Research Towards the Elimination of Health Disparities

1. Research Towards the Elimination of Health Disparities Yvonne T. Maddox, Ph.D. Deputy Director National Institute of Child Health and Human Development National Institutes of Health

2. “Advances in scientific knowledge have provided the foundation for improvements in public health and have led to enhanced health and quality of life for all Americans. Much of this can be attributed to the groundbreaking work carried on by, and funded by, the National Institutes of Health (NIH).” Tommy G. Thompson Secretary Department of Health and Human Services

3. The National Institutes of Health

4. NIH Mission To improve the health of the Nation through Biomedical Research and Research Training

5. Differences in Health Status

6. Advancing Clinical Research • Delaying the onset of Alzheimer’s Disease • Improving treatment for Parkinson’s Disease • Conquering diabetes • Improving treatments for spinal cord injury • Making AIDS treatment safer, easier and better • Improving outcome for cancer and heart disease patients

7. Changing Profile of the Nation • Life Expectancy • Racial Breakdown of Population • Social Economic Status

9. Racial breakdown of population

10. Child Poverty: Percentage of related children under 18 living below selected poverty levels by race (all families) *Persons of Hispanic origin may be of any race. Source: America’s Children: Key National Indicators of Well-Being 2000

13. Cancer Death rate from stomach cancer is substantially higher among Asian and Pacific Islanders, including Native Hawaiians, than among other populations.

14. Diabetes Native Americans, Hispanics, African Americans, and some Asian Americans and Pacific Islanders, including Japanese Americans, Samoans, and Native Hawaiians, are at particularly high risk for development of type 2 diabetes.

15. Diabetes • African-Americans are 1.7 times more likely to have diabetes than whites • Hispanics/Latinos are twice as likely to have diabetes than whites • Diabetes has reached epidemic proportions among Native Americans, among the Pimas of Arizona, prevalence is 50% Source: American Diabetes Association

21. Asthma • Asthma is 26 percent more prevalent in African-American children than in white children • Among 5 to 24 year olds, African-Americans are 4 to 6 times more likely to die from asthma than whites • The hospital discharge rate for asthma is 3.7 times higher for African-Americans than for whites Source: CDC, American Lung Association

23. Growing Mortality Disparity for American Indians Compared to U.S. All Races 1994-1996 Rates • Pneumonia and influenza – 71% greater • Homicide – 63% greater • Gastrointestinal disease – 42% greater • Infant mortality – 22% greater • Heart disease – 13% greater

24. Growing Mortality Disparity for American Indians Compared to U.S. All Races 1994-1996 Rates • Alcoholism - 627% greater • Tuberculosis – 533% greater • Diabetes – 250% greater • Injuries – 230% greater • Suicide – 72% greater

25. DHHS Initiative to Eliminate Racial and Ethnic Disparities in Health • Infant Mortality • Cancer Management • Cardiovascular Disease • Diabetes • HIV/AIDS • Immunizations

26. Historical Perspective • DHHS Response to the President’s Race Initiative • “Eliminating Racial and Ethnic Disparities in Health in six areas by the year 2010 (Infant Mortality, Cancer Screening and Management, Cardiovascular Disease, Diabetes, HIV/AIDS, and Immunizations”

27. Definition of Health Disparities “Differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States” First NIH Working Group on Health Disparities

28. Focus of the Initiative • Initially, NIH will focus on racial/ethnic minority populations (African-Americans, Asians, Pacific Islanders, Hispanics and Latinos, Native Americans, and Native Alaskans) • Research on health disparities related to socioeconomic status is also included in the definition.

29. Trans-NIH Initiative: Addressing Health Disparities

30. NIH Plan of Action (Goals) • Develop a Five-Year Strategic Research Agenda • Recruit and Train Minority Investigators • Advance Community Outreach Activities • Form Partnerships • Define, Code, Track, Analyze, and Evaluate Progress • Enhance Public Awareness

31. Research Objectives (1) • Advance the understanding of the development of diseases and disabilities that contribute to health disparities - Epidemiology and Risk Factors - Environment/Socioeconomic Status - Mechanisms of Disease - Genetic Variation

32. Research Objectives (2) • Develop new or improved approaches for detecting or diagnosing the onset or progression of disease and disabilities that contribute to health disparities • Develop new or improved approaches for preventing or delaying the onset or progression of disease or disabilities that contribute to health disparities • Develop new or improved approaches for treating diseases and disabilities that contribute to health disparities

33. Research Infrastructure Objectives • Support research training and career development • Provide support for institutional resources

34. Public Information, Outreach, and Education • Develop research-based information resources • Communicate research-based information to increase public awareness • Transfer knowledge to health care providers

35. NICHD Plan to Eliminate Health Disparities

36. Provisions That the Projects are of Benefit to the Community

37. Infant Mortality Rate(By Race and Hispanic Origin, Selected Years 1983-99)

38. Sudden Infant Death Syndrome (SIDS) Leading Causes of Infant Mortality – 1992 Congenital anomalies (21%) Sudden Infant Death Syndrome ( 15%) Low birth weight (11%) Respiratory Distress Syndrome (7%) Maternal complications (4%)

39. Theories of SIDS Cause circa • Bronchospasm Adrenal Insufficiency • Chromaffin deficiency • Maternal “overlay” • Gastric aspiration • Poisoning • Inborn error of metabolism • Parathyroid insufficiency • Anaphylactic shock • Endotoxemia • Bacterial sepsis • Viral infection • Status thymicolymphaticus (with venous or atrial compression) • Mechanical suffocation • Vagal reflex, etc. • Hypogammaglobulinemia • Mucous obstruction of trachea • Hypocalcemia with laryngospasm • Cardiac arrhythmia • Hypersensitivity

41. Impact of the Back to SleepCampaign A public-private partnership to reduce the risk of Sudden Infant Death Syndrome.

42. BACK TO SLEEP CAMPAIGN LAUNCHEDNATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT • Launch of Back to Sleep Campaign • Press conference, June 1994, Surgeon General • BTS Campaign Partners • American Academy of Pediatrics • SIDS Alliance • Association of SIDS and Infant Mortality Programs • National Heart, Lung, and Blood Institute, NIH • Maternal and Child Health Bureau, HRSA

43. Campaign Components • Media Materials (radio, TV, print) • Video • Posters • Crib Stickers • Magnets

44. Pre-AAP recommendation Post-AAPBTSCampaign Sleep Position Source: NICHD Household Survey SIDS Rate Source: National Center for Health Statistics, CDC

45. Sudden Infant Death Syndrome (SIDS)Leading Causes of Infant Mortality • Congenital anomalies • Short gestation/low-birth weight • Sudden Infant Death Syndrome

47. Back to SleepFocus on African American Communities • SIDS rate is 2.2 times higher in the black population than it is in the white population • Black mothers are twice as likely as white mothers to place their babies on their stomachs to sleep • Success of the Back to Sleep campaign demonstrates that a focused campaign can increase back sleeping and reduce the risk of SIDS

48. Reducing SIDS in African American Communities • Institute makes strong commitment to eliminating disparity in rates of SIDS between white and minority populations NICHD’s SIDS Strategic Plan

49. Newest Campaign Literature

50. Implementing the OutreachD.C. Metro Bus Ad