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107th Congress
Session I | Session II
Testimony on NIH Role in Eliminating Health Disparities
John Ruffin
Director, National Center on Minority Health and Health Disparities
March 12, 2002
Good Afternoon:
I am honored to join you today as the first Director of the National Center
on Minority Health and Health Disparities (NCMHD) for this
special hearing on Eliminating Health Disparities. First,
I would like to thank the Honorable Donna Christian-Christensen
and the Congressional Black Caucus, as well as the leadership
of the Congressional Hispanic Caucus and the Congressional
Asian Pacific American Caucus for inviting me to be a part
of this hearing. Thank you for realizing the need, for listening
to the American people, and helping to enact legislation to
create the Center. As members of minority groups, you understand
the needs as many of you and your families experience the
realities of health disparities. I appreciate this opportunity
to update you on the activities of the National Center on
Minority Health and Health Disparities.
To those of you who represent community organizations and
health care institutions, I would also like to thank you for
your commitment to serve the minority and health disparity
communities through your public education, outreach, empowerment
and health delivery efforts. Being on the frontlines, you
truly understand the depth of the health disparities crisis,
and we commend you for your perseverance and compassion.
As creators of the law, health disparities advocates and
health professionals, I need not tell you the statistics and
the disproportionate burden of disease and death from cancer,
stroke, heart disease and diabetes that confront minority
populations. You also recognize that while the United States
has made great strides in advancing the health of the nation,
not everyone has benefitted. These are just some of the influential
factors that urged the Congress to pass Senate Bill 1880 in
November 2000--the Minority Health and Health Disparities
Research and Education Act of 2000, to create the NIH's newest
Center, the National Center on Minority Health and Health
Disparities. The official launching of the Center took effect
in January 2001. Now, a little over one year old, I am proud
to share with you today the progress that the Center has made
in implementing the law. For the benefit of those of you who
may not be familiar with the law, let me briefly tell you
what the Congress has asked us to do.
According to Public Law 106-525, the National Center on Minority
Health and Health Disparities is authorized to promote minority
health and to lead, coordinate, support and assess the NIH
effort to reduce and ultimately eliminate health disparities.
The law also broadened the scope of the NCMHD constituency
to include other health disparity populations, such as the
medically underserved. The Center’s priority must be Minority
Health Disparities Research with a focus on conducting and
supporting behavioral, social, clinical, and biomedical research
among minorities; promoting and building research infrastructure
at minority serving institutions, disseminating health information
and enhancing community outreach to minority and health disparity
groups. To carry out these mandates, the Center is required
to implement three core programs--a Loan Repayment Program,
an Endowment Program and a Centers of Excellence Program,
as well as take the lead to develop a trans-NIH Comprehensive
Strategic Research Plan and Budget to reduce and ultimately
eliminate health disparities.
Many of you are familiar with our predecessor, the Office
of Research on Minority Health, which for 10 years served
as the foundation within the NIH to systematically address
minority health issues. As an Office, we worked with the NIH
Institutes and Centers and communities--some of you represented
here this afternoon--to identify research gaps and then applied
our findings to create science. We realized the complexity
of the issues and the multi-dimensional approach needed to
ensure resolution, and with many of your efforts, we were
able to effect positive results. Through our collaborative
efforts with the NIH Institutes and Centers and other organizations,
the Office of Research on Minority Health established about
100 health-related projects and supported approximately 30
research training programs, such as the “Bridges to the Future”
program with the National Institute of General Medical Sciences.
Other partnership projects undertaken with NIH Institutes
and Centers include:
- The African-American Study of Kidney Disease and Hypertension
and the Minority Organ and Tissue Transplant Program, with
the National Institute of Diabetes and Digestive and Kidney
Diseases;
- The development of research relationships between minority medical schools and the
NCI Comprehensive Cancer Care Centers, in collaboration with the National Cancer
Institute; and
- The Research Infrastructure in Minority Institutions program, administered by the
National Center for Research Resources for several years, which has now been
transferred back to the Center.
The ORMH collaborative activities expanded beyond the NIH
ICs. The Office also worked with other Department of Health
and Human Services agencies, including the Office of Minority
Health, the Centers for Disease Control and the Agency for
Healthcare Research Quality. With the Office of Minority Health,
ORMH supported projects such as:
- The Asian and Pacific Island American Health Forum, and
- The National Medical Association’s Mazique Symposium, as well as programs of
- The Association of Asian Pacific Community Health Organizations,
- The Association of American Indian Physicians,
- Quality Education for Minorities, and
- The National Alliance for Hispanic Health.
The Office succeeded by working collaboratively at various levels to unveil
the gaps, develop innovative projects to bridge those gaps,
evaluate the outcomes and ultimately translate the outcomes
into programs. The Center will continue to build upon these
activities and this collaborative philosophy.
Over the past year, the NCMHD
has worked diligently with its partners, the other Institutes
and Centers (ICs) and Offices at NIH
to implement its statutory requirements. I am grateful for
the extensive support and cooperation that the Center has
received from Dr. Ruth Kirschstein, Acting Director of NIH,
and all of the other IC Directors. The help of the other ICs
is demonstrated in the Center’s achievements that I will discuss.
In FY 2001, we were
appropriated a total of $132,044,000.00 to assume our activities.
I am pleased to inform you that we have implemented all of
our core programs mandated by Congress, developed the draft
Trans-NIH
Comprehensive Strategic Research Plan and Budget to Reduce
and Ultimately Eliminate Health Disparities, solidified our
organizational structure, hired new staff, co-sponsored several
projects with other NIH
Institutes and Centers and created the Center’s website, which
can be accessed at www.ncmhd.nih.gov.
NIH Comprehensive Strategic Research Plan and Budget
For the first time in the history of the National Institutes
of Health, it will have a comprehensive Strategic Research
Plan and Budget that will be a guiding mechanism for the conduct
and support of all NIH minority health disparities research
and other health disparities research activities. NCMHD was
honored to be charged with the development of this plan in
collaboration with the Director of NIH and the Directors of
the other NIH ICs. The Center has submitted the Strategic
Research Plan and Budget to the Office of the Director, NIH,
for review.
The Plan was developed with substantial input from various
stakeholders, including the public, academia and health professionals,
representing those populations that disproportionately experience
disparities in health. It describes current activities and
future plans of the NIH to address the health disparities
crisis, to build a culturally competent cadre of biomedical
and behavioral investigators and to increase the number of
minority clinical and basic medical scientists who are essential
to the success of our efforts.
There are three main goals of the plan--research, research
infrastructure and community outreach, which encompasses information
dissemination and public health education. Within each goal
there are areas of emphasis and objectives to accomplish the
priorities identified or mandated. Each objective outlines
an action plan, time-line, and performance measures to monitor
and report progress and outcome measures to demonstrate accomplishment
and ultimate impact. The Plan will continue to be an evolving
document over the next five years. Once finalized, it will
be posted on the NCMHD website on a continuing basis, and
comments from the public will be welcomed. We will update
and revise the Strategic Research Plan and Budget annually
with the continued collaborative input of the other NIH ICs,
and we will provide annual reports on our progress.
NCMHD Congressionally Mandated Programs
One of the new capabilities that the Center welcomes is the
opportunity to award grants. Although the Center still awaits
the appointment of its Advisory Council to offer advice and
serve as the second level of review for grant applications,
the NCMHD established two grant funding programs in FY 2001--the
Loan Repayment Program and the Endowment Program for Section
736 (Public Health Service Act) Institutions. We have also
recently launched another grant funding program--the Project
EXPORT Centers of Excellence Program. These are all programs
mandated by the law. However, none of this would have been
possible without the collaborative effort that the other NIH
Institutes and Centers extended.
Loan Repayment Program
Many minority individuals are often deterred from advancing
their careers, particularly in the sciences because of financial
constraints. With our loan repayment program, individuals
would not need to be concerned about the financial burden
involved in their pursuit of medical, scientific or other
health professions careers. The National Center on Minority
Health and Health Disparities created two loan repayment programs
in fiscal year 2001--the Loan Repayment Program for Health
Disparities Research and the Extramural Clinical Research
Loan Repayment Program for individuals from disadvantaged
backgrounds. The Loan Repayment Program for Health Disparities
Research is aimed at increasing the number of highly qualified
health professionals in health disparity research careers,
and focuses on basic, clinical, and behavioral research with
priority given to biomedical research. The Extramural Clinical
Research Program seeks to increase the number of highly qualified
health professionals from disadvantaged backgrounds who pursue
clinical research careers. Applicants to the loan repayment
programs must have a health professions degree, such as a
M.D., Ph.D., D.O., D.D.S., or equivalent doctorate degree.
Individuals completing their residencies, post-doctoral training,
and internships may also apply.
I am pleased to report that the first round of loan repayment
awards were made to 45 health professionals in FY 2001, eight
months after the Center’s creation. Twenty-eight awards went
to the Health Disparities Research Loan Repayment Program,
and seventeen awards to the Extramural Clinical Research Loan
Repayment Program. Of the total 45 awards, 34 individuals
were from a health disparity population and 11 were Caucasians
pursuing health disparities research. Health disparity populations
consist of African Americans, Hispanics, Asians, Pacific Islanders,
Native Americans, Alaska Natives and the medically underserved.
The medically underserved are members of the general population,
as well as racial and ethnic minorities who live below the
poverty line and live in non-metropolitan rural areas where
a high percentage of the counties are designated as health
professional shortage areas. The breakdown of the 34 health
disparity population awardees are as follows:
Race/Ethnicity
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Total
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HDR-LRP
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ECR-LRP
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African Americans |
22
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11
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11
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Native Americans |
02
|
02
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00
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Asian Americans |
04
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02
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02
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Hispanic Americans |
04
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02
|
02
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Caucasians |
02
|
00
|
02
|
The Endowment Program
The Center is fortunate to have had similar success in implementing
the Endowment Program for Section 736 Institutions, as required
by Public Law 106-525. These institutions are Centers of Excellence
already established by the Health Resources and Services Administration
under Section 736 of the Public Health Service Act. The purpose
of this program is to facilitate capacity building for minority
health disparities research and other health disparities research
at institutions that have a demonstrated commitment to educating
and training researchers from minority and health disparity
populations. In FY 2001, the NCMHD made the first round of
endowment awards to five institutions:
- Tuskegee University
- Charles R. Drew University
- Morehouse School of Medicine
- Meharry Medical College and
- Xavier University of Louisiana
Additionally, the Center is preparing to make endowment awards
to two institutions that participated in the FY 2001 competition,
per the recommendation of reviewers--the University of Puerto
Rico and Florida A&M University. The Endowment Program is
an on-going commitment of the Center. Presently, the Center
is finalizing the Request for Applications for the fiscal
year 2002 round of competition, and plans to issue awards
in September.
Centers of Excellence Program
The Centers of Excellence in Partnerships for Community Outreach,
Research on Health Disparities and Training (Project EXPORT)
will be established at academic institutions with a significant
number of students from racial and ethnic minority and other
health disparity populations. These Centers will:
- Promote the conduct of minority health and/or health disparities
research;
- Encourage the participation of members of health
disparity groups in biomedical and behavioral research as
well as prevention and intervention activities; and
- Build
research capacity in minority serving institutions.
The NCMHD recently concluded a series of technical assistance
workshops in Dallas, Texas; Morgantown, West Virginia; Birmingham,
Alabama and Seattle, Washington, to inform the community about
the program and the application requirements. Workshop presentations
are available on the Center’s website for interested constituents
who could not attend the workshops. Applications are currently
being accepted until May 24th. We plan to announce the FY
2002 awards in September.
Collaborative Projects
As the NCMHD evolves, we remain committed to forging partnerships
among disciplines, communities, individuals, and at all levels
of our constituency. With the support of our constituents
within and beyond the NIH community, we are able to identify
the issues and gaps in minority health and explore the approaches
that would help to make health disparities a historical phenomenon.
The NCMHD envisions an America in which all populations will
have an equal opportunity to live long, healthy and productive
lives. We will leave no one behind. With your cooperation
and willingness to collaborate with us, and your fellow constituents
we can conquer this crisis.
- Just last week, the American Academy of Ophthalmology issued
a press release on the findings of Project VER, which stands
for Vision, Evaluation, and Research Project. This was a joint
project of the NCMHD and the National Eye Institute, which
revealed that open-angle glaucoma was the leading cause of
blindness among a sample group of Hispanic Southern Arizona
residents of Mexican descent.
- Last year, the Diabetes Prevention Program that we supported
in partnership with the National Institute of Diabetes and
Digestive and Kidney Diseases showed that moderate diet
and exercise are beneficial in delaying and possibly preventing
type 2 diabetes for people who are overweight and at high
risk.
Other collaborative projects that the NCMHD supports with
other NIH ICs include:
- The Innovative Approaches to the Prevention of Obesity
Program with the National Institute of Diabetes and Digestive
and Kidney Diseases, which is aimed at evaluating interventions
to environmental factors that contribute to inappropriate
weight gain in children, adolescents and adults.
- The Overcoming Barriers to Treatment Adherence in Minorities
and Persons Living in Poverty Program, in conjunction with
the National Heart, Lung, and Blood Institute. The program
evaluates interventions to overcome treatment adherence
among racial and ethnic minorities and people living in
poverty faced with certain diseases.
- The Healthy Aging in Nationally Diverse Longitudinal Samples
(HANDLS) program, with the National Institute on Aging,
is a community-based research effort designed to evaluate
normative age-related health disparities in minority and
socio-economically diverse populations. The program uses
a Medical Research Van to facilitate the participation of
minority, medically underserved and socio-economically diverse
subjects in age related clinical research.
These are just examples of the many collaborative projects
that the Center is undertaking that hold much promise for
the American people.
New Initiatives
NCMHD is excited about the opportunity to undertake new approaches
to the health disparities crisis. As the Center prepares for
FY 2003, some of the projects that it is considering are:
- The Virtual University Program: to improve training outcomes
for students from minority and other health disparity groups,
improve the transition from undergraduate to graduate programs
and to independent investigators, and serve as a resource
for continuing education and/or retooling for faculty at minority
serving institutions.
- The Rural Poor and other Health Disparity
Groups: the NCMHD will collaborate with the National Institute
on Dental and Craniofacial Research (NIDCR) to support 1)
planning grants for research to prevent or reduce oral health
disparities, 2) pilot grants for research to prevent or reduce
oral health disparities, and 3) research infrastructure and
capacity building for minority institutions to reduce oral
health disparities.
- Community Outreach: the NCMHD is committed
to creating communication channels that lend themselves to
the bi-directional, interactive nature of effective outreach.
Accordingly, the NCMHD will divide its outreach efforts into
three major objectives:
- Outreach to Communities and their
Community Based Organizations;
- Outreach to Health and Social
Service Professionals; and
- Outreach to Health, Research
and Social Service Institutions, Professional Organizations,
and the Business Sector.
- Mississippi Delta Project: with
a medical research agenda for the Mississippi Delta Region,
the NCMHD will concentrate on:
- Solidifying the organizational
and technological network within the community to conduct
research on health disparities;
- Increasing the level of
involvement of community residents in health research;
- Facilitating the availability of culturally-appropriate health
education material; and
- Establishing a base for involvement
of small businesses with these entities.
Conclusion
The NCMHD
is grateful to the Congress, the Administration, the NIH
Institutes and Centers and to all of you for the overwhelming
support that you have provided the Center in transitioning
from the Office of Research on Minority Health to the National
Center on Minority Health and Health Disparities. I am proud
of the progress that the Center has made over the past year
in establishing its organizational structure and programs.
The American people can now learn about the Center’s activities
and programs by accessing our website at www.ncmhd.nih.gov,
which is now averaging about 50,000 hits a month. Through
continued and increasing collaborative ventures, NCMHD
will work diligently to define the health disparity issue
for every American, and garner support to ensure the health
of all Americans. We need you to work with one another and
to join us in this challenge to eliminate the health disparities
crisis. Health disparities is an issue that transcends minorities
and other health disparity populations--it is everybody’s
concern and calls for shared responsibilities to effect permanent
change.
Thank you again for the opportunity to speak with you today.
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