Research Towards the Research Towards the Elimination of Health Elimination of Health

DisparitiesDisparities

Yvonne T. Maddox, Ph.D.

Deputy Director

National Institute of Child Health and

Human Development

National Institutes of Health

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

Tommy G. Thompson

Secretary

Department of Health and Human Services

The National Institutes of HealthThe National Institutes of Health

NIH MissionNIH Mission

To improve the health of the Nation through Biomedical Research and Research Training

Advancing Clinical ResearchAdvancing 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

Changing Profile of the Nation Changing Profile of the Nation

Life ExpectancyRacial Breakdown of PopulationSocial Economic Status

Racial breakdown of populationRacial breakdown of population

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

There are Racial and There are Racial and Ethnic Differences in Ethnic Differences in many Diseases and many Diseases and

ConditionsConditions

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

CancerCancer

DiabetesDiabetes

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.

DiabetesDiabetes

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

AsthmaAsthma

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

Growing Mortality Disparity for Growing Mortality Disparity for American Indians Compared to U.S. American Indians Compared to U.S.

All Races 1994-1996 RatesAll Races 1994-1996 Rates

Pneumonia and influenza – 71% greaterHomicide – 63% greaterGastrointestinal disease – 42% greaterInfant mortality – 22% greaterHeart disease – 13% greater

Growing Mortality Disparity for Growing Mortality Disparity for American Indians Compared to U.S. American Indians Compared to U.S.

All Races 1994-1996 RatesAll Races 1994-1996 Rates

Alcoholism - 627% greaterTuberculosis – 533% greaterDiabetes – 250% greaterInjuries – 230% greaterSuicide – 72% greater

DHHS Initiative to Eliminate Racial DHHS Initiative to Eliminate Racial and Ethnic Disparities in Healthand Ethnic Disparities in Health

Infant MortalityCancer ManagementCardiovascular DiseaseDiabetesHIV/AIDSImmunizations

Historical PerspectiveHistorical 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”

Definition of Health DisparitiesDefinition 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

Focus of the InitiativeFocus 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.

Trans-NIH Initiative:Addressing Health

Disparities

NIH Plan of Action (Goals)NIH Plan of Action (Goals)

Develop a Five-Year Strategic Research Agenda

Recruit and Train Minority InvestigatorsAdvance Community Outreach ActivitiesForm PartnershipsDefine, Code, Track, Analyze, and

Evaluate ProgressEnhance Public Awareness

Research Objectives (1)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

Research Objectives (2)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

Research Infrastructure Research Infrastructure ObjectivesObjectives

Support research training and career development

Provide support for institutional resources

Public Information, Public Information, Outreach, and EducationOutreach, and Education

Develop research-based information resources

Communicate research-based information to increase public awareness

Transfer knowledge to health care providers

NICHD Plan to Eliminate Health DisparitiesNICHD Plan to Eliminate Health Disparities

Provisions That the Provisions That the Projects are of Benefit Projects are of Benefit

to the Communityto the Community

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

Sudden Infant Death Syndrome Sudden Infant Death Syndrome (SIDS)(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%)

Theories of SIDS Cause circa Theories of SIDS Cause circa

•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

•Bronchospasm Adrenal Insufficiency

•Chromaffin deficiency

•Maternal “overlay”

•Gastric aspiration

•Poisoning

•Inborn error of metabolism

•Parathyroid insufficiency

•Anaphylactic shock

•Endotoxemia

Impact of the Impact of the Back to SleepBack to Sleep

CampaignCampaign

A public-private partnership to reduce the risk of Sudden Infant Death Syndrome.

BACK TO SLEEPBACK TO SLEEP CAMPAIGN LAUNCHED CAMPAIGN LAUNCHEDNATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENTNATIONAL 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

Campaign ComponentsCampaign Components

Media Materials (radio, TV, print)

Video Posters Crib Stickers Magnets

SIDS Rate and Sleep Position, 1985-2000(Deaths per 1,000 Live Births)

1.41 1.41 1.37 1.4 1.391.3 1.3

1.2 1.17

1.03

0.87

0.74 0.770.72

0.670.62

7074

78 8185 85

54

39

28

0

0.5

1

1.5

1985 86 87 88 89 90 91 92 93 94 95 96 97 98 99 2000

Year

SID

S R

ate

0

50

100

Per

cen

t B

ack

and

Sid

e S

leep

ing

Pre-AAP recommendation Post-AAP BTS Campaign

Sleep Position Source: NICHD Household Survey SIDS Rate Source: National Center for Health Statistics, CDC

Sudden Infant Death Syndrome Sudden Infant Death Syndrome (SIDS)(SIDS)

Leading Causes of Infant MortalityLeading Causes of Infant Mortality

Congenital anomalies

Short gestation/low-birth weight

Sudden Infant Death Syndrome

SIDS Rates, United StatesDeaths per 1,000 live births

1.4 1.391.3 1.3

1.2 1.17

1.03

0.870.78 0.77 0.72

0.67 0.62

1.221.18 1.11 1.1

1 0.970.85

0.710.63 0.64

0.58 0.53 0.5

2.38 2.42.31 2.33

2.18 2.19

1.941.79

1.651.53

1.38 1.35 1.32

0

0.5

1

1.5

2

2.5

3

1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Total White BlackSource: National Center for Health Statistics, CDCFinal Data, 2000

Back to SleepBack to SleepFocus on African American Focus on African American

CommunitiesCommunities

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

Reducing SIDS in Reducing SIDS in African American CommunitiesAfrican American Communities

Institute makes strong commitment to eliminating disparity in rates of SIDS between white and minority populations

NICHD’s SIDS Strategic Plan

Newest Campaign Literature

Implementing the OutreachImplementing the OutreachD.C. Metro Bus AdD.C. Metro Bus Ad

Community ParticipationCommunity Participation

Campaign strategies targeted to the particular minority group “ Input from the people”

Provide the resource materials for health fairs and community events

Give progress reports on results

The NIH Health

Disparities Research Plan:

Where Do We Go

From Here?

National Center on Minority Health National Center on Minority Health and Health Disparities (NCMHD)and Health Disparities (NCMHD)

• Congress Established December, 2000 as part of the National Institutes of Health (NIH)

• Has Research and Research Training Grant Authority

• Special Research and Research Training Opportunities

Strategies to Eliminate Health Strategies to Eliminate Health DisparitiesDisparities

• Communicate evidenced-based results

• Increase access to care for low income and minority populations

• Improve quality and outcomes in the health care system

• Develop preventive approaches at the community level

• Build a knowledge base to understand the connection between SES, race, prevention, and health

• What is it?

• Establishing and Promoting Cultural Education Curricula

• Creating a Health Delivery Process that Supports an Environment for its Culturally Diverse Clients

Cultural CompetencyCultural Competency

“…“…. we're taking prevention directly to . we're taking prevention directly to the people of America. Throughout this the people of America. Throughout this year, we're going to give Americans the year, we're going to give Americans the tools, help and encouragement to live tools, help and encouragement to live healthier …. we're raising the profile of healthier …. we're raising the profile of prevention.”prevention.”

TOMMY G. THOMPSONSECRETARYDEPARTMENT OF HEALTH AND HUMAN SERVICES

http://healthdisparities.nih.gov/http://healthdisparities.nih.gov/