NCCAM's Work on Health Disparities
Credit: U.S. Census Bureau
The National Center for Complementary and Alternative Medicine (NCCAM) has as its vision:
To advance research to yield insights and tools derived from complementary and alternative medicine (CAM) practices to benefit the health and well-being of the public, while enabling an informed public to reject ineffective or unsafe practices.
An important aspect of realizing this vision is making these benefits available to all Americans. Among the challenges in this endeavor is the existence of health disparities in the United States. "Health disparity populations" are populations where there is a significant disparity (difference), compared with the general population, in the overall rates of one or more of the following:*
- Disease incidence (that is, the number of new cases of a specific disease in a population in a specific period of time)
- Disease prevalence (the overall number of cases)
- Disease morbidity (the amount of disability associated with a disease)
- Disease mortality (the overall death rate from a disease)
- Disease survival
Generally, life expectancy and overall health have improved in the United States in the past few decades. Among the reasons are an emphasis on preventive medicine, such as vaccines and behavior modification, and the development of new medical technologies. However, certain groups and individuals experience certain diseases, disorders, and conditions, as well as disability and premature death, disproportionate to their numbers in the population. They include racial and ethnic minority groups, as well as others who experience disparities because of their geographic location, income, level of education, disability, sexual orientation, cultural issues, and/or difficulties with language or literacy. Here are some examples drawn from Federal Government statistics.
- Population groups that have the worst health tend, statistically, to have the highest poverty rates and least education. The gains in health seen among Americans as a whole in recent years have not been seen in the lower socioeconomic groups. For example, people in the lowest-income families have three times the rate of activity limitation from chronic disease as people in the highest-income families. Infants of mothers who have less than 12 years of education have a mortality rate that is almost twice the rate among infants of mothers who have 13 or more years of education.
- Twenty-five percent of Americans live in rural areas (that is, with populations of 2,500 or fewer). Their rates of cancer, heart disease, diabetes, and injury-related deaths are higher than for urban populations. In rural Appalachia, for example, the rates of lung, colon, cervical, and rectal cancer are substantially higher than the national average.
- The infant mortality rate among American Indians and Alaska Natives is almost twice the rate among White Americans; among African Americans, it is more than twice the rate.
- Death rates from heart disease are more than 40 percent higher among African Americans than among Whites.
- Prostate cancer occurs more commonly in African American men than it is known to occur in any other group worldwide.
- Twenty-five percent of people with type 2 diabetes are from minority groups. Complications from that disease occur two to four times more often in minorities than in other groups.
- Native Americans and Alaska Natives suffer a disproportionately high rate of both depression and suicide.
- Hawaiian women die from cancer at a rate 20 percent higher than that of White Americans.
- Men have 6 years' less life expectancy than women, as well as higher death rates from each of the 10 leading causes of death.
- Women have a higher rate than men of certain diseases (even for some that are not specific to their biological gender), such as Alzheimer's disease and major depression.
Credit: Norman Shapiro
According to a report for the Institute of Medicine in 2002, members of minority groups tend to receive lower-quality health care than White patients do, even when they have comparable insurance, income, age, and severity of medical conditions.
They also tend to have worse outcomes from the care, including higher death rates. The report also concluded that there is not one cause of this gap, but many.
NCCAM is seeking to help address problems of health disparities through a multi-pronged approach:
- Conducting and supporting research, including studies on why and how ethnic and racial minority populations use CAM, especially for diseases (like asthma) that disproportionately affect them
- Supporting research infrastructure
- Increasing outreach and the dissemination of health information to medically underserved people
"Our broad-based research portfolio reflects the diversity of people who use CAM," said Stephen E. Straus, M.D., Director of NCCAM. "More needs to be known about how factors such as age, gender, race, ethnicity, and locale interact and affect the use of CAM. This knowledge will also inform research on why specific populations use certain CAM practices, whether for cultural reasons, effectiveness, or problems accessing health care. In turn, the findings will help health care providers better meet the needs of these groups, and, we believe, have an impact upon the problem of health disparities."
In December 2000, the Center established the Office of Special Populations (OSP), part of the Division of Extramural Research and Training, as the focus for NCCAM's activities in health disparities. The director of OSP is Morgan Jackson, M.D., M.P.H. Dr. Jackson led development of NCCAM's Strategic Plan To Address Racial and Ethnic Health Disparities; he implements the activities outlined in the plan; and he is NCCAM's liaison in health disparities endeavors with the National Institutes of Health (NIH) and the U.S. Department of Health and Human Services. CAM at the NIH interviewed Dr. Jackson.
Morgan Jackson, M.D., Ph.D.
CAM at the NIH: What led you to become interested in working in CAM and health disparities?
Dr. Jackson: Prior to joining NCCAM, I worked on minority health and health disparities for a number of years at the Agency for Healthcare Research and Quality (AHRQ). It became apparent that many populations combine traditional approaches with conventional health care. I came to NIH in order to foster research on these practices, as well as to study directly the use of traditional and CAM practices. NCCAM regards America's diverse racial and ethnic groups as invaluable resources for learning about systems of healing and health practices outside the mainstream.
CAM at the NIH: What research initiatives has NCCAM developed regarding health disparities?
Dr. Jackson: One important initiative is Secondary Analysis of Data on CAM Use in Minority Populations (PAR-03-102) . NCCAM has funded 11 grants through this initiative, and with the final application receipt date in August 2005, we hope to fund a few more. These grants are analyzing previously collected data on a variety of topics, including CAM use in older minority adults and CAM use and access to care in Asian Americans and Pacific Islanders. Another grant is developing an archive of data sets on CAM use in minority populations. Through these projects, we expect to gain a better understanding of the extent of CAM use, as well as reasons for and some consequences of CAM use in minority populations.
Although there have been several national surveys on CAM, most of them have had limited minority participation. A recent NCCAM collaboration with the National Center for Health Statistics, part of the Centers for Disease Control and Prevention, developed a supplement on CAM for the 2002 National Health Interview Survey (NHIS). Because the NHIS intentionally obtains data from a disproportionately large number of African Americans and Hispanic Americans, it represents the largest compilation of data on CAM use in minority populations to date. It will yield a wealth of information that can help address health disparities. (Editor's note: The 2002 NHIS data on CAM that have been published so far can be found at nccam.nih.gov/news/camstats/2002/report.pdf.)
CAM at the NIH: What are some of the challenges associated with CAM research in the area of health disparities?
Dr. Jackson: A major challenge is that CAM approaches alone cannot be expected to eliminate health disparities. Although several of today's mainstream medical practices once were considered CAM, most CAM practices lack proof of efficacy, so their use cannot be recommended in place of proven interventions. Incorporation of some CAM practices with conventional medicine may improve patient satisfaction or quality of life—for example, giving massage to cancer patients at the end of their lives.
CAM at the NIH: Can NCCAM research help improve health care delivery for underserved groups?
Dr. Jackson: We think that CAM practices afford a window into the cultural nuances of health behavior, and that a better understanding of why and how those practices are used can improve the cultural competence of health care delivery for all populations, particularly minority populations.
Credit: Eric Furtan
CAM at the NIH: In addition to NCCAM's program announcements, are there any other activities that focus on minority health/health disparities research, or opportunities for minority researchers?
Dr. Jackson: NCCAM has exciting opportunities now to examine healing practices used traditionally by indigenous peoples. For example, NCCAM is collaborating with the AHRQ, the Indian Health Service (IHS), and other components of the Department of Health and Human Services to develop a workshop focusing on research on traditional indigenous medicine. While it is challenging to study interventions involving a mixture of approaches, traditional Indian medicine and Native Hawaiian healing systems are important areas where research needs to be undertaken that is scientifically valid as well as culturally appropriate. In addition, NCCAM is working with the National Institute of General Medical Sciences and the IHS to fund research projects through the Native American Research Centers for Health program. NCCAM participates in two NIH-wide solicitations, Research Supplements to Promote Diversity in Health-Related Research and Ruth L. Kirschstein National Research Service Predoctoral Fellowship Awards for Minority Students, both of which support research-training experiences for minority students.
Notes
* Public Law 106-525, Minority Health and Health Disparities Research and Education Act of 2000
Resources
Statistical sources for this article are included below. Readers who do not have access to the Internet may contact the NCCAM Clearinghouse for the NCCAM plan or referrals to the sources outside NCCAM.
- National Center for Complementary and Alternative Medicine. Office of Special Populations. nccam.nih.gov/research/osp
- National Center for Complementary and Alternative Medicine. Strategic Plan To Address Racial and Ethnic Health Disparities. 2002. nccam.nih.gov/about/plans/healthdisparities
- National Institutes of Health. Strategic Research Plan and Budget to Reduce and Ultimately Eliminate Health Disparities, Fiscal Years 2002-2006. 2002. www.ncmhd.nih.gov/our_programs/strategic/volumes.asp
- National Center on Minority Health and Health Disparities. www.ncmhd.nih.gov
- U.S. Department of Health and Human Services, Office of Minority Health. www.omhrc.gov
- U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. 2000. www.healthypeople.gov/Document/tableofcontents.htm#under
- Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2002. www.iom.edu/report.asp?id=4475
