IC Directors' Meeting Highlights

Discussion Items

Combined Federal Campaign update: John Niederhuber, NCI

Dr. John Niederhuber provided an update on the Combined Federal Campaign. Now in Week 9, the CFC has received over $1.5 million in pledges from staff and contractors. Dr. Niederhuber congratulated those institutes who have already exceeded their contribution goals, such as NIBIB, NCRR and the Clinical Center. There are six weeks left in this year’s campaign to reach the goal of $2,045,000.

ProtoType Presentation—Introduction by John Gallin, CC; presentation by Phillip Lightfoot, CC

Dr. Gallin began with a brief history and rationale behind the development of ProtoType. ProtoType is an electronic writing tool developed to assist staff with protocol authoring and management. He noted that writing a protocol is hard work and that there is little standardization from one institute’s protocols to another. ProtoType is a web based system which combines standard templates and IRB approved standard language to facilitate the writing and review of a protocol. Dr. Gallin then introduced Phillip Lightfoot from the Department of Clinical Research Informatics at the Clinical Center.

Mr. Lightfoot described the various features of ProtoType which include a standard language repository, reference manager and IND Wizard. It has full Microsoft Word compatibility, portable imagery, and can be accessed with a standard NIH login. ProtoType uses a full version history of the protocol for both internal and external review purposes which tracks the status of the protocol.

Prototype also has many advantages to the Researcher. These include recommended language cassettes for the protocol body and consent/assent forms, an online archive of all the PI’s protocols, and an electronic submission system which moves the protocol through the review process without a paper trail. Forms, such as the 1195 and COI, are automatically generated in ProtoType and updated as needed based on new policies and regulations.

Finally, Dr. Gallin noted that ProtoType is being interfaced with PTMS, which some other institutes are currently using. In the past two months, 35 protocols from various institutes have been vetted through ProtoType. With 1,500 protocols being conducted at the Clinical Center, Dr. Gallin has requested that the IC Directors encourage their researchers to use ProtoType.

WHO Commission on Social Determinants and Health Equity: from research to action—Sir Michael G. Marmot, University College London

Sir Michael Marmot was appointed the Chair of the Commission on Social Determinants of Health created by the World Health Organization in 2005. He began his presentation with a call to action on the social determinants of health and health equity. He pointed out that the report of the Commission could also be seen as a research agenda: areas in which to research the causes of persistent health inequities. He began with the following statistics: The United States ranks second in the world in Gross Domestic Product yet men in the US are ranked 36th for surviving to age 65, and women are ranked 49th, based upon the Human Development Report of 2007/8. In the poorest section of Glasgow, UK, the life expectancy at birth for men is 54, yet in the richest section it is 82. There is universal healthcare available in Glasgow but there is still a 28 year gap in life expectancy. In Sir Michael’s findings from the Whitehall study mortality rates varied according to occupational hierarchy. Sir Michael emphasized that the implications of Whitehall is that health follows a social gradient, not only that health is worse among the poor. Similarly, in the Robert Wood Johnson Foundation’s Commission to Build a Healthier America 2008 report life expectancy beyond age 25 increased both for men and women based upon their education levels. Inequities in health, income, living conditions and education are factors in the social determinants of health.

The work of Sir Michael and the WHO commission brings forth recommendations for social justice; “creating conditions for people to lead flourishing lives” through empowerment. Key areas for action include health equity in all policies, fair financing, fair employment, and healthy places. These social determinants of health are the structural drivers of conditions at the global, national and local level.

Improving daily living conditions and investing in early childhood education provides one of the best ways to begin reducing health inequities. In his example of a slum upgrade in India, Sir Michael noted that with an investment of US$500 per household (with each individual homeowners investing US$50), there was an improvement in their health; improvements in the water system led to a decrease in waterborne illnesses. Children began attending school and the women were able to take on paid employment now that they no longer had to wait in long lines to collect water. This same “upgrading” of slums can be done on a global scale at a cost estimate of less than US$100 billion shared between international agencies, national and local governments, and the individual households themselves. Currently, the global community, including US, has committed more than US$5 trillion to the financial bailout.

Sir Michael ended by noting that closing the health gap is feasible if necessary changes in social, economic, and political policies are made. At the center of action should be the empowerment of people, their communities, and countries to receive their fair share—a world where social justice is taken seriously.

Gretchen Wood
cc: OD Senior Staff