Research and Prevention:
Closing the Chronic Disease Gap in
Minority Populations
NIH Perspectives
Lawrence A. Tabak, DDS, PhD
Principal Deputy Director, NIH
Department of Health and Human Services
Closing the Gap:
The View from NIH
 Health Disparities Research
 Minority Populations in Clinical Research
 Diversity of the Biomedical Workforce
Closing the Gap:
The View from NIH
 Health Disparities Research
 Minority Populations in Clinical Research
 Diversity of the Biomedical Workforce
Health Disparities Research: The Plans
HHS Health
Disparities Action
Plan
NIH Health
Disparities Strategic
Plan and Budget
HHS Disparities Action Plan
Goals, 2010–2015
 Transform health care
 Strengthen the nation’s Health and Human
Services infrastructure and workforce
 Advance the health, safety, and well-being of the
American people
 Advance scientific knowledge and innovation
 Increase the efficiency, transparency, and
accountability of HHS programs
NIH Health Disparities Strategic Plan
 Establishes principles for NIH’s health disparities agenda
 Outlines projects to address minority health and health disparities within
each NIH Institute and Center, NIH Office of the Director
 Sets three major goals for each NIH IC:
1. Conduct and support intensive research on factors underlying
health disparities
2. Engage in aggressive, proactive, community outreach, information
dissemination, and public health education
3. Expand and enhance research capacity to create a culturally
sensitive and culturally competent workforce
NIH’s Health Disparities Research: Objectives
 Advance understanding of the development and progression of
diseases and disabilities that contribute to health disparities
among racial and ethnic minority, low-income, rural, and
medically underserved populations
 Develop new or improved approaches for detecting, diagnosing,
preventing, delaying, or treating the onset or progression of
diseases and disabilities that contribute to health disparities
 Advance understanding of the causes of health disparities, e.g.,
non-biological bases of disease incidence and progression
Research on Factors Underlying Health
Disparities
Areas of Emphasis
 Clinical and Translational Research
 Comparative Effectiveness Research
 Social Determinants of Health
 Health Services Research
 Innovative Health Technologies
 Genetics and Biological Factors
 Behavioral and Social Sciences
NIH Research on Prematurity and Health
Disparities
 U.S. rate of preterm births is >12%, far
higher than many other developed nations
 In 2009, 13.9% of Black infants were low
birthweight, compared to 7.2% of White infants
 NIH’s Maternal Fetal Medicine Units Network
 14 clinical research centers
 Research includes identifying factors associated with disparities in
quality of obstetric care/outcomes
 Significant findings to date:
 Weekly progesterone injections for women with previous preterm
delivery reduces risk of preterm birth
 Magnesium sulfate before preterm birth provides neuroprotection
Racial Disparities in Cardiovascular
Disease (CVD)
 Morehouse and Emory Team up to Eliminate Health
Disparities (META-Health) study
 African Americans experience a higher burden of
CVD, while classification schema may
underestimate CVD risk
 Study Findings:
 African Americans have higher levels of oxidative
stress than whites (even after adjustment for
differences in risk factors)
 Racial differences in oxidative stress may play a
key role in racial disparities in CVD
Metab Syndr Relat Disord. 2012 Mar 2. [Epub ahead of print]
Colorectal Cancer Disparities
 Observation: Black men and women have higher
incidence and mortality rates compared to white
men and women
 Study Design:
 Screening sigmoidoscopy offered to study
participants
 Subjects with polyps or lesions were referred to
personal physician for follow-up colonoscopy
(cost not covered by the study)
Laiyemo et al, “Race and Colorectal Cancer Disparities: Health-Care Utilization vs Different Cancer Susceptibilities” JNCI 2010
Colorectal Cancer Disparities: Study
Points to Healthcare Utilization Rates
 Study Findings:
 Blacks and whites equally likely
to need follow-up colonoscopy
after a screening sigmoidoscopy
 Blacks less likely to receive the
follow-up colonoscopy
 No statistically significant
difference in the risk of colorectal
cancer by race based on
colonoscopy results
Closing the Gap:
The View from NIH
 Health Disparities Research
 Minority Populations in Clinical Research
 Diversity of the Biomedical Workforce
 Conclusions: We found very small differences in the
willingness of minorities, most of whom were
African-Americans and Hispanics in the US, to
participate in health research compared to nonHispanic whites. These findings, based on the
research enrollment decisions of over 70,000
individuals, the vast majority from the US, suggest
that racial and ethnic minorities in the US are as
willing as non-Hispanic whites to participate in health
research. Hence, efforts to increase minority
participation in health research should focus on
ensuring access to health research for all groups,
rather than changing minority attitudes.
PLoS Med 3(2): e19. doi:10.1371/journal.pmed.0030019, 2005
Minority Enrollment in NIH Domestic Clinical
Research
Closing the Gap:
The View from NIH
 Health Disparities Research
 Minority Populations in Clinical Research
 Diversity of the Biomedical Workforce
Diversity of the NIH-Funded Research
Workforce
Hispanic or Latino (of any race)
White
American Indian and Alaska Native
Native Hawaiian and other Pacific Islander
Other, unknown, not reported and more
than one race
Asian
Black or African American
2010 US Census
Bureau Report
2010 NIH Principal
Investigators on RPGs
Sources: US Census Report 2010; IMPACII; AAMC
Greater Diversity in Research Workforce
African Americans, Hispanics, and Native
Americans:
 Represent 31% of U.S. college age population but only
account for 14% of undergraduates in life sciences
 And even fewer in later stages
Greater Diversity in Research Workforce:
NIH Needs to Do More
Greater Diversity in Research Workforce
NIH’s Plan for Action:
 Evaluate current training programs
 Phase out unsuccessful programs, expand
successful ones
 Increase number of early career reviewers,
including those from underrepresented
populations
 Examine grant review process for bias and
develop interventions
 Improve support for grant applicants
 Gather expert advice on additional action steps
ACD Working Group on Diversity in the
Biomedical Research Workforce
 Reed Tuckson, M.D., co-chair
UnitedHealth Group
 John Ruffin, Ph.D., co-chair
NIH
 Lawrence Tabak, D.D.S., Ph.D., co-chair
NIH
 Ann Bonham, Ph.D.
AAMC
 Jordan Cohen, M.D.
AAMC
 José Florez, M.D., Ph.D.
Harvard Medical School
 Gary Gibbons, M.D.
Morehouse School of Medicine
 Renee Jenkins, M.D.
Howard University
 Tuajuanda Jordan, Ph.D.
Lewis and Clark College
 Wayne Riley, M.D., M.P.H., M.B.A.
Meharry Medical College
 Samuel Silverstein, M.D.
Columbia University Medical Center
 Dana Yasu Takagi, Ph.D.
University of California, Santa Cruz
 Maria Teresa Velez, Ph.D.
University of Arizona
 M. Roy Wilson, M.D., M.S.
NIH
 Keith Yamamoto, Ph.D.
University of California, San Francisco
 Clyde Yancy, M.D.
Northwestern University
Lawrence.Tabak@nih.gov
NIH
Turning Discovery into Health