The health status of all U.S. racial and ethnic groups has improved steadily over the last century. However, disparities in major health indicators among segments of the U.S. population, white and nonwhite groups, are growing. In general, African American, American Indian, and Hispanic ethnic and racial groups are disadvantaged relative to whites on most health indices, whereas Asian Americans appear to be as healthy, if not healthier, than whites on most indicators. A key component of the Institute's mission is to better understand age-related diseases and problems of older persons—this mission involves a special focus on elders of U.S. minority population groups. The term "health disparity" covers a broad range of diseases and includes virtually all population groups; however, the focus of this plan is on research initiatives that will advance aging research closer to the ultimate objectives of reducing and eliminating health disparities among older racial and ethnic minorities.
NIA, one of the 25 Institutes and Centers of the National Institutes of Health, leads a broad scientific effort to understand the nature of aging and to extend the healthy, active years of life for all citizens. Millions of Americans are leading healthier lives based, in part, on discoveries from aging research. More must be done to redress disparities in health among U.S. minority groups. Since the beginning of the 20th century, life expectancy at birth in the United States has increased from less than 50 years to more than 76 years. Life expectancy at birth has more than doubled for African Americans (and "other races" combined) since 1900, from 33 years to 69 years in 1991. For Caucasians, the increase was from 48 years to 76 years. The challenge for the 21st century will be to make these added years as healthy and productive as possible and to maintain the current trend of decline in disability across all segments of the population.
In 1974, Congress granted authority to form NIA to provide leadership in aging research, training, health information dissemination, and other programs relevant to aging and older people. Subsequent amendments to this legislation designated NIA as the primary Federal agency on Alzheimer's disease research. The NIA's mission is to improve the health and well-being of older Americans through research, and specifically, to:
NIA maintains a year-round scientific planning process that draws on interactions with scientists throughout the world, members of Congress, the Institute's National Advisory Council on Aging (NACA), and other advisory committees, constituency groups, and the public. These interactions stimulate internal consideration of potential new research strategies and provide a broad perspective for refining plans. Emphasis is given to novel proposals and collaborative projects that promise to stimulate activities with other research organizations.
NIA's health disparities strategic planning effort covers a 6-year period from fiscal years 2000 to 2005 and addresses goals for research, research training, research resources, and dissemination of health information that will ultimately reduce or eliminate domestic health disparities. Members of NIA's Minority Aging Research Review Committee, the scientific community, and the general public have been active in the plan's development. The health disparities strategic plan is one component of NIA's institute-level strategic planning process.
As a part of NIA's continuing effort to improve the health of minority groups and to encourage research careers for underrepresented population groups, NACA was asked, in September 1998, to form a special committee to conduct a year-long review of the NIA minority research and training efforts. The committee, comprised of selected members of Council, extramural researchers, and ad hoc Federal representatives, held several meetings, reviewed several hundred pages of material, and heard presentations by program staff and NIA leadership. The committee's eight primary recommendations are summarized below and have been considered in the development of this strategic plan. The final report of the NACA Minority Aging Review Committee will be published, and the detailed recommendations will be entered into the ongoing NIA scientific planning process. Briefly, their recommendations are to:
The NIA Strategic Plan To Address Health Disparities addresses three major areas of focus:
Areas of Focus 1, 2, and 3 represent broad areas of research, training, public information, outreach, and education that NIA will pursue in the years to come and that will help ensure that aging and health disparities research benefit from a strong infrastructure to support future research, program management, and information dissemination. The areas are not meant to be mutually exclusive, and there are many areas of overlap and interdependence among the NIA initiatives. For example, knowledge gained from basic research can lead to clinical interventions that improve health and quality of life and in turn reduce health disparities among population groups.
The initiatives discussed below complement ongoing and anticipated investigator-initiated research that will contribute to the overall pool of health disparities research. The initiatives are categorized as ongoing or future and are not meant to reflect research priority or timeframe for implementation.
To reiterate, the Strategic Plan to Address Health Disparities, the NIA Strategic Plan for Aging Research, and the year-long review of minority aging research (1998–1999) are integral parts of the overall NIA research planning process to support research initiatives that hold the greatest promise for advancing knowledge and redressing health disparities. Throughout this document, reference will be made to relevant sections of the NIA Strategic Plan for Aging Research. Goal C of the Strategic Plan for Aging Research has a direct and overlapping relationship with the NIA Strategic Plan to Address Health Disparities. Members of the scientific community and NACA have been involved in the development of the health disparities plan.
The NIA Strategic Plan To Address Health Disparities includes more than 60 initiatives describing research that NIA will continue during the next 5 years and future initiatives to eliminate or reduce health disparities among older minority individuals and population groups. To reiterate, the plan is divided into three major goals: research; research infrastructure; and public information, outreach, and education. Following each goal are initiatives labeled as "ongoing initiatives" and "future initiatives." Ongoing initiatives are NIA research projects and activities currently funded and anticipated to continue. Future initiatives are planned activities expected to begin during the period covered by the plan and may require additional vetting through conferences, workshops, special panels or other expert advice, and through the usual process for developing and approving program announcements or request for applications. Future initiatives are an indication of probable actions and are contingent on adequate levels of appropriations. This tactical document is dynamic and subject to additions, modifications, and yearly revisions.
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