DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL INSTITUTES OF HEALTH
Fiscal Year 2002 Budget Request
Witness appearing before the
House Subcommittee on Labor-HHS-Education Appropriations
John Ruffin, Ph.D., Director
National Center on Minority Health and Health Disparities
accompanied by
Ruth Kirschstein, M.D., Acting Director, National Institutes of Health
Dennis P. Williams, Acting Assistant Secretary, Management and Budget, DHHS
May 16, 2001
Mr. Chairman and Members of the Committee:
I
am honored to appear before you as the new Director of the National Center
on Minority Health and Health Disparities (NCMHD) to present the
President's budget request for FY 2002, a sum of $158.425 million, which reflects an increase of $26.356 million
over the comparable FY 2001 appropriation.
The
NIH budget request includes the performance information required by the
Government Performance and Results Act (GPRA) of 1993. Prominent in the performance data is NIH’s second annual
performance report which compares our FY 2000 results to the goals in our
FY 2000 performance plan. As
performance trends on research outcomes emerge, the GPRA data will help
NIH to identify strategies and objectives to continuously improve its
programs.
The
Secretary for Health and Human Services approved the NCMHD on January 16,
2001, as called for in Public Law 106-525. Within the National Institutes of Health, the NCMHD serves as the
focal point for planning and coordinating minority health and other health
disparities research. The
Center coordinates the development of a comprehensive health disparity
research agenda that identifies and establishes priorities, budgets, and
policy that govern the conduct and support of all NIH-sponsored minority
health and other health disparities research and training activities.
Significant progress has been made since the establishment of the
Center; however, considerable work remains to be done as the Center
transitions from an Office to a Center and assumes grant review, funding
and financial management functions. The development of a comprehensive research portfolio began with
the NIH Office of Research on Minority Health and will be expanded to
include the medically underserved and other health disparity groups as
designated by the Agency for Health Care Research and Quality.
As a part of its mandate to build capacity for minority health and
health disparities research, the Center also will expand it’s support of
training and the development of research infrastructure at Minority
Serving Institutions.
The
complexity of the disparity in health status relates to convergence of
multiple factors in unsuspecting ways to cause differences in disease
progression and in health outcomes. If
one tried to identify a priori all of the factors that could
potentially impact the overall health of an individual, the results would
look something like the attached schema. Accordingly, the Center will promote and increase participation in
minority health and health disparities research by expanding the number of
investigators involved in such research and by providing sustained funding
for a wide breadth of studies--basic, clinical, and population research;
studies on the influences of health processes; and research on the
societal, cultural, and environmental dimensions of health--all aimed at
identifying potential risk factors for disparate health outcomes.
LEVERAGING RESOURCES WITH THE NIH INSTITUTES AND CENTERS
The
NCMHD will continue to provide funding support to assist the NIH
Institutes and Centers (ICs) in the following ways: piloting new health
disparities programs, improving recruitment and retention in clinical
trials, and in providing competitive supplements to expand the focus of
existing programs. The Center
also will share in the support of selected targeted studies that are
supported by the NIH ICs. Selected
examples of the ways in which the Center leverages its funds with the NIH
ICs are provided below.
The
Jackson Heart Study (JHS), a targeted study co-supported by the
National Heart, Lung, and Blood Institute and the NCMHD, is an
investigation of the causes of the high rate of cardiovascular disease in
the state of Mississippi. The
objectives of the JHS are to: identify risk factors for the development
and progression of CVD; build research capacity in a minority serving
institution; and expand minority participation in CVD epidemiology
research. Initial
examinations among the JHS cohort began in the fall of 2000 and will take
3 years to complete. Some of
the newer areas of focus will include early indicators of disease,
genetics, sociocultural influences such as socioeconomic status and
discrimination, and physiological relations between common disorders such
as high blood pressure, obesity, and diabetes and their influence on
CVD.
The
Diabetes Genes, Treatment, and Prevention in Minorities Research program,
supported by the National Institute on Diabetes, Digestive, and Kidney
diseases and the NCMHD, focuses on the following groups: Hispanic diabetic
adults residing in a rural Texas-Mexico border community; centrally obese
African-Americans with impaired glucose tolerance; obese Hispanic high
school students in Colorado; African American children, adolescents, and
adults with diabetes; and Caribbean Latinos with non-insulin dependent
diabetes. Its objectives
include the development of treatment and prevention interventions that
specifically address diabetes in a range of minority populations and
elucidation of the genetic basis of diabetes in minority populations and
the underlying mechanisms controlled by gene expression.
The
National Institute for Nursing Research (NINR) and the NCMHD will pilot
planning activities for a new partnership initiative in NINR’s
extramural research program. The
focus will be on decreasing disparities in the burden of illness and
mortality experienced by racial and ethnic populations and the medically
underserved through a variety of approaches, which include basic,
epidemiological, clinical and prevention, control and population research.
Cultural and ethnic considerations, genetic diversity, and
social and economic influences on health and health outcomes are potential
areas of emphasis. The
activity will include partnership research, training, and other activities
between Minority Serving Institutions and research-intensive majority
institutions in institutions that provide services to the rural and urban
poor.
Other
potential areas where the NCMHD will leverage its funds with the NIH ICs
include: the intersection of
non-genetic factors and genes in health disparities, infectious origins of chronic diseases and research training.
AN INDEPENDENT RESEARCH GRANT PORTFOLIO
Independent
grant-making authority not only increases the Center's flexibility in
leveraging its funds with the NIH ICs, but it also enables the Center to:
focus on “gap areas” where such research is not conducted or
supported by the NIH ICs; more effectively build research capacity in
minority health and health disparities research, address barriers to the
participation of minority serving institutions in the research enterprise,
and to develop research capacity among community-based organizations.
With
respect to research, the NCMHD recognizes several pressing priorities.
Our new Division of Research will develop programs to fund
interdisciplinary teams of biomedical, clinical, and social science
investigators--teams that are crucial to developing strategies and tools
for eliminating health disparities. Another
priority of the Division of Research is to ensure that the power of
bioinformatics and genomics research, including pharmacogenomics, is
brought to bear on the health disparity program.
Our
new Division of Community-Based Research and Outreach will identify and
implement through research, effective and generalizable models of health
care delivery, disease prevention and intervention, and communication that
will improve community health outcomes in racial and ethnic minority and
other health disparities populations. The Division will utilize available data generated by other Federal
and state agencies to identify affected communities and to measure
progress in outcomes associated with specific interventions. Key areas of focus will be to promote research on investigation of
health behaviors, cultural health beliefs and environmental factors in
community health. Validated
findings will be utilized and incorporated by the Division to develop
culturally sensitive and appropriate community-based prevention messages.
CENTERS OF EXCELLENCE PROGRAM
As
mandated in its statutory authorities, the NCMHD also will develop and
implement a Centers of Excellence Program to support minority health
research and other health disparities research and research training for
members of health disparity populations. The exploratory grant mechanism will be used to plan for and
promote interdisciplinary biomedical and behavioral research and to plan
for the establishment of stable research and training programs.
Center planning strategies may focus on a specific research theme
(e.g., diagnosis, therapy, epidemiology) or integrate a broad spectrum of
research to include the basic, clinical, prevention, and population
sciences. Partnerships between minority institutions and majority
institutions will be encouraged.
RESEARCH ENDOWMENT PROGRAM
The
Center also will develop and implement a Centers of Excellence Endowments
Program for certain designated centers and those centers at Institutions of
Emerging Excellence. Potentially
a pilot initiative could begin in 2001. The purpose of the program is to provide enduring, forward-looking,
sustainable support for the Center’s minority health and health
disparities research programs and to provide continuing research
infrastructure support.
LOAN REPAYMENT PROGRAM
In
fiscal year 2001, the NCMHD will develop and implement two distinct
extramural loan repayment programs recently authorized by the Congress:
the Clinical Research
Loan Repayment Program (LRP) and the Health Disparities Loan Repayment
Program (HD-LRP). The emphasis
of the LRP on “clinical research” and on individuals from
“disadvantaged” backgrounds is consistent with the objective of building
a culturally competent cadre of clinical investigators. Such a cadre of clinical investigators not only will have the
potential of having an influence on the medical processes within their
communities but can also engage in and promote the development of clinical
research programs that reflect an understanding of the variety of issues and
problems associated with disparities in health status. The focus of the health disparities LRP is specifically on clinical
research related to diseases and conditions having an increased prevalence
among racial and ethnic minorities and other designated health disparity
groups.
OTHER CAPACITY BUILDING PROGRAMS
To
expand the number of investigators participating in minority health and
health disparities research the NCMHD will promote, assist, and support
research capacity building activities in the minority and medically
underserved communities. These
activities will focus on research infrastructure development, faculty career
development, and increasing the number of under-represented minority
students and students from health disparity groups with an interest in
careers in biomedical and behavioral research.
HEALTH INFORMATION DISSEMINATION
Our
health information dissemination activities will be multifaceted since
professionals and the lay-public obtain information from very dissimilar
sources. Information will be
transmitted to professional medical and scientific organizations for
dissemination among their membership, and also will be made available to the
public through media that are most likely to reach racial and ethnic
minority groups.
CONCLUSION
Recognizing
that the process of medical discovery occurs in stages, the Congress has
provided many new opportunities to build upon the previous efforts of the
Office of Research on Minority Health. Our commitment to the research needed to ultimately eliminate health
disparities will be steadfast and enduring, and we will be ever vigilant in
our efforts. We are excited
about these opportunities and greatly encouraged by the strong support the
Center has received from the Congress, the Administration, our fellow NIH IC
Directors and from groups and individuals across the Nation.