Yesterday

• The Report of the Secretary’s Task Force on Black and Minority Health (1985) asked the NIH to do more: 1) to determine why minorities were experiencing an undue burden of diseases, disability, and premature death and 2) to eliminate health disparities.

• Healthy People 2010 builds upon initiatives pursued over the past two decades and focuses HHS efforts on two goals: 1) increasing quality and years of healthy life; and, 2) eliminating health disparities. The NIH co-leads the coordination of the cancer focus area of the Healthy People 2010 initiative.

• Prostate cancer was the most common cancer among males in the United States (U.S.). Between 1973-77 and 1978-81, the reported incidence and mortality from prostate cancer rose sharply among black males in the U.S. – 60 percent were more likely to have prostate cancer compared to white males. Among black males, prostate cancer death rates increased by almost 12 percent compared to a more than 4 percent increase among white males.

• Between 1976-81, the 5-year overall relative survival rate for prostate cancer was 61 percent for black males compared to 71 percent for white males.

• Factors that contributed to poor cancer survival in blacks were: socioeconomic status, later stage diagnosis, delays in detection and treatment, treatment differences, and biologic/constitutional factors. In general, blacks tended to be less informed about cancer than whites.

• The U.S. Food and Drug Administration approved prostate-specific antigen (PSA) testing in 1986 which enabled the early detection and treatment of prostate cancer.

Today

• Despite improvements in the overall health of the general population, racial, ethnic, poor whites and other medically-underserved populations continue to experience striking disparities in the burden of illness, disability, and premature death.

• Prostate cancer remains the most common cancer in American men. African-American men continue to have higher prostate cancer prevalence and mortality rates compared to men in other populations. African-American men are 40 percent more likely to have prostate cancer and twice as likely as white men to die of the disease. In 1993, African-American Medicare beneficiaries were almost 2.5  times as likely their white counterparts to have a bi-lateral orchiectomy (surgery to remove the testicles) to treat prostate cancer.

• Between 1996-2003, the five-year relative survival rate for black men diagnosed with prostate cancer was nearly 95 percent compared to almost 99 percent for white men.

• The factors that influence prostate cancer health disparities are still not well understood. Age is the most important risk factor for contracting prostate cancer. Others are race, family history, and environment. Environmental factors likely account for the prostate cancers found in men with no family history, including geographic location, a high-fat diet, high caloric intake, and a sedentary lifestyle.

• The NCMHD was established by the Congress in 2000 to lead, coordinate, support and assess the NIH research effort to eliminate health disparities. The NCMHD promotes minority health and the health of other health disparity populations; and leads, coordinates, supports, and assesses the NIH effort to eliminate health disparities.

• The NCMHD-funded research advances the understanding of the development and progression of diseases and disabilities that contribute to health disparities. For example:

• African American Hereditary Prostate Cancer Study (AAHPC): The AAHPC, funded primarily by the NCMHD, is the first study to focus on prostate cancer in African-American families and the first genome-wide linkage analysis of prostate cancer in African Americans. This hereditary prostate cancer study, a collaborative effort between researchers at 12 institutions and the NIH, seeks to identify genetic risk factors that may explain the increased incidence and/or mortality of prostate cancer in African Americans. This research is essential to support the innovative scientific solutions our nation needs to eliminate health disparities in this country.

• The NCMHD programs focus on expanding the nation’s ability to conduct research and to build a diverse, culturally-competent research workforce to eliminate health disparities. Several programs support the NCMHD efforts in these areas, including the: NCMHD Centers of Excellence Program NCMHD Community-Based Participatory Research Program, NCMHD Loan Repayment Program, NCMHD Minority Health and Health Disparities International Research Training (MHIRT) Program, NCMHD Research Infrastructure in Minority Institutions (RIMI) Program; and NCMHD Small Business Innovative Research/Small Business Technology Transfer Program.

• Numerous NCMHD-funded health education campaigns are bringing useful health information to diverse communities. For example:

• Health Advocates in Reach (HAIR) Project: The Center for Minority Health at the University of Pittsburgh reaches out to people who might not have a primary care physician. The HAIR Project, through the Take a Health Professional to the People initiative, provides potentially life-saving information and health screenings at barber shops and beauty shops in neighborhoods where African Americans lack access to care. Many of the barbers and salon operators are certified by the Red Cross in cardiopulmonary resuscitation and continue their work as lay health advocates throughout the year. As part of the national HHS Closing the Gap initiative, each year physicians, nurses, public health educators, dentists, pharmacists, and other health professionals and advocates offer screenings for prostate cancer, diabetes, hypertension and other preventable conditions. As a result, men are receiving PSAs and digital rectal exams. Health screenings like these help detect diseases so individuals can get the early treatment that helps save lives.

• The NCMHD collaborates with other NIH Institutes and Centers, the Agency for Health Care Research and Quality (AHRQ), and the Health Resources and Services Administration (HRSA) to address health disparities by providing funding for minority health and health disparities research; training members of health disparity populations as research; and providing educational loan relief for health professionals committed to conducting research concerning health disparities.
  
• Other cancer collaborations include the: Racial and Ethnic Approaches to Community Health Program (REACH 2010); Appalachia Cancer Network; and Native Hawaiian Cancer Awareness Research & Training Network.

Tomorrow

• The Census Bureau predicts racial and ethnic minority populations in the U.S. will double in size some time in the 21st century. The increased efforts by the NIH will help ensure that the research agenda is in place for meeting the increased health needs expected and that minority, rural and urban poor, and other medically underserved populations will all benefit equally from these ongoing efforts. Innovative strategic partnerships among all segments of our society including the community will be critical in the NIH effort to eliminate health disparities.

• Guided by the NIH Strategic Research Plan and Budget to Reduce and Ultimately Eliminate Health Disparities and other initiatives, the pace of creating and translating new knowledge from research into prevention and treatment strategies to improve public health is expected to increase as are the number of scientists from underserved communities.