate normative age-related health disparities in minority and socio-economically diverse populations. The program uses a Medical Research Van to facilitate the participation of minority, medically underserved and socio-economically diverse subjects in age related clinical research.

These are just examples of the many collaborative projects that the Center is undertaking that hold much promise for the American people.

New Initiatives

NCMHD is excited about the opportunity to undertake new approaches to address health disparities. As highlighted in the FY 2003 budget, some of the projects that wil be of priority to the Center include:

• The Virtual University Program: to improve training outcomes for students from minority and other health disparity groups, improve the transition from undergraduate to graduate programs and to independent investigators, and serve as a resource for continuing education and/or retooling for faculty at participating institutions.
• The Rural Poor and other Health Disparity Groups: the NCMHD will collaborate with the National Institute on Dental and Craniofacial Research (NIDCR) to support 1) planning grants for research to prevent or reduce oral health disparities, 2) pilot grants for research to prevent or reduce oral health disparities, and 3) research infrastructure and capacity building for participating institutions to reduce oral health disparities.
• Community Outreach: the NCMHD is committed to creating communication channels that lend themselves to the bi-directional, interactive nature of effective outreach. Accordingly, the NCMHD will divide its outreach efforts into three major objectives:
• Outreach to Communities and their Community Based Organizations;
• Outreach to Health and Social Service Professionals; and
• Outreach to Health, Research and Social Service Institutions, Professional Organizations, and the Business Sector.
• Mississippi Delta Project: with a medical research agenda for the Mississippi Delta Region, the NCMHD will concentrate on:
1. Solidifying the organizational and technological network within the community to conduct research on health disparities;
2. Increasing the level of involvement of community residents in health research;
3. Facilitating the availability of culturally-appropriate health education material; and
4. Establishing a base for involvement of small businesses with these entities.

Conclusion

The NCMHD is grateful to the Congress, the Administration, the NIH Institutes and Centers and to all of you for the overwhelming support that you have provided the Center in transitioning from the Office of Research on Minority Health to the National Center on Minority Health and Health Disparities. I am proud of the progress that the Center has made over the past year in establishing its organizational structure and programs. The American people can now learn about the Center’s activities and programs by accessing our website at www.ncmhd.nih.gov which is now averaging about 50,000 hits a month. Through continued and increasing collaborative ventures, NCMHD will work diligently to define the health disparity issue for every American, and garner support to ensure the health of all Americans. Health disparities is an issue that transcends minorities and other health disparity populations -- it is everybody’s concern and calls for shared responsibilities to effect permanent change.

Thank you again for the opportunity to speak with you today.