>> GOOD MORNING.
MY NAME IS ELISO PEREZ-STABLE
THE DIRECTOR ON THE NATIONAL
INSTITUTE OF MINORITY HEALTH AND
HEALTH DISPARITIES.
TODAY'S SESSION IS OPEN TO THE
PUBLIC AND BEING BROADCAST ON
THE NIH VIDEO NETWORK.
COUNCIL MEMBERS PLEASE SPEAK
SLOWLY AND DISTINCTLY WHEN
REQUESTED TO SPEAK.
I'LL TURN IT OVER TO DR. PAUL
COTTON.
THE EXECUTIVE SECRETARY OF OUR
MEETING.
>> WELCOME TO THE 66th MEETING
OF ADVISORY COUNCIL.
TODAY'S SESSION OF THIS MEETING
IS OPEN TO THE PUBLIC AND
BROADCASTED ON THE NIH VIDEO
NETWORK.
COUNCIL MEMBERS REPEATING WHAT
YOU JUST HEARD, PLEASE BE SLOWLY
AND DISTINCTLY WHEN REQUESTED OR
CALLED UPON TO SPEAK.
THE VIDEOCAST OBSERVERS,
TECHNICAL STAFF AND NOTE TAKERS
WILL BE LISTENING TO NOTE YOUR
COMMENTS.
I WILL BEGIN THE ROLL CALL.
WHEN I CALL YOUR NAME GIVE A
BRIEF OVERVIEW OF WHO YOU ARE
AND WHAT YOU DO.
>> I'M DR. AJILORE.
DIRECT OF DEPARTMENT OF
PSYCHIATRY.
>> I'M AN ECONOMIST BY TRAINING
AND I LOOK AT THE PROGRAMS THAT
INCREASE ECONOMIC STATUS AND HOW
TO IMPROVE HEALTH AND WELL BEING
OF MINORITY POPULATION WITH A
FOCUS ON HISPANIC POPULATION.
>> GOOD MORNING I AM A PROFESSOR
OF MEDICINE AND RURAL HEALTH AT
OKLAHOMA STATE UNIVERSITY HEALTH
SCIENCES WHERE I DIRECT THE
CENTER FOR INDIGENOUS HEALTH
POLICY AND AN INTERVENTION
SCIENTIST FOCUSSED ON
CARDIOVASCULAR DISEASE RISK
REDUCTION PRIMARILY IN
INDIGENOUS POPULATIONS.
>> GOOD MORNING.
I'M A PROFESSOR AND CHAIR OF
NURSING AND COMMUNITY HEALTH.
MY RESEARCH FOCUSSED ON
MULTI-LEVEL STRATEGIES TO
ADDRESS HIV DISPARITIES AND ONE
OF THE MPIs FOR ELLISEO.
>> I'M FROM THE UNIVERSITY OF
NEW MEXICO A PROFESSOR OF HEALTH
POLICY AND I'M AN NPI FOR THE
SEAL PROJECT.
OUR RESEARCH IS TRANS
DISCIPLINARY TEAM SCIENCE WITH
COMMUNITY BASED PARTICIPATORY
RESEARCH.
THANK YOU.
>> REVEREND CURRY.
>> GOOD MORNING.
I'M THE PASTOR OF THE
PENNSYLVANIA AVENUE BAPTIST
CHURCH IN WASHINGTON, D.C.
TRAINED AS A CHEMICAL ENGINEER
AND THEOLOGIAN AND IN THE
STEERING COMMITTEE FOR SEAL.
>> I'M AT THE UNIVERSITY OF
MIAMI A PROFESSOR OF
PSYCHOLOPSYCHOLOGY
MEDICINE AND MOST OF MY WORK
FOCUSES ON UNDERSTANDING
MECHANISMS THAT DRIVE QUALITY OF
LIFE AND HEALTH OUTCOMES
PARTICULARLY IN MINORITY
POPULATIONS.
>> GOOD MORNING.
I AM PROFESSOR OF POPULATION
HEALTH AND MEDICINE AT THE NYU
SCHOOL OF MEDICINE AND SOCIAL
EPIDEMIOLOGIST BY TRAINING AND
FOCUSSED ON REDUCING CHRONIC
DISEASE IN NEW YORK CITY
MINORITIZED POPULATION AND NPI
OF THE NEW YORK SEAL.
>> DO WE HAVE EX-OFFICIO COUNCIL
MEMBERS ONLINE?
WE'LL COME BACK IF THEY APPEAR
LATER UP OUR BROADCAST.
WE'LL INTRODUCE NEXT OUR DEPUTY.
>> I'M MONICA WEBB COOPER DEPUTY
DIRECTOR OF NIMHD.
WELCOME.
>> I'M THE DIRECTOR AT THE
HEALTH SERVICES RESEARCH AT
NIMHD.
>> AND I'M THE DIRECTOR MUCH
COMMUNITY HEALTH AND POPULATION
SCIENCE AT NIMHD.
>> GOOD MORNING.
I'M THE DIRECTOR FOR THE
DIVISION OF INTEGRATIVE
BIOLOGICAL SCIENCES AT NIMHD.
>> I'M THE DIRECTOR OF THE
OFFICE OF BIO SCIENCES RESEARCH.
>> DID I MISS ANYONE?
IF I DID WE'LL CIRCLE BACK AND
YOU CAN INTRODUCE TO OUR LIVE
STREAMING AUDIENCE.
WE WILL NOW REVIEW THE FEBRUARY
2024 COUNCIL MINUTES.
THAT WILL BE VOTED ON BY OUR
COUNCIL MEM
COUNCIL MEMBERS THE MINUTES FOR
THE FEBRUARY 2024 COUNCIL
MEMBERS WERE POSTED IN THE
ELECTRONIC COUNCIL BOOK AND
HAVING REVIEWED THE MINUTES ARE
THERE QUESTIONS, CONCERNS OR
CORRECTIONS FOR THESE MINUTES?
HEARING NONE MAY I RECEIVE A
MOTION FOR ACCEPTANCE.
>> I MOVE FOR THE ACCEPTANCE OF
THE FEBRUARY COUNCIL MEETING.
>> IS THERE A SECOND.
>> I SECOND THE MOTION FOR
ACCEPTANCE.
>> ALL IN FAVOR PLEASE RAISE
YOUR HAND THANK YOU VERY MUCH
THE MOTION PASSES.
I WANT TO NOW GIVE YOU THE
FUTURE MEETING DATES TO PUT
THESE IN THE CALENDARS.
FEBRUARY 6, 2024.
I'M SORRY.
MAY 16, 2025, SEPTEMBER 5, 2025,
FEBRUARY, 2026, MAY 19, 2026,
AUGUST 11, 2026.
THE FEBRUARY COUNCIL MEETINGS
WILL BE VIRTUAL.
THE OTHER MEETINGS WE WILL BE
TOGETHER.
PLEASE REMEMBER A COUNCIL MEMBER
MAY HAVE ONE ABSENCE PER
CALENDAR YEAR.
AN INDIVIDUAL CANNOT SERVE ON
THE NIH PEER REVIEW PANEL WHILE
SERVING AS A COUNCIL MEMBER.
I WILL NOW TURN THE MEETING BACK
OVER TO DR. PEREZ-STABLE FOR THE
DIRECTOR'S UPDATE.
>> OKAY.
WELL, GOOD MORNING EVERYONE.
WE HAVE A GOOD SCHEDULE TODAY SO
THERE'LL BE TIME FOR
CONVERSATION AS YOU'RE SPEAKERS
WERE RESTRICTED WHEN THEY'LL BE
ABLE TO PRESENT AND WE SHOULDN'T
END TOO LATE SO I'M GOING TO TRY
AND PROVIDE A PERSPECTIVE ON
WHAT NIH OR NIMHD SPECIFICALLY
OVER THE LAST ALMOST FOUR MONTHS
SINCE WE MET IN EARLY FEBRUARY
AND WE'LL HAVE TIME TO ANSWER
QUESTIONS.
SO I'LL START WITH A NEW
LEADERSHIP APPOINTMENT
DR. KATHERINE NEZEL OF THE
FOGARTY CENTER AND I HAPPED TO
CO-CHAIR THE SEARCH WITH DR
DR. D'SOUZA AND IS ALSO THE
INTERNATIONAL RESEARCHER AT NIH
AS PART OF HER FOGARTY POSITION
AND FIRST WOMAN TO BE SELECTED
TO BE DIRECTOR OF FOGARTY.
PRIOR TO COMING TO NIH SHE WAS
PROFESSOR IN VACCINOLOGY AND
CHIEF OF THE DIVISION OF
GEOGRAPHIC MEDICINE MARYLAND
SCHOOL OF MEDICINE IN BALTIMORE.
SHE HAS EXPERIENCE IN AFRICA AND
SOUTH ASIA AND ALSO SPENT TIME
IN INDUSTRY AND ACADEMICS BEFORE
BEING IN HERE PREVIOUS POSITION
AT THE UNIVERSITY OF MARYLAND.
THERE'S ALSO A NEW DIRECTOR OF
THE CENTER FOR INFORMATION
TECHNOLOGY, DR. LOONEY.
I DID MEET WITH HIM SINCE HE
STARTED AND I THINK THIS IS EYE
REFRESHING NEW DIRECTION.
IT'S PART OF THE 27 INSTITUTES
AND CENTERS WE TALK ABOUT ITS
INFRASTRUCTURE AND EVERYONE'S
AFFECTED BY IT WITH DESK STOP
SUPPORT AND SYSTEMS ETCETERA.
HE COMES FROM AN ACADEMIC
CONTEXT FROM THE UNIVERSITY OF
WASHINGTON SCHOOL OF MEDICINE AS
PROFESSOR OF BIO MEDICAL
INFORMATICS AND MEDICAL
INFORMATION.
HE OVERSAW THE ENTIRE CLINICAL
DATA OPERATION INCLUDING SEVERAL
HUNDRED CLINICAL SITES IN THE
AREA.
HE'S GOT AN ACADEMIC RESEARCH
PERSPECTIVE ON THAT SIDE AS WELL
AS KNOWLEDGEABLE ABOUT THE
INFRASTRUCTURE AND SERVICE
ORIENTATION C.I.T. NEEDS TO HAVE
FOR IT TO THRIVE.
HE WAS ALSO THE DIRECTOR FOR THE
U.W. INSTITUTE FOR DATA SCIENCE
AND DIRECTOR OF INFORMATICS.
I THINK IT WILL BE A MOVE IN THE
RIGHT DIRECTION AND ALREADY HAS
HAD AN IMPACT IN THE INSTITUTE
DIRECTOR MEETINGS AND LOOK
FORWARD TO WORKING WITH HIM.
HE ALSO SPENT SOME TIME AT
UNIVERSITY OF CALIFORNIA SAN
FRANCISCO IN HIS EARLIER PART OF
HIS CAREER AS A POSTDOC AND
EARLY FACULTY.
THE NIH DIRECTOR, DR. MONICA
BERTAGNOLLI HAS LAUNCHED THROUGH
THE -- WHAT HAPPENED?
ARE WE OKAY?
OKAY.
TWO OF THE COMMON FUND PROGRAMS
TO SUPPORT CLINICAL RESEARCH AND
PRIMARY CARE SETTINGS SHE HAS
EMPHASIZED THIS SINCE SHE WAS
CONFIRMED SHORTLY AFTER SHE WAS
CONFIRMED AS THE NIH DIRECTOR
AND SPOKE TO US ABOUT IT IN THE
FEBRUARY COUNCIL WHEN SHE
PRESENTED AT OUR NIMHD COUNCIL.
A PRIMARY CARE FOCUS CLINICAL
RESEARCH NETWORK STARTS WITH THE
IDEA THAT SHE WANTS US TO DO
MORE CLINICAL RESEARCH AND WANTS
EVERY CLINICAL ENCOUNTER TO BE
PART OF DATA TO BE USED TO
ADVANCE KNOWLEDGE TO HAVE BETTER
CARE FOR ALL AMERICANS.
AND PARTICULARLY REACHING IN THE
AREAS AND INTO POPULATIONS THAT
HAVE NOT BENEFITTED FROM THE
ADVANCES OF SCIENCE AND HEALTH
CARE.
SPECIFIC TARGET WOULD BE BOTH
THE UNDER REPRESENTED
POPULATIONS THAT NIMHD IS
PARTICULARLY FOCUSSED ON AND
WILL NOTE RURAL AREAS.
IS A LONG TERM PROJECT THIS IS
NOT INSTANTANEOUS AND THERE ARE
NEW FUNDS FOR THIS IN FISCAL '24
AND THE OFFICE OF THE DIRECTOR
PROVIDED SOME FUNDS TO GET IT
STARTED.
THERE'S REQUEST FOR APPLICATIONS
THAT IS DUE IN A COUPLE OF WEEKS
AND TOE -- TO START A COUPLE
PILOT STUDIES.
MORE MONEY WILL BE AVAILABLE IN
FISCAL '25 AND WE ANTICIPATE
RAMPING UP WITH ADDITIONAL
CONGRESSIONAL SUPPORT IN THE
NEXT SEVERAL YEARS.
STAY TUNED TO WHAT THIS WILL
MEAN AS A FORMER PRIMARY CARE
DOCTOR MYSELF, I THINK THIS
APPEALS TO ME AND I THINK OUR
STAFF AND SOME OF YOU HAVE HEARD
ME SPEAK ABOUT EMPHASIS IN
PRIMARY CARE.
WE'LL HEAR MORE ABOUT THAT LATER
THIS MORNING AND ALSO THROUGH
THE RESEARCH CENTERS MINORITY
INSTITUTIONS AND ALSO THROUGH
OUR COMMUNITY ENGAGEMENT
ALLIANCE.
WE HAVE LAUNCHED INITIATIVES IN
THIS DIRECTION SO WE'RE VERY
EXCITED ABOUT THIS AND I'M
INVOLVED WITH AT LEAST ADVISING
THE GROUP THAT IS LEADING THIS
OR PROVIDING OVERSIGHT FOR THIS.
A REALLY IMPORTANT CHANGE
OCCURRED IN MARCH AFTER
CULMINATING PROBABLY 18 MONTHS
OR SO REQUEST FOR COMMENTS AND
PROCESSING.
IT WAS LAST FALL THAT I WAS AT
BRIEFINGS AT LEAST TWO TIMES I
THINK OR MAYBE THREE WITH
DR. WEBB COOPER AND OTHERS
HEARING FROM THE DEPARTMENT OF
HEALTH AND HUMAN SERVICES TEAM
THAT WAS SOCIALIZING THIS WITHIN
THE AGENCY.
THERE WAS CLEARED AND MADE
COMMENTS AND IT WAS OFFICIAL,
THE CHIEF STATISTICIAN OF THE
UNITED STATES WHO I BELIEVE SITS
IN THE DEPARTMENT OF COMMERCE
MADE THIS DECLARATION IN EARLY
MARCH AND THE OMB DIRECTOR WAS
CHANGED IN THE SUBSTANTIVE WAY
FOR THE FIRST TIME SINCE 1997.
SO THE TWO MAJOR CHANGES THAT
EVERYONE WILL NOTICE IS FIRST,
WE ARE ILLUMINATING THE TWO-PART
QUESTION AND ASKING A SINGLE
COMBINED RACE AND/OR ETHNICITY
QUESTION THIS BURIES THE
NON-HISPANIC PREFIX FOR
EVERYTHING WE'VE SEEN
POPULARIZED IN LITERATURE BUT I
WILL SAY I HAVE NEVER ENDORSED
THAT IF I HAD ANY CONTROL INTO
WHAT WENT INTO TEXT,
NON-HISPANIC, NON-LATINO.
THAT ASIDE, THE GOAL IS THAT AND
RACE AND ETHNICITY ARE DIFFERENT
IN MANY WAYS BUT THE REALITY IS
PEOPLE SEE THIS AS ONE CONSTRUCT
AND IT'S AN IDENTITY CONSTRUCT
AND THE BRITISH AND U.K. DO IT
SLIGHTLY DIFFERENTLY.
YOU SEE THE CATEGORIES ARE
FAMILIAR, HISPANIC OR LATINO AND
THE SECOND BIG CHANGE IS ADDING
MIDDLE EASTERN OR NORTH AFRICAN.
NATIVE HAWAIIAN OR PACIFIC
ISLANDER EMPHASIZING DIFFERENT
THAN ASIAN AND WHITE.
THIS WAS PREVIOUSLY PROPOSED IN
2015, 2016 AND WAS NOT IMPLEMENT
ED IN 2017.
THERE'S A SECOND LEVEL OF
IMPORTANT DETAIL HERE.
THESE ARE THE PRIMARY
CATEGORIES.
AND IT DOES SAY CHECK ALL THAT
APPLY AND THE IDEA IS IF YOU
CHECK MORE THAN ONE YOU'LL
AUTOMATICALLY BE CONSIDERED
MULTIRACIAL AND THAT BOX IS GONE
AND THE OTHER RACE BOX IS NO
LONGER AN OPTION.
SO PEOPLE CAN'T JUST SAY I'M
NONE OF THESE I'M SOMETHING
ELSE.
KEEP THAT IN MIND.
THERE'S AN A SECOND LEVEL UNDER
EACH CATEGORY THERE WILL BE
GEOGRAPHIC HERITAGE, IF YOU
WISH, TO DEFINE IT OFFERED.
THE SIX MOST COMMON IN THE
UNITED STATES.
NOW, IT'S NOT EXACTLY THAT
BECAUSE FOR AMERICAN INDIAN AND
ALASKAN NATIVE IT'S MORE TRIBAL
GROUPS OFFERED THE MOST LIKELY
FOR THE MOST NUMEROUS AT LEAST
BY THE CENSUS ASSESSMENT THEN
THERE'S COUNTRIES BY AFRICA AND
I BELIEVE THE CARIBBEAN AND
SIMILARLY FOR LATINO AND FOR
WHITE THERE'S COUNTRIES.
THIS WAS IMPLEMENTED IN 2020.
IT'S NOT SOMETHING PEOPLE NOTED
ENOUGH OR HAVE SEEN MUCH
ANALYSIS FROM THE CENSUS DATA.
HAS ALWAYS EXISTED FOR AMERICAN
INDIAN AND PACIFIC ISLANDER OR
LATINO AND 2020 WAS THE FIRST
TIME IMPLEMENTED FOR BLACK FOR
AFRICAN AMERICAN.
I BELIEVE FOR OUR COMMUNITY, ONE
OF THE THINGS TO BE THINKING
ABOUT AND WE WILL DO SOME OF
THAT AT NIMHD AS WELL IS HOW
DOES THIS OPERATIONALIZE ON A
RESEARCH SPECTRUM BECAUSE THESE
CATEGORIES AND THE SECOND-LEVEL
CATEGORIES REQUIRED FOR FEDERAL
AGENCIES TO COLLECT THIS DATA DO
NOT NECESSARY MEET THE NEEDS OF
ALL THE RESEARCH AREAS AND SO I
THINK THAT THAT'S IMPORTANT FOR
US TO THINK ABOUT AND HOW IT
GETS OPERATIONALIZED.
IT'S A CENSUS, IT'S NATIONAL AND
EVEN THOUGH ALL THE OF US HAVE
PROBLEMS WITH THE WAY IT'S
DEFINED, I THINK HAVING
STANDARDIZED COMMON WAYS TO
COLLECT THE DATA IS IMPORTANT TO
ASSESS THE RESEARCH AND PROVIDE
BEST OPTIMAL CARE AND HEALTH FOR
OUR COMMUNITIES.
FOR EXAMPLE JUST TO GIVE YOU ONE
IDEA UNDER HISPANIC OR LATINO IT
WOULD BE IMPORTANT TO CAPTURE
THE AFRO LATINO CATEGORY WHICH
IS AN IMPORTANT SUBCATEGORY NOT
CAPTURED CURRENTLY.
IF YOU SAY I'M HISPANIC AND
BLACK, THAT COULD BE ONE WAY OF
CAPTURING IT BUT MANY LATINOS
WHO HAVE MIXTURE WITH AFRICAN
HERITAGE OR BLACK DO NOT
IDENTIFY WITH BLACK BUT LATINO
AND THIS IS RESEARCH DONE BY THE
PUGH FOUNDATION.
OTHER CATEGORIES ARE RELEVANT
FOR OTHER GROUPS IN
SUBPOPULATIONS.
THAT'S THE KIND OF THING I'M
CONSIDERING.
NOW, THE DEPARTMENT ALSO
PUBLISHED A 2023 EQUITY ACTION
PLAN AS MOST OF YOU ARE AWARE
THERE'S BEEN A STRONG EMPHASIS
ON EQUITY WITHIN HEALTH AND
HUMAN SERVICES OVER THE PAST
THREE YEARS AND THESE WERE THE
FIVE GENERAL PRIORITIES THAT
WERE HIGHLIGHTED NEGLECT AND
IMPROVE CARE TO HELP CHILDREN
THRIVE AND THEIR FAMILIES AND
COMMUNITIES.
IT IS I THINK A CRITICAL PLACE.
WE KNOW THE TREMENDOUS ADVERSITY
THAT CREATE FOR A PERSON TO HAVE
A DISADVANTAGED CHILDHOOD AND
THE COUNTRY HAS MADE A
SIGNIFICANT PROGRESS IN REDUCING
CHILDHOOD POVERTY OVER THE LAST
30 YEARS BUT IT'S OBVIOUSLY NOT
ENOUGH.
YOU STILL HAVE CHILDHOOD POVERTY
AND THE UNITED STATES MAY DO
WORSE THAN OTHER HIGH-INCOME
COUNTRIES BUT IT'S NOT
ACCEPTABLE TO SAY WE'RE NOT THAT
BAD OFF BUT 30 YEARS AGO WAS
TWICE AS BAD IN POVERTY AMONG
ITS OWN CHILDREN HAS DECREASED
AND IT'S MORE THAN POVERTY
OBVIOUSLY.
TO PROMOTE ACCESSIBLE AND
WELCOMING HEALTH CARE AN ONGOING
CHALLENGE PARTICULARLY IN THE
CONTEXT OF THE INCREASING
COMMERCIALIZATION OF HEALTH AND
HEALTH CARE IN OUR COUNTRY.
NOW IT'S AN IMPORTANT POINT AND
OUTCOMES FOR RURAL AND ETHNIC
MINORITY COMMUNITIES AN
IMPORTANT ADDITIONAL POINT
PRIORITIZE THE BEHAVIORAL HEALTH
AND SEPARATION OF WHAT IS
BEHAVIORAL HEALTH AND MENTAL
HEALTH AND ROUTINE HEALTH CARE
SOMETHINGS ARTIFICIAL AND
CENTRAL TO NOT HOW ONE TAKES
CARE OF PEOPLE IN PRIMARY CARE
WE COULD NEVER DO THAT BECAUSE
THAT'S NOT HOW WE TOOK CARE OF
PATIENTS AND YET THE SYSTEM
WASN'T SUPPORTING THAT.
IT HAS GOTTEN BETTER BUT HAVE A
LONG WAY TO GO LOU THE SYSTEM
AND RESPONDS AND MANAGES HEALTH
CARE AND RURAL HEALTH FOR THE
MOST COMMON MENTAL HEALTH
PROBLEMS WHICH RELATED TO
DEPRESSIVE SYMPTOMS AND
DEPRESSION AND ANXIETY.
AND IN INCREASED DIVERSE IN
TRIAL DIVERSITY TO SUPPORT
INNOVATION.
WE WERE CHARGED TO CREATE SAY
HEALTH EQUITY FACT SHEET.
EACH OF THE AGENCIES AT THE
DEPARTMENT OF HEALTH AND HUMAN
SERVICES THE NIH HEALTH EQUITY
FACT SHEET AND NIMHD WAS MADE
RESPONSIBLE FOR GENERATING THIS.
THIS WAS FROM THE OFFICE OF THE
NIH DIRECTOR AND STAFF WERE
DILIGENTLY AT THIS BOTH IN OUR
OFFICE OF PLANNING AND STRATEGIC
ANALYSIS AS WELL AS
COMMUNICATIONS.
AND THIS IS AVAILABLE ON THE
WEBSITE.
IT WAS REVIEWED EXTENSIVELY BY
DR. DR. WEBB-HOOPER AND THE
OFFICE OF THE SURGEON GENERAL
WAS CONTACT AND THERE WAS A
FIRESIDE CHAT AND IT WAS
CELEBRATED ON MAY 23 AND
DR. MUTTI IS CELEBRATING PACIFIC
ISLANDER NATIVE HAWAIIAN
HERITAGE MONTH.
THIS MONTH WAS WIDELY ENDORSED
BY BOTH NIH THE OFFICE OF THE
DIRECTOR AS WELL AS THE
DEPARTMENT OF HEALTH AND HUMAN
SERVICES.
THE HOSTING AND ALL THE
BACKGROUND WORK WAS DONE AT
NIMHD.
DR. MONICA WEBB-HOOPER WAS THE
MODERA
MODERATOR.
I MISSED THIS EVENT BECAUSE I
WAS IN NEW YORK CITY FOR AN
EVENT THERE AND THE NEXT SPEAKER
WAS PROFESSOR AND INAUGURAL
DIRECTOR OF THE STAVROS
FOUNDATION INSTITUTE AT JOHNS
HOPKINS.
IT IS DR. MUTI'S OFFICE THAT
SELECTED THE DISTINGUISHED
LECTURESHIP AND WANTED TO MAKE
IT UP PERSON WHICH LOGISTICALLY
WAS GOING TO BE CHALLENGING AND
ENDED UP BEING ON VIDEOCAST AND
I'M SURE THE EVENT WAS
OUTSTANDING AND YOU CAN WATCH IT
ON THE LINK THERE.
I ALSO WANT TO CELEBRATE THE NIH
MENTAL HEALTH NATIONAL YOUTH
ESSAY CONTEST.
IT'S BEEN A COLLABORATION OF
NIMHD AND NIMHD AND NICHD SO
MENTAL HEALTH, CHILD HEALTH AND
HEALTH DISPARITIES.
THE CONTEST CHALLENGES HIGH
SCHOOL STUDENTS AGES 16 TO 18 TO
RAISE AWARENESS OF MENTAL HEALTH
ISSUES.
AND PARTICULARLY RESONATES IN
THE SETTING OF WHAT HAS
INCREASINGLY BEEN RECOGNIZED AS
A MENTAL HEALTH CRISIS FOR OUR
YOUTH.
IN PART EXACERBATED BY THE
ISOLATION OF THE PANDEMIC,
ISOLATION FROM SCHOOL, ISOLATION
FROM FRIENDS AND THE AFFECTS
SUBTLE OR OVERT OF CHANGES IN
HOW WE COMMUNICATE PARTICULARLY
THROUGH SOCIAL MEDIA AND OTHER
DIGITAL MEANS OPPOSED TO IN
PERSON INTERACTIONS.
WE HAD A HUGE NUMBER OF
SUBMISSIONS FROM ACROSS MOST OF
THE COUNTRY.
THE ESSAYS ADDRESS STIGMA AND
TRAUMA AND RESILIENCE, EQUITY,
ANXIETY.
I HAD NOTHING TO DO WITH WHO WAS
SELECTED.
I JUST APPROVED IT.
THERE ARE MODEST MONETARY AWARDS
AND LABELLED AS GOLD, SILVER AND
BRONZE AND THE ESSAYS I THINK
ARE AVAILABLE, I ASSUME, FOR
PEOPLE TO SEE.
I DON'T KNOW IF THERE'S
DESCRIPTIONS ON THE WEB LINK.
SHOUT OUT TO STAFF FROM THE
THREE INSTITUTES WHO HELPED
COORDINATE AND ORGANIZE THIS FOR
US.
I DID READ THE WINNING ESSAYS BY
THE WAY AND THEY'RE QUITE
MOVING.
I WANT TO ALSO POINT OUT THE ALL
OF US RESEARCH PROGRAM.
THE 27 INSTITUTES AND CENTER
DIRECTORS CO-AUTHORED SIGNED ON
TO AN ESSAY.
DR. BIARTH -- DR. BIANCHI WAS AN
AUTHOR BECAUSE HER NAME STARTS
WITH A "B" AND LATER WE'LL HAVE
THE SENIOR AUTHOR.
IT'S BASICALLY A STATEMENT OF
THIS PROGRAM.
AND MANY WILL REMEMBER IN 2015
THE YEAR THE PRECISION MEDICINE
WAS LAUNCHED.
I ARRIVED AT NIH JUST AS THAT
WAS STARTING.
IN FACT AND IT'S NOT ONLY
LAURNLED OVER THE NEXT COUPLE
YEARS BUT HAS NOW RECRUITED
SOMEWHERE CLOSE TO 800,000
INITIAL VOLUNTEERS WHO HAVE
COMPLETED THE INITIAL DATA.
MANY HAVE HAD THEIR GENETIC
ANALYSIS DONE THE GWAS.
THIS WAS DEEMED AS A GENETIC
STUDY.
THAT WAS THE IDEA TO BEGIN WITH
AND STILL BEING PROMOTED AS SUCH
BY MANY AND IT'S A LARGE COHORT
STUDY OF DIVERSE AMERICA THAT
WILL BE PROVIDING US WITH
TREMENDOUS AMOUNT OF INFORMATION
AND POSSIBILITIES FOR ANALYSIS
FOR ADVANCING KNOWLEDGE FOR
YEARS TO COME.
THE VOLUNTEERS COMPLETE ALL
SORTS OF QUESTIONNAIRES AND
AGREE, MANY NOT ALL BUT MOST
AGREE TO LINK TO THEIR
ELECTRONIC HEALTH RECORD WHICH
ARE HARMONIZED AND PROVIDED IN
THE DATABASE AND THERE'S A
DATABASE THAT EXIST AND PEOPLE
ARE USING IT.
THIS IS I THINK THE AN INFLEXION
POINT TO SAY THIS IS REAL.
THIS IS HAPPENING.
WE HAVE THIS ENORMOUS RESOURCE
AVAILABLE TO DO ANALYSIS.
THERE ARE ISSUES AND I WON'T GO
INTO THOSE RIGHT NOW BUT I THINK
OVER ALL THIS COMMITMENT AND
VISION INTRODUCED REALLY BY
FRANCIS COLLINS AND MADE
POSSIBLE BY CONGRESSIONAL
SUPPORT AND BROAD NIH SUPPORT
AND JOSH DENNY'S LEADERSHIP HAS
MADE THIS REAL AND WE'LL HEAR
MORE FROM HIM LATER.
PROBABLY THE MOST IMPORTANT
EVENT IS WE HAVE A BUDGET.
TO MARCH 23 WE WERE OPERATING
UNDER A CONTINUING RESOLUTION.
THE BILL TO FUND NIH WAS SIGNED
BY PRESIDENT BIDEN IN THE
MORNING HOURS OF MARCH 23.
IT WENT THROUGH CONGRESS AND THE
C.R. WAS GOING TO END AT M
MIDNIGHT ON MARCH 23 AND WE WERE
PREPARED TO DEAL WITH IT AND
OVER ALL THE NIH BUDGET WAS
FLAT.
DR. BERTAGNOLLI DEDICATED MANY
VISIT TO SENATORS AND CONGRESS
MEMBERS, CONGRESSIONAL MEMBERS
TO ADVOCATE FOR THE NIH BUDGET
SO WE WERE SPARED IMPORTANT
REDUCTIONS AND PREPARED TO
ABSORB UP TO A 5% TO 8% CUT AND
WERE TOLD IT'S THE BEST POSSIBLE
OUTCOME AND THAT'S SOMETHING I
WANT TO MAKE SURE EVERYONE'S
AWARE DR. BERTAGNOLLI STEPPED
INTO THE FIRE AND DID A
REMARKABLE JOB IN SUPPORTING THE
AGENCY AS NIH DIRECTOR.
THERE WERE SOME INCREASES.
NIMHD GOT INCREASES FOR MENTAL
HEALTH AMONG YOUTH.
THERE WERE INCREASES ON CANCER
AND THE MOONSHOT CATEGORY AND
THERE WERE MODEST INCREASES FOR
ALZHEIMER'S DISEASE FROM
CONGRESS AS MORE THAN ANYTHING
ELSE.
A SLIGHT INCREASE IN NIDA AND
THE HEAL INITIATIVE AND NIMHD
ACTUALLY RECEIVED MODEST
INCREASES IN TWO SPECIFIED
CATEGORIES.
I SEE THE INITIATIVE TO IMPROVE
NATIVE AMERICAN WAS $6 MILLION
NOT $10 MILLION.
THAT THE AN ERROR.
I APOLOGIZE FOR THAT.
NO MATTER HOW MANY TIMES YOU GO
OVER THE SLIDES THERE'S
SOMETHING THAT ESCAPES YOU.
MAYBE IT WAS WISHFUL THINKING
MAYBE IT WAS THE SIX PLUS FOUR
THAT GOT CONFUSED THERE.
THIS WAS AN INITIATIVE WE WERE
NOT EXPECTING.
IT IS BASED IN NIMHD WE HAVE
DONE ALL THE GROUND WORK TO
PREPARE FOR THIS INCLUDING
SPEAKING WITH COLLEAGUES AT NCI
AND HAVE TALKED TO DOUG LOWEY
WITH THIS AND BEEN IN DISCUSSION
WITH THE DRASHTH --
DIRECTOR OF THE TRIBAL HEALTH
RESEARCH AND WE'RE EXCITED ABOUT
THE POSSIBILITIES.
I THINK IT'S MUCH NEEDED
INVESTMENT AND WE WILL SEE HOW
THIS EVOLVES.
OUR INTENTION IS TO PUBLISH AN
IN THE FOR FUNDING OPPORTUNITY
IN A COMPETITION LINKED TO THE
NCI FUNDED CANCER CENTERS AS
DIRECTED BY THE LEGISLATION SOME
TIME BY MID JUNE.
THAT'S OUR GOAL.
WE WILL MAKE THIS HAP JPEN THIS
FISCAL YEAR AND EXPECT
ADDITIONAL SUPPORT IF CONGRESS
IS SO INCLINED.
WE WERE DIRECTED TO ESTABLISH AN
OFFICE ON NATIVE HAWAIIAN AND
PACIFIC ISLANDER HEALTH
RESEARCH.
THERE HAD BEEN BACK AND FORM
DISCUSSIONS FROM CONGRESSIONAL
STAFF.
THIS WAS NOT AS MUCH OF A
SURPRISE AND WE LAD A PLAN IN
PLACE AND DEVELOPING IT TO
ESTABLISH AN OFFICE WITHIN
PROGRAM THAT WILL BE FUNDING
RESEARCH CONDUCTING OUTREACH TO
THE COMMUNITY, WORK WITH
COMMUNITY GROUPS AND LEVERAGE
EXISTING PROGRAMS TO IMPLEMENT
THIS IN A ROBUST WAY.
WE'RE EXCITED ABOUT THESE ARE
THE TWO POPULATIONS IN THE
CENSUS IF YOU LOOK AT THE CENSUS
WE THINK THOUGH WE DON'T KNOW
HOW MANY PEOPLE WILL IDENTIFY
ADDS MIDDLE EASTERN OR AFRICAN
WERE LEFT OUT OF NATIONAL DATA
BECAUSE THERE WERE NOT SAMPLING
STRATEGIES.
WE'VE DONE BETTER WITH AMERICAN
INDIAN AND ALASKAN NATIVE AND
NOT THE CASE FOR NATIVE PACIFIC
ISLANDER AND THE SMALL
POPULATIONS END UP WITH NOT
ENOUGH AND EMPHASIZE WITH
DIFFERENT METHODS IS IMPORTANT
TO ADVANCE RESEARCH.
THIS IS A SNAPSHOT OF THE NIMHD
BUDGET SINCE 2016.
OUR GROWTH OVER THE NOT QUITE
10, NINE YEARS HAS BEEN ALMOST
DOUBLE.
THE FISCAL '24 DID NOT GO DOWN
THOUGH WAS AT RISK.
I WENT UP SLIGHTLY, $10 MILLION.
AND HOPE IT'S LAID A SOLID
FOUNDATION FOR CONTINUING
SCIENCE IN MINORITY HEALTH AND
HEALTH DISPARITIES.
ILLUSTRATION OF WHERE WE HAVE
BEEN WITH R01 APPLICATIONS AND
'24 IS FAR FROM OVER THROUGH '23
YOU SEE IN 2015 THE YEAR I WAS
HERE FOR JUST THE LAST MONTH OF
THAT FISCAL YEAR, NIMHD HAD
LAUNCHED AN RFA, A SET ASIDE FOR
R01s AND THE APPLICATIONS HAD
GONE DOWN IN FISCAL '16 WHERE WE
DOESN'T HAVE SET ASIDES AND
ACCEPTING APPLICATIONS FROM THE
PARENT R01 MECHANISM.
THAT WAS IN MY FIRST YEAR HERE
WHEN STAFF BEGAN TO GENERATE
IDEAS AND CONCEPTS AND OF COURSE
THOSE WERE NOT IMPLEMENTED OR
OPERATIONALIZED UNTIL LATER.
THE SHIFT IN R01 SCIENCE AS YOU
SEE BEGAN TO BE NOTED IN FISCAL
'17 WITH INCREASING NUMBER OF
APPLICATIONS UNTIL '23 WHEN WE
HAD A SLIGHT DECREASE FROM '22
TO '23.
THE SUCCESS RATE HAS VARIED
BECAUSE AGAIN WE HAVE A SMALLER
SAMPLE SIZE AND ALSO WITH
SHIFTING FUNDING FROM CENTERS TO
R01s AND AGAIN VARYING YEAR TO
YEAR DEPENDING ON WHAT CONGRESS
ASKS US TO DO.
WE BOTTOMED OUT IN 2020 AND
MOVED BACK UP TO 18% IN 2022 AND
2023 AND PROBABLY GO DOWN THIS
YEAR GIVEN THE RESTRICTION ON
THE BUDGET.
BUT WE HOPE TO KEEP IT IN THAT
RANGE AND KEEP INCHING IT UP AS
MUCH AS POSSIBLE AND WE'LL FIND
THE RIGHT BALANCE OF THE BUDGET.
SO I WANTED TO SHARE THE
NUMBERS.
THIS IS AN ILLUSTRATION OF
AWARDS AND SUCCESS RATES AGAIN.
AGAIN SHOWING THE NUMBER OF
APPLICATIONS, NUMBER OF AWARDS
AND SUCCESS RATE.
AGAIN, YOU CAN SEE THIS LINE
THAT WE'RE LOOKING AT HERE IS
REALLY WHAT MANY INSTITUTES --
YOU SAY WHERE DO OTHER
INSTITUTES SIT?
SOME INSTITUTES ARE BELOW 10%
SUCCESS.
SOME OF THE LARGE INSTITUTES ARE
AT THAT LEVEL.
SOME OF THE SMALLER OR LARGE OF
LARGE INSTITUTES, EYE INSTITUTE
IN THE MID TO HIGH 20th PERCENT.
TRADITIONALLY THAT'S WHERE NIMHD
USED TO BE MANY YEARS AGO AND
SOME INSTITUTES LIKE AGING FOR
EXAMPLE HAS ONE PAY LINE FOR
NON-ALZHEIMER'S DISEASE RELATED
AND HIGHER PAY LINE FOR
ALZHEIMER'S DISEASE RELATED
STUDIES.
SO ALL OF THE INSTITUTE
DIRECTORS FOCUS ON THIS.
IT'S R01 IS THE COMMON CURRENCY
THOUGH VARIES BY INSTITUTES.
SOME ARE MORE LIKELY AND WE
DON'T -- WE HAVE A LITTLE LESS
THAN HALF OF OUR BUDGET GOES TO
R01 SCIENCE OR RPGs COMPARED TO
OTHER INSTITUTES IT'S 80%.
SO WE'RE KIND OF IN THAT RANGE
AND I DON'T THINK GIVEN OUR
OTHER MANDATES THAT'S GOING TO
CHANGE SUBSTANTIALLY.
WE LIKE TO LOOK AT HOW WE'RE
DOING WITH EARLY STAGE
INVESTIGATORS.
THE EMPHASIS ON THIS RECENTLY
HAS BEEN REEMPHASIZED BY BOTH
DR. TABAK AND DR. BERTAGNOLLI.
THE LAST TIME NIH BUDGET GREW
RAPIDLY THE DOUBLING AND THEN
FLATTENED AND EVEN DECREASED
DURING THE SEQUESTER THE BIGGEST
GROUP THAT SUFFERED WERE EARLY
CAREER SCIENTISTS.
SO THE ESTABLISHED SCIENTISTS
WERE ABLE TO SUCCEED OR STAY
ALIVE OR MANAGE BUT IT WAS THE
EARLY CAREER PEOPLE THAT REALLY
SUFFERED.
SO WE'VE BEEN TOLD IN NO
UNCERTAIN TERMS AND I THINK ALL
THE DIRECTORS AGREE WE NEED TO
FIND WAYS TO PROTECT EARLY STAGE
INVESTIGATORS.
THERE'S A VARIETY OF WAYS TO DO
THIS PRIMARILY THROUGH OUR
FUNDING DECISIONS IS THE PRIMARY
WAY TO DO IT.
OTHER THINGS HAVE CHANGED SINCE
THAT TIME.
THERE WAS A THIRD OF NIH R01
APPLICATIONS AND MULTI-P.I.
OPPOSED TO A SING AT P.I. AND
THAT COULD BE A BENEFIT OR NOT
DEPENDING ON THE CONTEXT AND WHO
THE P.I.s ARE.
THIS IS NIMHD DATA.
AGAIN, GROUPING THE 2022 THROUGH
FISCAL YEARS SEPARATELY SEE THE
SUCCESS AWARD RATE FOR EARLY
STAGE INVESTIGATORS IMPROVED IN
THAT TIME BUT IS STILL SLIGHTLY
BELOW WHAT WE'RE CALLING
ESTABLISHED INVESTIGATORS.
THERE'S A GROUP I'M NOT SHOWING
YOU WHICH IS MID YEAR --
MIDCAREER PEOPLE AND A
COMPARISON AND TRYING TO KEEP
THIS BALANCED IN IMPLEMENTING
TOOLS AT OUR DISPOSAL INTERNALLY
THAT CAN ALSO PROTECT EARLY
STAGE INVESTIGATORS.
JUST TO REMIND EVERYBODY THIS IS
INDIVIDUALS NOT HAVING R01 BUT
WITHIN A 10 YEAR WINDOW OF THEIR
TERMINAL DEGREE OR RESEARCH
TRAINING.
SO THAT'S THE OPERATIONAL
DEFINITION WE USED.
SO SHIFTING BACK TO LEGISLATIVE
UPDATES, SOMETIMES IT COMES IN
SPURTS.
THE REQUEST FOR BRIEFINGS IN
FEBRUARY I WAS ASKED TO BRIEF
STAFF FROM THE SENATE HEALTH,
EDUCATION, LABOR AND PENSION
COMMITTEE SENATOR SANDERS' STAFF
AND THE AGING SENATE COMMITTEE
ON THE IMPLEMENTATION OF PEOPLE
WITH DISPARITIES AND DR. TABAK
ACCOMPANIED ME THOUGH I DID ALL
THE TALKING AND THEY WANTED
CLARIFICATION ON QUESTIONS AND I
THINK THEY WERE SATISFIED WITH
WHAT NIMHD'S PLAN AND WHAT NIH'S
PLANS WERE IN THIS CONTEXT.
THERE WAS ALSO AN IMPLEMENTATION
OF A PROJECT THAT HAD BEEN
DEVELOPED AND CONDUCTED OVER THE
LAST THREE YEARS LED BY THE
UNITE COMMITTEE WHICH HAS BEEN
CO-CHAIRED BY DR. WEBB HOOPER TO
LOOK AT THE DISEASE
CATEGORIZATION WE CALL RCDC AT
NIH.
BRIEFINGS ON THESE CHANGES TO
MINORITY HEALTH AND HEALTH
DISPARITIES CATEGORIES.
THIS IS WAS DEVELOPED THROUGH
MACHINE LEARNING ALGORITHM TO
IMPROVE WHAT WE DO AND
CATEGORIZE GRANTS.
PRIOR TO THIS, THIS WAS DONE
MANUALLY THOUGH THERE WAS
REASONABLE INTERCODER
RELIABILITY THERE WERE STILL
ERRORS PARTICULARLY THAT WERE
NOT ABLE TO FULLY CONTROL SOME
INSTITUTE CODERS WOULD BE OFF IN
A DIRECTION WE COULDN'T MANAGE.
IT WAS ALSO TREMENDOUS AMOUNT OF
STAFF BURDEN WITH THIS AND ONE
OF THE FEW CATEGORIES IN RCDC
DONE MANUALLY.
THERE ARE STILL OTHERS.
THIS I THINK WAS AN ADVANCE IN
MANY WAYS MULTIPLE DATA
DEMONSTRATIONS SHOWED WE WERE AT
LEAST AS GOOD AS MANUAL CODING.
AT THIS MINIMUM AND MUCH LESS
EFFORT AND WORK TO GET THERE.
IT PROBABLY WAS DISTINGUISHED
AND TOOK THINGS OUT THAT WERE
PREVIOUSLY COUNTED AS WELL AS
COUNT THE THINGS PREVIOUSLY NOT
COUNTED.
THE OTHER THING IT DID WAS
SOMETHING I TRIED TO PROMOTE
SINCE ARRIVING AT NIH WAS TO
HAVE A CLEAR SEPARATION OF WHAT
PEOPLE CALLED MINORITY HEALTH SO
IT CREATE A COMBINED MINORITY
MUTUALLY EXCLUSIVE.
IT ELIMINATES WHAT CALL DOUBLE
COUNTING THOUGH WE DON'T TALK
ABOUT THAT USUALLY PARTICULARLY
TO OUR CONGRESSIONAL STAFF.
IT HAPPENS ALL THE TIME BUT WAS
FRUSTRATING AT TIMES TO NOT SEE
WHAT WE WERE ABLE TO DIVIDE WITH
MANUAL METHODS BUT THIS IS A
MUCH MORE EFFICIENT WAY TO GET
AT WHAT WE'RE INTERESTED IN.
THE AMOUNT OF INVESTMENT IN
MINORITY HEALTH AND HEALTH
DISPARITIES IS NOW AVAILABLE
IT'S ACROSS THE AGENCY AND WILL
GIVE A BETTER BASELINE FOR THE
FUTURE.
WE ALSO SPOKE TO THE SAME SENATE
HOUSE AND ENERGY COMMITTEE AND
DR. TABAK AND DR. BERNARD
ACCOMPANIED ME ON THIS.
AGAIN, I LED THE DISCUSSION BOTH
DR. TABAK AND DR. BERNARD ADDED
COMMENTS.
THE COMMUNICATION STATEMENT IS
NOW AVAILABLE.
EVERY YEAR WE PRODUCE A
CONGRESSIONAL BUDGET
JUSTIFICATION AND SEE THE LINK
ON THE WEBSITE.
THIS IS PART OF THE PROCESS FOR
FISCAL '25 AND THIS WAS
PUBLISHED IN MARCH AND A SUMMARY
OF SOME OF THE MAJOR HIGHLIGHTS
OF ACCOMPLISHMENTS AND
EXPECTATIONS FOR THE FUTURE.
STRATEGIC PRIORITIES AND
ANTICIPATED IMPACT OF OUR
PRIORITIES.
I ENCOURAGE IF YOU'RE INTERESTED
TO READ IT OR REVIEW IT.
IT IS REALLY A PUBLIC DOCUMENT
MEANT FOR OUR CONGRESSIONAL
PARTNERS AND FUNDERS BUT IT'S
REALLY FOR ALL OF YOU TO ALSO
REACT TO.
WE'RE ALWAYS BUSY SEEING HOW WE
CAN PROMOTE OUR SCIENCE AND WHAT
WE DO BOTH TO OUR SCIENTIFIC
COMMUNITY AS WELL AS POTENTIAL
ORGANIZATIONS THAT WOULD BE
INTERESTED IN WHAT NIMHD DOES.
IN FEBRUARY I SPENT A COUPLE
HOURS AT THE OFFICES HERE IN
WASHINGTON AT A SYMPOSIUM ON
HEALTH SOME COLLEAGUES WERE
THERE AND PRESIDENT OF THE
UNIVERSITY AND THERE WAS A
CONGRESSIONAL MEMBER FROM
FLORIDA AND ALSO A
REPRESENTATIVE FROM THE
UNIVERSITY OF WASHINGTON HAD
ALSO BEEN INVITED.
I DID MEETING AT THE LEAGUE OF
UNITED LATIN AMERICAN CITIZENS
WHICH WAS MORE OF A PANEL
DISCUSSION.
WE DISCUSSED ISSUES AROUND
OBESITY.
IT'S THE OLDEST AND LARGEST
ORGANIZATION FOCUSSED ON
HISPANIC AND LATIN ISSUES.
THEY'RE NOT AS INVOLVED IN
ISSUES AROUND HEALTH AS OTHERS
BUT VERY IMPORTANT PUBLIC
ADVOCACY ORGANIZATION.
I THINK IT STARTED IN TEXAS AND
IS HEAVILY LED BY
MEXICAN-AMERICANS BUT REALLY AN
IMPORTANT CIVIL RIGHTS
ORGANIZATION AND IT'S GOOD TO
HAVE A PLACE OF OTHER
INDIVIDUALS IN THE PANEL AND THE
DISCUSSION WAS QUITE GOOD.
MONICA WEBB-HOOPER ATTENDED.
IB MARCH I WAS INVITED TO GO TO
THE BROD INSTITUTE IN BOSTON.
WHAT IS THE NIH DOING AT THE
BRODE A HIGH GENETICS THINK TANK
THAT WORKS CLOSELY WITH THE
HARVARD INSTITUTION AT BRIGHAM
AND MASS GENERAL AND RELATES TO
A FORMER MENTEE AND FRIEND RENE
SAL AZAR WHO HAD GONE TO THE THE
BROAD AS A CHIEF REQUEST OFFICER
AND HAD A ROLE IN THE DELL
SCHOOL OF MEDICINE AND MOVED TO
THE BROAD AND DECIDE -- DIED
UNEXPECTEDLY.
I HAD BEEN INVOLVED IN THE
MEMORIALS FOR HIM THE PERSON WHO
INVITED ME A WOMAN OF WHO IS
AFGHANI IMMIGRANT AND RUNS EIGHT
OF THE DIVERSITY PROGRAMS AT THE
BROAD INVITED ME AND IT WAS A
GOOD EXPERIENCE.
I THINK I MET WITH THE DIRECTOR
OF THE BROAD FOR ALMOST AN HOUR
AND DID A TALK AND MET WITH
OTHER SCIENTISTS THERE AND HAD
AN APPRECIATION FOR THE WORK
THEY DO.
BY THE WAY, THEY RUN ALL THE
GWAS FOR ALL OF US.
THAT'S THROUGH A CONTRACT JUST
TO GIVE YOU A SENSE OF THE SIZE
OF THE OPERATION.
IN MARCH I VISITED THE
UNIVERSITY OF MICHIGAN INSTITUTE
FOR HEALTH CARE POLICY AND
INNOVATION A COLLEAGUE FROM THE
MEDICINE GROUP SOCIETY INVITED
ME.
OUR FORMER COUNCIL MEMBER WAS
THERE AS WELL AS OTHER
COLLEAGUES I'VE KNOWN AND IT WAS
AGAIN SET UP AS AN INFORMAL
CONVERSATION.
I DID MEET WITH FELLOWS AND
ASSISTANT PROFESSORS AS WELL AS
THEIR LEADERSHIP WHICH WERE VERY
GOOD AND ALSO ATTENDED THE
RECORDS HEALTH SYMPOSIUM AT THE
RUTGERS BIOLOGICAL AND HEALTH
SCIENCES INSTITUTION WITH THEIR
DEAN AND OTHER FACULTY THERE AND
I SPOKE THERE.
OTHER ENGAGEMENTS IN MY CASE AT
THE NATIONAL MEDICAL ASSOCIATION
HEALTH POLICY AND THE INSTITUTE
AS A HILL BRIEFING AND THE PHOTO
WAS ON THE PRIOR SLIDE AND
MONICA WEBB-HOOPER ATTENDED THE
ACT FOR NIH FOUNDATION WHICH IS
ALWAYS A GREAT -- WAS IN THE
LIBRARY OF CONGRESS WHICH IS A
BEAUTIFUL SETTING AND I'VE BEEN
IN THE PAST AND IT'S A GREAT
OPPORTUNITY TO SPEAK WITH
CONGRESSIONAL MEMBERS AS WELL AS
CELEBRATE NIH.
IT'S SUPPORTED BY THIS ACT FOR
NIH.
MONICA WEBB HOOPER ALSO AT THE
OMAHA CARES DELTA SIGMA THETA
SORORITY FROM UNIVERSITY OF
NEBRASKA THE PHOTO AT THE TOP
AND SPEAKING AT THAT PART OF THE
COUNTRY WHICH DIFFERENT THAN
WHERE WE ARE.
AND ALISA LASANTA ATTENDED THE
MANA AND LATINO MAGAZINE ON LA
TINA HEALTH AND IT WAS A GREAT
OPPORTUNITY TO TALK ABOUT NIMHD
AND OUR WORK.
I WAS AT THE WHITE HOUSE
EISENHOWER OFFICE BUILDING OF
THE HOST WAS THE OFFICE OF
MINORITY HEALTH AND THE
SECRETARY MADE CLOSING COMMENTS
AND THE OSTP DIRECTOR OPENED THE
SESSION.
THERE WAS A BUNCH OF SMALL BREAK
OUT SESSIONS AND LIVE VIDEOCAST
PANEL THAT WAS AND I WAS PART OF
ONE OF THOSE.
THERE WERE TWO OR THREE PANELS
PRESENTED.
THIS PHOTO -- THREES ARE THE
NAVY STEPS THE EISENHOWER OFFICE
BUILDING FACE THE REAL WHITE
HOUSE AND THESE ARE THE STEPS
AND I'M LOST IN THE BACKGROUND
BUT IN THE PHOTO.
AND I THINK IT WAS A GOOD EVENT.
THERE WERE A LOT OF EXTRAMURAL
SCIENTIST AND ADVOCATES AND
LEADERS.
SEVERAL PEOPLE I KNOW I'M NOT
GOING TO REMEMBER ALL THE PEOPLE
I TALKED TO THERE BUT IT WAS A
BROAD REPRESENTATION OF DIVERSE
AMERICANS PRESENT.
WE WERE VERY PROUD TO AGAIN DO A
WEBINAR WITH THE CHILDREN'S INN
AT NIH APRIL 17 IN COLLABORATION
WITH NATIONAL INSTITUTE ON
MENTAL HEALTH.
WE SETTLED ON THE THEME OF
MENTAL HEALTH.
THE CHILDREN'S INN IS AN
AUTONOMOUS RESIDENTIAL PLACE FOR
FAMILIES OF CHILDREN WHO ARE AT
NIH FOR CLINICAL CARE.
KEEP IN MIND MANY OF THESE ARE
CHILDREN WITH SEVERE DISEASE
THAT IS NOT POSSIBLE TO TREAT
ANYWHERE ELSE AND AT NIH AS A
LAST RESORT WITH DISORDERS ONLY
POSSIBLE TO MANAGE AT NIH AND IF
YOU'RE ACCEPTED TO OUR PROTOCOL
AT NIH YOU DON'T PAY A PENNY.
THE SERVICE IS IMPECCABLE AT ALL
LEVELS.
AND THESE ARE INDIVIDUALS THAT
COME FROM ALL OVER THE WORLD
INDEPENDENT OF WHAT THEIR
BACKGROUND OR INSURANCE OR
ISSUES ARE ON.
THIS IS A GOOD EXCHANGE, A
CONVERSATION.
I MADE A SHORT PRESENTATION AND
THE DEPUTY DIRECTOR AND ASSUMED
TO BE ACTING DIRECTOR OF NIMHD
ALSO SPOKE.
IT WAS MODERATED BY ONE OF THE
MAIN SUPPORTER, PHILIPIA HILLMAN
AND IT'S SPONSORED MOSTLY
THROUGH PHILANTHROPY AND WE HAD
THE CEO OF CHILDREN'S INN AND
REPRESENTATIVE ROBIN.
APRIL WAS A BUSY MONTH AND WE
HAD TREMENDOUS OPPORTUNITY TO
HOST DR. SULLIVAN APRIL 22.
THIS WAS TO GENERATE ORAL
HISTORY FOR THE ARCHIVES.
DR. SULLIVAN WAS THE LAST THE
PHYSICIAN THE LAST SECRETARY OF
HEALTH AND HUMAN SERVICES THAT
LASTED A YEAR.
AND HE'S A REMARKABLE INDIVIDUAL
I'VE GOTTEN TO KNOW HIM SINCE
BECOMING DIRECT AT NIMHD AND WAS
THE FIRST PERSON TO CALL ME AND
CONGRATULATE ME WITH THE
THREE-HOUR TIME DIFFERENCE WAS
IN THE MORNING IN SAN FRANCISCO
AND IT WAS MY SON WHO BROUGHT ME
THE CELL PHONE AND SAID THERE'S
A DR. SULLIVAN THAT WANTS TO
TALK TO YOU.
I WAS ON THE EXERCISE MACHINE.
WE INVITED HIM TO CELEBRATE AND
HEAR WHAT HE COULD REPORT TO US.
KEEP IN MIND DR. SULLIVAN IS 90
OR 91 YEARS OLD.
HE IS REMARKABLE FOR HIS
PRESENCE AND MEMORY.
WE DID A FIRESIDE CHAT AND MAYBE
NOT REPRESENTED IN THE PHOTO
COMPLETELY BUT THERE WERE HALF A
DOZEN INSTITUTE DIRECTORS
PRESENT AS WELL AS A COUPLE
DEPUTIES AND IT'S ARCHIVED AT
THE NIH VIDEOCAST.
I WANT TO POINT PEOPLE TO THIS
IF YOU HAVE TIME OR WANT TO HEAR
FROM HOW HE REMEMBERS AND
RELATES THE ISSUES OF THOSE
DAYS.
AT THE END OF APRIL, BEGINNING
OF MAY THERE WAS OUR MANUAL
MEETING OF THE RESEARCH CENTERS
AND MINORITY INSTITUTIONS OR
RCMI PROGRAM WE TALK ABOUT NOT
INFREQUENTLY AT THE COUNCIL
MEMBERS.
BEING TOGETHER THE 22RCMIs
PRINCIPAL INVESTIGATORS OR
PROGRAM DIRECTORS AS WELL AS
OTHER SENIOR SCIENTIST AN ASKED
MANY PRESIDENTS OF THE
INSTITUTIONS TO ATTEND.
I SPENT TIME THERE THE FIRST DAY
AND HAD REPRESENTATIONS FROM THE
DIRECTOR OF NIGMS AND DR. LORSCH
AND DOUG LOWEY WAS THERE AND AND
MARIE BERNARD THE CHIEF OFFICER
FOR WORKFORCE DIVERSITY.
THERE WAS A LOT OF SCIENCE IN
THE POSTERS.
I WAS ABLE TO WALK THROUGH THE
POSTER SESSION IN THE AFTERNOON.
WE HAD A SEPARATE MEETING WITH
THE UNIVERSITY PRESIDENTS AND
UNIVERSITY INVESTIGATORS AND
OVER ALL A HIGH LEVEL, HIGH
QUALITY SCIENTIFIC MEETING AS WE
HAD MOVED THIS PROGRAM REALLY TO
A DIFFERENT LEVEL THEN 10 YEARS
AGO.
I COULD AN UNEQUIVOCALLY.
AND MOST MY INSTITUTIONS WOULD
AGREE AT THIS POINT AFTER A FEW
YEARS.
WE ALSO HAD A MEETING I ATTENDED
VIRTUALLY THE CENTERS FOR
EXCELLENCE AND ENVIRONMENTAL
HEALTH DISPARITIES ANNUAL
GRANTEE MEETING IN FEBRUARY HELD
IN NORTH CAROLINA ON THE NIEHS
CAMPUS AND WAS HOSTED BY THE
BAYLOR INSTITUTE AND BROUGHT
TOGETHER AGAIN THE GRANT
RECIPIENTS AND DISCUSSED
DIFFERENT WAYS OF REDUCING
HEALTH DISPARITIES RELATED TO
ENVIRONMENTAL HARMS.
THERE'S A THREE CENTERS LOOKING
TO WRITE REQUEST FOR
APPLICATIONS FOR FUTURE CENTERS.
WE'RE HOPING TO GROW THIS
PROGRAM MODESTLY WITH SUPPORT
FROM OTHER INSTITUTES AND WE'LL
SEE HOW THAT EVOLVES FOR FISCAL
'25 AS WE GET READY TO PUBLISH A
NEW RFA.
WE HAVE SCIENTIFIC WORKSHOP ON
RESEARCH ON NATIVE HAWAIIAN AND
PACIFIC ISLANDER HEALTH.
NOTED EARLIER WE HAD A $4
MILLION FOR THE RESEARCH ON
NATIVE HAWAIIAN AND PACIFIC
ISLANDER HEALTH AND AT THE TIME
WE RECOMMENDED WE DO WORKSHOP
FIRST BEFORE THE NOTICE IS
PUBLISHED.
THIS IS FEBRUARY THE NOFO IS
BEING DEVELOPED.
THIS MEETING WAS ROBUST AND
VIBRANT.
THE RESEARCHERS AND COMMUNITY
ADVOCATES WERE PRESENT.
LOTS OF CRITICAL HEALTH TOPICS
AND NEEDS, GAPS IN KNOWLEDGE
WERE IDENTIFIED AND HAD
DETERMINATES OF NHLBI HEALTH AND
METHODOLOGICAL APPROACHES AND
INTERVENTIONS TO IMPROVE HEALTH.
SEVERAL POINTS ABOUT SOCIAL
DETERMINATE OF HEALTH AND
CULTURALLY VALID ASSESSMENT
TOOLS AND COMMUNITY
PARTICIPATION FOR SUCCESSFUL
PARTNERSHIPS.
AND THE NIH POPULATION IS
DISSEMINATED ACROSS THE
TERRITORIES OF THE UNITED STATES
AND CONCENTRATED IN HAWAI'I,
CALIFORNIA, UTAH AND
INTERESTINGLY ENOUGH, ARKANSAS.
THE PACIFIC TERRITORIES ALSO ARE
INCLUDED THOUGH THE REACH IS
CHALLENGING.
WE'VE HAD PREVIOUS PROGRAMS IN
THE PACIFIC TERRITORIES.
SO I LOOK FORWARD TO SEEING THIS
DEVELOP.
NOW, WE HAVE THE MANDATE IN
OFFICE TO I SEE THIS RESEARCH
WILL ADVANCE UP CARING FOR THIS
GENERALLY UNDER REPRESENTED,
UNDER STUDIED POPULATION WHERE
MULTIPLE INDICATORS OF HEALTH
DISPARITIES THAT MAKE IT VERY
DIFFERENT FROM THE HETEROGENEOUS
GROUP OF ASIAN AMERICANS.
AND SHOUT OUT TO THE UPCOMING
HEALTH DISPARITIES RESEARCH
INSTITUTE IN AUGUST.
THIS YEAR AS A WEEK LONG
TRAINING EXPERIENCE TO HAVE
SENIOR INVESTIGATORS AND
POSTDOCS AND ASSISTANT PROFESSOR
LEVEL PROFESSION COME TO NIH AND
LEARN FROM NIH AND INTERACT WITH
STAFF AND OTHER INSTITUTES AND
BE EXPOSED TO SOME SCIENTIFIC
LECTURES, GRANT WRITING SESSION
AND GRANT REVIEW MOCK REVIEW
WITH REAL GRANTS AND REALLY
INTERACT WITH EACH OTHER AND
NETWORK WITH EACH OTHER.
WE HOPE WE CONTINUE TO BUILD
COMMUNITY THROUGH THIS.
WE HAD OVER 500 SCHOLARS ATTEND
OUR HGRIs IN THE SUMMER.
WE HAD THREE CONSECUTIVE YEARS
OF VIRTUAL MEETINGS AND 2021 AND
2022 AND 2023 WE RESTARTED IN
PERSON.
SO IT LIMITS OUR NUMBERS TO
ABOUT 50 BUT IT'S A HUGE
ADVANTAGE TO DO IT IN PERSON.
SHIFTING TO DATA, I WANTED TO
START WITH THIS SOBERING
STATISTIC FROM THE AMERICAN
ASSOCIATION OF MEDICAL COLLEGES.
MEDICAL SCHOOL ENROLLMENT AND
GRADUATES BY RACE AND ETHNICITY.
WITH ALL THE ADVERSITY WE FACE
ABOUT HOW TO SELECT AND PROMOTE
DIVERSITY IN THE WORKFORCE AND
BY THE WAY THEY'RE SIMILAR
INFORMATION ON S.T.E.M. Ph.D.s
IN THE U.S. WITH U.S.-BASED
DEGREES IN S.T.E.M. INCLUDING
SOCIAL SCIENCES.
THIS IS NOT ANY DIFFERENT IN
THAT REALM.
SOME OF THESE PHYSICIANS OF
COURSE GO ON TO DO SCIENCE, THE
MAJORITY DON'T.
THE MAJORITY DO CLINICAL CARE
WHICH IS EQUALLY IMPORTANT FOR
US TO PROMOTE THE HEALTH OF OUR
COMMUNITIES.
BUT AGAIN, I HIGHLIGHTED THE
AREAS WHERE WE ARE MOST
EFFICIENT.
YOU CAN SEE THAT.
LESS THAN 1% OF OUR MEDICAL
SCHOOL GRADUATE IN '22 WERE
AMERICAN INDIAN AND ALASKAN
NATIVE AND THE NUMBERS HAVE
DECREASED OF THE POSITIONS TO
PUT IN TERMS OF SOBERING
NUMBERS.
LESS THAN 1% ARE NATIVE HAWAIIAN
PACIFIC ISLANDERS AND LESS THAN
1% AND FOR BLACK AFRICAN
AMERICAN AND LATINO HISPANIC THE
TOTAL ADDS UP TO ABOUT 13%.
SO, IT HAS INCHED UP SLIGHTLY.
YOU LOOK AT MEDICAL SCHOOL
ENROLLMENT IS SLIGHTLY HIGHER.
THIS IS WHEN WE INCLUDE THE FACT
THAT THERE ARE FOUR HBCU MEDICAL
SCHOOLS THAT ARE MAJORITY BLACK
AFRICAN AMERICAN AND RECENTLY
LEARNED THERE MAY BE A FIFTH ONE
IN LOUISIANA WITH XAVIER
PLANNING TO START A MEDICAL
SCHOOL.
THE FOUR MEDICAL SCHOOLS IN
PUERTO RICO AND THEY THE
MAJORITY LATINO.
SO IF YOU TAKE THOSE AWAY, WHAT
WOULD THE STATUS BE?
THIS IS A CHALLENGE.
ONLY MADE MORE CHALLENGING BY
THE SUPREME COURT DECISION LAST
YEAR.
JUST A REMINDER BECAUSE WE'RE
NOT GOING TO SOLVE THIS
OVERNIGHT.
WE'RE NOT GOING TO SOLVE THIS IN
MY LIFE TIME BUT WE'VE GOT TO
KEEP THIS FRONT AND CENTER IN
PROMOTING TO DECREASE HEALTH
DISPARITIES AND EMPIRICAL
EVERYDAY SAYS IF WE TRAIN MORE
UNDER REPRESENTED CLINICIAN US
DECREASE HEALTH DISPARITIES
BECAUSE THEY'RE MORE LIKELY TO
TAKE CARE OF PATIENTS OF NOT
ONLY THEIR GROUP BUT PEOPLE WHO
ARE POOR AND UNINSURED AND
MEDICAID AND YET WE DON'T DO
THIS.
MY OPPORTUNITY TO KEEP REMINDING
US.
LET ME TURN TO RESEARCH ADVANCES
OVER THE LAST FEW MONTHS.
I WANT TO HIGHLIGHT THIS NOT
FUNDED BY NIMHD BUT WANTED TO
EMPHASIS A RANDOMIZED TRIAL.
AND THE DIRECTED MEDICAL AND IN
THE NAVAJO THERAPY PUBLISHED IN
JAMA AND INTERNAL MEDICINE AND
MILE AN HOUR INDIAN PATIENTS
WITH REDUCED EJECTION FRACTION
HEART FAILURE 24% TO 36% AND
THOUGH IT'S BECOME LESS AND LESS
COMMON IN THE EVOLUTION OF HEART
FAILURE AS A CONDITION WE HAVE
SEEN MUCH MORE DIASTOLIC
DYSFUNCTION WHERE THE MUSCLE IS
STIFF OPPOSED TO LOSING PUMP
ABILITY.
MOST COMES FROM PRIOR HEART
ATTACKS WHERE YOU LOSE TISSUE
AND YOUR PUMP FUNCTION GOES
DOWN.
THERE ARE LITERALLY DOZENS OF
STUDIES THAT SHOW THIS IS THE
WAY YOU TREAT IT AND THE
MEDICATIONS YOU SHOULD BE ON AND
PROLONGS LIFE.
I WITNESSED THAT AS A CLINICIAN
WITH PEOPLE WITH REDUCED
EJECTION FRACTION AND LIVING 20
PLUS YEARS AND THIS WAS A STEP
WEDGE PRAGMATIC EFFECTIVENESS
TRIAL AND A TELEHEALTH MODEL
SERVICE US USUAL CARE AND THE
SAMPLE SIZE IS RELATIVELY SMALL,
103 PHONE BASED METHOD AND
TELEMONITORING AND THERE ARE
WAYS TO DO THIS.
YOU CAN GET PEOPLE'S WEIGHT, YOU
CAN MONITOR THEIR BLOOD PRESSURE
AND HEART RATE.
THERE'S A VARIETY OF METHODS
AVAILABLE OR EASY TO DO FROM A
REMOTE PERSPECTIVE.
OF COURSE IF YOU GET SYMPTOMS
AND THE OUTCOME OF INTEREST WAS
INCREASED CLASSES OF DRUGS WHICH
ARE MULTIPLE.
BOTH ARE SYMPTOMS AND PROLONGING
LIFE.
THE INTERVENTION WAS REMARKABLY
EFFECTIVE IN 66% WITH AN ODDS
RATIO AND TO IMPROVE AT 30 DAYS
WAS LESS THAN 2.
THIS WAS CONDUCTED AGAIN IN
NAVAJO NATION.
AND HIS WAS PARTIALLY FUNDED BY
NIMHD AND ANALYZED THE IMPACT OF
STRUCTURAL RACISM ON DIABETES
PREVALENCE AND USED A DATA SET
LOOKING AT OVER 11,000
U.S. CENSUS TRACKS LINKING THE
CDC PLACES DATA ON DIABETES
PREVALENCE, THE HOMEOWNERS LOAN
AND RED LINING DATA AND
OPPORTUNITY INSIGHT ON SOCIAL
DETERMINATES OF HEALTH.
AND CONDUCTING EQUATION
MODELLING SHOWED A DIRECT
ASSOCIATION BETWEEN RED LINING
AND DIABETES PREVALENCE AND
INDIRECT ASSOCIATION THAT
INVOLVED THE CONSTRUCTS OF
HISTORY OF INCARCERATION, LEVEL
OF POVERTY IN THE AREA AND LEVEL
OF DISCRIMINATION AND SUBSTANCE
USE, HOUSING, QUALITY OF HOUSING
AND EDUCATION AND FOOD SECURITY.
AND TREATMENT OF UNCONTROLLED SO
HYPERTENSION TREATMENT IS WELL
ESTABLISHED A GOOD WAY TO
PREVENT ADVERSE CARDIOVASCULAR
OUTCOMES.
BACK IN THE 1960s THE TERM
SILENT KILLER WAS COINED BECAUSE
PEOPLE DON'T HAVE SYMPTOMS FROM
HYPERTENSION.
IN MANY WAYS IT'S A RISK FACTOR
AND NOT A DISEASE.
YOU DON'T TREAT THE RISK FACTOR
YOU GET DISEASE AND STROKES AND
HEART FAILURE AND HEART ATTACKS.
WE MOSTLY CONSIDER IT A DISEASE
NOW.
UNCONTROLLED HYPERTENSION AT A
LEVEL ABOVE 140 OVER 90 AND SOME
CONSIDER IT 130 OVER 85 AND USE
140 OVER 90 UP THIS STUDY.
THIS FOCUSSED ON AFRICAN
AMERICAN OR BLACK ADULTS WITH
PERSISTENT HYPERTENSION
ATTENDING RURAL PRIMARY CARE
CLINICS IN ALABAMA AND NORTH
CAROLINA.
THE MAJORITY FEMALE AND YOU SEE
THE MEAN AGE IN THE LATE '50s.
IT'S ADVERSE OUTCOME FOR AN
INDIVIDUAL, FAMILY AND SOCIETY
TO HAVE A MAJOR STROKE IN
THE 'EM -- 50s AND LEADS TO
DISABILITY AND DYSFUNCTION FOR
THE INDIVIDUAL.
SO THIS IS AN IMPORTANT TIME TO
PREVENT.
SO PEER COACHING, PRACTICE
FACILITATION AND ENHANCE USUAL
CARE AND COMPARING THESE THREE
ARMS ESSENTIALLY THE STUDY WAS A
NEGATIVE STUDY AND CLUSTERED
RANDOMIZED TRIAL AND THE OVER
ALL RESULTS DID NOT AFFECT BLOOD
PRESSURE CONTROL BUT THE INTENT
TO PREVENT AND IN ANALYSES UNDER
THE AGE OF 60 THE PEER COACHING
AND PRACTICE FACILITATION
INTERVENTIONS WERE BETTER THAN
ENHANCED USUAL CARE AND LED TO A
5 MILLIMETER REDUCTION IN
SYSTOLIC BLOOD PRESSURE
CLINICALLY AND STATISTICALLY
SIGNIFICANT.
NOW, TURNING TO NIMHD FUNDED
RESULTS, THIS IS A STUDY ON
REPORTED SELF-ESTEEM LINKED TO
IMMUNOMETABOLISM FROM AN R01
GRANT FROM OUR INSTITUTE AND
MECHANISTIC IN LOOKING AT
RELATIONSHIPS BETWEEN THE GUT
MICROBIOME IN A GROUP OF HAWAI'I
AND MOSTLY USING STOOL SAMPLES
AND BIOMARKERS OF INFLAMMATORY
DISEASE WERE FOUND DIFFERENCES
IN ABUNDANCE OF GUT BACTERIA AND
DNA METHYLATION.
WHAT THE FINDINGS MEAN IN THE
LONG RUN IS UNKNOWN.
THIS IS WHAT DISCOVERY SCIENCE
IS ABOUT.
AND I THINK USING THE FRAMEWORK
OF KNOWING THE POPULATION,
KNOWING YOUR RACE AND ETHNICITY
AND SOCIO ECONOMIC STAT US AND
WHAT DISEASE OUTCOMES ARE MORE
OR LESS PREVALENT IN THOSE
GROUPS ALLOWS US THEN TO TRY TO
IDENTIFY IN THIS CASE BIOLOGICAL
MECHANISMS TO HELP IDENTIFY
BEHAVIORAL MECHANISMS OF
OUTCOMES.
GREAT MINDFULNESS AS A
PROTECTIVE FACTOR FOR TRAUMA.
AGAIN, MORE IN A MECHANISTIC
STUDY AMONG GULF COAST RESIDENTS
EXPOSED TO WEATHER EVENTS,
CATASTROPHIC HURRICANES AND
SURVEYED TWICE DURING THE
COVID-19 PANDEMIC.
THE MORE SEVERE POSTTRAUMATIC
STRESS SYMPTOMS RELATED TO
TRAINED MINDFULNESS AND COVID-19
EXPOSURE AND HISTORY OF ANXIETY
AND DEPRESSION IN LATINO
ETHNICITY AND LOWER INCOME AND
OLDER AGE.
SO THIS IS A FACTOR THAT COULD
IMPROVE RESILIENCE AND MAY
INFORM INTERVENTIONS AND THIS
WAS A PROJECT CONDUCTED BY K
AWARD RECIPIENT.
MATERNAL ADVANCES RELATED TO DNA
METHYLATION.
THIS IS AN AREA NIMHD HAS BEEN
FUNDING NOW FOR THE LAST SEVEN
OR EIGHT YEARS UNDER THE SOCIAL
EPIGENOMICS INITIATIVE.
THE STUDY LOOKED AT MATERNAL
ADVERSE CHILDHOOD EXPERIENCES
OUR ACES AMONG PREGNANT WOMEN
WITH SELF-REPORTED
DISCRIMINATION AND STRESS AND
DISCRIMINATION WAS ASSOCIATED
WITH HYPOMETHYLATION AND PROTEO
LIPID IMPORTANT FOR
DIFFERENTIATION IN LATINO
NEWBORNS WITH HYPER METHYLATION
OF THIS GENE AND HOW DO THE
MEASURES IN BEHAVIORAL RESEARCH
PARTICULARLY IN THIS CASE
FINANCIAL STRESS DISCRIMINATION
WHAT DOES IT DO IN TERMS OF
CHANGES IN EPI GENGENOMICS AND
METHYLATION AND THE STRESSORS
MAY INFLUENCE METHYLATION IN A
WAY THAT AFFECT THE NEWBORN
IMPRINTING THEIR GENES AND
FURTHER EXPRESSION OF THE GENE
AND TO BE CLEAR THESE ARE NOT
PERMANENT CHANGES THEY'RE
POTENTIALLY MODIFIABLE AS TIME
EVOLVES SO AS NOT TO BE
FATALISTIC ABOUT THESE OUTCOMES.
I HAVE TO LOVE THIS ONE
TRADITIONAL DIET RELATES TO
LOWER HEPATIC STEATOSIS AND
BEANS ARE AN IMPORTANT PART OF
MUCH OF CENTRAL AMERICA AND
MEXICO THE CARIBBEAN AND
NORTHERN, SOUTH AMERICA AND
BEANS ARE PULSES, LENTILS WHICH
ALSO ARE COMMON IN OTHER
GEOGRAPHIC AREAS OF THE WORLD
HAVE A POSITIVE EFFECT ON
METABOLIC FUNCTION IN OUR BODY
AND YET THE PRACTICE OF
CONSUMING THIS IN THE DIET WANES
WITH GENERATIONS IN THE U.S. AND
WE'RE LOOKING AT THIS IN MY OWN
RESEARCH LAB THANKS TO A POSTDOC
WHO'S A NUTRITIONIST AND LOOKING
AT ACCULTURATION SO I'M LEARNING
MORE ABOUT THIS AND THINKING
MAYBE I SHOULD BE EATING MORE
BEANS AS A WAY TO BALANCE OTHER
THINGS EITHER WAY LOOKING AT
HEPATIC STEATOSIS AND THE
APPRECIATIVE MECHANISM OF WHAT
PEOPLE END UP WITH FATTY
INFILTRATION OF THE LIVER
LEADING TO CHRONIC INFLAMMATION
IN ADDITION TO CAUSING DISEASE
AND SYMPTOMS AND PEOPLE GET SICK
WITH THIS IT RESULTS AS ONE OF
THE MECHANISMS BY WHICH
INDIVIDUALS GET CANCER AND LIVER
CANCER CAN BE CAUSED BY OTHER
THINGS AS WELL.
THIS IS DISPROPORTIONATELY MORE
COMMON AMONG LATINOS
PARTICULARLY THOSE OF MEXICAN
AMERICAN HERITAGE.
LOOKING AT THIS AS A WAY TO
DECREASE HEPATIC STEATOSIS AND
THIS IS A PUBLICATION BY A K
AWARDEE TO NIMHD.
THIS IS A STUDY COMING AGAIN
FROM A K AWARDEE OF MANAGING
HYPERTENSION IN SOUTH ASIANS
WITH DIABETES.
SOUTH ASIANS DESPITE NOT
NECESSARILY HAVING ACCESS, HIGH
BMI MAINLY MALES HAVE A
DISPROPORTIONATE RISK OF
DIABETES AS A METABOLIC
DYSFUNCTION AND CARDIOVASCULAR
DISEASE.
THIS STUDY WAS TO TRY TO FOCUS
ON UNCONTROLLED BLOOD PRESSURE
USING A COMMUNITY HEALTH WORKER
MODEL AND INTERVENTION AND
FEASIBILITY TRIAL THAN THE K23
AWARDEE AND 190 PARTICIPANTS
WITH DIABETES TO EMPHASIZE IT'S
NOT JUST GENERAL TREATMENT OF
HYPERTENSION BUT FOCUSSING ON
PEOPLE WITH DIABETES AND
CONTROLLING THEIR BLOOD PRESSURE
WHICH MAGNIFIES THE POTENTIAL
BENEFIT OF WHATEVER INTERVENTION
WORKS AND SHOWING ED CONTROL AND
TWICE AS COMMON OF THE CONTROL
ARMS.
THE COMMUNITY HEALTH WORKER
MODEL WORKS IN THIS POPULATION
FOR A PARTICULAR OUTCOME THAT IS
HIGHLY SIGNIFICANT IN SOUTH
ASIANS AS WELL AS IN THE
COMMUNITY IN GENERAL.
THIS IS AN OUTCOME PAPER FROM
ONE OF THE R01s WE FUNDED.
I THINK IN 2020 WHEN WE FIRST
DELVED INTO THE MATERNAL HEALTH
ISSUES WHEN THIS BECAME A
HIGHLIGHT OF U.S. IS HIDING
MATERNAL MORTALITY AND 30 OTHER
COUNTRIES ARE OF COMPARABLE HIGH
INCOME AND WHAT'S GOING ON.
WE LAUNCHED THE SMALL INITIATIVE
AND FUNDED FIVE R01s PARTNERING
WITH A COUPLE OF THEIR I.C.s.
THIS EXAMINED HOSPITAL,
RESIDENTIAL AND OTHER FACTORS IN
GEORGIA IN FETAL DEATH RECORDS
AND THE AND THE DISCHARGE WAS
HIGHER AMONG BLACK NOT QUITE
DOUBLE THE RISK.
THERE WERE HOSPITAL FIXED
EFFECTS EXPLAINING THE LARGEST
PORTION.
THIS CONSISTENT WITH DATA THAT
HAD BEEN GENERATED ALSO IN NEW
YORK CITY PREVIOUS TO THIS
INITIATIVE WHERE IF YOU WENT TO
A HOSPITAL WHERE THE MAJORITY OF
PATIENTS WERE DISPROPORTIONATELY
CARED FOR BLACK WOMEN IN THE LB
CONTEXT THE OUTCOMES WERE WORSE
AND IF YOUR WHITE YOUR OUTCOME
WAS WORSE THAN IF YOU GO TO A
HOSPITAL AS A BLACK WOMAN WHERE
THE MAJORITY ARE WHITE.
AND DELVING IN THE DETAILS IS
IT'S NOT WHAT'S WRONG WITH BLACK
MOMS AND IT MIGHT BE BUT IT'S
MORE OF A SYSTEM ISSUE RELATING
TO THE QUALITY OF CARE NOT JUST
INTRAHOSPITAL BUT ALSO
POSTPARTUM.
WE'LL CONTINUE TO PURSUE THIS
WITH AN INITIATIVE WE WERE
EXPECTING TO FUND SOME GRANTS
LATER THIS FISCAL YEAR.
THE RACIAL DIFFERENCES IN CARE
PROCESS AND OTHER FACTORS WITHIN
THE SAME HOSPITAL TRANSLATE TO
DISPARITIES.
KEEP IN MIND ALSO THE DATA ON
SEVERE MATERNAL MORBIDITY IS THE
PATHWAY TO DEATH.
WE HAVE 1,000 MATERNAL DEATHS A
YEAR IS FAIRLY UNCOMMON OR
ALMOST A RARE EVENT THOUGH IT
GETS A LOT OF ATTENTION BECAUSE
IT SHOULDN'T HAPPEN.
THERE'S ABOUT 50,000 AT LEAST
CASES OF SEVERE MATERNAL
MORBIDITY.
THIS IS I THINK YOU LOOK AT
HYPERTENSION AND STROKE AND WE
FOCUS ON THAT AND THIS IS
MORBIDITY LEADING TO MORTALITY.
IN GEORGIA IS PARTICULARLY
CHALLENGING.
WE LOOK AT THE GEOGRAPHIC
DISTRIBUTION OF MATERNAL DEATHS.
THERE'S HOT SPOTS IN THE
SOUTHEAST AND GEORGIA IN
PARTICULAR.
THIS IS I THINK A PARTICULARLY
RELEVANT ANALYSIS T TO FIND WAY
TO ADDRESS THE ISSUE.
IT CANNOT COME FROM JUST A
GLOBAL PROGRAM ACROSS THE
COUNTRY BECAUSE MOST THE PLACES
ARE DOING MUCH BETTER.
WE HAVE TO FIND WHERE WE HAVE
THE BIGGEST PROBLEMS AND THEN
INTERVENE THERE MORE
AGGRESSIVELY PARALLELED WITH
OTHER THINGS LIKE HIV INFECTION.
THE HOT SPOTS BOTH STATES AND
REGIONAL AREAS.
THIS IS A PUBLICATION THAT CAME
FROM THE HISPANIC COMMUNITY
HEALTH STUDY LOOKING AT ECHO
CARDIO GRAPHIC MEASUREMENTS IN
LATINAS WITH A HISTORY OF
HYPERTENSION AND WOMEN WITH THIS
HISTORY OF HYPERTENSIVE
DISORDERS OF PREGNANCY.
IT'S BECOMING MORE CLEAR THE
PERIOD OF PREGNANCY HAS YOU'LL
THIS BEAUTY AND WONDER AND
REPRODUCTION AND HAVING THE NEXT
GENERATION BUT IT'S ALSO A
PERIOD OF RISK FOR THE PREGNANT
PERSON AND IT'S NOT SO MUCH YES,
SEVERE MORBIDITY AND MORTALITY
BUT THERE'S EVENTS THAT CAN
HAPPEN WITH HYPERTENSION AND
DIABETES.
WE'VE KNOWN THIS AND I'VE
LEARNED ABOUT THIS IN MEDICAL
SCHOOL.
WE'VE KNOWN THIS MANY YEARS AND
WHAT THE CONSEQUENCES ARE
LONG-TERM IS WHAT THESE ANALYSES
ARE ABOUT.
THE HYPERTENSION USED OFTEN AS
MANAGED OR RESOLVES.
IT'S GESTATIONAL DIABETES IN
PARALLEL SIMILARLY GETS BETTER
BUT IT DOES INCREASE RISK FOR
LATER CONSEQUENCES AND THAT'S
WHAT THE STUDY WAS FOCUSSED ON.
LOOKING AT MECHANISMS WITH
STRUCTURAL ABNORMALITIES IN THE
LEFT VENTRICLE COULD PREDICT
HEART FAILURE AND CARDIOVASCULAR
DISEASE AND DEATH IN THE FUTURE.
ALMOST INVARIABLY BY PHYSIOLOGY
PREGNANCY OCCURS AT AN AGE YOU
DON'T EXPECT THESE CONDITIONS TO
MANIFEST HEART DISEASE BUT
REFERRING TO WHAT HAPPENED
AFTERWARDS AND HOW THIS COULD BE
INTERCEPTED ON AND TREATED IN A
WAY THE ADVERSE EFFECTS ARE NOT
MANIFESTED YEARS LATER.
THIS IS MENTAL HEALTH CARE USED
BY LATINO PATIENTS IN A CENTER
AND RETROSPECTIVE CARE WHERE WE
SEE CARE OVER MANY YEARS AND THE
ESTIMATED LIKELIHOOD OF
RECEIVING MENTAL HEALTH
SERVICES.
ABOUT 14% RECEIVE THESE MENTAL
HEALTH SERVICES IN SPANISH
PREFERRING LATINO PATIENTS HAVE
SIGNIFICANTLY LOWER RATE THAN
WHITE PATIENTS AT AN ESTIMATED
RATE OF .59.
SO IT'S HUMBLING TO THINK IF YOU
NEED HEALTH CARE THAT YOU AREN'T
ABLE TO TALK TO A HEALTH CARE
PROFESSIONAL IN THE LANGUAGE YOU
SPEAK.
ONE ATTITUDE MAY BE WELL, GO
LEARN ENGLISH AS I HEARD FROM
SOME PEOPLE MANY YEARS AGO, WHY
DON'T THEY JUST LEARN ENGLISH
AND THAT'S NOT GOING TO ALWAYS
BE POSSIBLE, RIGHT.
WE HAVE A CERTAIN PROPORTION OF
THE U.S. POPULATION THAT DOESN'T
SPEAK ENGLISH WELL CALLED
LIMITED ENGLISH PROFICIENCY.
THE MAJORITY OF THE INDIVIDUALS
IN THE COUNTRY SPEAK SPANISH.
NOT ALL.
THERE'S MANDARIN, CHINESE,
CANTONESE AND CREOLE AND ALMOST
TWO OF THIS THIRDS OF THOSE WHO
HAD LIMITED PROFICIENCY IN THE
COUNTRY PREFER SPEAKING SPANISH.
KNOW WE GET A PROFESSIONAL
INTERPRETER AND NOT DOING
CLINICAL CARE WITH TOTAL JUST
BARRIERS OF COMMUNICATION BUT IN
MENTAL HEALTH IT'S AN ALMOST
LIKE WHERE DO YOU START WHEN THE
OBSERVATION AND PHYSICAL EXAM
ARE THE MAIN THERAPEUTIC
APPROACHES IN MENTAL HEALTH.
THIS IS OF GREAT RELEVANCE AND
THE OTHER CHALLENGE IS HOW MANY
CLINICIANS SPEAK SPANISH.
SAY THEY HAVE COVERAGE AND
ACCESS AND RESOURCES TO PAY FOR
MENTAL HEALTH VISIT, HOW MANY OF
THOSE CLINICIANS SPEAK THEIR
LANGUAGE?
BELIEVE ME IT'S VERY FEW.
IN THE DMB AREA WHERE MAYBE 18%
OF THE POPULATION IS LATINO AND
10% OF THEM SPEAK SPANISH YOU
CAN DO THE MATH.
IT'S A LOT OF PEOPLE AND SAN
FRANCISCO THERE WAS A CHALLENGE.
I COULDN'T FIND A SPANISH
SPEAKING CLINICIAN PARTICULARLY
COVERED BY INSURANCE.
THIS IS A MAJOR CHALLENGE AND
NOW MORE SO FOR LESS FREQUENTLY
SPOKEN LANGUAGE AND RESEARCH IN
THIS AREA IS OF SPECIAL
IMPORTANCE AND WHETHER THE
DIAGNOSIS IS THE SAME OR
DIFFERENT THERE'S NO
EPIDEMIOLOGICAL MAJOR
DIFFERENCES IN RATES OF
DEPRESSION AND ANXIETY BY RACE
AND ETHNICITY.
MOST THE ISSUES IN MENTAL HEALTH
DIAGNOSIS RELATE TO CARE.
ACCESS TO CARE AND MANAGEMENT
AFTER DIAGNOSIS.
SO UNLIKE SOME OTHER CONDITIONS
LIKE SAY DIABETES WHERE WE SEE
BIG DIFFERENCES BY RACE AND
ETHNICITY IN TERMS OF INCIDENTS
WE DON'T SEE MUCH LOWER
DIFFERENCES BY RACE AND
ETHNICITY IN MENTAL HEALTH
DIAGNOSIS.
THE IMPACT OF MEDICAID EXPANSION
AND THE K AWARDEE PUBLICATION
RECENT PUBLICATION IN EXAMINING
WHAT'S IT'S LIKE TO HAVE ACCESS
TO CARE WHICH IS A BLUNT
MEASURE.
YOU SAY I HAVE EXPANDED MEDICAID
AND NOW CAN SEE SOME DOCTOR
DEPENDING ON WHERE YOU LIVE AND
MEDICAID BUT THERE ARE NOWADAYS
MAYBE LESS THAN 10 STATES THAT
DON'T HAVE AN EXPANDED MEDICAID
AND ALL THIS DOES IS RAISES THE
ELIGIBILITY FOR MEDICAID FROM
POVERTY OVER 60% OF POVERTY TO
140, 150, 200 PERCENT OF
POVERTY.
IT MAKES WORKING POOR ELIGIBLE.
IT'S NOT A GIVE AWAY IT'S MAKING
PEOPLE PEOPLE WORKING A
RESTAURANT, DOING CONSTRUCTION
DO NOT GET EMPLOYER PROVIDED
INSURANCE TO GET MEDICAID UP TO
A CERTAIN STATE WHAT POLICIES
ARE.
IT PROVIDES COVERAGE FOR WOMEN
WHO ARE PREGNANT AND IT FILLS
THIS GAP OF CHILDREN COVERED BY
CHIP ADULTS OVER 65 AND THIS IS
THE GAP 18 TO 64 AGE RANGE.
LATINOS HAVE THE HIGHEST RATE OF
UNINSURED AND AFTER THE ACA
BEING MORE THAN DOUBLE WHAT THE
RATE IS FOR WHITE AMERICANS BUT
IN THIS ANALYSIS THERE WAS
IMPACT OF MEDICAID EXPANSION
WITH REDUCTION IN CARDIOVASCULAR
DISEASE MORTALITY OVER ALL AND
IN ALL POPULATIONS.
NO DIFFERENCE ACROSS RACE.
WE HAVE SEEN AN UPTAKE OF
MEDICAID EXPANSION IN MORE AND
MORE STATES.
THE MOST RECENT ONE I READ ABOUT
WAS MISSISSIPPI.
THERE ARE HOLDOUTS AT A
POPULATION POLICY LEVEL.
THIS IS SOMETHING THAT WE SHOULD
CONTINUE TO PROMOTE.
IT'S NOT THE ANSWER BUT IT IS A
MAJOR STEP IN THE RIGHT
DIRECTION.
I WON'T GO OVER THIS IN DETAIL
BUT THESE ARE MEASURES FOR HIV
TESTING AND PREP AMONG LATINO
SEXUAL MINORITY MEN.
A VARIETY OF TOOLS AND BARRIERS
TO IMPLEMENT PREP IN USE HIV
TESTING.
WE'RE BEGINNING TO SEE MORE
IMPACT OF THE AVAILABILITY OF
THE MANAGEMENT OF BOTH
PREVENTING HIV INFECTION THROUGH
PREP IN POPULATIONS AT RISK AND
ALSO THE TREATMENT AND
SUPPRESSION OF VIRAL PRESENCE IN
INDIVIDUALS INFECTED.
WE HAVE THE TOOLS TO HAVE
INFECTION WITH HIV AND YOU'RE
PROBABILITY OF A NORMAL LIFE
EXPECTANCY WITH VIRAL
SUPPRESSION.
AND THE FACT THAT WE EVENT BEEN
ABLE TO DO THIS WE SHOULD BE
ABLE TO IMPLEMENT THIS MORE
BROADLY IN OUR COUNTRY.
WHO SUFFERS FROM THIS?
MEN WHO HAVE SEX WITH MEN WHO
ARE BLACK OR LATINO MAKE UP
THREE-QUARTERS OF THE
INDIVIDUALS IN THIS CATEGORY.
AND ANOTHER IMPORTANT GROUP ARE
FEMALES WHO ARE PARTNERS OF
THESE INDIVIDUALS.
THIS IS A HIGH PRIORITY FOR NIH,
NIAID AND US AT NIMHD AND ARE
ALWAYS LOOKING FOR BETTER
APPLICATIONS YOU, GOOD
APPLICATIONS THAT FOCUS ON HIV
AREAS THIS IS A PROJECT FROM OUR
INTRAMURAL DIVISION.
THIS IS JAMA NETWORK OPEN AND
COVID-19 TREATMENT OF PUBLIC
HEALTH CARE SITES FROM COVID-19
SPATIAL CLUSTERS OF COUNTIES AND
SO LESS ACCESS TO TREATMENT IN
COUNTIES WITH HIGH POVERTY AND
IN UNINSURED RATES AND WE SERVE
THE COLLECTIVE IN WANTING TO
FORGET WHAT HAPPENED THE LAST
THREE YEARS BECAUSE NOBODY WANTS
TO TALK ABOUT COVID ANYMORE BUT
HAVE TO KEEP REMINDING OURSELVES
THIS IS A MAJOR LIFE EVENT AND
WE HAVE SCIENTIFIC TOOLS TO BE
ABLE TO ADDRESS THIS.
WE HAVE A VACCINE EFFECTIVE AT
PREVENTING SEVERE DISEASE AND
MORTALITY PARTICULARLY AND
PERHAPS PRIMARILY IN OLDER
ADULTS AND PEOPLE WITH CERTAIN
CONDITIONS.
WE HAVE EFFECTIVE THERAPY IF
YOU'RE INFECTED PARTICULARLY
AGAIN IN THE SAME GROUPS IF YOU
START TREATMENT EARLY YOU
CLEARLY PREVENT SEVERE DISEASE
HOSPITALIZATION AND
COMPLICATIONS LEADING TO
POTENTIAL DEATH.
THIS INFECTION IS NOT GOING TO
GO AWAY.
IT WILL CONTINUE TO BE PART OF
OUR ANNUAL REQUEST FOR BOOSTERS.
AND ADDRESSING AND MAKING SURE
THAT AREAS THAT ARE
DISADVANTAGED SOCIO ECONOMICALLY
AND PERHAPS THERE'S NO ACCESS TO
PHARMACIES OR MORE UNINSURED
PEOPLE WHO GOT ACCESS TO THE
TREATMENT PAY TO THE $8 OR $9
FOR THE HOME TEST TO MAKE I
DIAGNOSIS WE'RE CONTINUING TO
ADDRESS THIS.
DR. ALTUCCI LOOKS AT THE SMOKING
CESSATION TREATMENT.
SHE'S FOCUSSED ON PRIMARY DATA
AND USING THE SMOKE-FREE DOT-GOV
TEXT MESSAGING DATABASE.
IN THIS CASE WITH LATINO USERS
IN ESPANOL AND USING THE SPANISH
VERSION IMPROVED RETENTION AND
ENGAGEMENT AMONG LATINO USERS
BUT NOT ENGAGE ABSTINENCE.
PERHAPS WITH A LARGER SAMPLE
THAT COULD BE OBTAINED OR
TWEAKING THE CONTENT OF THE
INTERVENTION.
AND SMOKING CESSATION IS NOT A
SHORT TERM ISSUE.
I EXPERIENCED WITH PATIENTS OF
ANY ETHNIC RACIAL GROUP EVERY
TIME YOU SMOKE AND IT SEEMS LIKE
YEARS LATER THEY SAY, DOCTOR, I
QUIT, I FINALLY DID IT AND
FOCUSSING ON IT IS NOT A
ONE-TIME THING TO DO.
SO I THINK ENGAGEMENT AND
RETENTION IS AN IMPORTANT
PROCESS OUTCOME TO KEEP IN MIND
HERE.
THIS IS FROM A LAB LOOKING AT
TRENDS IN ADOLESCENT SUICIDE BY
METHOD.
AGAIN, THE FIREARM IS THE MOST
EFFECTIVE AND UNFORTUNATELY USED
EVEN AMONG ADOLESCENTS AND ALSO
USE OTHER METHODS AS HIGHLIGHTED
HERE.
AND THE INCREASE IN SUICIDES
OVER THE DECADE FROM 2011 TO
2020 AND IT WAS PARTICULARLY
STARK AMONG FEMALES THE DATA FOR
ADULTS FEMALES MAKE MORE
ATTEMPTS, MALES ARE MORE
SUCCESSFUL AND THAT'S THE
GENERALITY RELATED TO THE MODE
OF USE BECAUSE FIREARMS ARE MORE
EFFECTIVE.
AN AREA OF EFFECTIVENESS IN
MENTAL HEALTH CRISIS AND IN A
ADOLESCENTS AND WE TALKED ABOUT
THIS IN COUNCIL AT DIFFERENT
TIMES AND I'LL END WITH A
CELEBRATION OF AWARDS.
IN THIS CASE AND WE SHARE THE
POST-BAC POSTER DAY FACES FROM
OUR TRAINEES IN THE INTRAMURAL
PROGRAMS AND NIH HAS A VIBRANT
EDUCATIONAL ENVIRONMENT AND
NIMHD IS ONE OF THE INTRAMURAL
PROGRAMS THAT FOCUSES ON
POPULATION AND SOCIAL BEHAVIORAL
ISSUES AND ISSUES AROUND
MINORITY HEALTH AND HEALTH
DISPARITIES.
WE'RE IN THE ONLY ONE BUT WE'RE
PROUD OF WHAT WE CONTRIBUTE TO
THE AGENCY IN THIS ASPECT AND TO
THE FUTURE OF SCIENTISTS.
SO AGAIN, FOR ALL OUT THERE,
CONSIDER COMING TO WORK FOR
NIMHD.
WE'RE ALWAYS LOOKING FOR GREAT
PEOPLE TO FOCUS ON SCIENCE AT
NIMHD AND NIH AND THANK YOU
AGAIN FOR YOUR ATTENTION.
WE'RE OPEN FOR CONVERSATION FROM
THE COUNCIL MEMBERS.
THANK YOU.
A
>> IS THERE A GENERAL OFFICE AND
WONDERING WHAT THAT LOOKS LIKE.
>> THANK YOU FOR THE QUESTION.
THE TERMINOLOGY IS RELATIVE.
IT'S NOT AN OFFICE IN THE
CONTEXT OF THE OFFICE YOU DIRECT
WITHIN THE OFFICE OF THE
DIRECTOR.
BUT OPERATIONALLY WE WILL CALL
IT AN OFFICE.
WE'LL SIT IN PROGRAM SO UNDER
THE DIVISION OF BIOLOGICAL AND
BEHAVIORAL AND ENVIRONMENTAL
SCIENCES YOU CAN THOUGH YOU LOSE
YOUR ACRONYM.
LED BY DR. RENA DAS.
THAT'S HOW WE'RE
OPERATIONALIZING IT AND THERE'LL
BE A DIRECTOR AND THERE WILL BE
A SUPERVISORY ROLE AND WILL
STAFF APPROPRIATELY.
KEEP UNMIND IT'S A $4 MILLION
BUDGET AND ONE RCMI GRANT.
SO, WE DO NEED TO REALLY FOCUS
ON THIS, GET IT SET UP.
THIS FISCAL YEAR AND SEE HOW IT
GETS IMPLEMENTED.
EVENTUALLY RELATING ACROSS THE
AGENCY ONCE WE ESTABLISH IT.
WE HAVE A GOOD PLAN SET UP WE
WILL SHARE AT THE APPROPRIATE
TIME AS WE MAKE FUNDING
DECISIONS AND FORTUNATELY WE HAD
A CONCEPT A YEAR AGO THAT WE
CLEARED.
WE'LL HAVE A NOFO, NOTICE OF
FUNDING OPPORTUNITY AVAILABLE
THIS FISCAL YEAR TO FUND GRANTS
FOR '25 AND WE HAD THIS TERRIFIC
WORKSHOP IN FEBRUARY.
I THINK WE'RE WELL POISED TO
WE'RE NOT STARTING FROM SCRATCH.
WE'VE BEEN THINKING ABOUT THIS
FOR SOME TIME BECAUSE NATIVE
HAWAIIAN PACIFIC ISLANDER
POPULATIONS HAVE NOT BEEN EASY
TO FOCUS ON AND UNTIL 2017
NATIONAL DATA ON MORTALITY WERE
NOT EVEN AVAILABLE ACROSS THE
COUNTRY.
EVERY AGENCY NOW REPORTS OUT
MORTALITY DIFFERENTLY.
THERE HAVE BEEN DIFFERENT
PUBLICATIONS LOOKING AT CANCER
AND MORTALITY FOR EXAMPLE,
SHOWING THOUGH CANCER INCIDENS
MAY NOT BE THAT DIFFERENT AND
MORTALITY WAS DIFFERENT MALES
AND FEMALES.
WE'VE KNOWN FROM LOCAL STUDIES
THAT METABOLIC ISSUES RELATING
TO DIABETES IN PARTICULAR ARE
MORE FREQUENT IN NATIVE HAWAIIAN
PACIFIC ISLANDERS.
SO I THINK THIS WILL PROVIDE AN
OPPORTUNITY TO ADVANCE THE
KNOWLEDGE IN THIS POPULATION.
>> THAT WAS FOR 2024 FISCAL
YEAR.
>> OF COURSE.
>> I'M SORRY.
>> YOU HAVE TO SPEND IT BEFORE
OCTOBER.
>> WELL, WE DON'T WANT TO LEAVE
MONEY ON THE TABLE.
>> OKAY.
>> IT'S GREAT TO SEE ALL THE
DIFFERENT TYPES OF ANNUAL
MEETINGS YOU'RE HAVING FOR THE
CENTERS OF EXCELLENCE AND
ENVIRONMENTAL HEALTH DISPARITIES
AND OTHER GROUPS.
SO I'M JUST THINKING BECAUSE I'M
INVOLVED IN THE NIEHS CHILDREN'S
COLLABORATIVE ENVIRONMENTAL
HEALTH CENTERS AND THEY DO
INVESTIGATOR DEVELOPMENT AND ONE
OF THE CHALLENGES IS SUPPORTING
A NETWORK AND WONDERING IF
THERE'S OPPORTUNITY TO
COLLABORATE.
YOU ALREADY HAVE THE
COLLABORATIONS WITH NIEHS TO
HAVE THE CONVENING OF OTHER
GRANTEE NETWORKS TACKLING
ENVIRONMENTAL HEALTH
DISPARITIES.
>> THAT'S A GOOD SUGGESTION.
DEBBIE, IF YOU'RE STILL IN THE
ROOM -- THERE SHE IS.
TAKE NOTE.
IT'S SOMETHING WE CAN ADD TO
OUR -- I'LL MAKE A COMMENT.
OUR COLLABORATION BEFORE I
ARRIVED AT NIMHD HAS BEEN ROBUST
HAS EVOLVED.
I THINK CLIMATE CHANGE IN THE
SPECTRUM AND ENVIRONMENTAL
DISPARITIES AND THERE'S
DISCUSSION ABOUT ENVIRONMENTAL
JUSTICE ISSUES IN RESEARCH
COMING FROM THE DEPARTMENT OF
HEALTH AND HUMAN SERVICE AND
APPROPRIATELY SO.
SO I THINK THAT'S WHERE
LEVERAGING THESE OPPORTUNITIES
TO CREATE MORE NETWORKING ACROSS
THESE DIFFERENT PROGRAMS IS I
THINK AN IMPORTANT SO THANK YOU
FOR THAT.
OKAY, ANY OTHER COMMENTS OR
QUESTIONS FROM COUNCIL?
>> DR. STONE DO YOU HAVE A
QUESTION OR COMMENT?
>> YES, THANK YOU.
I APPRECIATE WHAT YOU PRESENT
EACH MEETING.
I AGREE IT'S SOBERING TO SEE THE
DATA FROM THE AMERICAN MEDICAL
ASSOCIATION AND THE UNDERMINING
DUE TO THE SUPREME COURT
DECISION AND WONDERING IF
NIMHD'S THINKING AHEAD ON THE
PORTFOLIO AND THE POSSIBLE
REDUCTION OF UNDER REPRESENTED
MINORITY SCHOLARS IN THE
PIPELINE AS WELL AS URM FACULTY
AND HOW YOU MIGHT THINK OF
MITIGATING THAT OR MAYBE
BOOSTING OR INCENTIVIZING THE
PIPELINE WITH THE RESEARCH.
>> SO, I WANT TO JUST BE CLEAR.
OUR OBJECTIVES ARE UNCHANGED.
BUT WE HAVE TO BE EXTREMELY
CAUTIOUS ABOUT BEING CLEAR THAT
WE DO NOT MAKE FUNDING DECISIONS
OR SELECTION OF APPLICANTS ON
THE BASIS OF IDENTITY
CHARACTERISTIC AND THIS GOES FOR
RACE AND ETHNICITY AND FOR
GENDER OR SEX.
THIS IS THE LAW.
WHETHER WE AGREE WITH IT OR NOT
THIS IS THE INTERPRETATION OF
THE LAW AND WE NEED TO BE VERY
IMPORTANT THAT BE THE MESSAGE
AND OUR COMMUNITY DO NOT
INTERPRET WHAT WE WANT TO SEE
HAPPEN AS ANOTHER WAY OF MAKING
CHOICES ON THAT BASIS.
SO, THIS IS A SOCIETAL ISSUE WE
THINK IS IMPORTANT.
OTHERS DON'T -- WE DO SEE THIS
AS A WAY OF IMPROVING NOT JUST
HEALTH CARE BUT ALSO SCIENCE AND
IT'S A LONG GAME.
THERE'S BEEN PROGRESS SINCE I
STARTED BUT CERTAINLY 14% IS NOT
WHERE WE SHOULD BE IN THE LONG
RUN.
SO, I DO THINK WE'LL CONTINUE TO
DO EVERYTHING WE CAN TO ADVANCE
TO APPROACH OUR GOALS WITHIN THE
LIMITATIONS THAT WE HAVE.
I WILL SAY THAT USING SOCIO
ECONOMIC CRITERIA THOUGH PERHAPS
MORE BLUNT EXCLUDES THE LIVED
EXPERIENCE OF RACISM THAT OCCURS
WITH UNDER REPRESENTED GROUPS.
DOES HAVE AN EFFECT IN THE
DESIRED DIRECTION.
WE'VE SEEN THAT IN CALIFORNIA
WHERE AFFIRMATIVE ACTION WAS
OUTLAWED BY A REFERENDUM OF THE
VOTING PUBLIC IN 1997 I THINK
AND CONFIRMED IN A SECOND EFFORT
TO CHANGE THAT AND THERE ARE
WAYS OF IMPROVING THE PIPELINE
AS YOU SAY IN CALIFORNIA
PRIMARILY THROUGH GREATER ACCESS
TO HIGHER EDUCATION AND ROBUST
COMMUNITY COLLEGE NETWORK WHERE
STUDENTS FROM UNDER PRIVILEGED
BACKGROUNDS ARE ABLE TO ATTEND,
GET A QUALITY EDUCATION AND BE
ACCEPTED TO UNIVERSITY OF
CALIFORNIA WHICH IS IN THE SAME
BETTER OR WORSE BUT SAME LEAGUE
AS THE IVY LEAGUE IN TERMS OF
QUALITY EDUCATION.
IT'S STATE SUPPORTED OR
AFFORDABLE TUITION AND ALMOST
HALF THE STUDENTS UNDERGRADUATE
STUDENTS, MIND YOU, IN THE U.C.
SYSTEM ATTEND CAMPUSES ARE FIRST
IN THEIR FAMILY TO ATTEND
COLLEGE.
THERE IS A WAY TO DO THIS.
IT'S JUST NOT UNIVERSALLY
IMPLEMENTED.
THE OTHER TOOL IS GEOGRAPHIC.
WE CAN SAY THIS IS WHAT THE IDEA
STATES PROGRAM IS ABOUT AND
NIGMS.
WE CAN ALSO IMPLEMENT.
THIS IS WHAT WE DO IN PART WITH
RESEARCH ACTIVE INSTITUTIONS OR
THE LESS RESOURCED INSTITUTIONS.
THIS IS WHERE WE'RE TRYING TO
DEAL WITH THE TRIBAL
EPIDEMIOLOGY CENTERS AND WHAT WE
WILL CONTINUE TO DO AS MUCH AS
WE CAN IN OUR OWN LIMITED SCOPE
AND PROMOTE AND THERE IS I THINK
GENERAL SUPPORT FOR THIS ACROSS
NIMH AND THIS IS NOT ONLY NIGMS
AND A COUPLE OTHERS, THIS IS
GENERALLY SUPPORTED AND KEEP
BRINGING THIS UP AND PROMOTING
IT.
THERE ARE OTHER THINGS AT WORK
THE HOLISTIC ADMISSION
PERSPECTIVE OPPOSED TO A PURE
DID YOU GET A TEST SCORE OR ARE
A GPA OR GO TO A SCHOOL THAT
PREPARED YOU TO GET A GOOD SCORE
ON YOUR TEST.
CERTAINLY IN THE MEDICAL
PROFESSION IT'S DEFENSIBLE IT'S
NOT HOW GOOD YOU ARE TAKING TEST
BUT A DIFFERENT SET OF QUALITIES
THAT MAKE YOU A GOOD CLINICIAN
AND SO HOLISTIC ADMISSION IS
MUCH MORE CONSISTENT IN THAT
CONTEXT THOUGH ONE CAN ARGUE IT
YOU'D BE CONSIDERED FOR ALL OF
THIS.
IT'S HARD TO DO THIS WHEN
THOUSAND AND THOUSANDS OF PEOPLE
ARE ON BUT WE HAVE TO FIND THESE
ALTERNATIVE APPROACHES GIVEN THE
CURRENT RULINGS ON THAT.
RACE CONSCIOUS, RACE AWARENESS
ADMISSIONS ARE NOW NOT
ACCEPTABLE IN THE COUNTRY.
HOPE THAT HELPS, LISA.
>> THANK YOU SO MUCH.
>> THANK YOU.
SO I HAVE A QUESTION.
ONE OF THE STUDIES YOU DISCUSSED
INDICATED THAT MENTAL HEALTH
AMONG LATINOS IS LESS TREATED
AND WHAT ARE THE FUNDS TO
ADDRESS SOME OF THOSE.
>> SO, I DON'T REMEMBER THE
DETAILS OF WHAT I SAID BEFORE
BUT WILL TRY TO REITERATE WHAT I
THINK IS THE ISSUE.
MAJOR MENTAL HEALTH ISSUES ARE
SIMILAR ACROSS GROUPS.
I DON'T THINK THERE'S BEEN MAJOR
DIFFERENCES SAY WITH
SCHIZOPHRENIA, PSYCHOSIS AND
BIPOLAR DISORDERS.
THERE ARE SOME DIFFERENCES IN
THINGS LIKE AUTISM AND ATTENTION
DEFICIT DISORDERS WRITTEN ABOUT
BUT IN THE CLINICAL CONTEXT,
THIS WAS PRIMARILY REFERRING TO
DEPRESSION, DEPRESSIVE SYMPTOMS
AND ANXIETY AND SEVERE ANXIETY.
PEOPLE FROM LATIN AMERICAN
BACKGROUND IN GENERAL, THIS IS
GENERALIZED TO MIND-BODY
CONNECTIONS.
IF I TELL A PATIENT, WELL, THIS
IS REALLY PSYCHOLOGICAL PROBLEM
OR A STRESS ISSUE OR SOMETHING
RELATED TO EVENTS OPPOSED TO A
PHYSICAL PROBLEM THAT I NEED TO
FIND THE RIGHT TEST AND
MEDICATION TO GIVE YOU, THEY
GENERALLY ARE RESPONSIVE TO THAT
AND IN THAT CONTEXT CHEMICAL
IMBALANCE THAT LEADS TO YOUR
SEVERE DEPRESSIVE SYMPTOMS CAN
BE TREATED IN PART WITH THIS
MEDICATION AND PEOPLE HAVE
ACCEPTED THAT.
OTHER CULTURES HAVE A DIFFERENT
ACCEPTANCE AND PEOPLE HAVE
WRITTEN ABOUT THIS FOR DECADES,
BOTH MEDICAL ANTHROPOLOGISTS AND
CLINICIANS.
THE PROBLEM IS IN ACCESSING
MEDICAL HEALTH CARE.
BECAUSE THE WAY THE SYSTEM
SEPARATED OUT MENTAL HEALTH CARE
FROM CLINICAL CARE AS A PRIMARY
CARE DOCTOR WE COULDN'T DO THAT
BECAUSE PATIENTS CAME TO US WITH
WHATEVER THEY HAD AND I DID
RESEARCH ON MEDICAL DEPRESSION
AS A FELLOW WITH PSYCHOLOGISTS
AND SHOWED IT WAS COMMON AND
UNDER RECOGNIZED AND UNDER
TREATED INTERVENTIONS DO WORK.
SO THIS HAS EVOLVED ENORMOUSLY
AND CLINGS SAY WE SCREENED FOR
DEPRESSION.
YOU CAN ASK FOR ONE OR TWO
QUESTIONS AND GET A SENSE OF
SOMEONE NEEDS FURTHER
VALIDATION.
WE CAN DO THE PHQ 9 THE
DIAGNOSTIC TOOL AND SAY SOMEONE
NEEDS TO BE CONSIDERED FOR A
THERAPEUTIC TRIAL.
I THINK THE DATA HAVE INFORMED
US IN WHAT TO DO AND AS A
CLINICIAN AND IF YOU HAVE ACCESS
TO ME I CAN DO A LOT OF THAT.
BUT IF I THINK THE PATIENT NEEDS
ONCE A WEEK COUNSELLING WITH A
MENTAL HEALTH PROFESSIONAL,
ACCESS TO THAT IS CHALLENGING
BECAUSE A LOT OF INSURANCES
DON'T COVER IT.
OR YOU DON'T HAVE ACCESS TO
SOMEONE WHO SPEAKS YOUR LANGUAGE
IN THIS CASE WHAT'S THE USE OF
GOING TO A COUNSELLING SESSION
TO AN INTERPRETER.
YOU CAN DO IT THROUGH AN
INTERPRETER AND IT'S BETTER THAN
NOTHING BUT REALLY BECOMES MORE
AND MORE CHALLENGING.
I FOUND THAT FREQUENTLY TO BE A
PROBLEM.
THERE'S A LIST OF AVAILABLE
PEOPLE WHO ARE PART OF THIS PLAN
WHO WOULD DO BEHAVIORAL THERAPY,
BEHAVIORAL HEALTH CARE FOR YOUR
PATIENTS.
90% WERE NOT TAKING NEW PATIENTS
FOR EXAMPLE.
THAT WASN'T UNCOMMON.
AND FINDING MODELS WHERE WE
INTEGRATED THE BEHAVIORAL HEALTH
THERAPY INTO HEALTH CARE WAS A
DIRECTION I THINK SOME SYSTEMS
HAVE MOVED TO INCORPORATING THAT
INTO THE PRACTICE SETTING OR
INTO THE PRIMARY CARE SETTING
OPPOSED TO BEING SPUN OFF TO A
SEPARATE ENTITY AND SO I THINK
THOSE ARE THE CHALLENGES.
SOMEONE WHO DOESN'T SPEAK
ENGLISH WELL THE BARRIERS ARE
MULTIPLIED.
>> THANK YOU FOR YOUR GREAT
PRESENTATION.
I WAS VERY MUCH INTERESTED IN
THE STRUCTURAL RACISM
CORRELATION THAT YOU MENTIONED
WITH DIABETES.
AND I'M WONDERING IF YOU COULD
SPEAK TO OR SPECULATE ON ANY OF
THE DOWN STREAM SOCIAL
DETERMINATE AND THEIR
CORRELATIONS WITH STRUCTURAL
RACISM.
PARTICULARLY AROUND MAYBE
HYPERTENSION, OTHER TRAUMATIC
MATTERS.
>> NOT SURE WHAT YOU'RE ASKING.
>> OKAY.
SO, IF STRUCTURAL RACISM
CORRELATES WITH DIABETES, RIGHT,
THEN CAN WE THINK OF OTHER
COMORBIDITIES OR OTHER SOCIAL
DETERMINATES WHERE YOU MIGHT
FIND SIMILAR CORRELATIONS.
>> DEFINITELY.
LEONARD'S PUBLICATION WAS
FOCUSSING ON THINGS WE PUBLISHED
IN THE LAST SEVERAL MONTHS.
THERE'S A MAP OF THE DISTRICT OF
COLUMBIA SHOWING THE EFFECTS OF
RED LINING AND SEGREGATION IN
THE DISTRICT.
THE AREA EAST OF THE RIVER
COMPARED TO NORTHWEST SHOWING
NOT JUST THE USUAL LIFE
EXPECTANCY DIFFERENCES BUT
CARDIOVASCULAR DISEASE AND
MECHANISTIC DIFFERENCES IN TERMS
OF BLOOD PRESSURE, INFLAMMATORY
MARKERS AND EVENTS.
THIS WHOLE RED LINING POLICY
WHICH WAS A POLICY WAS AN
INTENTIONAL PLAN THAT
MARGINALIZED AFRICAN AMERICAN
BLACK AMERICANS IN MOST CITIES
IN THE U.S., MOST LARGE URBAN
CITIES AND SUBSEQUENTLY OR
CONSEQUENTLY LATINO POPULATIONS
AS WELL BY CREATING NOT ONLY
SEGREGATED COMMUNITIES BUT
CREATING ENORMOUS BARRIERS TO
ACCESS AFFORDABLE LOANS TO GROW
EQUITY.
WHICH IS HOW AMERICAN FAMILIES
BUILD WEALTH.
IT WAS A IMPLEMENTED AND USED BY
THE APARTHEID REGIME AS A MODEL
AND CITED BY THE NAZI REGIME IN
GERMANY AS A SUCCESSFUL MODEL OF
HOW TO DO THESE THINGS AND POST
WORLD WAR II WHEN THE
U.S. EMBARKED ON A 25, 30-YEAR
ECONOMIC BOOM THAT BUILT ON
PARTLY ON PURCHASING PROPERTY AS
A WAY OF ENHANCING HEALTH AMONG
FAMILIES BLACK AMERICANS AND
LATINO AMERICANS TO A LESSER
EXTENT WERE DISENFRANCHISED AND
THERE ARE MAPS HISTORICALLY
ARCHIVED IN MOST URBAN CITIES
SOMEWHAT ATTENUATED AS YOU MOVE
WEST BECAUSE OF THE LACK OF
POPULATION AND DIFFERENCES IN
POPULATION BUT NOT ABSENT BY ANY
STRETCH OF THE IMAGINATION.
AND AS OTHERS HAVE SAID AND I
HAVE SAID, THIS IS LIKE OH, YOU
START A MONOPOLY GAME WHERE YOU
CAN'T PLAY.
YOU HAVE TO WAIT AN HOUR BEFORE
YOU CAN START PLAYING AND THEN
BY THEN EVERYONE HAS HOTEL, SIX
PROPERTIES OR HOUSES AND WHAT
THIS PROMOTED WAS THE STRUCTURAL
BARRIERS WE STILL WITNESS TODAY.
EFFORTS TO DISMANTLE THIS HAVE
MADE SOME PROGRESS IN SOME AREAS
BUT STOPPED FOR POLITICAL
REASONS PRIMARILY AND THERE IS
STILL A CONCEPT THAT I THINK IS
TRUE THAT THE IDEA OF HAVING A
COMMUNITY AND URBAN SETTING IN
RURAL AREAS BE DIFFERENT HOW YOU
OPERATIONALIZE THIS THAT'S NOT
UNIFORM.
IT'S GOOD FOR THE COMMUNITY'S
HEALTH AND BY UNIFORMITY I DON'T
REFER TO RACE AND ETHNICITY
BECAUSE THAT'S ACCORDING TO WHO
IS IN THE AREA BUT SOCIO
ECONOMIC SO WEALTHY PEOPLE WILL
ALWAYS BE SEPARATE.
THE 1% ASIDE BECAUSE THEY WON'T
BE INTEGRATED BUT A COMMUNITY
HAS WORKING PEOPLE AND PEOPLE
WHO ARE PROFESSIONALS, PEOPLE
BETWEEN PROFESSIONAL, I THINK
THAT HAS POTENTIAL TO BE
HEALTHIER AND I'VE ALWAYS SEEN
SOME EMPIRICAL EVIDENCE TO
SUPPORT THAT BUT YOU CAN'T DO
THIS IN A RANDOMIZED TRIAL AND
HOW DO YOU MOVE IN THAT
DIRECTION?
PART OF THE UNDERLYING THEME I
WOULD SAY THE CAMPUS INITIATIVE
WE LAUNCHED IS HOPEFULLY
SOMETHING WE CAN WORK TOWARDS IN
SEAL EVENTUALLY BUT WOULD MEAN
FOR HEALTH RESEARCHERS TO WORK
WITH PEOPLE IN HOUSING AND
PEOPLE IN LOCAL GOVERNMENT AND
PEOPLE IN EDUCATIONAL HIERARCHY
AND IN COMMERCIAL SECTOR ABOUT
FOOD ACCESS AND THINGS OF THAT
TYPE.
SO ONE IS NOT SORT OF
CATEGORIZED.
I THINK -- YOU MUST KNOW THIS,
KENDRICK, THERE WERE NO
FULL-SERVICE SUPER MARKETS EAST
OF THE RIVER UNTIL TWO OR THREE
YEARS AGO THEY OPENED THAT ONE.
>> CURRENTLY THERE ARE FOUR EAST
OF THE RIVER FOR APPROXIMATELY
160,000 PEOPLE.
MUCH OF THAT HAS HAPPENED AS A
RESULT OF WHAT YOU TALKED ABOUT
IN TERMS OF THE STRUCTURAL
RACISM PARTICULARLY AROUND THE
RED LINING COMPONENT.
IT CREATES FOOD DESERT AND FOOD
SWAMP.
YOU MAY CALL IT FOOD APARTHEID
IN SOME REGARD.
AS YOU CONTEND AND DEAL WITH
THOSE ISSUES WE'RE ALSO SEEING
CORRESPONDINGLY ISSUES WITH
HIGHEST INCIDENTS OF KIDNEY
DISEASES AND MORTALITY
ASSOCIATES WITH CANCER, HIGHEST
INCIDENTS OF SUICIDE, HIGHEST
INCIDENCES OF OTHER SORT OF
TRAUMA AS A RESULT ALL THESE
THINGS.
SO, I AM CURIOUS IN YOUR
COMMENTS WITH REGARD TO THIS
CORRELATION BECAUSE I THINK THE
PAPER IS SEMINOLE IN THE FACT IT
POINTS OUT STRUCTURAL RACISM AND
DIABETES, BUT WE CAN CORRELATE
THAT WITH PERHAPS OTHER
COMORBIDITIES.
AND PSYCHOSOCIAL ISSUES AS WELL.
THANK YOU.
>> THANK YOU FOR THAT.
OKAY, PAUL.
>> OKAY, WE'RE GOING TO TAKE OUR
BREAK AND RESUME AT 11:00 a.m.
THANK YOU VAECH.
THANK YOU VERY MUCH.
>> I'LL PRESENT ON RESEARCH ON
PRIMARY CARE FOR POPULATIONS
THAT EXPERIENCE HEALTH
DISPARITIES COMPARED TO WHITE
COUNTERPARTS, RACIAL OR ETHNIC
MINORITY GROUP WERE MORE LIKE TO
REPORT FAIR HEALTH STAT AND MORE
LIKELY TO DIE OF DIABETES AND
HEART DISEASE, MORE LIKELY TO
REPORT GOING WITHOUT MEDICAL
CARE AND LIKELY TO REPORT NOT
HAVING A USUAL MEDICAL PROVIDER.
PRIMARY MAY BE A WAY TO ADVANCE
HEALTH EQUITY BECAUSE IN
COMPREHENSIVE HEALTH CARE THAT
COVERS PREVENTION, WELLNESS,
MANAGEMENT OF ACUTE AND CHRONIC
CONDITION AND TREATMENT FOR
VARIETY OF HEALTH CONCERNS
INCLUDING PHYSICAL, BEHAVIORAL
AND SOCIAL.
THE PURPOSE OF THE INITIATIVE IS
TO SUPPORT RESEARCH ON PRIMARY
CARE FOR POPULATIONS THAT
EXPERIENCE HEALTH DISPARITIES TO
UNDERSTAND THE ASSOCIATION
BETWEEN RECEIPT OF PRIMARY CARE,
HEALTH DISPARITIES AND HEALTH
EQUITY, TO EVALUATE FACTORS AND
MECHANISMS THAT INFLUENCE THE
EFFECTIVENESS OF PRIMARY CARE
AND TO DEVELOP INNOVATIVE
SUSTAINABLE INTERVENTIONS WITHIN
PRIMARY CARE TO IMPROVE HEALTH
AND HEALTH OUTCOMES.
ACCESS TO PRIMARY CARE HEALTH
SERVICES HAS INCREASED LARGELY
DUE TO HEALTH CARE REFORM
DESPITE IMPROVED ACCESS HEALTH
DISPARITIES PERSIST.
POPULATIONS THAT EXPERIENCE
HEALTH DISPARITIES ARE LIKELY TO
RECEIVE SCREENING, STATINS FOR
PRIMARY PREVENTION OF HEART
DISEASE, CANCER SCREENING,
EXCUSE ME, AND RETINAL SCREENING
FOR DIABETES.
THEY'RE ALSO LESS LIKELY TO
RECEIVE EVIDENCE-BASED TREATMENT
FOR A VARIETY OF HEALTH
CONDITIONS.
THESE POPULATIONS ARE MORE
LIKELY TO RECEIVE LOW VALUE CARE
WHICH MAY INCLUDE NON-EVIDENCE
BASED CANCER SCREENING AND
TREATMENT OF MIGRAINES AND HAVE
HIGH BLOOD PRESSURE AND GLUCOSE
LEVELS ABOVE THE STANDARDS
RECOMMENDED FOR OPTIMAL
OUTCOMES.
A RECENT STUDY FOUND A
CORRELATION BETWEEN PHYSICIANS
AND LIFE EXPECTANCY AND THERE'S
BEEN A STEADY DECLINE IN THE
PRIMARY CLINICIAN WORKFORCE DUE
TO THE RISE IN SPECIALIZATION
AND NURSE PRACTITIONERS AND
PHYSICIAN ASSISTANTS.
HIGH QUALITY PRIMARY CARE AS
DEFINED BY THE NATIONAL
ACADEMIES SCIENCES ENGINEERING
MEDICINE AS WHOLE PERSON
INTEGRATED ACCESSIBLE AND
EQUITABLE HEALTH CARE PROVIDED
BY INTERPROFESSIONAL TEAMS
ACCOUNTABLE FOR ADDRESSING THE
MAJORITY OF AN INDIVIDUAL'S
HEALTH AND WELLNESS NEEDS ACROSS
SETTINGS AND THROUGH SUSTAINED
RELATIONSHIPS MAY REDUCE
DISPARITY AND MORE RESEARCH IS
NEED.
AN PORTFOLIO FOUND INVESTMENT OF
2% OF THE NIH BUDGET AND 15% OF
THE NIMHD BUDGET IN FISCAL YEAR
2023 TAKEN TOGETHER THE
PERSISTENT DISPARITIES IN HEALTH
AND HEALTH OUTCOMES DESPITE
IMPROVED ACCESS THE POTENTIAL
FOR HIGH QUALITY PRIMARY CARE TO
MOVE THE NEEDLE ON REDUCING
DISPARITIES AND HEALTH EQUITY
AND THE LIMITED PRIMARY HEALTH
CARE RESEARCH PORTFOLIO WITHIN
NIH PROVIDE THE BACKGROUND FOR
INCREASING THE INVESTMENT IN
RESEARCH ON PRIMARY CARE THAT
PRIORITIZES POPULATIONS THAT
EXPERIENCE HEALTH DISPARITIES.
THE INITIATIVE WILL SUPPORT
RESEARCH USING A VARIETY OF
STUDY METHODS TO INVESTIGATE THE
EFFECTIVENESS OF PRIMARY CARE IN
ADDRESSING THE HEALTH CARE NEEDS
OF POPULATIONS THAT EXPERIENCE
HEALTH DISPARITIES OR STUDIES
THAT PROPOSE TO DEVELOP AND
TEST, IMPLEMENT AND/OR EVALUATE
SUSTAINABLE INTERVENTIONS WITHIN
PRIMARY CARE TO REDUCE
DISPARITIES AND ADVANCE HEALTH
EQUITY.
THERE'S A VARIETY OF TOPICS THAT
SHOULD BE EXPLORED IN THIS AREA
TO FULFILL THE OBJECTIVES OF
THIS INITIATIVE.
RESEARCH ON THE PROVISION OF
HIGH-QUALITY PRIMARY CARE TO
IMPROVE HEALTH OUTCOMES MIGHT
EXAMINE FACTORS AND MECHANISMS
AT MULTIPLE LEVELS THAT ARE
ASSOCIATED WITH ACCESS, QUALITY
AND HEALTH OUTCOMES OR DEVELOP
AND TEST, IMPLEMENT AND/OR
EVALUATE INNOVATIVE STRATEGIES
TO OPTIMIZE TIMELY RECEIPT OF
DIAGNOSTIC AND TREATMENT
SERVICES AND TIMELY REFERRAL TO
SPECIALISTS.
RESEARCH ON THE COORDINATION OF
CARE THROUGH INTERPROFESSIONAL
TEAMS TO IMPROVE CARE QUALITY
AND IMPROVE HEALTH OUTCOMES MAY
EXAMINE MULTI-LEVEL FACTORS AND
MECHANISMS FOCUSSED ON THE
FUNCTIONING AND EFFECTIVENESS OF
CARE TEAMS AND IMPLEMENT AND
EVALUATE AND ADDRESS CHALLENGES
IN CARE COORDINATION.
RESEARCH ON THE ROLE, STRUCTURE
AND EFFECTIVENESS OF PRIMARY
CARE AND UNIQUE POPULATIONS
AND/OR SETTINGS MIGHT FOCUS ON
UNIQUE CARE TO PRIMARY CARE
STRUCTURE AND WORK FLOW AND THE
RESULT ON HEALTH OUTCOMES OR
PARTNER WITH THE COMMUNITY TO
CODESIGN INNOVATIVE STRATEGIES
TO IMPROVE ACCESS AND
UTILIZATION OF CARE FOR
POPULATIONS WHO MAY AVOID
TRADITIONAL CARE SETTINGS DUE TO
STIGMA OR OTHER SOCIAL
CIRCUMSTANCES.
FOR THIS PARTICULAR PRIORITY,
PROPOSALS SHOULD IDENTIFY WHY
THE POPULATION OR SETTING IS
UNIQUE.
UNIQUE SETTINGS MAY INCLUDE
PLACES OF WORSHIP, BARBERSHOPS
OR CLINICS.
RESEARCH ON THE ROLE OF THE
PRIMARY CARE WORKFORCE IN
FACILITATING OR CHALLENGING THE
EFFECTIVENESS OF PRIMARY CARE
MAY EXAMINE THE ROLE OF
SPECIALIZATION WITHIN PRIMARY
CARE ON ACCESS, QUALITY AND
OUTCOMES OR CLINICIAN-LEVEL
FACTORS THAT INFLUENCE MEDICAL
DECISION MAKING.
IN SUMMARY, MORE RESEARCH IS
NEEDED ON PRIMARY CARE FOR
POPULATIONS THAT EXPERIENCE
HEALTH DISPARITYIES AND THE
PRIORITIES THAT HIGHLIGHT KEY
GAPS IN KNOWLEDGE THAT SHOULD BE
ADDRESSED TO ADVANCE THE SCIENCE
IN THIS AREA.
THANK YOU AND I WELCOME FEEDBACK
AND QUESTIONS.
>> THANK YOU SO VERY MUCH FOR AN
OUTSTANDING PRESENTATION OF A
CONCEPT.
THIS CONCEPT IS INCREDIBLY
IMPORTANT BECAUSE OF AN AREA
VERY MUCH NEEDED IN TERMS OF
RESEARCH AROUND PRIMARY CARE I
LIVE AND WORK AS A POS --
PASTOR IN A NEIGHBORHOOD WHY
MOST PEOPLE USE THE EMERGENCY
ROOM FOR PRIMARY CARE INSTEAD OF
HAVING PRIMARY CARE DOCTORS.
I'M VERY CURIOUS ABOUT AS WE GO
THROUGH LOOKING AT THE
PROVISIONS FOR HIGH QUALITY
PRIMARY CARE TO IMPROVE THE
HEALTH OUTCOMES HOW WE'RE GOING
TO CONSIDER THE CULTURAL
LITERACY OR COMPETENCY WITH
REGARD TO MAKING SURE PHYSICIANS
HAVE SUCH AND ALSO CONSIDERING
LITERACY IN GENERAL WITH REGARD
TO THOSE PATIENTS THAT HAVE
WOULD NORMALLY SEEN PRIMARY
CARE.
THOSE THAT CURRENTLY IN THE
NEIGHBORHOOD WHO I SERVE HAVE
LOW LITERACY RATES AND OFTEN
TIMES THOSE WHO ARE PHYSICIANS
ARE NOT NECESSARILY CULTURALLY
COMPETENT.
SO HOW ARE WE GOING TO BEGIN TO
START TO THINK ABOUT CULTURAL
COMPETENCY AS WELL AS LITERACY
AND ALL THAT GOES INTO
UNDERSTANDING HOW WE MAKE AND
PROVIDE FOR HIGH-QUALITY AND I
WOULD ADD LOW COST PRIMARY CARE?
>> THANK YOU FOR THE QUESTION.
I THINK CULTURAL COMPETENCY AND
HEALTH LITERATURE AND CULTURAL
LITERACY ARE VERY IMPORTANT
TOPICS AND ALL REQUIRE
ADDITIONAL RESEARCH.
SO THERE IS AN OPPORTUNITY WITH
THIS INITIATIVE FOR MORE
RESEARCH SPECIFICALLY THERE'S AN
INTEREST IN THE
PATIENT-CLINICIAN CONCORDANCE
AND HOW THIS EFFECTS HEALTH
EQUITY.
MUCH OF RESEARCH ALREADY DONE IS
CROSS-SECTIONAL SO THERE'S A
NEED FOR MORE RESEARCH TO
UNDERSTAND CAUSE AND EFFECT AND
THAT TYPE OF RESEARCH OR
PROPOSALS WOULD BE APPROPRIATELY
SUBMITTED IN RESPONSE TO THIS
INITIATIVE.
>> THANK YOU SO MUCH.
WHEN YOU TALK ABOUT THIS WHOLE
PART AROUND ACCESS AND WE NOTED
CULTURAL COMPETENCY AND THOSE
SORTS OF THINGS AND YOU HAVE
CONCORDANCE AS WELL OR HARMONY,
HOW DO WE START TO HAVE
CONVERSATION AROUND
TRUSTWORTHINESS OF PRIMARY CARE
PHYSICIANS PARTICULARLY WHEN YOU
START TO TALK ABOUT LEARNING
WHAT MAKES A PATIENT
COMFORTABLE.
HOW DOES THAT TIE TO QUALITY AND
HOW DOES THAT IMPACT THE
CONTINUITY OF CARE?
>> I'LL ANSWER THAT IN TWO WAYS.
FIRST, THERE'S A CURRENT
ANALYSTS OF FUNDING OPPORTUNITY
FOCUSSED ON THE
PATIENT-CLINICIAN RELATIONSHIP
GOING TO THE COMMENT YOU MADE.
IN DEVELOPING THE CONCEPT FOR
CONSIDERATION IS THAT PRIMARY
CARE IS REALLY AN OVER ARCHING
THEME THAT WE SEE MOVING IN MANY
THAT ARE ALREADY ESTABLISHED AND
TRY TO CARVE OUT UNIQUE AREAS
WHERE THERE WASN'T SIGNIFICANT
OVERLAP.
SPEAKING TO THIS PARTICULAR NOFO
CALLED FOR ADDITIONAL
CO-DESIGNING OF PARTICULAR
INTERVENTIONS OR STRATEGIES.
SO IN THAT WAY TRUST CAN BE
BUILT BETWEEN THE MEDICAL FIELD
RESEARCHERS AS WELL AS THE
COMMUNITY IN DESIGNING SOME
INTERVENTIONS TO IMPROVE ACCESS
AND UTILIZATION AND HOPEFULLY
TRUST AS WELL AS IN THE PROCESS.
>> SO AS YOU THINK ABOUT DESIGN,
ARE YOU ALSO CONSULTING PART OF
COMMUNITY-BASED ORGANIZATIONS
AND THOSE WHO WOULD BE
CAREGIVERS IN DEVELOPING SUCH AN
INTERVENTION THAT WOULD BE
SUITABLE FOR A COMMUNITY.
>> YES, ALL THE ABOVE.
IDEALLY CO-DESIGN DOES INVOLVE
THE LIVED EXPERIENCE AND
INDIVIDUALS FROM THIS COMMUNITY
AND COMMUNITY-BASED
ORGANIZATIONS, RESEARCHERS AND
MEDICAL CLINICIANS AS WELL
WORKING TOGETHER.
>> WITH THAT IN MIND COULD YOU
SPEAK TO THE INTERSECTIONALITY
FRAMEWORK AS IT RELATES TO SEX
AND GENDER AND ALL THAT INCLUDED
IN THE WHOLE INTERVENTION AND
DESIGN PROCESS?
>> YES, NIMHD SUPPORTS RESEARCH
ESPECIALLY LOOKING AT THE
INTERSECTION OF SOCIO ECONOMIC
STATUS AND RACIAL ETHNIC
MINORITY WHILE OTHER
INTERSECTIONS.
SO IT IS VERY IMPORTANT FOR
PROPOSALS TO CONSIDER
INTERSECTIONAL LENS IN THE
DESIGN.
>> IF WE WERE TO GO FURTHER WITH
REGARD TO COORDINATION OF
PROFESSIONAL TEAMS AND WHO IS
THAT IN MIND?
WOULD THAT CRUD NOT ONLY THE
SOCIAL WORKERS BUT HOW ABOUT
INCLUDING THOSE LIKE COMMUNITY
ADVOCATES OR CHAPLAINS OR OTHERS
THAT ARE PART OF PERSONAL
NETWORKS AND PART OF THE SOCIAL
CAPITAL THAT WOULD BE PART OF
THIS INTERPROFESSIONAL TEAM.
>> THE MAKEUP OF THE
INTERPROFESSIONAL TEAM SHOULD BE
TAILORED SO THE ORGANIZATION AND
COMMUNITY.
HOW THAT TEAM LOOKS MAY VARY BY
PROPOSAL.
HOWEVER THERE'S A WIDE BREADTH
OF WHO COULD BE INCLUDED IN THE
TEAM DEPENDING ON WHAT THE NEEDS
OF THE PATIENTS ARE AND THE
ORGANIZATION.
COMMUNITY HEALTH WORKERS YOU,
PATIENTS, SOCIAL WORKERS,
CLINICIANS SHOULD ALL BE
CONSIDERED IN INTERPROFESSIONAL
TEAMS.
>> YOU MENTIONED EARLIER THAT
WILL YOU CONSIDER
NON-TRADITIONAL HEALTH CARE
OPTIONS LIKE BARBERSHOPS AND
HOUSES OF WORSHIP.
I'M WONDERING IF YOU WOULD
CONSIDER OR HAVE YOU CONSIDERED
WITH REGARD TO THE ROLE,
STRUCTURE AND EFFECTIVENESS OF
PRIMARY CARE FOR UNIQUE
POPULATIONS, LET'S SAY, THOSE
NON-TRADITIONAL HOURS
PARTICULARLY SINCE THE JOB
MARKET HAS CHANGED SIGNIFICANTLY
SINCE THE PANDEMIC, DOES THIS
ALLOW FOR THE CONSIDERATION OF
THOSE WHO ARE PART OF THE GIG
ECONOMY?
THOSE WHO ARE PART OF OTHER
SORTS OF WORK FRAMEWORKS THAT
HAVE EMERGED SINCE THE PANDEMIC?
>> IT DEFINITELY DOES.
ONE OF THE CONSIDERATIONS THAT
WE THOUGHT OF WITH THAT UNIQUE
SOCIAL CIRCUMSTANCES WAS PEOPLE
WHO HAVE WORK HOURS THAT DO NOT
ALLOW FOR GOING TO CLINICS NOR
TRADITIONAL 9:00 TO 5:00 HOURS
AND THOSE WHO MAY HAVE
CAREGIVING ROLES.
THAT PARTICULAR PRIORITY
DEFINITELY DOES ALLOW FOR
STRATEGIES AS YOU MENTIONED AS
HAVING UNIQUE HOURS FOR
PROVIDING CLINICAL CARE.
BUT I THINK THE IMPORTANCE OF
THAT PARTICULAR NOTE AS WELL THE
CO-DESIGN.
TRYING TO DETERMINE WHAT IS BEST
FOR THE COMMUNITY BY INCLUDING
THE COMMUNITY AND MAKING THE
DECISIONS.
>> THANK YOU VERY MUCH.
INCLUDING THE COMMUNITY I WANTED
TO BROADEN THE SCOPE TO BEGIN TO
LOOK AT IF SOCIETY'S DEVELOPED
BASED ON THREE PRIMARY
STRUCTURES, YOUR GOVERNMENTAL
STRUCTURE, YOUR NONPROFIT
STRUCTURE INCLUDING ACADEMIC
INSTITUTIONS AS WELL AS
COMMUNITY THEN YOU HAVE THE
PRIVATE SECTOR, HOW CAN THOSE
THREE COME TOGETHER TO HELP
PROVIDE THIS WHOLE IDEA OF
RE-IMAGINING OF PRIMARY CARE?
>> IT'S VERY IMPORTANT FOR ALL
OF THOSE TEAMS TO COME TO THE
TABLE BUT I THINK IT'S IMPORTANT
TO NOTE THAT THEY -- ALL THOSE
GROUPS SHOULD BE AT THE TABLE
FROM THE BEGINNING AGAIN TO HELP
WITH THE CO-DESIGN.
IT'S NOT DESIGNING AND THEN
ENFORCING WITHOUT INPUT FROM ALL
OF THE IMPORTANT KEY PERSONS
THAT SHOULD BE AT THE TABLE.
>> THANK YOU.
>> AS THE SECOND REVIEWER DO YOU
HAVE ADDITIONAL COMMENTS?
>> THANK YOU TO YOU AND YOUR
COLLEAGUES FOR PUTTING TOGETHER
A STRONG CONCEPT.
IT'S DOCUMENTED THERE'S A
MULTIPLE CHALLENGES IN PRIMARY
CARE NOT ONLY ABOUT PROVIDER
SHORTAGES BUT REACTIVE RATHER
THAN PREVENTIVE CARE AND LACKS
GROUNDING AND EVIDENCE-BASED
STRATEGIES AND VALUE-BASED
APPROACHES.
I THINK ANOTHER PHENOMENON THAT
WE'RE WITNESSING IS THERE'S ALSO
A SHORTAGE OF SPECIALTY WITH
SPECIALISTS IN OUR COMMUNITY,
PRIMARY CARE SETTINGS ARE MORE
AND MORE BURDENED WITH DEALING
WITH COMPLEX MANAGEMENT AND
FOLLOW-UP CARE FOR CONDITIONS
LIKE CANCER AND CARDIOVASCULAR
DISEASE.
I FELT THIS WAS A VERY MUCH
NEEDED INITIATIVE THAT TAKES THE
RIGHT STEPS TO ADDRESS THESE
CHALLENGES.
I HAD A FEW ADDITIONAL COMMENTS
AND THANK YOU TO MY COLLEAGUE
FOR RAISING ALL THE IMPORTANT
ISSUES.
ONE OF THE COMMENTS WAS THAT WE
HAVE A PRETTY WELL ESTABLISHED
RRT THAT DOCUMENTS
EVIDENCE-BASED STRATEGIES THAT
DOCUMENT MULTIPLE CHRONIC
DISEASES LIKE DIABETES AND
OTHERS IMPACT SPECIFIC
COMMUNITIES BUT CAN BE PREVENTED
AND WELL MANAGED IF DELIVERED IN
THESE SETTINGS.
I WONDER OF STRATEGIES YOU WOULD
PROMOTE OR REQUEST TO IMPLEMENT
THOSE EVIDENCE-BASED STRATEGIES
WITHIN THE PRIMARY CARE
SETTINGS.
>> SO FOR MULTIPLE CHRONIC
CONDITIONS IS AN AREA WHERE WE
HAVE NOTICE OF FUNDING
OPPORTUNITIES SPECIFICALLY
FOCUSSED ON MODELS FOR CARE FOR
INDIVIDUALS WITH MULTIPLE
CHRONIC CONDITIONS WHICH WOULD
INCLUDE WITHIN PRIMARY CARE AND
TO YOUR POINT, WE DEFINITELY
MANY OF THE RESEARCH OR SOME
RESEARCH DONE TO DEVELOP MODELS
IS NOT DIVERSE SO TAILORING SOME
OF THESE EVIDENCE-BASED
STRATEGIES TO THE COMMUNITY
POPULATION THAT EXPERIENCE
HEALTH DISPARITIES WOULD BE VERY
IMPORTANT.
>> THANK YOU.
IT'S IMPORTANT TO HIGHLIGHT THAT
ACCESS DOESN'T NECESSARY MEAN
INDIVIDUALS WILL USE SERVICES SO
I THINK AS MENTIONED IN THE
CONCEPT IS UNDERSTANDING THE
MULTILEVEL FACTORS OR
DETERMINATES THAT MAY SERVE AS
BARRIERS.
SO IT WILL BE REALLY IMPORTANT
TO BE ABLE TO CHARACTERIZE THE
EXPERIENCES OF THE COMMUNITY A
QUALITY ENGAGEMENT AND LISTENING
SESSIONS AND BYE DIRECTIONAL
DISCUSSIONS WITH THE APPROPRIATE
STAKEHOLDERS WOULD BE ESSENTIAL
IN THE PRIORITY -- RIGHT
PROGRAMS AND THERE ARE BARRIERS
AND THERE'S CULTURAL COMPETENCY
OR INFLUENCES THAT MAY INTERACT
WITH THE ATTITUDES AND
OBLIGATIONS THAT MAY SUPERSEDE
ENGAGEMENT AND STIGMA AND
PERCEIVED DISCRIMINATION AND THE
LIST GOES ON SO I WANT TO
HIGHLIGHT IT'S CRITICAL AS THE
PROGRAMS ARE DEVELOPED.
THERE'S AN EMPHASIS ON PEDIATRIC
AND YOUNG ADULT POPULATIONS AND
I THINK I JUST WANT TO HIGHLIGHT
NOT TO OVERLOOK THE MENTAL
HEALTH CRISIS IN THAT COMMUNITY
ADDING SIGNIFICANT BURDEN.
IN ADDITION TO SYSTEMIC BURDEN
OF OTHER CONDITIONS FACED BY
YOUNG ADULTS.
ONE QUESTION I HAD WAS GIVEN
THERE IS EMPHASIS ON
SUSTAINABILITY OF THE PROGRAMS,
HAVE YOU CONSIDERED PROVIDING
GUIDANCE AND IMPLEMENTATION
MODELS OR OTHER FRAMEWORKS THAT
ARE AVAILABLE THAT WILL HELP
SHAPE THE RESEARCH DESIGNS AND
ADD SCIENTIFIC RIGOR AND METHODS
TO MAKE SURE MECHANISMS ARE IN
PLACE TO SUSTAIN WHATEVER
PROGRAMS ARE IMPLEMENTED WITHIN
THE PRIMARY CARE SETTINGS?
>> WE DID NOT DISCUSS
SPECIFICALLY CALLING FOR
SPECIFIC MODELS BUT IN GENERAL
HAVING A MODEL OR CONCEPTUAL
MODEL AT LEAST BEHIND ANY
RESEARCH PROPOSED IS HIGH
QUALITY AND WE WOULD BE LOOKING
FOR THOSE THINGS BUT WE HAVE NOT
DISCUSSED SPECIFIC MODELS.
THAT'S SOMETHING OUR TEAM COULD
CONSIDER.
>> WE HIGHLY ENCOURAGE THAT AND
I LIKE THE EMPHASIS ON
VALUE-BASED CARE AND WOULD ALSO
RECOMMEND MAKING SURE THE RIGHT
STAKEHOLDERS AND SPECIFICALLY
MANAGED DOSE AND RESOURCES AND
BUDGET AND CLINICAL WORK FLOWS
AND TRAINING ETCETERA, GET
ENGAGED THROUGH THE PROCESS
EARLY ON BECAUSE THOSE ARE
DECISION MAKERS.
WE RESEARCHERS CLINGS WILL GO IN
WITH THE BEST INTENTIONS AND
REALITIES OF THE PRESSURES MANY
SYSTEMS HAVE.
ENGAGING THOSE INDIVIDUALS AND
COST BENEFIT AND THE RIGHT
PROCESSES IN THE PRIMARY CARE
SETTINGS WHERE THEY UNDERSTAND
MAYBE NOT IMMEDIATELY BUT IN THE
LONG RUN THERE WILL BE COST
SAVINGS TO THE SYSTEM AND BETTER
WORK FLOWS AND LESS ON THE
CLINICIANS.
I THINK THAT'S IT.
THANK YOU.
>> THANK YOU VERY MUCH.
ANY OTHER COMMENTS OR CONCERNS
FROM COUNCIL MEMBERS?
>> THIS IS GREAT, THANK YOU.
IT'S CONSISTENT WITH THE NIH
DIRECTOR'S COMMON FUND PROGRAM
FOR PRIMARY CARE AND WONDER DO
YOU INCORPORATE THAT INTO WHAT
YOU'RE EXPECTING TO GET OR
HOPING TO SEE IN PROPOSALS?
>> WE DEFINITELY WILL TAKE A
LOOK AT THAT.
WE DIDN'T INCORPORATE THAT INTO
THIS PROPOSAL BUT THERE'S STILL
MORE WORK TO BE DONE.
THE WORK WE DO IS HOPEFULLY TO
COMPLEMENT OTHER EFFORTS AND
PART OF THAT IS LOOKING AT WHAT
THE COMMON FUND ALREADY HAS IN
PLACE AND NOT DUPLICATING BUT
ADVANCING.
>> ARE THERE OTHER COMMENTS FROM
OTHER COUNCIL MEMBERS.
SEEING NONE, MAY I HAVE A
MOTION.
>> I MOVE THAT THIS CONCEPT BE
APPROVED AND MOVED TO NOFO.
>> THANK YOU.
>> I SECOND THAT MOTION.
>> THANK YOU VERY MUCH.
BY SHOW OF HANDS.
THANK YOU THE CONCEPT IS PASSED
AND WILL BE MOVED FORWARD TO
NOFO.
>> GOOD MORNING.
THE CONCEPT IS UNDERSTANDING THE
INFLUENCE OF INTERPERSONAL
BIASES ON HEALTH OUTCOMES AND
DISPARITIES.
THE OBJECTIVE OF THE INITIATIVE
IS TO SUPPORT RESEARCH THAT
EXAMINES MECHANISMS AND PATHWAYS
LINKING EXPOSURE TO ADVERSE
HEALTH CONDITIONS AND
DISPARITIES.
IMPLICIT FORMS INDICATES
UNCONSCIOUS AND AUTOMATIC AND
EXPLICIT MEANS CONSCIOUS AND
OVERT AND LEADS TO DOWN STREAM
DISCRIMINATION.
THE INTERPERSONAL PORTION OF THE
PHRASE INTERPERSONAL BIASES
INFORM RELATED TO RELATIONSHIPS
TO COMMUNICATION BETWEEN PERSONS
HENCE THE WAY PERSONAL BIASES
ARE TRANSMITTED.
SO CONSISTENTLY AND RESEARCH
SHOWS INTERPERSONAL BIASES
PREDICT DOWN STREAM DISEASES,
CONDITIONS AND NEGATIVE
OUTCOMES.
FOR INSTANCE THE FIGURE ON THE
BOTTOM LEFT SHOWS A RELATIONSHIP
BETWEEN COMMUNITY LEVEL IMPLICIT
BIAS AND HEART FAILURE
PREVALENCE FOR BLACK AND WHITE
MEDICARE RECIPIENTS.
BOTH BLACK AND WHITE MEDICARE
RECIPIENTS SHOW HIGHER
PREVALENCE OF LIVING IN
COMMUNITIES HIGH IN IMPLICIT
PRO-WHITE, ANTI-BLACK BIAS BUT
THE RELATIONSHIP IS STRONGER FOR
BLACK MEDICARE RECIPIENTS.
THE FIGURE ON THE TOP RIGHT
SHOWS THE RELATIONSHIP BETWEEN
THE PHYSICAL WELL BEING OF THOSE
LIVING WITH THIS AND THE Y AXIS
INDICATES LOWER SCORES INDICATES
LOWER PHYSICAL WELL BEING.
AS YOU CAN SEE, HIGH IMPLICIT
AND EXPLICIT BIAS PREDICTS THE
LOWEST DEGREE OF PHYSICAL WELL
BEING OF PERSONS LIVING WITH HIV
AND BY VIRTUE OF BEING HUMAN
WE'RE MEMBERS OF VARIOUS SOCIAL
GROUPS BASED ON OUR STIGMATIZED
AND MARGINALIZED IDENTITIES AND
STATUSES.
SO THINK ABOUT A BLACK TRANS
WOMAN OF LOW SES LIVING WITH HIV
THAT PERSON WOULD BE ENCOUNTERED
JUST BASED ON THOSE CATEGORIES.
SO IT'S IMPORTANT THE RESEARCH
RIGHT NOW IS TOO PREMATURE TO BE
ABLE TO DEDUCE EXACTLY THE
INFLUENCES OF INTERSECTIONAL
APPROACHES AND HOW THEY
INFLUENCE DOWN STREAM HEALTH
OUTCOMES BUT CONSISTENTLY
RESEARCH DOES SHOW BIAS EXPOSURE
PREDICTS INFLAMMATION, OXIDATIVE
STRESS AND POOR CIRCULATION WITH
ASTHMA HYPERTENSION AND MATERNAL
HEALTH OUTCOMES AND MENTAL
HEALTH AND WELL BEING.
KNOWLEDGE GAPS REMAIN AND
RESEARCH MECHANISMS LINKING BIAS
EXPOSURE TO HEALTH OUTCOMES.
THE MODEL ON THE RIGHT IS BASED
ON A REVIEW PUBLISHED IN HEALTH
PSYCHOLOGY OUTLINING THE
ASSOCIATIONS AND PHYSIOLOGICAL
REPRESENTATIVES AND ADVERSE
HEALTH CONDITIONS AND HEALTH
DISPARITIES.
RESEARCH REMAINS SILOED IN THE
SCIENTIFIC DISCIPLINES AND
LOOKING AT HEALTH DISPARITIES
AND MOREOVER LIKE THE PLEAS OF
TRANS-DISCIPLINARY SCIENTISTS
THERE'S BEEN LITTLE APPROACHES
TO BIASES TO DOWN STREAM
DISPARITIES.
NIMHD HAS TAKEN INITIATIVES AND
EFFORT IN FUNDING PROJECTS THAT
LOOK AT BIASES IN HEALTH.
FOR INSTANCE THERE'S THE NOFO
ABOUT STRUCTURAL RACISM AND
DISCRIMINATION AND THE YOUTH
BIAS PREVENTION WITH A FOCUS ON
DISCRIMINATION AND INTERVENTIONS
TO LESSEN THE IMPACT OF
DISCRIMINATION.
MORE RELATED TO THIS IS A
WORKSHOP BEING LED BY NIMHD
ALONG SIDE OTHER PARTNER
INSTITUTES AND CENTERS THAT
ENTITLE THE ADDRESSING HEALTH
OUTCOMES AND DISPARITIES.
THAT WILL TAKE PLACE JUNE 17 AND
18, 2:30 AND 5:30 AND A CLINGS
PERSPECTIVE TO GAIN MORE
COMPREHENSIVE UNDERSTANDING OF
THE STATE OF THE SCIENCE.
WE RAN A PORTFOLIO ANALYSIS ON
NIH FUNDED PROJECTS TO 2023 FOR
RESEARCH PROJECT GRANTS USING
KEY WORDS ASSOCIATED WITH
INTERPERSONAL SCIENTISTS AND
PROJECTS WERE DEEMED AS
INCLUSIVE AND ASSOCIATED WITH
INTERPERSONAL BIASES.
NIMHD FUNDED 30 PROJECTS WHICH
IS THE HIGHEST -- THE SECOND
INSTITUTE THAT FUNDS THE HIGHEST
NUMBER OF PROJECTS ON THIS
SCIENCE.
OUT OF THOSE 30, 16 WERE R01s
AND TWO LOOKED AT THE DIFFERENCE
IN INTERPERSONAL BIASES AND ONE
LOOKED AT SUBSTANCE USE AMONG
SGM POPULATIONS BUT NONE LOOKED
AT INTERPERSONAL BIASES AND THE
RELATION TO HEALTH.
IT LEADS ME TO THE CONCEPT.
THE INITIATIVE HERE IS TO
SUPPORT MULTI-DISCIPLINARY
MULTI-LEVEL RESEARCH LEARNING
BIASES TO HEALTH OUTCOMES AND AL
AND LONGITUDINAL AND
INTERVENTIONAL AND OF PARTICULAR
IMPORTANCE OF STUDIES ARE HIGHLY
ENCOURAGED TO USE INTERSECTIONAL
APPROACHES TO EXAMINE THE
IMPLICATIONS OF MULTIPLE FORMS
OF BIASES.
STUDIES TO ALSO LOOK AT
ASSOCIATIONS BETWEEN AND AMONG
COGNITIVE PERCEPTUAL AND
PREJUDICE CONCERNS, VIGILANCE,
STIGMA, INTERNALIZED,ISMS AND
TRANSCRIPTIONAL REGULATION,
INFLAMMATION, TELOMERE LENGTH
AND CHRONIC PHYSICAL AND MENTAL
HEALTH CONDITIONS.
SO AMONG THE PRIORITIES ARE
STUDIES THAT ASSESS THE TEMPORAL
PROCESSES BETWEEN ACTUAL AND
PERCEIVED EXPOSURE AND ADVERSE
HEALTH OUTCOMES.
STUDIES THAT EXAMINE CUMULATIVE
EXPOSURE TO BIASES OVER TIME ON
OXIDATIVE STRESS AND THE
INFLUENCE OF BIAS EXPOSURE WITH
MULTIPLE SOCIAL DETERMINATES OF
HEALTH ACROSS DOMAINS INCLUDING
THE BUILT ENVIRONMENT AND LEVELS
OF INFLUENCE NAMELY THE
INTERPERSONAL AND COMMUNITY
LEVELS.
STUDIES THAT ASSESS BIASES AND
MITIGATE THE INFLUENCE OF BIAS
ON HEALTH.
STUDIES THAT EXAMINE THE
INFLUENCE OF BIAS EXPOSURE ON
HEALTH PROMOTED BEHAVIORS SUCH
AS ABSTAINING FROM SUBSTANCE USE
AND HEALTH CARE UTILIZATION AS
WITH THE CANCER GUIDELINES AND
LINKING BIASES TO MALADAPTIVE
PHYSIOLOGICAL RESPONSES AND
STEREOTYPING AND PREJUDICE IN
CONTRAST TO STRESS AND OTHER
PHYSIOLOGICAL RESPONSES AND
METHODS TO IMPROVE THE EXISTING
MEASUREMENT TOOLS AND NOW
TAILORED TOOL TO MEASURE THE
IMPACT TO BIASES IN MULTIPLE
POPULATIONS.
THANK YOU.
>> THANK YOU VERY MUCH.
>> THANK YOU FOR THIS REALLY
EXCITING CONCEPT.
I HAVE THREE MAJOR AREAS I WANT
TO HIGHLIGHT WITH THE HOPE OF
STRENGTHENING THIS FURTHER.
I AGREE WITH YOU THERE'S A HUGE
OPPORTUNITY HERE TO BE ABLE TO
MAKE STRIDES IN BOTH THEORETICAL
AND METHODOLOGICAL ISSUES ON
INTERPERSONAL BIAS AND WONDERING
IF YOU'RE WILLING TO SPEAK ABOUT
THE BUILT ENVIRONMENT AS PART OF
SITUATING IDENTITIES THAT MIGHT
RESOLVE THAT BIAS AS PART OF
THIS CONCEPT.
>> THAT'S AN EXCELLENT QUESTION.
IT'S ONE THAT INFLUENCED THIS
CONCEPT IN THAT SO WE HAVE THE
STRUCTURAL BASIS CONCEPT.
SO IT'S IN A TOP-DOWN MANNER
EXAMINING THE INFLUENCE OF
STRUCTURAL RACISM INCLUDING THE
BUILT ENVIRONMENT.
THE YIN TO THE YANG AND THE
OTHER SIDE OF THE COIN TO TARGET
THE PROBLEM OF THE EXPOSURE TO
BIASES AT THE STRUCTURAL OR
INTER PER
INTERPERSONAL DIFFERENCES.
>> AND LOOK FOR THOSE
OPPORTUNITIES.
MY OTHER TWO THOUGHTS ON THIS
ARE MORE CONCEPTUAL AS WE THINK
OF INTERPERSONAL BIAS AND ONE
THING I SEE WITHIN THE
LITERATURE IS WE END UP
MEASURING AT THE INDIVIDUAL
LEVEL UNIT OF ANALYSIS AND
PERSONAL PROCESS.
SO WOULD REALLY HOPE THAT WE'RE
THINKING AS WE THINK OF SEXUAL
IDENTITIES WE THINK OF NETWORK
LEVEL DYNAMICS SO IF WE ARE ABLE
TO UNDERSTAND HOW INTERPERSONAL
BIASES PROPAGATE OR CURTAIL OR
MITIGATE IT, IT MAY GIVE
INSIGHTS FOR INTERVENTION DOWN
THE LINE WHICH I THINK ARE
IMPORTANT FOR US.
AND EQUALLY THEN THINKING ABOUT
SYSTEMS.
SO WHAT ARE THE POLICIES AND
STRUCTURES AND COMMUNITY NORMS
THAT MAY BE ENABLING OR
DISSUADING THE BIASES FROM
OCCURRING.
EXCITED FOR THE CONCEPT AND
LOOKING FORWARD TO LEARNING
MORE.
>>
>> THANK YOU, FOR YOUR RESEARCH
AND FOR REALLY PUTTING THE
EFFORT INTO DEVELOPING THIS
INITIATIVE.
I'M PARTICULARLY STRUCK AND
IMPRESSED WITH THE PRIORITY FOR
MULTI-DISCIPLINARY AND
HIGH-LEVEL RESEARCH FOR
UNDERSTANDING MECHANISMS AND
PATHWAYS.
I HAVE TWO ADDITIONAL
CONSIDERATIONS AROUND WANT TO
ASK HOW YOU'RE THINKING
REGARDING PATHWAYS AND PATHWAYS
AND OUTCOMES AND HOW ARE YOU
DI
THINKING OF THE STRUCTURES AND
SYSTEMS AS AN OPPORTUNITY.
>> THE WAY THE CURRENT
LITERATURE ESTABLISH THE
PROCESSES INVOLVED IS FROM TO
INTERPERSONAL BIASES DOWN TO
HEALTH OUTCOMES AND SOCIETAL
DISPARITIES.
BY WAY OF DIFFERENT MECHANISMS
AND PATHWAYS AND THE MEDIATORS
AND THEY INVOLVE THE PRECLINICAL
AND ONE BEING PRECLINICAL END
POINTS AND CARDIOVASCULAR
REACTIVITY, PREMATURE AGING
MEASURES AND PROMOTE HEALTHFUL
BEHAVIORS AS WELL.
THERE'S A WHOLE CONSTELLATION OF
MEDIATORS BY WHICH INTERPERSONAL
BIASES INFLUENCE HEALTH
OUTCOMES.
BECAUSE THIS CONCEPT AND
INITIATIVE IS ROOTED IN THE
INTERPERSONAL LEVEL THEN THE
FOCUS IS LARGELY ON WHAT WE
DON'T KNOW YET WHICH IS A THREAD
BETWEEN EXPOSURE BIASES DOWN TO
HEALTH OUTCOMES.
WITH THAT SAID ALSO A SPECIAL
ATTENTION GIVEN TO INTERPERSONAL
BIASES AT THE THE INDIVIDUAL
LEVEL INFLUENCE BIASES AND
STRUCTURAL BASIS OF
DISCRIMINATION AT THE SYSTEMS
LEVEL.
LIKE I INDICATED BEFORE, WE'RE
NOT GOING TO -- WE'RE GOING TO
GET SOMEWHERE BUT NOT MAKE
HEADWAY UNLESS WE TACKLE THE
PROBLEM BI-DIRECTIONALLY.
>> THANK YOU.
I THINK THERE'S AN OPPORTUNITY
YOU'RE TAPPING INTO HERE TO
FURTHER OR EXPLICITLY NAME THE
EXPOSURES THROUGH INTERSECTING
SYSTEMS AND STRUCTURAL RACISM
AND THE OPPORTUNITY TO LOOK AT
DIVERSE IMPACTS FOR
MULTI-CULTURAL COMMUNITIES WHICH
IS TYPICALLY IN SILOS.
INTERPERSONAL BIASES OCCUR
WITHIN SOCIAL DOMAINS AND THOSE
SOCIAL DOMAINS AND STRUCTURES
ARE ROOTED IN HISTORY AND MAYBE
RECONSIDER AS A THOUGHT IN THE
CONCEPT THE EXPOSURES, SOME OF
THE WORK FOR SOME DOCTORS AND
CONSIDER IMMIGRATION POLICIES
AND OTHER POLICIES AND EDUCATION
AND HOUSING.
I THINK ALIGNING AND NAMING
ANOTHER PRIORITY EXPOSURES IN
TERMS OF INTERGENERATIONAL AND
HISTORICAL TRAUMA THAT COMES
FROM AMERICAN INDIAN SCHOLARS
AND SHEDDING LIGHT ON CURRENT
EXPOSURES.
THEY'RE TRIGGERS AND CAN
RE-TRIGGER PARTICULAR HEALTH
OUTCOME BUT NOT JUST AT AN
INDIVIDUAL LEVEL BUT IS THERE AN
OPPORTUNITY TO LOOK AT
INTERGENERATIONAL OUR FAMILIAL
OUTCOMES AND SCHOLARS ARE
LEADING GAP AREAS IN
POSITIONALITY BUT IN CANADA
LOOKING AT THE INTERSECTIONALITY
OF OPPRESSIVE SYSTEMS AND WHEN
YOU LOOK AT SYSTEMATIC REVIEWS
AND 40% LOOKS AT HEALTH OUTCOMES
SO THIS IS AN OPPORTUNITY FOR
NIMHD TO LEAD AND FOR YOU TO BE
PART OF THAT AND REINFORCING OR
PUTTING THE CALL FOR THE
QUANTITY OF METHODS.
QUALITATIVE RESEARCH HAS BEEN AT
THE CORE OF INTERSECTIONAL
RESEARCH AND OUTCOMES BUT THE
METHODS ARE SIMPLISTIC AND UNDER
REPRESENTED UP RESEARCH
SCHOLARSHIP.
CONSIDERING BEYOND MORE
SIMPLISTIC LOOKING AT
MULTI-LEVELS AND BRINGING IN THE
CALL FOR DIFFERENT DISCIPLINES
SUCH AS SOCIOLOGY AND
ANTHROPOLOGY AND ALSO POLITICAL
SCIENCE AND LEGAL SCHOLARS GIVEN
OPPORTUNITY TO LOOK DEEPER AND
TEST THE MEASUREMENTS OR DEVELOP
MEASUREMENTS AROUND
METHODOLOGIES.
>> THANK YOU.
THANK YOU SO MUCH.
THOSE ARE EXCELLENT POINTS.
IN PARTICULAR TO YOUR FIRST
POINT I THINK IT'S IMPORTANT TO
CONSIDER THE FACT THAT THERE'S
RESEARCH SHOWING THAT.
DOWN STREAM GENERATIONS CAN
PREDICT THE HEAVILY OF IMPLICIT
BIASES ENCOUNTERED BY OUR
ANCESTORS REALLY.
AND I THINK IT'S REALLY
IMPORTANT TO BE ABLE TO APPEAL
TO OTHER DISCIPLINES IN
PARTICULAR SOCIOLOGY AS WELL TO
ASSESS ASSOCIATIONS BETWEEN
EXPOSURES ON DOWN STREAM
TECHNOLOGIES AND A LOT CAN BE
GAINED BY USING QUANTITATIVE
METHODS TO ASSESS
INTERSECTIONALITY AND TWEAK THE
I.T. TO ASSESS THE INFLUENCES ON
DOWN STREAM HEALTH DISPARITIES
AND STATISTICALLY YOU CAN
CERTAINLY USE MODERATION IN
ORDER TO BE ABLE TO SEE HOW
THESE TYPES OF BIASES INTERACT
AND TO DIFFERENTIALLY PREDICT
HEALTH OUTCOMES.
THANK YOU.
>> THANK YOU.
>> THANK YOU FOR EXCELLENT WORK.
A COUPLE CONCERNS YOU MAY WANT
TO CONSIDER FROM THE POINT OF
VIEW OF BIO CHEMISTRY AND
BIOLOGY.
IN ADDITION TO BIAS, THERE ARE
MANY OTHER EXPOSURES THAT CAN
READ TO STRESS.
IT COULD BE A TYPE OF STRESS
LABELLED AS STRESS WHICH CAN
ALSO LEAD TO EPIGENETIC CHANGE
AND SLEEP DISORDERS MAY LEAD TO
CHANGES IN THE LEVELS OF
INFLAMMATORY MARKERS AND
INTERLEUKINS AND THE QUESTION
BECOMES HOW DO YOU DESIGN THIS
OR WE CAN ROOT OUT ALL THE OTHER
BACKGROUND WHICH ARE LIKELY TO
OCCUR.
I HOPE THAT YOU CONSIDER THE
NOTION OF INDIVIDUALS VERY
STRONG AND CLEAR INCREASING
CRITERIA FOR ROOM THE STUDIES
OTHERWISE THERE'LL BE OVERLAPS.
FOR EXAMPLE THERE'S GENETIC
DEFICIENCY AND THOUGHT IT WAS
BUILD UP OF STRESS.
THEY'RE PART OF THE STUDY HOW DO
YOU DISTINGUISH THIS?
>> THAT'S A GREAT POINT.
I THINK IT'S ALSO IMPORTANT TO
NOTE BIASES GIVE WAY SO SO IN
ADDITION TO THE PRECLINICAL END
POINTS AND PSYCHOLOGICAL
PROCESSES THAT INCLUDE INCLUDES
WORRY, RUMINATION, THREAT,
VIGILANCE FOR THREATENING CUES
IN THE ENVIRONMENT AND BY WAY OF
THOSE IS THAT A WAY TO
EMPIRICALLY OUTLINE THE
ASSOCIATIONS BETWEEN BIAS
EXPOSURE TO HEALTH OUTCOMES.
I THINK IT WILL BE REALLY
IMPORTANT TO EXPLICITLY OUTLINE
THE PROCESSES INVOLVED TO RULE
OUT OTHER FACTORS THAT ARE NOT
ASSOCIATED WITH THE EXPOSURE
BIASES.
>> AND SO THEN IN THAT CASE
THERE WILL BE AN EXPECTATION IF
THERE ISN'T INTERVENTION THE
MARKERS CAN GO DOWN.
>> EXACTLY.
GOOD POINT.
>> THREW DR. GARRIDO FOR AN
EXCELLENT PRESENTATION AND
DISCUSSION.
I'M WONDERING IF YOU HAVE OR
WOULD CONSIDER THE TECHNOLOGY TO
CAPTURE EXPOSURES IN REAL TIME
AT LEAST ON IMPACT BECAUSE WE
KNOW SHE'S EXPOSURES MAY NOT BE
THE SAME AS WHEN THEY'RE REAL
TIME OCCURRING IN THE
ENVIRONMENT.
SO IS THAT SOMETHING THAT IS
MAYBE BEING CONSIDERED?
>> EXCELLENT POINT.
ABSOLUTELY.
THAT'S THE OTHER NOTABLE
COMPONENT OF THIS INITIATIVE IS
USING UNCONVENTIONAL TECHNOLOGY
TO REALLY ASSESS ALL THESE
VARIOUS DIFFERENT ASSOCIATIONS.
SO, YES, THANK YOU.
>> THANK YOU FOR THAT EXCELLENT
SUMMARY.
I GUESS I HAVE TWO QUESTIONS.
ONE, DOES THIS POTENTIALLY HAVE
ANY OPPORTUNITY FOR FOLKS TO
START INTERVENING AND ARE THERE
POTENTIAL ETHICAL CONCERNS WE
SHOULD BE THINKING ABOUT?
>> SURE.
SO IN THE BEGINNING I CONSIDERED
MAKING THE INTERVENTION PORTION
A CORE COMPONENT OF THE
INITIATIVE BUT I THINK WE NEED
TO REALLY HAVE A CLEAR PICTURE
AND DEDUCE THE PATHWAYS AND
MECHANISMS FIRST BEFORE
CONSIDERING INTERVENTIONS.
IN SOCIAL PSYCHOLOGY THERE'S
INTERVENTIONS BEING DEVELOPED TO
ADDRESS NOT ONLY IMPLICIT BIAS
BUT THE BEHAVIORAL OUTCOMES AND
MAYBE MITIGATING INTERNAL BIASES
BECAUSE SCIENCE SHOWS A CORE
BATTLE TO NEUTRALIZE BIASES.
OF COURSE, IF PEOPLE WANT TO GO
AHEAD AND DEVELOP INTERVENTIONS
BASED ON THE MECHANISTIC
FINDINGS THEY'RE WORKING ON AND
IMPLEMENTING EVIDENCE-BASED
INTERVENTIONS FROM SOCIAL
PSYCHOLOGY THEN IT'S MORE THAN
WELCOME BUT THE FOCUS IS TO
OUTLINE WHAT EXACTLY ARE THE
CONSOLATION OF PROCESSES THAT
TRULY GIVE WAY TO THE CHRONIC WE
CONSISTENTLY SEE FROM EXPOSURE
TO BIASES?
AS FAR AS ETHICAL CONCERNS
THERE'S ALWAYS ETHICAL CONCERNS
WHEN WE TALK ABOUT AS SOCIALLY
SENSITIVE AS IMPLICIT BIAS.
AND SO ALL THE MORE REASON TO BE
ENSURE THAT ETHICAL PROCESSES
AND PROTOCOLS ARE USED BY
EXTERNAL GRANTEES.
>> ARE THERE OTHER COUNCIL
MEMBERS?
OKAY.
SEEING NONE PLAY MAY I HAVE I
AMOTION TO MOVE THIS CONCEPT
FORWARD FOR FUNDING DEVELOPMENT?
IS THERE A SECOND MOTION?
>> I SECOND THAT MOTION.
6:
>> THANK YOU.
IT'S BEEN PROPERLY MOVED AND
SECONDED.
ALL IN FAVOR BY SHOW OF HANDS.I
SECONDED.
ALL IN FAVOR BY SHOW OF HANDS.
THE MOTION PASSES.
>> THANK YOU.
>> WE'RE GOING TO MOVE INTO OUR
NEXT PRESENTATION.
>> GOOD AFTERNOON AND GOOD
MORNING.
THANK YOU FOR THE OPPORTUNITY TO
PRESENT TODAY.
I'M GOING TO TALK ABOUT
SUPPLEMENTAL INCOME PROGRAMS OR
SOCIAL INSURANCE PROGRAMS AND
HEALTH ACROSS THE LIFE COURSE
WITH A FOCUS ON HISPANIC
POPULATION.
IN MY PRESENTATION I WOULD LIKE
TO HIGHLIGHT THE IMPORTANCE OF
RESEARCHERS WORKING HAND IN HAND
WITH POLICY MAKERS TO DESIGN
MORE EFFECTIVE SOCIAL INSURANCE
PROGRAMS FOR VULNERABLE
POPULATIONS AND EXPERIMENTAL
DESIGNS ARE USED IN THE CLINICAL
SETTING AND ANALYZING SOCIAL
INSURANCE PROGRAMS.
I WOULD LIKE TO ACKNOWLEDGE A
LARGE TEAM OF COLLABORATORS FOR
THE DIFFERENT EXPERIMENTS I'M
GOING TO PRESENT AND
UNIVERSITIES AROUND THE COUNTRY,
MEXICO AND EUROPE.
SO PREVIOUS RESEARCH HAS FOUND
SOCIO ECONOMIC STAT IS A
FUNDAMENTAL CAUSE OF HEALTH
DISPARITIES.
SO SOCIO ECONOMIC STATUS COULD
BE EDUCATION AND INCOME.
SO LOWER SOCIO ECONOMIC STATUS
EXPERIENCE HEALTH PROBLEMS IN
INDIVIDUALS SHORTLY AFTER AND
HIGHER STATUS MAY NOT PRESENT
HEALTH PROBLEMS UNTIL
ENVIRONMENT.
THE LIFE COURSE PATTERNS BETWEEN
LOW SOCIO ECONOMIC STATUS
INDIVIDUALS MAY SUGGEST AN
INCREASING HEALTHY START IN
INDIVIDUALS.
IN THIS FIGURE I'M SHOWING
POVERTY RATES BY AGE GROUPS.
IN THE BLUE BAR 0 TO 17 AND 18
TO 65 IN THE ORANGE BAR AND 66
OR OLDER IN THE GRAY BAR AND WE
OBSERVE THE UNITED KINGDOM,
CANADA, THE UNITED STATES AND
MEXICO.
YOU CAN SEE HERE THAT THE
U.S. HAS HIGHER POVERTY RATES
THAN THE U.K. AND CANADA ACROSS
THE THREE AGE GROUPS WE HAVE
HERE.
THIS IS EXACTLY THE MOTIVATION
FOR THESE PRESENTATION AND FOR
THE RESEARCH PROJECTS.
AND IF WE ANALYZED FURTHER THE
POVERTY RATE IN THE U.S. IT'S
MUCH HIGHER IN BLACK AND
HISPANICS ALMOST DOUBLE IN THE
AGE GROUPS.
SO IN TERMS OF SOCIAL INSURANCE
PRMZ PROGRAMS COULD BE CASH OR
NON CASH AND PROGRAMS INCOME
PROGRAMS AND NON-CASH COULD BE
ACCESS TO HEALTH CARE, FOOD
STAMPS OR SUBSIDIES AND WE'LL
FOCUS ON CASH BENEFITS THAT
IMPACT OR IMPROVE SOCIO ECONOMIC
STATUS AND COULD BE TEMPORARY OR
PERMANENT.
SO TEMPORARY LIKE BASIC INCOME
PROGRAMS AND PERMANENT LIKE
OTHER INCOME PROGRAMS.
SO INTERVENTIONS ACCORDING TO
THEORY AND THE LIFE COURSE
APPROACH INTERVENTIONS THAT
IMPROVE SOCIO ECONOMIC STATUS
ACROSS THE LIFE COURSE COULD
AFFECT THE LIFE EXPOSURES AND
REDUCE HEALTH DISPARITIES.
WE'LL FOCUS ON THE DESIGN AND
EFFECT OF SUPPLEMENTAL PROGRAMS
FOR LOW-INCOME OLDER ADULTS AND
SINGLE MOTHERS WITH CHILDREN.
FIRST I'M GOING TO TALK ABOUT
THE EXPERIMENTAL SUPPLEMENTAL
PROGRAM FOR OLDER ADULTS.
THIS WAS CONDUCTED IN MEXICO IN
THE STATE OF YUCATAN PENINSULA
HERE.
IT HAS HIGH POVERTY RATES AND
INDIGENOUS POPULATION AND WE
FOCUSSED IN THE PROGRAM STARTED
70 YEARS OLD OR OLDER.
WE TESTED DIFFERENT
IMPLEMENTATION DESIGNS WHETHER
THE SUPPLEMENTAL INCOME WAS
DISPERSED EVERY MONTH OR TWO
MONTHS AND HOW WE IMPLEMENTED
WITH THE DEBIT CARD FOR
INDIVIDUALS WHO DOESN'T HAVE
PREVIOUS ACCESS TO THE FINANCIAL
SECTOR OR WERE ILLITERATE AND
WENT TO 28% OF THE MINIMUM WAGE
OR 55% OF THE MEDIAN HOUSEHOLD
INCOME.
I WOULD LIKE TO ACKNOWLEDGE THE
FUNDING FROM THE NATIONAL
INSTITUTE ON AGING, THE
GOVERNMENT OF THE STATE OF
YUCATAN MEXICO AND THE RAND
CORPORATION CENTER FOR THE STUDY
OF AGING.
I'M GOING TO BRIEFLY DESCRIBE
HOW WE ANALYZED THE EFFECTS OF
THE PROGRAM.
SO WE COLLECTED LONGITUDINAL
DATA AT BASELINE AND FOLLOW UP
SERVICE FOR TREATMENT AND
CONTROL GROUPS.
THE SURVEY WAS BASED ON THE
U.S. HEALTH AND RETIREMENT
SURVEY THE HRS AND THE MEXICAN
FAMILY SURVEY FROM THE HRS THAT
IS THE MEXICAN HEALTH AGING
STUDY.
WE COLLECTED DATA IN PERSON AND
ALSO COLLECTED BIOMARKERS AND
TROPO METRIC MEASUREMENTS AND
COLLECTED DATA AT THE COMMUNITY
LEVEL FOR INFRASTRUCTURE AND
THERE'S A LARGE INDIGENOUS
POPULATION AND MANY SPOKE MAYAN.
WE TRANSLATED TO SPANISH AND
MAYAN AND HIRED BILINGUAL
INTERVIEWERS TO CONDUCT THE
SURVEY IN SPANISH OR MAYAN AND
DID ABOUT 65,000 HOUSEHOLDS AND
INTRODUCED ABOUT 16,000 AND
VISITED GROCERY STORES AND LOOK
AT THE PRICES AND THE ECONOMY ON
THE PROGRAM.
SO I'M GOING TO GIVE AN OVERVIEW
OF THE FINDINGS OF THESE
SUPPLEMENTAL INCOME PROGRAM.
THIS IS THE RESULTS SIX MONTHS
AFTER THE INTRODUCTION OF THE
PROGRAM FOR THE PROGRAM
DISPERSED EVERY PUBLIC HEALTH.
SO WHAT WE FOUND WAS AN INCREASE
IN HEALTH CARE UTILIZATION.
AN INCREASE OF THOSE REPORTING
GOING TO THE DOCTOR AND NUMBER
OF VISITS TO THE DOCTOR AS WELL
IN MEDICATION ACCESS.
WE FOUND STRONG EFFECTS IN
COGNITIVE ABILITIES, REDUCTION
IN ANEMIA AND IMPROVEMENT IN
FOOD AVAILABILITY.
WE FOUND THERE WAS REDUCTION IN
WORK FOR PAY AND REDUCTION IN
FAMILY TRANSFER.
SO THIS MAY BE A POSITIVE OR
NEGATIVE OUTCOME OF THE PROGRAM
BECAUSE REDUCTION IN FAMILY
TRANSFERS WAS NOT COMPLETE NOT
100% OF THE AMOUNT OF THE SUB
SUBSIDY REPRESENTED BUT CLOSE TO
30% AND THAT MAY ALSO IMPLY AS
FREQUENTLY AND THE OLDER ADULT
AND MAY HELP IN OTHER CHORES OR
ACTIVITIES.
WE ANALYZED THE POTENTIAL
POSITIVE OR NEGATIVE EFFECTS OF
THE PROGRAM.
WE FOUND MECHANISMS FOR MEN AND
WOMEN.
WE FOUND A STRONG EFFECT ON
HEALTH FOR BOTH.
MAYBE EVEN MORE FOR WOMEN AND
WOMEN SPENT MORE ON HEALTH CARE
UTILIZATION AND MEN MORE ON FOOD
AVAILABILITY.
NOW, WHEN WE VARY THE FREQUENCY
OF THE PAYMENT WHAT HAPPENED?
SO WE CONFERRED A PROGRAM WHERE
THE INCOME SUPPLEMENT WAS
DISPERSED EVERY MONTH VERSUS
ANOTHER PROGRAM WHERE THE INCOME
SUPPLEMENT WAS DISPERSED EVERY
TWO MONTHS AND THESE ARE THE
EFFECTS OF THE PROGRAM 18 MONTHS
AFTER THE INTRODUCTION.
SO ACCORDING TO ECONOMIC THEORY,
IT SAYS THE INCREASE IN
PERMANENT INCOME WHAT HAPPENS TO
INDIVIDUALS?
THEY ADJUST THEIR BUDGET
CONSTRAINT AND CONSUMPTION
ACROSS PERIODS.
THIS WOULD IMPLY DIFFERENT
FREQUENCY PAYMENT AND MEAN
INDIVIDUALS CONTINUE CONSUMING
IN THE SAME RATE IN ALL THE
WEEKS DURING THE MONTHS.
NOW, PREVIOUS RESEARCH HAS FOUND
THAT FOR THE U.S. THAT
HOUSEHOLDS WITH LITTLE SAVINGS
DO NOT NUMBER HAVE CONSUMPTION
BETWEEN SOCIAL SECURITY PAYMENTS
AROUND IT'S LESS COSTLY FOR THE
GOVERNMENT TO DISPERSE INCOME
SUPPLEMENTS EVERY TWO MONTHS OR
WITH LESS FREQUENCY.
AROUND THE WORLD THERE ARE MORE
PROGRAMS DISPERSED EVERY TWO
MONTHS AND WANTED TO TEST WHAT
HAPPENS IF WE HAVE MORE FREQUENT
PAYMENTS IN CONSUMPTION AND
HEALTH.
HERE WE CAN OBSERVE FOOD
EXPENDITURE PER CAPITA AFTER THE
INTRODUCTION OF THE PROGRAM.
IF YOU CAN SEE THE FIRST ONE IS
FOR THE MONTHLY PROGRAM AND THE
SECOND ONE BELOW IS FOR THE
EVERY TWO MONTH PROGRAM.
THE EVERY TWO MONTH PROGRAM WE
SEE THE SAME AMOUNT EVERY TWO
MONTHS.
THIS IS THE DAY THEY RECEIVE THE
INCOME SUPPLEMENT AND IN THE
HORIZONTAL ACCESS YOU CAN SEE
THESE ARE THE NUMBER OF WAYS
AFTER THEY RECEIVE THE INCOME
SUPPLEMENT.
TWO WEEKS LATER WE SEE THE FLAT
PATTERN OF FOOD EXPOSURE SO LIKE
THE FIRST FIGURE.
AND ZERO WAS THE FIRST DAY OF
THE MONTH AND WE COULD OBSERVE A
FLAT OR FLATTER OR SMOOTHER
PATTERN OF FOOD EXPENDITURE FOR
BOTH POPULATIONS BEFORE THE
IMPLEMENTATION OF THE PROGRAM.
ONCE WE INTRODUCED IT EVERY
MONTH AND SEE A FLAT PATTERN AND
HIGHER LEVEL BECAUSE THEY HAVE
NOW THE SUBSIDIES AND SPENDING
MORE ON FOOD BUT IN THE EVERY
TWO MONTH PROGRAM WE OBSERVE
SOMETHING DIFFERENT.
YOU CAN SEE HERE WHERE WE HAVE
THE ZERO THE FIRST DAY THEY
START RECEIVING THE SUPPLEMENT
THEY INCREASE THEIR FOOD
EXPENDITURE AND MAYBE THE FIRST
2.5 WEEKS AND THEN THEY THERE
SAY SHARP DECLINE IN FOOD
EXPENDITURE.
SO THIS MAY IMPLY HOUSEHOLDS ARE
INCREASING THEIR FOOD
EXPENDITURE THE FIRST 2.5 WEEKS
AND THERE'S A SHARP DECLINE.
WE OBSERVE WHERE YOU SEE HERE AN
INCREASE IN FAMILY TRANSFERS AND
REDUCE THE FOOD EXPENDITURE THEY
START TRANSFERRING BEFORE THE
NEXT PAYCHECK OR JUST BEFORE
THEY RECEIVE THE NEXT
DISBURSEMENT OF THE INCOME
SUPPLEMENT AND MAY IMPLY BECAUSE
BECAUSE THEY DECLINE THE FOOD
EXPENDITURE AND THIS IS THE
POVERTY CYCLE FOR THE FIRST
WEEKS AND THEN FOOD EXPENDITURE
DROPS SIGNIFICANTLY.
SO WHY ARE INDIVIDUALS, WHY IS
THE CONSUMPTION MOVING.
IT MAY BE THE LACK OF SAVINGS.
PREVIOUS RESEARCH HAS FOUND
LOW-INCOME INDIVIDUALS DON'T
HAVE ACCESS TO THE FINANCIAL
SECTOR AND IF THEY SAVE UNDER
THEIR MATTRESS THEY MAY HAVE
FEAR OF IT BEING STOLEN AND
WAITING TO MAINTAIN A LARGE
AMOUNT OF MONEY PAUSE OF FAMILY
PRESSURES.
PREVIOUS RESEARCH FOUND WHEN
INDIVIDUALS RECEIVE LARGE
DISBURSEMENTS MAY FACILITATE
HOME IMPROVEMENTS OR DURABLE
GOODS WITH THAT AMOUNT AND SHOW
YOU WHAT WE FOUND IN THE AFFECTS
OF THE PROGRAM AND THE EVERY TWO
MONTH PROGRAM.
IN THE FIRST COLUMN WE SEE THE
EFFECTS OF THE PROGRAM.
STRONG INCREASING FOOD
AVAILABILITY AND HEALTH CARE
UTILIZATION.
NO CHANGES ON BUYING DURABLE
GOODS HOWEVER WE FOUND IMPROVED
AVAILABILITY IS NOT AS STRONG OR
HIGH AS IN THE PROGRAM.
AND WE FOUND NO EFFECTS ON
HEALTH CARE UTILIZATION BUT FIND
AN INCREASE IN DURABLE GOODS
PARTICULARLY CELL PHONES WITH
THE AMOUNT OF MONEY RECEIVED
EVERY MONTH THEY CAN AFFORD CELL
PHONES AND OTHER DURABLE GOODS
OF SIMILAR PRICE.
THIS IS AN OVERVIEW OF THE
DIFFERENT RESEARCH PRODUCED FROM
THE EXPERIMENTS BUT JUST TO GIVE
A SUMMARY.
SO THE SUPPLEMENTAL INCOME
PROGRAM IMPLEMENTED EVERY MONTH
OR TWO MONTHS AND FOUND
DIFFERENT MECHANISMS FOR WOMEN
AND MEN AND WOMEN INCREASING
THEIR HEALTH CARE UTILIZATION
AND MEN FOOD AVAILABILITY WE
FOUND STRONG EFFECTS IMPROVEMENT
IN LUNG FUNCTION AND IMMEDIATE
RECALL AND DECLINE OF DEPRESSIVE
SYMPTOMS AND IMPROVEMENT IN
OBJECTIVE LIFE EXPECTANCY AND
REDUCTION IN FRAILTY
PARTICULARLY FOR WOMEN.
IN CONTRAST THE EVERY TWO MONTH
PROGRAM WE FIND IMPROVEMENT IN
FOOD AVAILABILITY AND DURABLE
GOODS BUT NO EFFECTS IN THE
OUTCOMES I MENTIONED BEFORE IN
TERMS OF HEALTH.
EVEN WHEN THEY'RE OLDER ADULTS
OR OLDER IN A VERY DISADVANTAGED
SITUATION WITH CHRONIC
CONDITIONS THERE'S STRONG
EFFECTS OF A CASH TRANSFER
PROGRAM.
WE DECIDED TO ANALYZE THIS AND
NOW WORKING WITH THE CITY OF
PROMOTING CLINICAL RESEARCH TO
IMPLEMENT A CASH TRANSFER
PROGRAM FOR SINGLE MOTHERS FOR
CHILDREN.
I'M TALK BRIEFLY ABOUT THE
PROGRAM.
IT'S FOR 12 MONTHS AND THESE ARE
PARTICULARLY SINGLE MOTHER THAT
HAVE AN INCOME BELOW THE POVERTY
LINE.
THE PROJECT IS ONGOING.
I'M GOING TO SHOW THE PRIMARY
RESULTS OF THE BASELINE SURVEY
AND FOCUS GROUPS AND HAVE A
FOLLOW UP SURVEY AND HAVE A
CONTROL GROUP IN THIS EXPERIMENT
AS WELL.
THIS IS THE CONCEPTUAL WORK OF
THE SURVEY.
WHERE WE HAVE THE INTERVENTIONAL
INCOME PROGRAM AND HAVE.
EXPERTS IN THE DIFFERENT TOPICS
AND HAVE A MULTI-DISCIPLINARY
GROUP AND PRODUCED FINDINGS IN
MATERNAL AND CHILDHOOD AND
FAMILY OUTCOMES PARTICULARLY ON
HEALTH, AND CHANGES ON
EMPLOYMENT ALSO FAMILY OUTCOMES
RELATED TO FOOD AVAILABILITY,
ECONOMIC STRENGTH AND HEALTH
OUTCOMES FOR CHILDREN.
SO THESE ARE THE RESULTS OF THE
BASELINE STUDY OF THESE
PROGRAMS.
SO WE HAVE IN THE FIGURES
TREATMENT AND CONTROL GROUPS
INCLUDED IN THE FIGURES.
SO YOU CAN SEE HERE THAT MOST
THE WOMEN ARE BETWEEN 31 AND 40
YEARS OLD.
THEY HAVE BETWEEN ONE AND TWO
CHILDREN IN THE HOUSEHOLD 90%
ARE LATINX OR HISPANIC AND
INTERESTING TO HIGHLIGHT
EDUCATION AND CLOSE TO 80% OF
HIGH SCHOOL GRADUATES HAVE LESS
THAN HIGH SCHOOL AND BLUE
SECTIONS OF THE PIE AND I THINK
IT'S WORTH HIGHLIGHTING AND
THERE'S BEEN MORE RESEARCH
COMING OUT INDIVIDUALS THAT HAVE
LESS THAN COLLEGE EDUCATION ARE
MORE LIKELY TO EXPERIENCE
INVOLUNTARY JOB SEPARATION.
MANY ARE PUSHED OUT OF THE LABOR
FORCE AND MAY COME BACK TO WORK
AS SELF-EMPLOYED OR PART-TIME
WORKERS BUT IT'S NOW IN THE
MARKET THERE'S A LOT OF PEOPLE
PARTICULARLY TO SUCCEED
PARTICULARLY TO THOSE WITH LESS
THAN COLLEGE EDUCATION.
WE THINK OF POVERTY BEING IN
POVERTY DURING YOUR PRIME
WORKING YEARS WILL LIKELY
TRANSLATE TO POVERTY IN OLD AGE.
IT'S VERY IMPORTANT TO CONSIDER
THIS AS THE POPULATION IN THE
U.S. IS AGING RAPIDLY PROBABLY
MORE THAN EVER BEFORE AND WE
HAVE PARTICULARLY FOR BLACK AND
HISPANICS THEY'LL DOUBLE IN THE
NEXT DECADES AND SO WE HAVE TO
THINK ABOUT IF WE DON'T
INTERVENE SOON WE'RE GOING TO
HAVE A HIGHER POVERTY RATES AT
OLDER AGES.
THESE ARE OUTCOMES OF THE SURVEY
AND DEPRESSIVE SYMPTOMS WE FOUND
CLOSE TO 50% OF THE PARTICIPANTS
REPORT HAVING DEPRESSIVE
SYMPTOMS.
IN TERMS OF PERCEIVED STRESS WE
OBSERVED MOST THE TIME CLOSE TO
40% AND 44% SOMETIMES.
MORE THAN 50% SHOW THEY'RE NOT
CONFIDENT AT ALL AND THEY HAVE
THEIR DEBT UNDER CONTROL.
IN TERMS OF LIKE HOW MUCH DEBT
INFLUENCE THEIR LIFE MORE THAN
50% REPORT A LOT OF OR A GREAT
DEAL.
AND IN DECEMBER THAT WAS
INTRODUCTION OF THE PROGRAM AND
THE PARTICIPANTS REPORTED MAINLY
THEY WERE SPENDING THE MONEY ON
FOOD CLOTHING, SCHOOL SUPPLIES
AND RENT AND GAS.
AND THERE'S REDUCED ECONOMIC
STRENGTH AND IMPROVE MENTAL
HEALTH AND REDUCED DEPRESSION
AND ANXIETY.
THEY HIGHLIGHTED IMPROVED THE
FLEET AND CHILDREN'S IMPROVEMENT
UP MENTAL HEALTH AND REDUCED
ANXIETY AND IMPROVED HOME
ENVIRONMENT BECAUSE THEY FELT
LESS STRESS AND MORE ABLE TO
SPEND TIME WITH THEIR FAMILY AND
I THINK IT'S WORTH ALSO
HIGHLIGHTING THEY ALSO MANY OF
THEM REPORTED THEY WERE ALLOWED
TO GET OUT OF THE SURVIVAL MODE
AND PLAN AHEAD.
MOST THE FOCUS GROUP
PARTICIPANTS REPORTED FEELING
DESPERATE BECAUSE OF THE RISING
PRICES IN THE U.S.
MANY OTHERS REPORTED USING THE
CASH.
ONE SAID SHE USED THE MONEY TO
TAKE A COURSE TO BECOME A HAIR
DRESSER AND THAT WOULD HELP
IMPROVE THEIR CAREER PROSPECTS
MORE THAN THE CURRENT JOB SHE
HAD.
IN TERMS OF THE FINDINGS IN THE
RESEARCH AND ANXIETY RUNS
BETWEEN SOCIO CLERK AND HEALTH
AND ENVIRONMENTAL METHODS GIVES
US THE OPPORTUNITY TO ANALYZE
THE EFFECT OF AND SHOCK ON THE
HOUSEHOLD OF THE PARTICIPANTS ON
HEALTH AND WELL BEING OF THE
RECIPIENTS AND EXPERIMENTAL
DESIGN WILL HELP IDENTIFY THE
MECHANISMS BETWEEN INCOME AND
HEALTH AND IT TRANSLATED TO HELP
US IMPLEMENT A PROGRAM IN THE
U.S. AND OBTAIN POTENTIALLY
BETTER HEALTH OUTCOMES IN THE
CITY OF EL MONTE AND CALIFORNIA
AND ONE KEY TAKEAWAY IS
IMPLEMENTATION MATTERS.
IT'S IMPORTANT TO THINK OF
HEALTH FOOD DESIGN AND PROGRAMS
TO HAVE A MORE EFFECTED IMPACT.
AND IT SEEMS BOTH PERMANENT AND
TEMPORARY INCOME PROGRAMS MORE
FREQUENT PAYMENTS WILL IMPROVE
THE HEALTH AND WELL BEING OF
RECIPIENTS.
THANK YOU.
>> THIS WAS WONDERING AND
WONDERING IF YOU CAN SPEAK TO
IMPLEMENTATION AND ARE THERE
PROGRAMS BUNDLED WITH THE
SUPPLEMENT AND DO YOU SEE THAT
POTENTIAL PAIRING AS AN
OPPORTUNITY FOR RESEARCH OR HAS
THAT BEEN DONE?
THIS IS NOT MY AREA.
>> IT'S IMPORTANT TO ANALYZE HOW
PROGRAMS COMPLEMENT EACH OTHER.
THEY FOCUS ON THE EFFECT OF
SPECIFIC PROGRAM SO WE EXPECTED
LIKE A YEAR AGO ANALYZING HAVING
ACCESS TO HEALTH CARE AND INCOME
OR SUPPLEMENTAL INCOME PROGRAM,
HOW DO THEY COMPLEMENT AND HOW
CAN WE BEST DESIGN THE PROGRAMS
SO THEY CAN COMPLEMENT BETTER
BECAUSE HEALTH CARE PROVIDES AN
INDIVIDUAL PERHAPS ACCESS TO
HEALTH INSURANCE AND HAVING
ADDITIONAL INCOME.
THERE'S NOT A LOT OF RESEARCH
AND IT'S AN IMPORTANT QUESTION.
>> EXCELLENT PRESENTATION AND TO
HEAR ABOUT YOUR WORK.
THERE'S BEEN SOME STUDIES THAT
INDICATED THAT IF YOU REDUCE
MATERNAL DEPRESSION, MOTHERS
PSYCHOSOCIAL STRESS YOU ALSO
HAVE IMPACT ON THE CHILDREN.
SO I WONDER IF I DON'T KNOW IF
YOU'RE DOING THAT IN THE CURRENT
STUDY OR IF THAT'S IN
CONSIDERATION FOR OTHER STUDIES
BUT ARE YOU MEASURING THE IMPACT
ON CHILDREN?
>> IN THE FOCUS GROUPS BECAUSE
THE MOTHERS ARE LESS STRESSED IT
CORRELATES TO LESS ANXIETY IN
THE CHILDREN BECAUSE THEY FEEL
STRESS AND THEY'RE PERHAPS LESS
PATIENT AND IMPROVED THE HOME
ENVIRONMENT AND IT'S AN
IMPORTANT POINT.
THANK YOU.
>> THANK YOU SO MUCH FOR THE
PRESENTATION.
I JUST WANT TO REFLECT, IF YOU
COULD, ON THE CONTEXT OF LATIN
AMERICA AND THE U.S. AND THESE
PROGRAMS HAVE BEEN IMPLEMENTED
IN OTHER COUNTRIES AND I'M MORE
FAMILIAR OF THE MEXICAN ONES AND
ARGENTINA.
SOME OF THE CRITIQUES COMING
FROM SOME PARTS OF SOCIETY IS
THAT IT'S DIVERTED THE FUNDS FOR
OTHER THINGS AND NOT USED ASS
INTENDED AND KEEPS PEOPLE FROM
GAINFUL EMPLOYMENT BY OH, WE
HAVE A SUBSIDY, WE DON'T HAVE TO
WORRY ABOUT WORKING.
COMMENT ON THAT AND THEN
RECENTLY IT'S BECOME -- I'M
GOING TO A RELATED SPECTRUM
WHICH IS BEHAVIORAL ECONOMICS
THE WHOLE ISSUE OF PAYING
INDIVIDUALS TO CHANGE BEHAVIOR
AND SO THAT HAS GOTTEN SOME
TRACTION OFTEN FUNDED BY NIA BUT
NOT EXCLUSIVELY ON SMOKING
CESSATION OR LOSING WEIGHT AND
MORE RECENTLY I THINK I WAS
READING A PLAN ALREADY STARTED
PAYMENTS TO INDIVIDUALS WHO HAVE
ADDICTION TO PARTICULAR
SUBSTANCES, NOT OPIOIDS BUT
AMPHETAMINE LIKE SUBSTANCES,
COCAINE, IF THEY SHOWED THEY ARE
WITHOUT USING DRUGS THROUGH
URINE TESTING TO REMAIN THAT WAY
AND HAVING TO PROVE IT WITH THE
URINE TESTS PERIODICALLY.
WOULD YOU COMMENT ON THIS LINE
OF WORK OF HOW THIS CAN BE USED
IN IMPROVING HEALTH?
>> THANK YOU.
>> THANK YOU FOR THE GREAT
QUESTION.
SO YES, PARTICULARLY GOVERNMENTS
AROUND THE WORLD ASKING IF WE
GIVE CASH TO INDIVIDUALS HOW
WILL THEY USE THE MONEY USING ON
SMOKING OR AND AS THE BEEN SHOWN
THAT THIS IS NOT THE CASE.
VERY LOW INCOME POPULATION WE
SEE FREQUENT PAYMENTS MORE
FREQUENTLY ARE ABLE TO USE THE
CASH TRANSFER PROGRAMS FOR BASIC
NEEDS.
AND WE MAY THINK POLICY MAKERS
LIKE WE SHOULD DESIGN THIS TYPE
OF SPECIFIC PROGRAM BUT IT MAY
BE IT'S NOT ONE SIZE FITS ALL.
AND HAVING A CASH TRANSFER
PROGRAM I WOULD SAY IS MORE
FLEXIBLE AND INDIVIDUALS HAVE
THE AGENCY TO DECIDE HOW TO
SPEND THE MONEY.
AND I THINK WE SHOULD THINK THAT
ALL INDIVIDUALS HAVE THAT AGENCY
TO BE ABLE TO KNOW HOW TO SPEND
THE MONEY.
AND EVEN WHEN AS RESEARCHERS WE
MAY THINK THEY SHOULD HAVE SPENT
IT THIS WAY BECAUSE IT'S MAYBE
MORE EFFECTIVE I THINK EVERY
PERSON KNOWS HOW BEST AND HOW IT
WOULD BENEFIT THEM THE MOST
GIVEN THEIR CIRCUMSTANCES.
AND I THINK NOW THAT WE'RE USING
SOCIAL INSURANCE PROGRAMS
EXPERIMENTAL METHODS WE CAN
ANALYZE THE DIFFERENT EFFECTS IN
THE HEALTH AND WELL BEING OF
POPULATIONS.
SO I UNDERSTAND THE CONCERN BUT
I THINK NOW RESEARCH AROUND THE
WORLD HAS SHOWN THAT THIS IS NOT
THE CASE.
IN TERMS OF BEHAVIOR IT'S
DIFFICULT TO CHANGE BEHAVIOR.
THERE'S BEEN SO MANY EXPERIMENTS
ON HOW TO INCENTIVIZE OR SEE
CHANGES IN BEHAVIOR.
SO INCOME CAN BE RELATED
TRANSLATE TO LOWER DEPRESSIVE
SYMPTOMS OR LOWER ANXIETY AND
THIS COULD BE ASSOCIATED WITH
SPECIFIC BEHAVIORS.
SO I THINK THAT NEEDS TO BE
TESTED FURTHER BUT THERE COULD
BE A LINK BETWEEN THOSE ASPECTS
OF HEALTH RELATED BEHAVIORS.
I WILL SAY PARTICULARLY FROM THE
EXPERIMENT IN CALIFORNIA THEY'RE
ABLE TO USE TEMPORARY CASH
TRANSFER FOR 12 MONTHS AND HAVE
BEEN REPORTED BEING ABLE TO DO
COURSES OR DOING SOMETHING ELSE
THAT WOULD ALLOW THEM TO GET
MORE TRAINING AND BE ABLE TO
HAVE BETTER CAREER PROSPECTS.
SO, AGAIN, A SMALL AMOUNT OF
MONEY FREQUENTLY HIGHER
FREQUENCY COULD ALLOW
POPULATIONS TO CHANGE THEIR
BEHAVIORS.
>> DR. STONE.
THANK YOU FOR THE RESEARCH,
DR. AGUILA, AND HOW MANY
FAMILIES WERE YOU ABLE TO TEASE
OUT IMMIGRATION STATUS?
>> THAT WAS AN IMPORTANT
QUESTION FOR US.
WE WERE INTERESTED BUT WE DIDN'T
WANT TO ASK IMMIGRATION STATUS
BECAUSE THEY DIDN'T WANT TO
CAUSE FEAR ABOUT THIS SO WE
DON'T HAVE THAT INFORMATION.
>> THANK YOU.
THAT MAKES SENSE.
THE REASON I WAS ASKING AS WE
THINK OF FEDERAL, STATE AND
LOCALITIES IN TERMS OF OFFERING
CASH ASSISTANCE AND MITIGATING
THE CYCLES ACROSS FAMILIES
PARTICULARLY LOW-INCOME
IMMIGRANTS AND OTHERS, WITH
MINIMUM WAGE LOSS IT VARIES
BETWEEN $7 ALABAMA AND
MISSISSIPPI TO OTHER AREAS JUST
OVER $17.
MINIMUM WAGE PLAYS A BIG FACTOR
IN TERMS OF INCOME SECURITY BUT
THEN WITH SNAP AND FEDERAL
BENEFITS, IN AUTHORIZED OR
UNDOCUMENTED IMMIGRANTS ARE
INELIGIBLE BUT STATES ARE ABLE
TO DETERMINE AND POLICY WISE HOW
COULD WE TAKE SOME OF THE
FINDINGS SHOWING THE POSITIVE
IMPACTS AND MAKE THE CASE AT THE
STATE AND LOCAL LEVEL AND FOR
COUNTY GOVERNMENTS THERE'S ALSO
EXPRESSION AND AUTHORITY TO MAKE
CHOICES ON WHO CAN GET CASH
BENEFITS AND HOUSING ASSISTANCE.
I'M THINKING THILS IN TERMS
OF -- THIS IN TERMS OF POSITIVE
FINDING AND HOW TO SHARE THIS
WITH OTHER STATES AND RUNNING
THE DISSEMINATION.
>> THANK YOU FOR THE QUESTION.
YES, AS WE RANDOMIZE WE HAVE
MORE THAN 3,000 APPLICANTS FOR
ALL OVER THE COUNTRY.
SO THERE'S A HUGE NEED AND IT
WAS ONLY -- IT ONLY QUALIFIED
THOSE LIVING IN THE CITY OF EL
MONTE AND THOSE LIVING IN THAT
CITY.
THERE WERE NO OTHER REQUIREMENTS
BUT SHOWING YOU WERE BELOW THE
POVERTY LINE.
SO, WE DON'T HAVE THAT
RELATIONSHIP BECAUSE WE'RE NOT
ASKING BUT POTENTIALLY THERE ARE
IMMIGRANTS IN THE SAMPLE AND
IT'S AN IMPORTANT TOPIC.
THIS IS A GOOD OPTION TO HAVE
TEMPORARY CASH TRANSFER PROGRAMS
TO ALLOW PEOPLE TO MOST OF THEM
IN THE FOCUS GROUP BEING ABLE TO
BE LESS STRESSED AND THINK ABOUT
THE FUTURE AND HOW TO OVERCOME
COME THROUGH TRAINING OR HELPING
MORE THE CHILDREN THEY LAG
BEHIND DURING THE PANDEMIC.
MANY OF THEM WERE ONLINE AND
MANY REPORTED THEY HAD TO PAY
MONEY TO PAY PRIVATE CLASSES TO
HELP THEIR CHILDREN CATCH UP.
SO THERE'S MANY MANY NEEDS IN
THE COMMUNITY THAT THIS CASH
TRANSFER OR TEMPORARY CASH
TRANSFER COULD HELP.
IN TERMS OF DISSEMINATION OTHER
CITIES HAVE APPROACHES AND WE'VE
GIVEN INFORMATION ON THE SURVEY
AND MAY BE WORKING WITH SOME OF
THEM.
>> THANK YOU VERY MUCH.
IT'S BEEN A VERY GOOD
PRESENTATION AND RICH
DISCUSSION.
AND.
WE'RE GOING TO BREAK NOW FOR
LUNCH.
I REALLY NEED YOU BACK AT 1:14
UP YOUR SEATS BECAUSE THE
PRESENTATION WILL START AT 1:15
AND YOU WON'T WANT TO MISS A
MOMENT OF IT.
PLEASE GET BACK.
THANK YOU VERY MUCH.
>> WE'RE READY TO RESTART AND E
HAVE KARINA WALTERS.
IT'S BEEN A WONDERFUL
PARTNERSHIP ON MANY PROGRAMS.
I'M SURE SHE'S BEEN BUSY CROSS
THE AGENCY.
SHE'S A SOCIAL EPIDEMIOLOGIST
FOCUSED ON HEALTH PREVENTION AND
DISEASE.
SHE HAD A STELLAR CAREER IN THE
UNIVERSITY OF WASHINGTON WITH
RESEARCH IN SUBSTANCE ABUSE AND
PHYSICAL ACTIVITY PROMOTIONS AND
DIABETES PREVENTION AND
DEPRESSION IN HIV PREVENTION SHE
SERVED ON NUMEROUS NIH GRANTS AS
PRINCIPLE INVESTIGATOR OR
CLINICAL INVESTIGATOR INCLUDING
FROM NIMHD
>> I'LL GIVE A SHOUT OUT TO ONE
TODAY.
>> SHE WAS FULL PROFESSOR THERE
AS AT THE UNIVERSITY OF
WASHINGTON SCHOOL OF SOCIAL WORK
AND HER DEGREE IS FROM THE
UNIVERSITY OF CALIFORNIA LOS
ANGELES AND PLEASE WELCOME AND
WE LOOK FORWARD TO YOUR
PRESENTATION.
>> THANK YOU.
[SPEAKING NON-ENGLISH]
>> THE INDIGENOUS PEOPLES OF
THIS LAND.
GOOD AFTERNOON.
MY NAME IS KARINA WALTERS.
I JUST INTRODUCED MYSELF IN
INDIGENOUS LANGUAGE OF OKLAHOMA
AND PAY MY RESPECTS TO THE
INDIGENOUS PEOPLE OF THIS LAND
AND TERRITORY WE'RE IN.
IT'S AN HONOR AND PRIVILEGE TO
BE ABLE TO SHARE WITH YOU A
LITTLE BIT ABOUT THE TRIBAL
HEALTH RESEARCH OFFICE AND ABOUT
MY RESEARCH AND WHAT I BRING TO
THIS OFFICE AND A LITTLE BIT
ABOUT MY PHILOSOPHY IN THE WORK
I'VE BEEN DOING TO THIS POINT.
IT'S A BIG TRANSITION AN
EXCITING PLACE TO BE.
THE TRIBAL HEALTH RESEARCH
OFFICE SITS IN THE OFFICE OF THE
DIRECTOR WHERE ONE OF THE NOW
16.
IT WAS 14 OFFICES OF THE OFFICE
OF THE DIRECTOR.
WE'RE THE SYNERGISTIC HUB FOR
AMERICAN INDIAN AND INDIGENOUS
AND POPULATIONS AND TEND TO BE A
FORWARD FACING OFFICE A LITTLE
BIT MORE THAN OTHER OFFICES.
BECAUSE OF OUR ROLE AND WE
GENERATE DATA SCIENCE AND
WORKFORCE THAT BUILDS OFF THE
LIVES AND COMMUNITIES OUR
ULTIMATE GOAL IS TO BUILD HEALTH
EQUITY THROUGH CREDIBLE AND
MEANIN
MEANINGFUL INDIGENIST VIEWS AND
USING OUR VIEWS AND KNOWLEDGES
IN THE WORK WE DO.
AS THE THEME SUGGESTS IT'S ABOUT
INDIGENOUS KNOWLEDGES EMPOWERING
THE SCIENCE.
WE'RE FWIGUIDED BY VALUES DEVELD
SINCE I'VE BEEN HERE.
I KNEW I HAD TO MAKE AN ACRONYM
SO WE CHOSE THE ACRONYM CEDAR.
IT'S A BEAUTIFUL MEDICINE TO
INDIGENOUS PEOPLE ALL OVER THE
COUNTRY UP TO ALASKA AND OFTEN
IT'S A MEDICINE FOR CLEANSING
AND PURIFYING AND HEALING AND
MULTIPLE PURPOSES.
WE CHOSE THE WORD TO GUIDE US
THROUGH OUR ACTIONS AND C STAND
FOR CREATIVITY.
WE WANT TO MOVE BEYOND
CONVENTIONAL SCIENCES AND
EMPLOYEE INDIGENOUS METHODS TO
MAKE SURE SCIENCE DRIVES
SUSTAINABLE POPULATION HEALTH
CHANGE AND EMBRACE STRONGEST
ETHICS AS POSSIBLE.
WE WANT THE HIGHEST STANDARDS OF
ETHICAL AND PROFESSIONAL
BEHAVIOR AND WANT TO BE
CULTURALLY RESPONSIVE AND WE
WANT TRANSPARENCY AND HONESTY IN
OUR INTERACTIONS.
THIS HAS TO DO IN WITH
RECOGNIZING AND RESPECTING
TRIBAL SOVEREIGNTY AND RIGHTS TO
SELF-DETERMINATION AND WE HOLD
OURSELVES ACCOUNTABLE FOR THE
LASTING IMPACT OF OUR WORK AND
COMMITMENTS MADE TO PARTNERS AND
RESPONSIBLE SO WE RESPECT AND
VALUE THE UNIQUE DIVERSE TALENTS
THE COMMUNITIES BRING TO THE
ISSUES WE'RE TRYING TO ADDRESS
AND RESPECT THE CHALLENGE AT THE
NIH AND OTHER PARTNERS.
THE OTHER PIECE IS BEING MINDFUL
THAT WE'RE A GOOD ANCESTOR.
WE WANT TO MAKE SURE THE ACTIONS
WE TAKE AT THE OFFICE THAT IT
DOESN'T JUST IMPACT THE CURRENT
GENERATION BUT WE'RE THINKING
SEVEN GENERATIONS AHEAD AND A
GREAT OPPORTUNITY TO HEAL THE
THINGS OUR COMMUNITIES DIDN'T
GET A CHANCE TO HEAL SEVEN
GENERATIONS AGO AND CONSIDER
THAT RESPONSIBILITY TO BE AN
IMPORTANT POWERFUL PLACE TO BE
AND WANT TO HONOR THAT.
SO WHO DO WE SERVE?
WE SERVE 574 FEDERALLY
RECOGNIZED TRIBAL NATIONS.
IF YOU TAKE AMERICAN NATIVE AND
ALASKAN NATIVE ONLY WE'RE ABOUT
2.5% OF THE POPULATION RIGHT
NOW.
IF YOU INCLUDE PEOPLE WHO SAY
I'M AMERICAN INDIAN FIRST AND
FOREMOST AND HAVE OTHER ETHNIC
TIES AND AFFILIATIONS WE JUMP UP
TO 4% TO 97 MILLION PEOPLE WE
ENGAGE NATIVE HAWAIIAN AND OTHER
POPULATIONS OF THE
U.S. TERRITORY LIKE GUAM AND
OTHERS AND THAT'S A MANDATE AS
WELL THOUGH THEY'RE NOT --
HAWAIIANS ARE NOT RECOGNIZED AS
TRIBAL GOVERNMENT BUT WE SEE
THEM AS INDIGENOUS PEOPLE AND
EXPECT TO CONFER AND CONSULT
WITH THEM IN THE WORK WE DO AS
WELL.
THAT BRINGS ME TO THE NEXT POINT
WHERE IT'S IMPORTANT TO HAVE A
TRIBAL.
HEALTH OFFICE AT THE NIH BECAUSE
AN IMPORTANT AND UNIQUE MEMBER
OF THE FAMILY.
YOU CAN'T PUT US IN A RACE OR
ETHNIC CLASS.
WE HAVE A POLITICAL STATUS IN
THE UNITED STATES.
OUR OBLIGATION IS TO THE 574
TRIBAL SOVEREIGN NATIONS AND
TREATIES AND LAWS IN THE AND
AFFIRMED THAT ABLE TO NATIONS
RETAIN THEIR POWERS OF
SELF-GOVERNMENT AND TRIBAL
INDIAN RESPONSIBILITY A LEGAL
ENFORCEABLE OBLIGATION ON THE
PART OF THE UNITED STATES
GOVERNMENT TO PROTECT TREATY
RIGHTS AND ASSETS AND RESOURCES
INCLUDING ECONOMIC, SOCIAL AND
HEALTH AND THE EXPECTATION IS
GOVERNMENT IN PERPETUITY HAS A
RESPONSIBILITY AND TRUST
RESPONSIBILITY TO ENSURE THEY'RE
WORKING TOWARDS RAISING THE
STANDARD OF LIVING AND SOCIAL
WELL BEING FOR AMERICAN INDIANS
AND ALASKAN NATIVES AS A
SOVEREIGN TREATY AND I TALKED
ABOUT HOW MANY NATIVE
POPULATIONS THERE ARE WE'RE
PROJECTED TO BE 10.1 MILLION BY
2060.
WE'RE A YOUNG POPULATION AND
HAVE MORE CHILDREN ON AVERAGE
THAN OTHER GROUPS AND THOUGH WE
HAVE 574 FEDERALLY RECOGNIZED
TRIBES WE HAVE STATE RECOGNIZED
TRIBES WE'RE ACCOUNTABLE TO.
WE HAVE 274 RESERVATION TRUST
LANDS WE HAVE TO BE MINDFUL OF
AND 200 UNIQUE LANGUAGES AND
MANY OF OUR TRIBES STILL SPEAK
AS A PRIMARY LANGUAGE THEIR
FIRST LANGUAGE THEIR TRIBAL
LANGUAGE.
I'M A MEMBER OF THE CHOCTAW
NATION OF OKLAHOMA AND THE
MISSISSIPPI BAND OVER 80% OF
THEIR CHILDREN THEIR FIRST
LANGUAGE IS CHOCTAW.
IT STILL EXISTS TODAY.
51% FOR THOSE WHO GO TO ALASKAN
NATIVE AND CALIFORNIA AND NEW
MEXICO AND STATES WITH THE
HIGHEST PERCENTAGE OF AMERICAN
NATIVES ARE PRIMARILY IN ALASKA,
MONTANA AND OKLAHOMA AND YOU'LL
SEE DIFFERENT THINGS.
THE LARGEST URBAN INDIAN PONGS
-- POPULATIONS ARE IN
CALIFORNIA AND NEW YORK AND 70%
OF COMMUNITY LIVES IN
OFF-RESERVATION AREAS BUT ONE OF
THREE PEOPLE LIVING IN TRIBAL
AREAS RETURN HOME ANNUALLY FOR
CEREMONIES OR TO BE CONNECTED
WITH FAMILY MEMBERS, SOMETIMES
DURING THE SUMMER MONTHS AND
OTHER TIMES FOR HEALTH CARE
BECAUSE THEY GET THEIR HEALTH
CARE THROUGH INDIAN HEALTH
SERVICE.
SOMETIMES THEY WAIT TO GET
SUPPORT BECAUSE THEY DON'T HAVE
INSURANCE IN THE URBAN
ENVIRONMENT AND WAIT AND MAKE
THAT LONG TREK HOME.
THAT'S NOT UNCOMMON.
WE'RE LIVING A HEALTH REALITY
OUR ANCESTORS DID NOT DREAM FOR
US.
WE SUFFER FROM CHRONICALLY UNDER
FUNDED INACCESSIBLE HEALTH CARE
SYSTEM.
TO GIVE AN EXAMPLE, INDIAN
HEALTH SERVICE FOR EXAMPLE WAS
FUNDED WELL BELOW WHAT FEDERAL
PRISONERS GET IN TERMS OF HEALTH
CARE.
SO WE ABSOLUTELY -- IT'S
IMPROVED BUT WE'RE NOWHERE NEAR
WHERE WE SHOULD BE.
OUR STRUCTURAL DETERMINATES OF
HEALTH ARE THE POOREST IN THE
NATION AND HAVE STANDARD OVER
CROWDED HOUSING AND FOOD DESERTS
AND HIGH INSECURITY THAT
SKYROCKETED DURING THE PANDEMIC
AND SOME DON'T HAVE ELECTRICITY
AND EXPOSURE TO POLLUTANTS AND
TOXIN.
THESE AROUND OTHER FACTORS LED
TO CHRONIC DISEASE.
WE DON'T HAVE JUST HEART DISEASE
OR DIABETES, WE HAVE MULTIPLE
SYNERGISTIC SIMULTANEOUSLY WHICH
MEANS DEVELOPING INTERVENTIONS
OR EVEN TRACKING SOME OF THE
CAUSAL FACTORS RELATED TO THAT.
YOU CAN'T JUST GO BY ONE
DISEASE.
WE HAVE TO LOOK ACROSS DIFFERENT
DISEASES FOR OUR COMMUNITIES.
THE MORTALITY RATES THIS GIVES A
COUPLE EXAMPLES.
WE HAVE THE HIGHEST
UNINTENTIONAL INJURY RATE AND
HIGHEST DIABETES RATES AND LIVER
DISEASE AND ALCOHOL-INDUCED
MORTALITY AND IN 2022 THE
HIGHEST RATES OF 56.6 DEATHS PER
100,000 AND 33% INCREASE IN
OVERDOSE DEATHS AND IN MONTANA
AN ELDER SAID FROM DECEMBER TO
FEBRUARY THEY LOST 24 YOUNG
PEOPLE TO FENTANYL IN A SMALL
COMMUNITY WE'RE NOT IN GOOD
HEALTH RIGHT NOW.
WE HAVE THE HIGHEST SUICIDE
RATES FOR MEN AND WOMEN AND IT
VARIES BY COMMUNITY.
SOME COMMUNITIES ARE GETTING HIT
HARDER WITH THE RATES THAN
OTHERS.
HOW MANY PEOPLE PARTICIPATE IN
CLINICAL TRIALS WE HAVE THE
HIGHEST RATE.
WHAT'S THE IMPACT?
WE NOW HAVE THE LOWEST LIFE
EXPECTANCY SINCE WORLD WAR II.
ONE OUT OF FOUR WILL LIVE TO 45.
MY MOTHER IS A GREAT CASE IN
POINT.
I THINK OF HER OFTEN BECAUSE
THIS WORK FOR ME IS PERSONAL AND
PROFESSIONAL.
MY MOM PAST AT 45 FROM HER THIRD
RARE FORM OF CANCER LIKELY
CAUSED FROM TOXIN EXPOSURE WHEN
HER MOM LABORED IN SALINAS SO
SHE FELL INTO THAT STATISTIC.
LIFE EXPECTANCY VARIES BY TIME.
IN THE SOUTH WEST SOME LIFE
EXPECTANCIES SOME TRIBES FOR MEN
IS ONLY 46.
FOR WOMEN IT'S 52.
WE'RE IN A HEALTH CRISIS AND
WE'RE INVISIBLE.
WE'RE NOT IN NATIONAL HEALTH
DATA.
IF YOU LOOK AT THE HEALTH DATA
AND GOES TO AFRICAN AMERICAN,
LATINO, ASIAN SOMETIMES, NOT
ALWAYS, AND WHITE.
WE'RE OTHER.
YET WE'RE DISPROPORTIONATELY
IMPACTED BY THE HEALTH OUTCOMES
AND IF YOU COULD HAVE TOLD ME IN
MY TRIBE ONE OF THREE CHILDREN
BY 25 WOULD BE LIVING WITH
DIABETES WHY IS THAT A HEALTH
CRISIS?
GRANDPARENTS WILL OUTLIVE THEIR
GRANDCHILDREN AND WE WERE THE
DESCENDANTS OF TRAIL OF TEARS.
THEY DID NOT WALK THAT TRAIL OF
TEARS FOR US TO DIE BUT A VISION
OF LIFE IN -- LOVE IN LIFE AND
IT'S MY PERSONAL OBLIGATION AND
OFFICE'S OBLIGATION TO HARNESS
OUR COLLECTIVE WISDOM AND
SCIENTIFIC KNOWLEDGE TO ACHIEVE
HEALTH AND HEALTH EQUITY.
I'M GIVE -- DRIVEN TO DO THIS.
IT'S ABOUT HARNESSING POWER TO
HEAL THROUGH SCIENCE.
WE'RE DOING THAT THROUGH FOUR
MAIN AREAS.
ONE IS THROUGH ADVANCING
INDIGENOUS RESEARCH THE CREATIVE
RESEARCH THAT WE'RE HOPING BY
AND FOUR COMMUNITIES INCLUDING
INNOVATION AND OTHER INDIGENOUS
METHODOLOGIES AND TO BEGIN TO
LOOK AT DEVELOPING NOT ONLY
CULTURALLY CREDIBLE AND VALID
SCIENCE BUT SUSTAINABLE HEALTH
IMPACT AND CULTIVATING CAPACITY.
IMPROVING NOT ONLY THE KNOWLEDGE
AT THE NIH WE DO WORK
INTRAMURALLY TO INCREASE
COMPETENCIES AND UNDERSTANDING
ABOUT ISSUES OUR COMMUNITIES ARE
FACING.
ALSO IF WE HAVE 1,000 Ph.D.s IN
THE ROOM HOW MANY DO YOU THINK
WOULD BE AMERICAN INDIAN OR
ALASKAN NATIVE?
TAKE A WILD GUESS.
IT'S ONE-THIRD OF ONE PERCENT
ARE Ph.D.s BUT HOW MANY ARE
RESEARCHERS?
VERY SMALL PROPORTION.
THE REASON IS OUR COMMUNITY GOES
INTO MORE SERVING PROFESSIONALS,
PSYCHOLOGY AND WE HAVE MORE WORK
TO DO TO CREATE A REPRESENTATIVE
WORKFORCE BECAUSE OF BRINGING
THAT EXPERIENCE TO THE TABLE TO
HELP FLUSH OUT AND BUILD SCIENCE
AND BUILD BETTER SCIENCE IN
PARTNERSHIP WITH COMMUNITIES.
THE THIRD ELEMENT WE DO WHICH IS
UNIQUE TO OUR OFFICE, WE ARE
RESPONSIBLE FOR TRIBAL
CONCENTRATION.
ARE AND FEDERAL AGENCIES CONSULT
WITH TRIBES BEFORE MAKING BIG
DECISIONS IMPACTING TRIBAL WELL
BEING AND WORKING WITH NIMHD
WITH THE CANCER MANDATES THAT
CAME THROUGH AND HELPING IN THE
CONSULT AND BLAZING NEW PATHS
FOR STRATEGIC INITIATIVES,
POLICIES AND COLLABORATIONS.
WE GET TO BRING OUR OWN
EXPERIENCE AND SCIENCE TO THE
FOREFRONT TO BEGIN TO PULL
TOGETHER ACROSS THE DIFFERENT
I.C.s OPPORTUNITIES TO DEVELOP
NEW INITIATIVES, PAUSE FOR NEW
SCIENCE THAT WOULD BE RESPONSIVE
TO COMMUNITY IDENTIFIED NEEDS.
WE'RE DEVELOPING GUIDANCE HERE
AND THE BIDEN ADMINISTRATION
MANDATED THAT FEDERAL AGENCIES
DEMONSTRATE HOW THEY'RE
INCORPORATING INDIGENOUS
KNOWLEDGES IN THE WORK THEY DO.
WE'LL HARMONIZE WITH THAT POLICY
AND WORKING WITH THE NIH ON THAT
AND NIMHD ON THAT.
WE'RE WORKING ON DEVELOPING AN
INDIGENOUS DATA SOVEREIGNTY
POLICY AT THE NIH.
WE'RE ALSO DEVELOPING
CROSS-CUTTING INITIATIVE AROUND
BOARDING SCHOOL HEALING
INITIATIVE.
I'LL GIVE A COUPLE HIGHLIGHTS ON
THAT RIGHT NOW.
IN TERMS OF THE DATA SOVEREIGNTY
AND AN INDIAN COUNTRY IT'S BEEN
STRONG A NUMBER OF YEARS AND THE
RECENT EXECUTIVE ORDER ALSO SAID
IN RECOGNIZING SELF-GOVERNANCE
WE'RE ALSO RECOGNIZING
INDIGENOUS DATA SOVEREIGNTY WORE
LOOKING TO HAVE A POLICY AND
ALREADY HAVE GUIDANCE BUT WE
NEED A POLICY TO WE DON'T HAVE
THE GIANT OCTOPUS WITH 27
INSTITUTES WITH ITS OWN BRAIN
SYSTEM DOING ITS OWN THING AND
THIS WILL HELP GET IN SYNC AND
HONORING DATA SOVEREIGNTY WITH
TRIBES.
IN TERMS OF BOARDING SCHOOL
HEALING INITIATIVE, TO GIVE A
COUPLE HIGHLIGHTS WHY THIS IS
IMPORTANT, I DON'T THINK I NEED
TO GO TOO MUCH INTO THIS.
DO YOU KNOW WHAT HAPPENED WITH
THE BOARDING SCHOOL?
1819 TO 1960s, FEDERAL
GOVERNMENT HAD A MASSIVE POLICY
TO REMOVE NATIVE KIDS AND PLACE
THEM IN RESIDENTIAL SCHOOLS
FORCING THEM TO ASSIMILATE TO
NOT SPEAK THEIR LANGUAGE AND
SPEAK ENGLISH AND ENFORCED
CHRISTIANITY AND THE IMPACT
IMPACTED GENERATIONS AND THEY
LAUNCHED THE BOARDING SCHOOL
HEALING INITIATIVE IN 2021.
FINISHED A REPORT WHERE SHE
LOOKED TO SEE HOW MANY BOARDING
SCHOOLS THEY WERE AND WHAT
IMPACT IT HAD.
WHERE ARE THE GRAVE SITES OF
CHILDREN WHERE EITHER MURDERED
OR DIED IN THESE SCHOOLS.
SHE SAID THE IMPACT OF THESE IS
HEARTBREAKING AND WANTS TO
CONTINUE TO SEE THE EVIDENCE AND
HAVE SEEN THE EVIDENCE
CONTINUING TO THIS DAY AND IT'S
WRITHING DISPARITY AND ARE NOT
ONLY GIVES VOICE TO SURVIVORS
AND LAUNCHED THE ROAD TO HEALING
RIGHT NOW.
THEY'RE IN THAT PHASE OF THE
INITIATIVE AND GOING TO AROUND
THE COUNTRY ASKING SURVIVORS TO
TOLL THEIR STORIES.
I WAS A FORMER THERAPIST.
WHEN I HEARD THAT I THOUGHT, OH,
WE NEED TO DO SOMETHING ELSE
HERE.
YOU CAN'T JUST OPEN UP THAT CAN
AND NOT HAVE SOMETHING FOR IT.
SHE'S HELPING █COMMUNITIES DO
MORE APPROACHES AND WE SHOULD BE
LEADING THE CONVERSATION ON
DEVELOPING RESEARCH ON THE
BIOLOGICAL TRAUMA SAYING WHAT IS
THE STATE OF SCIENCE WITH
RESPECT TO THAT AND WORKING WITH
BOARDING SCHOOL SURVIVORS AND
COMMUNITY MEMBERS DOING THE WORK
ON THE GROUND TO IDENTIFY WHAT
WOULD HELP BUILD INNOVATIVE
HEALING INTERVENTIONS AND HEALTH
PROMOTION INTERVENTIONS OF
COMMUNITY LEVEL.
WHAT WE'VE DONE IS WE'VE MOVE
FORWARD WITH BUILDING LOOKING TO
BUILD A SUMMIT PROBABLY THIS
FALL WHERE WE'RE GOING TO DO
JUST THAT AND BRINGING UP
SUBJECT MATTER EXPERTS IN
INTERACIAL PEOPLE AND INVITING
NIH AND HOPEFULLY EVERYONE COULD
BE THERE TO LISTEN IN AND HEAR
WHERE THE CURRENT STATE OF THE
SCIENCE AND PRACTICE IS.
WE CAN INNOVATE A PLAN TO
RESPOND AND INVITING TO
SYNCHRONIZE ACROSS HHS TO BUILD
INITIATIVES.
WE'RE PARTNERING WITH THE
NATIONAL BOARDING SCHOOL OF
HEALING COALITION IN CHARGE OF
THE REPORT AND ARE VERY EXCITED
ABOUT THIS.
STAY TUNED FOR THAT AND
SOMETHING WE CAN GET EXCITED
ABOUT.
FOR A MINUTE I WANT TO SHARE
BRIEFLY ABOUT MY OWN RESEARCH
AND THE REASON I GET EXCITED
ABOUT THIS IS BECAUSE I DID
RESEARCH IN HISTORICAL TRAUMA.
THAT'S MY BACKGROUND.
AND ONE OF THE THINGS WE
IDENTIFIED FOR A LONG TIME IS
IT'S NOT JUST ENOUGH TO IDENTIFY
EVENTS AND CREATE INTERVENTIONS
THAT ADDRESSED IT.
WE LOOKED AT INCORPORATING
ORIGINAL TEACHINGS, INSTRUCTION,
RESTORING RELATIONAL WAYS OF
BEING AND TO TRANSFORM HOW WE
TELL THE STORY OF OUR LIVES.
TO SHARE BRIEFLY WHY -- I SAY
ORIGINAL STRUCTURE AND SOMETIMES
PEOPLE AREN'T SURE WHAT THAT
MEANS SO I'LL DO A COMIC BOOK
VERSION FROM THE CHOCTAW POINT
OF VIEW.
WE HAVE A STORY WHERE SUN AND
MOON WERE LOVERS IN THE SKY.
AND THEY HAD ALL THEIR STAR
CHILDREN AND LIVED TOGETHER IN
THE BRIGHT SKY TOGETHER AND THE
MOON NOTICED THERE'S A SUN FLARE
SOMETIMES AND SAID IF ANY OF
YOUR FLARES HIT ME OR MY
CHILDREN WE'RE GOING TO THE
OTHER SIDE WORLD AND I'M TAKING
MY STAR CHILDREN AND GOING TO
THE OTHER SIDE AND SAID DON'T
WORRY, THAT WON'T HAPPEN.
SURE ENOUGH, SHE LOOKS UP AND HE
GOT HER STAR CHILDREN AND WENT
TO THE OTHER SIDE OF THE WORLD
AND HOW WE GOT DARKNESS AND
BEGGED HER AND SAID PLEASE COME
BACK.
IT WAS AN ACCIDENT AND SHE SAID,
NO, THIS IS THE PROTOCOL AND I
KNOW YOU LOVE ME AND I LOVE YOU
AND YOU NEED TO VISIT YOUR STAR
CHILDREN SO EVERY MONTH WE'LL
MEET IN THE MORNING AND SHARE
THE NIGHT SKY TOGETHER AND CAN
VISIT THE CHILDREN AND THAT'S
HOW IT WAS.
THAT'S A CHOCTAW STORY.
SO THAT'S WHAT WE TALK ABOUT
WHEN WE SAY MAKING THINGS
ORIGINAL IN STRUCTURED CENTERED
TO BRING OUT OUR STORIES AND
GUIDE OUR BEHAVIORS AND WORK
WITH THAT.
IF I CORRECT MY HEALTH NOW I'M
IMPACTING THE NEXT SEVEN
GENERATIONS AND I'M MY GREAT
GRAND MOTHER'S GRANDDAUGHTER AND
RESTORING OUR LIVES TO HEALTH
AND WELLNESS AND A PARADIGM
SHIFT THAT HELPED ME IN THE WORK
I'LL TAKE FIVE MINUTES ABOUT
HISTORICAL AND INTERGENERATIONAL
TRAUMA AND I WAS TOLD A STORY
ABOUT THE CRABS AND THE BUCKETS.
WE USE THAT FOR LATERAL
ALIGNMENTS OFTEN.
FIS
FISHERMEN PUT CRABS IN BUCKETS
BECAUSE THEY TRY TO CRAWL OUT
AND THEY PULL THE OTHER DONE AND
IF I WAS A SOCIAL WORKER CRAB
I'D SAY PUT OUR PINCERS TOGETHER
AND THE QUESTION MADE ME REALIZE
I'D BEEN BUCKETING MY OWN
SCIENCE BECAUSE HE SAID CRABS
DON'T LIVE IN A BUCKET.
WHY DO WE ACCEPT THAT AS THAT
NATURAL CRAB BEHAVIOR AND HE
SAID WHEN CRABS ARE IN A HEALTHY
ENVIRONMENT, WHEN THEY'RE IN
THEIR NATURAL HEALTHY
ENVIRONMENT THEY PULL EACH OTHER
UP ON ROCKS.
I'M SURE THERE'S ONE OR TWO
CRABS THERE BUT IT HAPPENS BUT
IT'S THE NATURAL CRAB BEHAVIOR
THAT LIFTED EACH OTHER UP IN
ROCKS AND SHIFTED MY THINKING
AND WE SEE THIS IN INDIAN
COUNTRY AND A BIG SHIFT.
IT'S NOT JUST ABOUT HISTORICAL
TRAUMA OR THINGS LIKE THAT BUT
HOW DO WE MAKE HEALTHIER
ENVIRONMENTS AND GET BACK TO THE
ENVIRONMENT AND DO SETTING SPACE
INTERVENTIONS OR WORK AND CREATE
HEALTHIER ENVIRONMENTS SO
HEALTHFUL HABITS EMERGE AND THE
BIG MOVE HAS BEEN LAND-BASED
HEALING WORK AND BUST OUT OF
TYPICAL SERVICES-ORIENTED
RESEARCH AND SERVICES ARE
CRITICAL BECAUSE THEY'RE
BAND-AIDS TO HELP US PUT THINGS
TOGETHER BUT DON'T PRODUCE
SUSTAINABLE CHANGE AT A
POPULATION LEVEL.
WE'RE AT THE POINT WHERE THE
TRAIN LEFT THE STATION.
ONE OF THREE KIDS WILL BE TYPE
II DIABETES AND DON'T HAVE TIME
FOR BEHAVIORS AND FAMILIES COME
TOGETHER BUT VA TO DO SOMETHING
TO IMPACT THE POPULATION.
IT WAS A PROJECT THAT MICHELLE
JOHNSON AND WE WORKED ON AND
I'LL SHARE SLIDES FROM OUR EARLY
WORK THE PILOT PHASE WORK FOR
THIS WAS FUNDED IN PART THROUGH
OUR NIMHD GRANT AS A
COMPREHENSIVE CENTER OF
EXCELLENCE BACK IN OUR DAY AND
WORKED WITH OUR TRIBE WHO ASKED
ME TO COME AND HELP ADDRESS THE
ISSUE.
THE THINGS WE FOCUSSED ON WAS ON
HEALTH PROMOTION AND WANTED TO
FLIP THE SCRIPT AND NOT HAVE IT
BE ABOUT SUBSTANCE ABUSE
PREVENTION BUT THE ORIGINAL
TEACHINGS AROUND MEDICINES AND
INCORRECT RELATIONSHIP WITH
MEDICINE WHAT ARE THE NATURAL
CONSEQUENCES AND HOW DO WE
CORRECT FOR THAT AND THOSE KIND
OF THINGS.
THEY ASKED US, MY TRIBE IS DOING
THE BEST THINGS FOR OBESITY
PREVENTION AND DIABETES
PREVENTION RIGHT NOW.
WE HAVE STATE OF THE ART GYMS.
BETTER THAN GOLD'S GYM.
WE HAVE STATE OF THE ART HEALTH
FACILITIES AND STATE OF THE ART
NUTRITION PROGRAMS AND THE BEST
BARIATRIC SURGERY YOU CAN GET
FOR FREE IN MY TRIBE.
WE HAVE STRUCTURAL INTERVENTIONS
WHERE THEY HAVE THE FOOD
PROGRAMMING FOR TRIBAL
CAFETERIAS AND PUT IN WALKWAYS
AND YET HAVE SEEN LESS THAN 3%
CHANGE IN TERMS OF HEALTH.
THE TRIBE SAID WHAT CAN WE DO
DIFFERENTLY.
AND IT CAME TO ME SIMPLY, OUR
ANCESTORS WEREN'T SUPPOSED TO BE
DYING THIS WAY.
WE HAVE TO RECONNECT TO THE LOVE
OF LIFE AND HAVE TO CREATE OUR
OWN CHOCTAW HEALTH PROMOTION
MODEL AND WE PARTNERED WITH A
CHIEF SISTER, SHARON FLEMING AND
DECIDED TO DO THAT TO COME UP
WITH OUR OWN HEALTH PROMOTION,
INTERVENTION BY FIRST REWALKING
THE TRAIL OF TEARS OURSELVES IN
PARTNERSHIP WITH OUR TRIBAL
COMMUNITY.
THAT SOUNDS A LITTLE BIT CRAZY
BUT WE FELT WALKING THE STEPS OF
OUR ANCESTORS WE SAID WE DON'T
WANT THIS TO BE A PROGRAM WE'RE
DEVELOPING.
WE WANT THIS TO BE A SHIFT IN
COMMUNITY ATTITUDES AND PUTTING
BACK IN CULTURAL ROLES AT A
COMMUNITY LEVEL THAT ARE FOR
FREE.
IT DOESN'T TAKE A LOT OF MONEY
TO DO.
THE TRIBE SAID OKAY AND SO WE
WALKED 8 TO 10 MILES A DAY IN
ARKANSAS IN THE MIDDLE OF JUNE
AND OVER 254 MILES DURING THAT
TRIP AND HAD A SIMPLE QUESTION,
WHAT'S THE ROAD TO CHOCTAW
HEALTH AND DID TRIBAL RESEARCH
AND WANTED TO GET BETA FROM THE
ARCHIVAL RESEARCH OF LETTERS AND
FEDERAL LETTERS FROM OTHERS THAT
GAVE US AN IDEA WHAT OUR AN
ANCESTORS IMAGINED FOR US AND
WORKED HARD TO FIND ORIGINAL
ROOTS.
WE HAD AN ARMY GUY WHO USED TO
DO THE G.I.S. MAPPING FOR THE
MILITARY AND TOOK OLD 1820, 1830
MILITARY MAPS AND WE WERE GOING
TO WALK THAT TRAIL THE INTACT
TRAILS AND DID IT THROUGH SWAMPS
AND WOUND UP IN WILDLIFE REFUGES
AND DID G.I.S. BLOGGING AND
PERFORM FOCUS GROUPS AND
INTERVIEWS AND 13 CHOCTAWS WHO
STEPPED FORWARD.
PRIMARILY WOMEN AND WE ASKED
ELDERS AND THEY SAID IT'S
SUPPOSED TO BE THE WOMEN WHO
STEP UP TRADITIONALLY IN ANCIENT
TIMES THE CHOCTAW WOMEN WERE
RESPONSIBLE FOR THE CEREMONIES
TO MAKE THINGS RIGHT AGAIN AND
WE WENT FORTHWITH THE WOMEN AND
HAD HEALTH SPECIALISTS WHO SAID
I'M GOING TO DO THIS BECAUSE IF
I'M GOING TO ASK MY COMMUNITY I
SHOULD ASK MYSELF FIRST.
THE ROOTED APPROACH IS HOW WE
LOOKED AT THIS.
WE HAVE TO FIX OURSELVES FIRST.
WE DID FASTING AND ABSTAINING
AND SHE CAN TELL YOU ABOUT PART
OF THIS AND THESE ARE PICTURES
FROM WALKING THE TRAIL.
THE IRB WAS A NIGHTMARE BECAUSE
YOU HAVE TO BE 12 YEARS OLD OR
OLDER TO SURVIVE IN THE
MOCCASINS AND SURVIVE AND WHERE
THE TEACHINGS ARE AROUND AND
LOOKING AT TEACHING AND IT WAS
NOT ABOUT MEMORIALIZING A WALK
OR TRAUMA.
IT WAS ABOUT RECONNECTING TO THE
LOVE AND CENTERING THE LOVE AND
IT WAS VERY POWERFUL.
MAIN OBSERVATIONS IS WE CONTINUE
TO CENTER THE TRAUMA AND
COLONIZING STRESS AND THE
YOUNGEST PERSON ON THE TRAIL
WHICH WAS POWERFUL ON DAY THREE
SHE SAID I GET IT NOW.
I HEAL OTHERS WHEN I MAKE MYSELF
HEALTHY.
IF I'M A HEALTHY TEENAGER I CAN
HEAL THE WORLD AND WE'RE LIKE
WE'RE DONE.
WHO NEEDS A KID'S INTERVENTION?
WE'RE DOWN.
AND THINGS ON THE LAND WERE
POWERFUL BECAUSE STORIES CAME
OUT THAT WOULD NOT HAVE
OTHERWISE COME OUT IF WE HAD A
50-MINUTE CONVERSATION.
STORIES EMERGED WHERE BEING ON
THE LAND SPARKED THE STORIES AND
GOT FUNDED AND TOOK OVER 150
CHOCTAW WOMEN AND DID A CLUSTER
RANDOMIZED STEP WEDGE DESIGN
ADDRESSING OBESITY AND SUBSTANCE
ABUSE AND WE SAID WE'RE BUILDING
CHOCTAW HEALTH LEADERS AND
ASKING CHOCTAW WOMEN TO STEP IN
THAT ROLE AND WHO WANTS TO BE A
LEADER AND START WITH YOU FIRST
TO START WITH YOURSELF ON BEHALF
OF YOU AND YOUR FAMILY AND LEARN
TO DO A PREVENTION EVENT YOU'LL
BE RESPONSIBLE FOR SUSTAINING
AND THEN ASK YOU TO BE YOUR
HEALTH LEADER FOR YOUR
COMMUNITY.
DO YOU WANT TO DO THAT?
WE HAD WOMEN WHO SIGNED UP WHO
WANTED TO DO THAT AND WHAT WAS
AMAZING ABOUT IT WAS BECAUSE WE
DIDN'T MAKE IT ABOUT A DISEASE
FOCUS BUT RATHER THE HEALTH
PROMOTION FOCUS AND STEPPING
INTO THE IMPORTANT ROLES, SO
THEY WENT THROUGH THE THREE-WEEK
CURRICULUM AT THE CULTURALLY
BASED CURRICULUM BASED ON OUR
PLANNED SYSTEMS FROM OUR TWO
WALKS AND THE BEHAVIORS
ASSOCIATED WITH EACH OF THE
CLANS AS MODELS FOR CHANGE AT
THE END OF THE 12 WEEKS THEY DID
A DID A CEREMONY RE-WALKING THE
TRAIL OF TEARS THEMSELVES AND AT
THE END THEY THEN WERE RECEIVED
BY THEIR COMMUNITY AND A FEAST
WAS HELD FOR THEM AND HONORED
THEM AS HEALTH LEADERS AND GOT
BOOSTER SESSIONS AND GOT $1,000
TO PUT ON A COMMUNITY EVENT THAT
HAD TO BE SUSTAINABLE BEYOND THE
PROJECT YEARS AND THEY DID THAT
AND STILL HAVE TO THIS DAY
PROJECTS WOMEN WHO ARE STILL
RUNNING PROJECTS ANNUALLY OR
STILL ONGOING TO.
THEY'RE CALLED -- IF YOU'VE SEEN
WALKING WARRIORS THEY'RE ONLINE.
THEY NOW HAVE THE NETWORK OF
WOMEN ACROSS THE WORLD ACTUALLY
WALKING WITH THEM.
IT WAS VERY TRANSFORMATIVE.
THAT'S SOMETHING I WANTED TO
SHARE THAT CAME FROM THE WORK WE
DID ORIGINALLY AT NIMHD AND
RETURNING IT BACK TO WHY IS THIS
IMPORTANT AND WE'RE LOOKING TO
LOOK AT INNOVATION AND LOOK AT
DIFFERENT WAYS OF APPROACHING,
ADDRESSING THE HEALTH INEQUITIES
IN INDIAN COUNTRY AND LOOKING
FOR CREATIVE WAYS TO ADDRESS
THESE ISSUES BECAUSE AS I SHOWED
YOU EARLIER, THIS IS PERSONAL.
THIS IS PROFESSIONAL.
AND WE'RE IN A CRISIS AND WE
NEED EVERYBODY'S HELP.
THANK YOU TO ALLOWING ME TO
SHARE THAT WITH YOU.
QUESTIONS?
>> THANK YOU.
WHAT'S THE POLICY NOW?
I DON'T KNOW ABOUT THE TISSUE
SAMPLES AND HOW DO YOU RECRUIT?
>> THE FIRST ON GENOMIC AND
GENETIC, THEY HAVE SOVEREIGNTY
POLICIES WE'RE LOOKING WITH THE
OFFICE OF SCIENCE POLICY AND
NHGRI AND OTHERS TO BASICALLY
ALIGN OUR GENOMICS POLICY WITH
TRIBAL ORDINANCES LAWS AND
STANDARDS.
THEY OWN THEIR DATA AND RIGHT TO
THEIR BIO SPECIMENS.
THE ISSUE IS DEVELOPING GOOD
MOUs AND HONOR THAT AND TRY TO
EQUALLY INVESTED IN HAVING
STRONG SCIENCE THAT'S GOING TO
BENEFIT THEIR COMMUNITY.
IT'S NOT CAUSING HARM, TRIBES
INTEREST AGREED TO IT.
WE HAVE A PROCESS OF ENGAGING
THE TRIBE AND WE'RE HAVING TO
WRITE THAT OUT NOW SO WE'RE IN
THE SAME PAGE WITH RESPECT TO
THAT.
BECAUSE OF TRIBAL SOVEREIGNTY
IT'S EXEMPT FROM THE COMMON
RULE.
THEIR ORDINANCES ARE MORE
STRINGENT THAN THE CURRENT
COMMON RULE IT TAKES PRECEDENCE
AND BIO SPECIMENS ARE PART OF
THAT.
IF OUR TRIBAL LANDS AND CHOCTAW
NATION IS BIGGER THAN THE STATE
OF MASSACHUSETTS.
PEOPLE DON'T REALIZE HOW BIG
THAT IS IN SOUTHEASTERN
OKLAHOMA.
ALASKAN TAKES UP THE MIDDLE HALF
OF THIS COUNTRY IF WE WERE TO
SUPERIMPOSE ALASKA AND WE HAVE
TO THINK OF WAYS AS SCIENTISTS
HOW TO DO TWO THINGS.
ONE WORK WITH SMALL SAMPLE SIZES
IN SOME CASES AND IN OTHER CASES
MAKING SURE WE HAVE ENOUGH
FUNDING SO TRIBES CAN DO A STUDY
IF YOU'RE LOOKING ACROSS LARGE
GEOGRAPHIC EXPANSES.
ALASKA USES PUDDLE JUMPER PLANES
TO GET TO REMOTE LOCATIONS.
IT CREATES A BIGGER BURDEN BUT
WE CAN BE CREATIVE.
WE APPRECIATED HAVING RANDOMIZED
STEP WEDGE SAMPLING BECAUSE WE.
GO BY COMMUNITY UP PLACE OF
INDIVIDUALS AND THAT WAS
IMPORTANT TO THE COMMUNITY.
>> THAT WAS WONDERFUL.
THE WORK SGRO HAS DONE IN THE
PAST IN THE PORTFOLIO ANALYSIS
WONDERING IF THE REVIEWERS DO
THE WORK TO BE DONE AND HOW MANY
PRs ARE NOFOs ARE AVAILABLE FOR
RESEARCH IN THE SPACE?
>> TO THE FIRST QUESTION, WE
ACTUALLY JUST LAUNCHED A DETAIL
THAT WENT LIVE END OF LAST WEEK
SPECIFICALLY ASKING FOR NIH TO
PLEASE COME OVER WITH DOING OUR
PORTFOLIO.
SO ANYBODY AT NIH COME SEE ME.
SO THAT'S ONE OF THE FIRST THING
WE'RE TRYING DO IS DO A
COMPREHENSIVE PORTFOLIO FOR A
STRATEGIC PLAN WE HOPE TO LAUNCH
NEXT YEAR.
SECOND QUESTION?
NOFOs.
THERE ARE SOME THAT ARE
FORTHCOMING RIGHT NOW.
THERE'S ONGOING ONES AVAILABLE
BUT.
INTERVENTION RESEARCH FOR NATIVE
AMERICAN HEALTH IS A GREAT ONE
FOR R01s AND R34s I BELIEVE NOW
AND I BELIEVE NIMHD IS ON THAT
AS WELL AND THE KNOWLEDGE GRANTS
ONGOING IN TWO MONTHS IN THE
NATIVE AMERICAN RESEARCH CENTERS
FOR HEALTH THROUGH NIGMS AND HAD
RECENT NOFOs IN PROCESS OR
FILLED I SHOULD SAY.
A PROGRAM TIED TO HEAL AND
OPIOID AND PAIN OVERDOSE AND
GENERAL NOFOs WHERE NATIVE
PEOPLE APPLY.
THE CENTERS OF EXCELLENCE FOR
NIMHD FOR EXAMPLE OR OTHER
NATIVE NOFOs.
ESPECIALLY AROUND THE
INTERGENERATIONAL TRAUMA.
>> THANK YOU SO MUCH.
THAT WAS AMAZING.
THAT WAS A WONDERFUL
PRESENTATION OF YOU AND THE
ISSUES.
A LOT TO DO AND LEARN TOGETHER.
WE DO HAVE ONE RCMI IN ARIZONA
THAT HAS A MAJOR FOCUS ON
AMERICAN INDIAN AND ALASKAN
NATIVE.
AS YOU KNOW HISTORICALLY SOME
GRANTS UNIVERSITY OF WASHINGTON
AND UNIVERSITY OF MEXICO HAD A
STRONG THEME AND WE ARE
CONTINUING TO WORK WITH THE
TRIBAL EPIDEMIOLOGY CENTERS.
HOPEFULLY WE'LL CONTINUE TO MOVE
ON THAT AND YOU ALSO REFERRED TO
THE NATIVE AMERICAN CANCER
OUTCOMES DIRECTIVE.
FOR LATER DISCUSSION, YOU
MENTIONED NOT JUST TRIBAL
MEMBERS BUT URBAN INDIAN AND
NATIVE HAWAIIANS AND WHAT ABOUT
INDIGENOUS PEOPLE OF LATIN
AMERICA?
>> THE BORDER CROSSES UP
PHENOMENA THAT'S TRUE FOR CANADA
AS WELL AND WE SAY NORTH AMERICA
INCLUDES INDIGENOUS PEOPLE OF
MEXICO AS WELL AND CERTAINLY
SOME COMMUNITIES AROUND AND
WHERE WE GET CALLED TO ADDRESS
THE ISSUES ARE AROUND LACK OF
PROPER INFORMED CONSENT FOR
SPECIMENS FOR INDIGENOUS
POPULATIONS SOUTH OF THE BORDER
BECAUSE PEOPLE CAN GET AWAY WITH
THAT.
WE END UP SPENDING A LOT OF TIME
SAYING THAT'S NOT OKAY AND
FIGURING OUT WAYS TO ADDRESS
THAT.
I'D LOVE TO SEE MORE WORK IN
THAT SPACE.
IT'S AN IMPORTANT AREA.
>> THANK YOU VERY MUCH.
>> WHILE THE SLIDE DECK IS
UPLOADING I WANT TO INTRODUCE MY
COLLEAGUE WHO WILL BE THE NEXT
AND FINAL PRESENTATION FOR TODAY
AND WE'LL WRAP UP.
JOSH DENNY IS THE CHIEF
EXECUTIVE OFFICER OF THE
NATIONAL INSTITUTE OF HEALTH ALL
OF US RESEARCH PROGRAM, WHICH
YOU HEARD ABOUT EARLIER TODAY
FROM ME.
JOSH IS ALSO A GENERAL
INTERNIST.
SO WE SHARE THAT IN COMMON.
HE CAME TO NIH FROM VANDERBILT
WHERE HE HAD BEEN FACULTY MEMBER
THERE FOR MANY YEARS.
THE ALL OF US RESEARCH PROGRAM
HAS A GOAL OF ENROLLING AT LEAST
1 MILLION PEOPLE AND THE
REASONING WAS CALLED THE
PRECISION MEDICINE INITIATIVE
FOCUSSED NOT JUST ON DEVELOPING
OR THINKING ABOUT PHYSICIAN
MEDICINE FOR ALL POPULATIONS BUT
CREATING A LARGE OBSERVATIONAL
COHORT STUDY IN THE UNITED
STATES IN PART WITH THE U.K. BIO
BANK STUDY AND WILL BE A
RESOURCE FOR RESEARCHERS AND FOR
UNDERSTANDING NOT ONLY
MECHANISMS AND GENERATING IDEAS
FOR INTERVENTIONS FOR REALLY
YEARS AND YEARS TO COME.
WE'RE AT AN INFLECTION POINT
WITH THE ALL OF US AND JOSH I'M
SURE WILL SHARE SOME THOUGHTS
WITH YOU.
HE AS I SAID CAME FROM
VANDERBILT AS PROFESSOR OF
INFORMATICS AND MEDICINE AND WAS
THE DIRECTOR FOR FAMILY
PRECISION MEDICINE AND VICE
PRESIDENT FOR PERSONALIZED
MEDICINE AT VANDERBILT
UNIVERSITY MEDICAL CENTER.
HE'S DONE A NUMBER OF THINGS IN
HIS OWN RESEARCH AND ACTIVE IN
RESEARCH AT NIH PARTICULARLY HAS
BEEN A PIONEER IN THE USE OF
ELECTRONIC HEALTH RECORDS FOR
GENOMIC STUDIES AS WELL AS
HAVING MANAGED COMPLEXITY OF
ELECTRONIC HEALTH RECORD DATA.
THE FLOOR IS YOURS.
>> THANK YOU VEX FOR THE WARM
INTRODUCTION AND THE OPPORTUNITY
TO SPEAK WITH YOU ALL TODAY.
IT IS A REAL PLEASURE TO COME
BEFORE YOU AND SHARE WHERE WE
ARE WITH THE ALL OF US RESEARCH
PROGRAM AND ENTHUSIASTIC TO WORK
WITH THE PROGRAM AND ACROSS NIH.
SO THE ALL OF US RESEARCH
PROGRAM WAS THOUGHT OF IN 2015
AND LAUNCHED IN 2018.
OUR MISSION FROM THE BEGINNING
HAS BEEN THE SAME TO ACCELERATE
HEALTH RESEARCH AND MEDICAL
BREAKS THROUGH AND PREVENTION
AND TREATMENT AND CARE FOR YOU
WILL OF US.
IT STARTS WITH THE IDEA OF
NURTURING RELATIONSHIPS WITH
INDIVIDUALS ACROSS THE COUNTRY
AND THE RICH DIVERSITY OF THE
UNITED STATES REFLECTING THE
PARTICIPANTS WE RECRUIT AND
LONGITUDINAL FOR DECADES AND
WANT TO GET THE SOURCE IN A
TRUSTWORTHY MANNER TO ACCELERATE
SCIENCE AND THINK ABOUT THIS AS
AN ECO SYSTEM OF RESEARCH
FUNDERS IN COMMUNITIES AS PART
OF THIS RESOURCE.
SINCE WE LAUNCHED NATIONALLY IN
2018 WE HAD OVER 800,000 CONSENT
TO BE PART OF THE STUDY ACROSS
ALL U.S. STATES AND MOST
U.S. TERRITORIES AND SEND IN BIO
SPECIMENS AND WE CAN SEND A KIT
FOR DNA COLLECTION.
THE VAST MAJORITY OF THE PEOPLE
AGREE TO SHARE ELECTRONIC HEALTH
RECORDS.
IN THIS COUNTRY IT'S HARD TO
GATHER THOSE SO THERE'S A GAP
FROM PEOPLE WHO SAY YES AND
COLLECTING THE RECORDS AND MANY
WANT TO CONTRIBUTE BIO SPECIMENS
AND NOT EVERYONE DOES AND THAT'S
OKAY BUT SEEK TO GET THE BIO
SPECIMEN NUMBER TO 1 MILLION.
IN 2023 WE LAUNCH PUERTO RICO AS
A LARGER SITE WITH BRICK AND
MORTAR RECRUITING EFFORT AND SEE
THOSE WHO JOINED IN PUERTO RICO.
THE RACE AND ETHNIC DIVERSITY IS
NOT THE ONLY MEASURE OF UNDER
REPRESENT REPRESENTATION WE
FOCUS ON.
WE WANT TO EMPHASIZE ALL MANNERS
OF DIVERSITY.
YOU CAN SEE WE'RE ABOUT HALF
IDENTIFYING AS A RACE AND/OR
ETHNICITY OTHER THAN
NON-HISPANIC WHITE AND THE OTHER
CATEGORIES.
AS YOU LOOK INTO THE RESOURCE
THERE'S INTERSECTIONALITY WE
THINK IS SO IMPORTANT.
THINKING ABOUT THAT YOU CAN LOOK
ACROSS THAT AS WE UPDATED SOME
OF THAT OVER TIME FOR INSTANCE
WHEN WE FIRST LAUNCHED WE DIDN'T
HAVE A DISABILITY QUESTIONNAIRE
TO ASSESS DISABILITIES AND ROOM
HAVE THE ABILITY TO ACCESS TO
HEALTH CARE.
AND SO THOSE ARE THINGS WE
UPDATED WITH OUR PARTICIPANTS
OVER TIME AND METRICS WE INCLUDE
HERE.
IN MOST WE OVER REPRESENT
COMPARED TO THE U.S. POPULATION.
IN SOME CASES WE DON'T.
RURAL AND ASIAN AMERICAN
INDIVIDUALS ARE A LITTLE BIT
LOWER THAN THE U.S. CENSUS
NUMBERS.
ABOUT 10% IDENTIFY AS SEX AND
GENDER MINORITIES AND WE GET THE
SAME INFORMATION NO MATTER HOW
AND WHERE THEY ENROLL INCLUDING
A SURVEY.
WE RELEASE ONE A YEAR AND
PHYSICAL MEASURES.
IF YOU COME IN PERSON AND DONATE
BIO SPECIMENS WE COLLECT
MEASURES FROM YOU OF BIO
SPECIMENS AND SERUM, PLASMA AND
CELL-FREE DNA AND COLLECT URINE
AND HAVE THE ABILITY IF YOU HAVE
WAYS TO LINK DEVICES IN AND HAVE
PILOT PROGRAMS THAT GIVE DEVICES
TO PEOPLE AS WELL.
AND WE'RE APPROACHING 60,000
DEVICES.
WE HAVE DONE IN ADDITION TO OUR
CORE SETS OF DNA DATA AND
GENERATING UP SOME CASES OTHER
OMICS DATA AS PILOT PROGRAMS AND
WE HAVE DONE STRUCTURAL VARIANCE
THERE AND DID TEST OF COVID
SEROLOGY EARLY IN THE PANDEMIC
FINDING EARLIER CASES THAN
EXPECTED IN SEVERAL STATES.
WE THOUGHT IT WAS REALLY
IMPORTANT TO RETURN VALUE TO
PARTICIPANTS.
WE ASKED THEM IN DIFFERENT
SCENARIOS ACROSS THE COUNTRY IN
FOCUS GROUPS AND SURVEYS WHAT
WOULD BE VALUABLE TO YOU.
THE NUMBER ONE REASON PEOPLE
JOIN IS TO PROVIDE HEALTHIER
FUTURE FOR THEMSELVES, THEIR
COMMUNITIES AN ALTRUISTIC
NATURE.
IN TERMS OF VALUE WE CAN ALSO
PROVIDE GENETICS CAME TO THE TOP
OF THE LIST.
WE RETURN TWO CLASS OF
INFORMATION.
ONE IS NON-HEALTH RELATED
ANCESTRY AND OTHER TRAITS LIKE
WHETHER YOU CAN TAKE CILANTRO
AND LAUNCHED THAT END OF 2020
AND MORE PEOPLE HAVE SEEN THAT
ABOUT 170,000 PEOPLE HAVE SEEN
THAT KIND OF INFORMATION AND GET
TO CHOOSE WHETHER THEY SEE THIS
OR NOT AND HAVE HEALTH-RELATED
RESULTS WHICH WE HAD FOR ABOUT A
YEAR AND A HALF HOW AND OFFER
THAT BETWEEN 1 TO 5,000 A WEEK.
THEY CAN CHOOSE TO RECEIVE THIS
INFORMATION.
IF THEY SAY YES WE GENERATE THAT
INFORMATION FOR THEM AND LOOK AT
THE VARIANCE AND RECALL WHETHER
THEY HAVE A LIKELY PATHOGENIC
AND GENES THAT HAVE ACTIONABLE
RESULTS AND INTERPRET PHARMACO
GENETICS FOR THEM AND PREPARE
THAT REPORT.
OF THE ACM59 GENES THROUGH
GENETIC COUNSELORS THEY'RE
AVAILABLE FOR ANY PURPOSE PEEK
ENGLISH OR SPANISH AROUND HAVE
TRANSLATION FOR 200 LANGUAGES
AND OVER 100,000 PEOPLE HAVE
RECEIVED HEALTH RELATED GENETIC
RESULTS AT THIS POINT.
THOSE INDIVIDUALS AMONG THE 59
GENES OF ACTIONABLE RESULTS 3%
WILL HAVE A POSITIVE RESULT
THAT'S PEOPLE WHO HAVE HAD
POTENTIALLY LIFE-CHANGING
RESULTS WHERE THEY LEARNED ABOUT
HEREDITARY CANCERS AND
HEREDITARY ARRHYTHMIAS IF THEY
HAVE VARIANTS AND ON THE
PHARMACO GENETIC GENES ABOUT 59%
HAVE AN ACTIONABLE RESULT.
ABOUT 20% OF PEOPLE WHO HAVE A
VARIANT WILL BE EXPOSED TO A
MEDICATION FOR WHICH THEY WOULD
HAVE AN ALTERNATE RECOMMENDATION
GIVEN THEIR PHARMACO GENETIC
RESULTS AND THERE'S ABOUT 50
MEDICATIONS WE PROVIDE SUPPORT
FOR.
THIS TO PERSONALIZE GIVES
DISTRIBUTION FOR TWO TOGETGENET
VARIANTS AND MY RESULTS ON THE
SIDE.
I'M FALLING IN THE INTERMEDIATE
METABOLIZER FOR WHAT WOULD GET
AN ALTERNATE MEDICATION AND IF I
NEED A STATIN I SHOULDN'T TAKE
THIS ONE BECAUSE I'D BE STRESS
FOR MUSCLE TOXICITY FOR THAT.
AND SO WE ARE RETURNING THE
GENETIC VARIANTS WE CALL INTO A
RESOURCE THAT AGGREGATES
CLINICAL INTERPRETATION ON
GENETIC VARIANTS.
WE MADE OUR FIRST SUBMISSION
ABOUT A MONTH OR SO AGO.
THIS WAS ABOUT 32,000 GENETIC
VARIANTS WE CALLED AND
INTERPRETED ACROSS THE 59
HEREDITARY DISEASE RISK GENES
AND THE VARIANTS INCLUDE
SUBMISSIONS THAT HAVE NOT BEEN
SUBMITTED BEFORE AND THE FIRST
SUBMISSION FROM OUR DATA SET
PUTS US IN THE TOP 20 OF ALL
SUBMITTERS TO CLENVAR SO FAR.
THAT'S WHAT WE BELIEVE ARE HIGH
QUALITY INTERPRETATIONS
AVAILABLE FOR THE WHOLE
COMMUNITY AS OTHER PHYSICIANS OR
PROVIDERS LOOK AT GENETIC
VARIANT ED -- VARIANTS AND THI
SHOWS THE RARE VARIATION
DISCOVERED OVER TIME AS WE'VE
HAD DIFFERENT DATA SETS
RELEASED.
OUR CURRENT GENOMIC DATA SET IS
245,000 WHOLE GENOME SEQUENCES.
IN THAT WE'VE SEEN OVER A
BILLION GENETIC VARIANTS ACROSS
THE GENOME AND WITHIN THAT,
TWO-THIRDS WAS NOT IN THE COMMON
IMMIGRATION SERVICE CALLED
NOMAD.
275 MILLION VARIANTS WERE NOT IN
DB SMITH AND IN PART DUE TO THE
RICH DIVERSITY OF OUR DATA SET.
THIS GETS AT HOW WE GIVE
RESEARCHERS ACCESS TO DATA.
WE HAVE A PUBLIC TIER ANYBODY
CAN GO IN AND QUERY THE DATA
SET.
WE ENCOURAGE PEOPLE TO EXPLORE,
SEE THE DIAGNOSIS, MEDICATION
EXPOSURES, LAB VALUE,
DISTRIBUTIONS HOW PEOPLE ANSWER
SERVICES AND WHETHER THERE'S
ENOUGH CASES OF A DISEASE THAT
STIMULATES HYPOTHESES.
ALL DATA THAT DOESN'T ALLOW FOR
REDEDICATION AND ALLOWS TO
EXPLORE THE GENETIC VARIANTS AND
DISTRIBUTED ACROSS THE
POPULATION CLINICALLY SIG 234I6
OF NIF CANT AND
SIGNIFICANCE AND YOU CAN GET
RESEARCHERS TO COME IN AND DO
RESEARCH ACROSS A MORE
DE-IDENTIFIED REGISTERED TIER OR
MORE DEEPER DETAILED CONTROL
TIER WHERE WE PUT OUR GENETIC
INFORMATION.
WE TRY TO ENCOURAGE PEOPLE TO
ACCESS THE DATA THEY NEED TO DO
THE RESEARCH THEY NEED.
THERE'S DIFFERENT PATHS.
HERE'S WHAT THE RESEARCHER WORK
BENCH LOOKS LIKE.
ONCE YOU GO THROUGH THE BASIC
TRAINING YOU CREATE WORK SPACES.
EVERYTHING I'M TALKING ABOUT IS
WHAT WE CONSIDER NON-HUMAN
SUBJECTS RESEARCH AND HAS BEEN
COVERED BY THEIR CONSENT WHICH
MEANS YOU DON'T HAVE TO DO A NEW
IRB APPROVAL FOR EACH PROJECT.
IT'S COVERED BY THE CONSENT AND
DE-IDENTIFICATION BASIC
PROFESSIONS ACROSS THE DATA.
THERE'S NO OBVIOUSLY IDENTIFYING
INFORMATION IN THE INFORMATION
AT THIS POINT.
THAT MEANS A NEW RESEARCHER CAN
DO RESEARCH AND YOU CAN DO
DESTIGMATIZING RESEARCH
TRIGGERING A REVIEW AND YOU GET
STARTED GET POSTED PUBLICALLY
AND OF IT IS AVAILABLE FOR US TO
LOOK AT.
THERE'S WEB-BASED TOOLS TO DO
BASIC COHORT DEVELOPMENTS AND
POINT AND CLICK AND CREATE A
BILLING CODE AND SURVEY ANSWERS
AND GO TO ONE OF THESE
STATISTICAL ENVIRONMENTS.
WE'VE HAD A JUPITER NOTEBOOK FOR
FROM THE BEGINNING.
THE FIRST IS WHETHER OR NOT YOUR
INSTITUTION DOESN'T HAVE TO BE
AN ACADEMIC INSTITUTION HAS AN
AGREEMENT WITH THE PROGRAM.
IF NOT, OBVIOUSLY YOUR
INSTITUTION HAS TO HAVE A
BLANKET STATEMENT.
WE HAVE ABOUT 800 INSTITUTIONS
RIGHT NOW THAT HAVE AGREEMENTS
WITH US AND IF STEP ONE IS DONE,
STEPS TWO THROUGH FOUR OF THE
INDIVIDUAL LEVEL COMING ON AND
CREATING AN ACCOUNT, GOING
THROUGH OUR TRAINING AND SIGNING
THE CODE OF CONDUCT CAN ALL BE
COMPLETED IN AN HOUR AND A HALF
OR TWO HOURS AND GET STARTED
WITH RESEARCH IMMEDIATELY AT
THAT POINT.
RIGHT NOW THE MEDIAN ACCESS TIME
FROM A RESEARCHER SIGNING ON TO
ACTUALLY GETTING THROUGH THAT
STEP AND BEING ABLE TO START
DOING WORK IS ABOUT 29 HOURS.
WE THINK WE'VE BEEN ABLE TO
FACILITATE THE ONBOARDING
PROCESS.
WE STARTED WITH THE BELIEF IN
THE IMPORTANCE OF ENGAGEMENT
BEFORE WE DID ANYTHING.
WE DID 77 ENGAGEMENT STUDIOS
LIKE FOCUS GROUPS IN 17 CITIES
ACROSS THE COUNTRY COVERING A
NUMBER OF TOPICS HOW TO BUILD
THE STUDY.
IT'S NOT JUST ABOUT ENGAGING
PARTICIPANTS, IT'S ALSO ABOUT
ENGAGING RESEARCHERS.
WE WANT TO BUILD A RESEARCHER
COMMUNITY THE BIOMEDICAL
WORKFORCE AND SUPPORT THEM AS
MUCH AS WE CAN.
THIS GIVES A SENSE OF 2023 OF
THE DEEP WORK OUR ENGAGEMENT
PARTNERS HAVE DONE ACROSS THE
COMMUNITY AND THINK ABOUT IT
FROM OUTREACH AND THE LEFT THE
MOBILIZATION OVER 600,000 PEOPLE
TOUCHED BY ENGAGEMENT EVENTS
OVER 1200 EVENTS.
WE REACHED 170,000 PROGRAM
PARTICIPANTS AND DO THEM IN
INTERNALLY AND WORK WITH
DIFFERENT HEALTH CARE CENTERS OF
RECRUITING ACROSS THE POINTS.
AND GET TO THE RESEARCH AS WELL
AS PARTICIPANT COMMUNITIES.
AND I JUST WANT TO HIGHLIGHT ONE
EVENT RECENTLY MAY OF THIS YEAR
AND WE'VE HAD A GROUP THAT LOOKS
AT THE LEGACY AND THE HEALTH
SERVICE STUDY OF UNTREATED
SYPHILIS IN TUSKEGEE AND THEY'VE
BEEN AN IMPORTANT PARTNER WITH
US AND PART OF OUR STEERING
COMMITTEE FOR A LONG TIME.
THE EVENT WAS DONE THERE AND
BRING THAT LEAD AND BROUGHT AN
ENGAGEMENT VAN AND YOU SEE
DR. WATSON ON THE FAR LEFT.
AND SO THIS IS JUST ONE OF THE
KINDS OF THINGS WE ENGAGED IN
AND ONE OF OUR ENROLLMENT
PARTNERS.
TUSKEGEE IS MOVING TO THE
ENGAGED ENROLLMENT AS WELL.
SO FAR WE HAVE OVER 11,000
RESEARCHERS THAT SIGNED UP TO
USE THE RESOURCE.
OUR GOAL WAS TO HIT 10,000 BY
THE END OF 2026.
SO WE HIT THE GOAL OF A LITTLE
OVER TWO AND A HALF YEARS EARLY
AND RECENTLY LAUNCHED AND
ALLOWED IN THE FALL
INTERNATIONAL RESEARCHERS TO
JOIN AS WELL.
WE HAVE FOCUSSED ON BEYOND OUR
TYPICAL R1 RESEARCH INSTITUTIONS
TO ENGAGE LESS RESOURCED
INSTITUTIONS, NON PROFITS, HBCUs
AND HISPANIC SERVING
INSTITUTIONS AND MENTORSHIP
PROGRAMS AND RESEARCH SCHOLARS
AND PARTNERING RESEARCHERS IN
THE PROCESS.
WE HAVE SIX CONTINENTS REPRESENT
ED A COLLEAGUE AND I ARE DOING
A SEMINAR VIRTUALLY IN AFRICA
NEXT WEEK AND TRYING TO THINK OF
THE RESOURCE HERE AND WHAT WE
CAN DO AND REACH PEOPLE.
THIS GIVES A RANGE OF CONDITIONS
AND RELEASE OFF THE DATA
RESOURCE.
THERE'S LARGE SAMPLE SIZES IN
THE DATA SET AND IT'S A QUARTER
MILLION GENOMES.
IT'S A HUGE DATA SET AND HAVE
OVER 560,000 NOW THAT DONATED
DNA.
THE NUMBERS WILL INCREASE AS WE
GET MORE ELECTRONIC HEALTH
RECORD DATA AND WE HAVE INCIDENT
DISEASE AS WELL.
THOUSANDS OF PEOPLE WITH
INCIDENT DIABETES FOR INSTANCE.
WE'RE APPROACHING 500
PUBLICATIONS AND GIVES A SENSE
OF SOME HERE.
I'LL GO DEEPER INTO SOME OF
THOSE AND THE THEMES WE SEE.
THE FIRST STUDY SURPRISINGLY
WERE MORE CASE CONTROL THINGS
AND WE'RE SEEING MORE GENETIC
STUDIES AND SEEING DIFFERENT
THINGS COME OUT WITH THAT AND
ONE THING I'M EXCITED ABOUT AND
I WORKED WITH THE E.P.A. BIO
BANK SET AND WHEN YOU SEE THE
COHORTS THEY'RE PREDOMINANTLY
ONE ANCESTRY AND THE ANALYSES
MAY START WITH EXCLUDING THE
PEOPLE THAT AREN'T AS COMMON IN
THE DATA SET AND FOCUSSING IN ON
THE PREDOMINANT ANCESTRY WHICH
IS EUROPEAN ANCESTRY AND AS
PEOPLE WATCH THE DATA SET
THEY'RE LOOKING AT DIVERSITY AND
INCLUDING THE BROAD -- WHATEVER
CONDITION THEY'RE LOOKING AT THE
BROAD REPRESENTATION WE HAVE IN
THE DATA SET.
I'M VERY GRATIFIED TO SEE THAT
BE OCCURRING.
IN FEBRUARY WE HAD A NUMBER OF
PUBLICATIONS THAT CAME OUT
TOGETHER AS A CLUSTER AND THIS
INCLUDED A PAPER THAT IS ON THE
TOP RIGHT HERE THAT WAS A PAPER
WRITTEN ACROSS THE DIFFERENT
DIRECTORS OF INSTITUTES AND
CENTERS OF THE NIH REALLY
HIGHLIGHTING THE VALUE OF THE
RESOURCE ACROSS ALL CONDITIONS,
HEALTH STATUSES FOR PROMOTION OF
HEALTH AND MACHINE LEARNING AND
HIGHLIGHTING IT'S AN OPPORTUNITY
TO DIVERSIFY THE RESEARCH AND
ONE RESOURCE TO PROMOTE THAT.
WE'RE TRYING TO SEE THE PLATFORM
FOR THE BROADER NIH COMMUNITY.
AND OTHER STUDIES I WON'T INTO
DEPTH WITH A LOT OF THESE.
I'LL MAYBE HIGHLIGHT ONE OTHER
AND GO DEEPER ON ONE.
ON THE BOTTOM LEFT IS ANOTHER
THING I'M INTERESTED IN BECAUSE
THIS LOOKED AT TAKING RISK
SCORES ESTABLISHED UP OTHER
COHORTS AND THEY'RE UNDERGOING
CLINICAL TRIALS THROUGH A
NETWORK FUNDED BY NHRGI AND
WITHOUT OUR RESOURCE WE WOULDN'T
HAVE FELT AS COMFORTABLE HAVING
A MORE BROADLY APPLICABLE RISK
SCORE TO APPLY IN A CLINICAL
POPULATION AND NOW TO TALK ABOUT
ONE OF THE STUDIES AND SOMETHING
WE DIDN'T DO AS WELL AND TO LOOK
HOW WE CAN EVOLVE AND IN THE
PAPER WE CONSIDER GENOMICS
MARKER PAPER, IF YOU WILL, ON
OUR RESOURCE, ONE OF THE FIGURES
DISPLAYED GENETIC ANCESTRY USING
A PROGRAM TO ARTIFICIALLY TAKE A
MATHEMATICAL REPRESENTATION
ACROSS THE DIMENSIONALITY OF
GENETIC ANCESTRY AND GROUP THEM
TOGETHER IN THE WAY THAT OVER
REPRESENTS AND HIGHLIGHTS IN
WAYS THAT ARE NOT REALLY
BIOLOGICAL CLUSTERING AND IN THE
PAPER AND FIGURE IN THE TOP LEFT
PANELS A AND B ARE FIGURES WE'RE
TALKING ABOUT WHERE THE INTENT
WAS TO LITTLE THE DIVERSITY OF
OUR DATA SET AND IT'S NOT AT ALL
ABOUT THE FIGURE.
IT WAS PART OF IT AND IT
ATTRACTED ATTENTION AND I THINK
FOR A PERFECT REASON.
IT SHOWS SOMETHING WE WEREN'T
INTENDING TO SHOW WITH THE DATA.
SO I WANT TO -- WE ISSUED A
COUPLE STATEMENTS AND TALKED
ABOUT IT IN DIFFERENT PLACES AND
WHAT I WANT TO SAY IS WE POSTED
THIS ON THE WEBSITE AND TALKED
WITH PARTNERS.
WE'RE CURRENTLY IN A PROCESS
WORKING TO REVISE THE FIGURE.
IT HAS TO GO THROUGH PEER REVIEW
AND IT WILL BE REPLACED BUT BE
THAT NORMAL PROCESS THAT THE
JOURNAL TAKES TO GO THROUGH PEER
REVIEW AND THAT PROCESS.
AND WE'RE DOING A MUCH BROADER
PANEL OF ADVISORS THAT HAVE
LOOKED AT THAT AND HELPED US
THINK ABOUT THIS.
I HOPE THE WAY WE ADDRESS THIS
AND WE'VE SEEN A NUMBER OF
STATEMENTS FROM JOURNALS TALKING
ABOUT HOW WE TALK ABOUT GENETIC
ANCESTRY AND TALK ABOUT RACE AND
ETHNICITY.
RECOGNIZING ONE AS A SOCIAL
CONSTRUCT THE MANY DIMENSIONAL
DEEP DIMENSIONS OF HUNDREDS OF
DIMENSIONS WE COULD THINK ABOUT
TOWARDS THE BIOLOGICAL
REPRESENTATION OF INHERITED
GENETIC VARIANCE AND HOW DO WE
DO THIS AND ELEVATE THE
DISCUSSION IN OUR JOURNALS.
SO PART OF THE THINGS WE HELPED
FUND WAS THE NASCENT REPORT AND
HAVE SEEN STATEMENTS FROM
JOURNALS COME OUT THAT PROVIDE
BEST GUIDANCE ON THIS AND SO I'M
HOPEFUL OUR PROCESS OF GOING
THROUGH THIS IS THAT HELPS
ELEVATE IT MORE BROADLY FOR THE
COMMUNITY.
WE HAVE ALSO INSTITUTED NEW
POLICIES IN PERSONALLY AROUND
CERTAINLY THE PAPERS WE CAN
REVIEW AND THAT SORT OF THING TO
HELP ISSUE OTHER GUIDANCES IN
THE PROCESS.
I WANT TO LOOK AT A COUPLE OTHER
DATA AROUND STUDIES THAT HAVE
COME OUT.
SO THIS IS TWO OTHER FIGURES
FROM THE PAPER AND A TABLE.
WHAT WE SEE HERE IS WE REPLICATE
AS YOU WOULD EXPECT LDL SIGNALS
IN A LARGE GENOMIC STUDY ON THE
MIDDLE PANEL WE'RE LOOKING AT
PHENOME WIDE ASSOCIATION STUDIES
AND DIFFERENT ASSOCIATIONS IN
DIFFERENT POPULATIONS.
AND THEN ON THE RIGHT THIS TABLE
HERE I THINK SHOWS THE BREADTH
AND REPLICATION OF OUR DATA
ACROSS A NUMBER OF GENETIC
VARIANTS ASSOCIATED WITH
DIFFERENT CONDITIONS AND HIGH
REPLICATION RATES AND WHAT IS
HIGHLIGHTED HERE IS BY
PREDOMINANT GENETIC ANCESTRY
THERE'S JUST NOT AS MUCH AS
KNOWN OUT THERE FOR DIVERSITY OF
GENETIC VARIANTS AND DISEASE
ASSOCIATIONS BECAUSE THE DATA
SETS AS YOU PROBABLY WELL KNOW
MORE THAN 90% OF GENETIC
ASSOCIATION STUDIES OUT THERE
USE PEOPLE OF EUROPEAN ANCESTRY.
THAT'S WHAT THE SECOND ROW IS.
THERE'S OVER 1,000 VARIANT
ASSOCIATION PAIRS AVAILABLE TO
TEST EUROPEAN ANCESTRIES BUT
LOOKING ACROSS OTHER POPULATIONS
WE DON'T HAVE AS DEEP A
KNOWLEDGE BASE.
THAT STOOD OUT IN THE STUDY.
ANOTHER STUDY THAT LOOKED AT
RISK VARIANCE A COMMON CAUSE OF
KIDNEY DISEASE IN WITH PEOPLE
WIN WEST AFRICAN ANCESTRY AND A
PERCENTAGE ON DIALYSIS HAVE THE
VARIANCE.
THERE'S AN A RARE VARIANT IN THE
CHANNEL OF APOL1 THE VARIANT
BEING LOOKED AT HERE THAT SEEMS
TO MITIGATE THE RISK AND IT
POINTS TO A POTENTIAL WAY TO
GENETICALLY HIGHLIGHT AND TARGET
AND MITIGATE THE RISK OF APOL1
MEDIATED KIDNEY DISEASE.
IT TOOK DIFFERENT DATA SETS AND
OUR DATA SET IS MUCH LARGER THAN
THE DATA USED IN THE STUDY AND
WILL CONTINUE TO GROW OVER TIME.
AND SO THERE ARE DRUGS IN -- I
DON'T KNOW IF THEY'RE PHASE III
TRIALS LOOKING AT THE MECHANISM.
I WANT TO TALK ABOUT OUR
SCIENTIFIC ROAD MAP AND WHAT
WE'RE THINKING ABOUT HERE.
WE START AT THE BOTTOM WITH A
SET OF CORE DATA AND METHODS AND
TOOLBOX TO PROVIDE TO
RESEARCHERS ON TOP OF THAT.
WITH THE ULTIMATE GOAL OF
ADVANCING PRECISION HEALTH
MEDICINE EQUITABLY ACROSS
ASSESSMENT AND COMMUNITIES.
AND WE THINK WE CAN DEAL WITH
AND ADVANCE HEALTH TOWARDS BOTH
COMMON AND RARE CONDITIONS.
WE FIND PEOPLE WITH RARE DISEASE
ARE OVER REPRESENTED IN THE DATA
SET.
WE THINK ABOUT MATERNAL CHILD
HEALTH AND ONE REASON WE'RE LOOK
BEING FORWARD TO LAUNCHING THE
PEDIATRIC COHORT WE CAN TALK
ABOUT LATER.
WE WANT TO GET TO ENVIRONMENTAL
MEASURES AND WORKING WITH NIEHS
TO ADD TO THE DATA SET AND HAVE
QUESTIONS ABOUT LIFESTYLE AND
SUBSTANCE ABUSE AND BEHAVIORAL
HEALTH AND LOOKING ACROSS THESE
KINDS OF THINGS WE HAD DONE
INITIAL MAPS THAT LOOK AT THE
WORK SPACES PEOPLE ARE DOING
USING TERMINOLOGY QUERIES AND
THINGS LIKE THAT AND SEE THE
NUMBER ONE THEME WE SEE IN THE
RESEARCHERS USING THE RESOURCE
ARE INCLUDING THEMES OF HEALTH
EQUITY.
IT'S ALSO THE MOST COMMON THING
WE SEE AS THEMES IN PUBLICATIONS
PEOPLE ARE WRITING WHICH I'M
EXCITED TO SEE.
WE ARE BUILDING A FOUNDATION OF
DATA WHERE WE'LL NEED PEOPLE TO
NOT ONLY DO RESEARCH BUT USE THE
BIO SPECIMEN OR BUILD OUT AND
ENROLL PEOPLE TO FURTHER
STUDIES.
WE CALL THESE ANCILLARY STUDIES.
WRITING A STUDY AND DOING AND
BUILD OUT FROM ANOTHER NIH AND
WE THINK THIS CAN GO FROM
RANDOMIZED CONTROL TRIALS TO USE
OF A BIO SPECIMEN TO A
CUSTOMIZED SURVEY.
HERE'S THREE WE LAUNCHED SO FAR.
AND I MENTION THE SEROLOGY STUDY
EARLIER EXPLORING THE MIND AND
NUTRITION FOR PRECISION HEALTH
WILL ENROLL 10,000 PEOPLE AND VA
MEASUREMENTS LIKE THE MICROBIOME
AND METABOLOMICS AND HAVE OTHER
STUDIES AND SURVEYS THAT GO OUT.
GOOD MORNING AMERICA DID A PIECE
ON THIS AND THERE'S A PIECE AND
THIS GOOD MORNING AMERICA VIDEO
RESULTED IN THE HIGHEST SINGLE
DAY ENROLLMENT WE EVER HAD.
I THINK IT CAME OUT A FEW WEEKS
AGO.
SHE'S PART OF THE STUDY AND GOT
HER GENETIC HEALTH RESULTS BACK
AND IS ALSO PART OF THE STUDY
HERE.
THIS GIVES QUANTITATIVE MEASURES
OF THINGS THAT HAVE TO DO WITH
COGNITION AND BEHAVIORS.
THINGS LIKE RISK TAKING,
RECOGNIZING EMOTION, WE'RE
LOOKING AT CITY OR MOUNTAIN AND
HOW FAST WE DO IT AND METRIC
BEHIND IT.
ONE THING THAT'S EXCITING ABOUT
THIS IS IT'S BEEN THROUGH --
THERE'S ANOTHER PROJECT AT NIMHD
HAS BEEN WORKING ON FOR A NUMBER
OF YEARS THAT HAVE HAD THE
AVAILABLE STUDIES AND IN A FEW
MONTHS WE GOT THE NUMBER OF
RESPONSES OVER A NUMBER OF YEARS
BY LAUNCHING OUR PROGRAM AND
IT'S OPEN TO THE PUBLIC AS WELL.
AND OF COURSE THE POWER IS THE
DATA ARE LOCATED AND
CROSS-ANALYZED AND WITH OTHER
INSTITUTES AND CENTERS EXPANDED
TO OTHER METRICS AND TESTS AS
WELL.
ELISEO MENTIONED THE INFLECTION
POINTS AND WE'RE FUNDED THROUGH
TWO SOURCES AND THIS IS ONE OF
THE CHALLENGING POINTS SO FAR
THIS YEAR.
OUR FUNDING COMES FROM BASE
APPROPRIATIONS WHICH IS THE
TYPICAL WAY THE NIH FUNDED AND
THEN IN 2016 THE 21st CENTURIES
CURES ACT WAS PASSED WITH
DIFFERENT LEVELS OF FUNDING
DECIDED UPON IN 2016 AND AS A
RESULT OF THE BOLUS OF 2023 THE
BASIC APPROPRIATION WAS REDUCED
SIGNIFICANTLY.
THE CURES FUNDING REDUCED IN
2024 BUT WE DIDN'T HAVE CHANGE
IN THE BASE FUNDING.
THAT RESULTED IN 34% BUDGET LOSS
FOR US THIS YEAR AND THE
POTENTIAL FOR ANOTHER DECREASE
EVEN MORE SIGNIFICANT NEXT YEAR.
THIS HAS HAD DRAMATIC INFLUENCES
ACROSS OUR CONSORTIUM AND THE
HARDEST HIT AREAS ARE ENROLLMENT
AND ENGAGEMENT.
IF YOU IMAGINE YOU CAN'T LET
YOUR SAMPLES GET WARM YOU HAVE
TO PROTECT YOUR DATA AND HAVE TO
FOCUS ON YOUR EXISTING AND IN
TERMS OF RETURN RESULTS AND THE
GENETIC SEQUENCES AND HEALTH
RELATED RESULTS AND THOSE KINDS
OF THINGS.
SO IT'S HIT HARD A NUMBER OF OUR
ENGAGEMENT ENROLLMENT ARMS.
LAST YEAR WE EXPECTED TO ENROLL
OVER 330,000 PEOPLE AND THINK
WE'LL ENROLL 40,000, 50,000 AND
PAUSED OUR LAUNCH OF PEDIATRICS
WHICH WE DID A FULL SCALE TEST
OF AND DEVELOPED EVERYTHING IN
2023 AND TESTED WITH A SMALL
NUMBER OF PEOPLE AND WERE ABLE
TO BETA LAUNCH THAT AND WE CAN
CONTINUE IN THE PROMISE AND
DEVELOP THE COHORT AND DELIVER
ON THE PROMISE WHEN WE ENROLL.
THE DOCUMENT WALKS US THROUGH
SOME OF THAT.
WHAT ARE OUR PRIORITIES?
IN 2024 WE'RE IMPLEMENTING NEW
TECHNOLOGIES TO HELP US CLOSE
SOME OF THE ELECTRONIC HEALTH
REPORT GAP AND OTHER IS CHANGING
OUR PARTICIPANT FACING
TECHNOLOGIES BOTH HAVE THE
ABILITY TO HELP US REDUCE OUR
COST WHICH IS IMPORTANT RIGHT
NOW.
ALSO WITH PARTICIPANT PREVALENCE
SHOULD HELP GET TO OUR
PARTICIPANTS IN MORE WAYS AND
MORE MODALITIES AND WOULD LIKE
TO ADD ADDITIONAL LANGUAGES.
WE'RE LOOK BEING TO CLOSE THE
GAP IN TERMS OF GENOMIC RESULTS
AND WANT TO FOCUS AND EXPAND ON
THE STUDIES AND DEVELOP OUR
CAPABILITY MORE SO AS A PLATFORM
FOR OTHER PEOPLE TO BUILD ON AND
INTEND TO DIVERSIIFY RESEARCHER
ACCESS IN THE SAME TRUSTED
VETTED WAY WE ALLOW OTHERS TO
ACCESS THE RESOURCE.
AND WE STAND READY TO LAUNCH
PEDIATRICS AS A CORE CAPABILITY
AND COHORT WHEN WE HAVE FUNDING
TO SUPPORT IT.
WE'RE PLANNING FOR THE NEXT
RELEASE IN 2024.
THIS GIVES A SENSE OF THAT.
RIGHT NOW YOU HAVE 24,000 WHOLE
GENOMES THAT WILL BRING THE
NUMBER UP TO 400,000 AND
INCREASE OUR DATA SETS AND WE'RE
LOOKING FORWARD TO THE RACIAL
AND ETHNIC SUB CATEGORIZATION
AND ASK WHAT POPULATION YOU
IDENTIFY WITH AND THE HIGH-LEVEL
ANSWE
ANSWERS AND THOUGHTS HOW TO FEEL
COMFORTABLE WITH
RE-IDENTIFICATION RISK AND FEEL
GOOD ABOUT THE NEXT LEVEL OF
QUESTIONS AND SOME PEOPLE HAVE
SPECIFICATIONS.
FOR PEOPLE ANSWER ASIAN, MORE
THAN 90% IDENTIFY ANOTHER LEVEL
OF CLASSIFICATION OF WHAT
COUNTRY THEY'RE FROM TYPICALLY
OR ETHNICITY.
THAT WILL BE COMING OUT WITH THE
NEXT DATA SET AND IMPORTANTLY
WE'VE BEEN WORKING CLOSELY WITH
ANOTHER TRIBAL CONSULTATION OVER
THE LAST YEAR.
THAT REPORT WAS RELEASED IN 2024
AND WITH THAT WORK WE'VE DONE WE
WILL RELEASE OUR FIRST DATA SET
OF PARTICIPANTS TO INCLUDE AS
PART OF THE SELF-IDENTIFICATION
ALASKAN INDIAN AND AMERICAN
INDIAN OR ALASKAN NATIVE AND
WILL COME AS PART OF THE DATA
SET IN CONCERT WITH THE WORK
DOING WITH TRIBAL COMMUNITIES.
WE HAD A LEADERSHIP TRANSITION
TO ANNOUNCE AND MARTIN MENDOZA
OUR FIRST DIRECTOR OF HEALTH
EQUITY LEFT TO ASSUME THE FIRST
CHIEF HEALTH EQUITY OFFICER FOR
CMS.
WE'RE EXCITED FOR HIM BUT WILL
MISS HIM.
IN THE MEANTIME DR. JANET
SANCHEZ WILL TAKE OVER BUT WE
INTEND TO INITIATE A NATIONAL
SEARCH FOR THIS.
FOR THOSE WATCHING THIS KNOW
THAT SUCH AN ANNOUNCEMENT WILL
BE COMING AND I HOPE WE'LL GET A
NUMBER OF GOOD CANDIDATES FOR
THAT POSITION.
WITH THAT I'LL SAY THANK YOU FOR
THIS AND HAPPY TO TAKE
QUESTIONS.
I APPRECIATE YOUR TIME,
INTEREST.
THOSE USING THE RESOURCE AND
LISTENING OR HERE THANK YOU FOR
THAT AS WELL TO MAKE THE STUDIES
THAT MAKE A DIFFERENCE IN IMPACT
OVER TIME.
THANK YOU.
>> HOW ARE YOU DOING?
WITH 34% BUDGET CUT AND
POTENTIALLY CUT WHAT'S THE
OUTLOOK FOUR OR FIVE YEARS FROM
NOW?
>> I'M HOPEFUL THAT THIS LOOKS
LIKE WHAT WAS CREATED WITH THE
CURES ACT.
HOPING FOR ACTION THAT WOULD
INCREASE OUR BASE SUPPORT.
THE PRESIDENT'S BUDGET REQUEST
IS FOR RESTORATION TO THE 2023
LEVELS AND SO I'M HOPEFUL THAT
WILL BE THE OUTLOOK.
THAT'S INCREASED IN WHAT WILL BE
REQUIRED TO SUPPORT ENROLLMENT
AND LAUNCH THE PEDIATRIC COHORT.
WE'RE A LARGE COHORT AND ONE OF
THE LARGEST IN THE WORLD.
WE HAVE DIVERSITY UNMATCHED IN
TERMS OF NATIONAL OR
INTERNATIONAL COHORTS IN TERMS
OF PERCENTAGES BUT IT'S REALLY
IMPORTANT WE GET BIGGER BECAUSE
THERE'S CERTAIN QUESTIONS YOU
CAN'T ANSWER UNLESS YOU HAVE
HUGE COHORTS AND THERE ARE
POPULATIONS AND COMMUNITIES WE
STILL NEED TO GET TO AND WE HAVE
AN INFRASTRUCTURE TO DO THAT.
SO WE'RE CERTAINLY LOOKING AT
WAYS WE CAN REDUCE OUR COST AND
BECOME MORE EFFICIENT IN TERM OF
TECHNOLOGIES AND WAYS TO REACH
PEOPLE BUT IN THE END MONEY
WOULD BE NEEDED TO SUPPORT THE
ENROLLMENT EFFORT AT THE SCALE
WE WANT TO DO.
ANYONE WHO WANTS TO HELP CARRY
THE MESSAGE FORWARD I'M ALWAYS
HAPPY -- WE WOULD LOVE TO BE
PART OF ANY COMMUNITY MEETINGS
YOU MIGHT HAVE WITH OFFICIALS
AND THINGS LIKE THAT.
WE ARE TRYING TO CARRY THAT
MESSAGE AND WHERE THERE'S
PARTNERSHIPS TO ENGAGE IN THE
DISCUSSION TO TELL THE REAL
VALUE OF OUR COHORT.
>> THANK YOU FOR THE EXCELLENT
PRESENTATION AND IMPRESSIVE
WORK.
WHAT DO YOU THINK OF A SAMPLE
SELECTION OF SPECIFIC MINORITY
GROUPS.
YOU MENTIONED ALREADY YOU HAVE
THE COHORTS YOU ALREADY HAVE BUT
FOR SOME WONDERING WHETHER YOU
HAVE SAMPLES AND HOW TO OVERCOME
THAT.
>> IS YOUR QUESTION DO WE FOCUS
ON CERTAIN TYPES OF RECRUITMENT
OR IF THERE IS A POPULATION
INTERESTED IN JOINING?
>> I WAS WONDERING WHETHER YOU
COMPARED THE CHARACTERISTICS AND
TRYING TO UNDERSTAND EVEN IF YOU
HAVE DIFFERENT MINORITY GROUPS
WHETHER YOU HAVE SOME SAMPLE
SELECTION IN TERMS OF EDUCATION
PERHAPS HIGHER INDIVIDUALS AND
MINORITY GROUPS FROM HIGHER
EDUCATION AND BACKGROUND AND
ENROLLED AND THOSE WITH
EDUCATION AND HOW TO OVERCOME
THAT WILL BE VERY AVAILABLE.
>> GREAT QUESTION.
IT MAY OR MAY NOT BE OBVIOUS TO
EVERYONE BUT WE'RE NOT NOR
INTENDING TO BE A REPRESENTATIVE
COHORT.
WE INTEND TO REFLECT AND OVER
REPRESENT AS MUCH AS POSSIBLE
DIVERSITY ACROSS THE UNITED
STATES AND ANYONE CAN SIGN UP.
ANYONE CAN GO TO THE WEBSITE AND
JOIN.
WE HAVE SPECIFIC ENGAGEMENT AND
ENROLLMENT EFFORTS WE PICKED AND
CHANGED TO SOME DEGREE OVER TIME
TO TRY TO OVER REPRESENT CERTAIN
POPULATIONS AND THERE HAVE BEEN
A COUPLE STUDIES OUT THERE AND
WE HAVE COMPARED U.S. CENSUS
NUMBERS AND THINGS LIKE THAT.
IF YOU LOOK AT A STATE BY STATE
LEVEL.
WE HAVE MORE REPRESENTATION THAN
YOU'D EXPECT IN CERTAIN STATES
THAN OTHERS AND THAT'S A FACTOR
WHERE WE HAVE LARGE RECRUITMENT
SITES AND THE NORMAL COMPETITIVE
PROCESS WHO MADE IT THROUGH AND
WAS SELECTED TO BE AN ENROLLMENT
SITE.
AND THAT WAS BASED ON FACTORS OF
HOW THEY CAN REACH A DIVERSE
COMMUNITY.
THERE'S CERTAIN AREAS I WOULD
LIKE TO CONTINUE TO INCREASE.
IF YOU LOOK AT THE NUMBER OF
ASIAN-AMERICANS, NATIVE
HAWAIIANS, PACIFIC ISLANDERS
THEY'RE LOWER THAN THE CENSUS
NUMBERS AND THERE'S A COALITION
THAT'S A PARTNER OF OURS AND WE
HAVE DONE WORK WITH HAWAI'I AND
WOULD LOVE TO EXTEND THAT
RESEARCH FOR INSTANCE AND GO ON
THROUGH IN OTHER COMMUNITIES AND
WE'RE ALWAYS LOOKING TO FILL IN
THOSE GAPS AND ONE THING WE SEE
IT MIGHT BE A COMMUNITY OR
ORGANIZATION AND HAVE DONE
PARTNERSHIPS THAT REPRESENT
COMMUNITY AND MAYBE THERE ARE
EASY WAYS BECAUSE WE HAVE THE
NATURAL INFRASTRUCTURE TO
PARTNER WITH THEM AND SEND OUT A
MAILER COULD BE THE EASIEST
IMPLEMENTATION POINT AND COULD
BE DEEPER AND WE DO THIS NOW AND
HAVE MOBILE ENGAGEMENT UNITS
WHERE PEOPLE CAN ENROLL.
PARTNER WITH A COMMUNITY CENTER
AND LOTS OF WAYS WE LOOK TO
CLOSE THE GAPS.
WE'RE ALWAYS INTERESTED IN IDEAS
BY THE WAY.
IF YOU HAVE OTHER IDEAS, WE'D
LOVE TO CONTINUE TO FORM THE
PARTNERSHIPS.
>> I APPRECIATE THE RACIAL AND
ETHNIC DIVERSITY.
ARE YOU ABLE TO COMMENT ON THE
DIVERSITY.
>> THOSE ARE QUESTIONS IT WAS ON
THE RIGHT SIDE OF THE EARLY
FIGURES.
I DIDN'T CALL IT OUT AS MUCH.
WE CAPTURED THAT I'M NOT SURE
HOW THEY COMPARE TO THE CENSUS
AVERAGES.
MY RECOLLECTION IS WE'RE SIMILAR
OR EXCEED AND HAVE QUESTIONS ON
INCOME, FAMILY SIZE, HEALTH
INSURANCE STATUS, ACCESS TO
HEALTH CARE, EDUCATION.
WE MAY BE A LITTLE MORE EDUCATED
THAN THE U.S. POPULATION BUT NOT
A WHOLE LOT.
>> AND REGARDING SOCIO
ECONOMICS.
>> SOCIAL DETERMINATES OF HEALTH
MODULE IT'S ONE OF THE MODULES I
FOUND INTERESTING FROM THE FACT
WHEN WE DO OUR TESTING WITH
PARTICIPANTS AND HAVE THEM GIVE
OUR FEEDBACK IT'S THE ONLY TIME
WE HAD OUR PARTICIPANTS TELL US
THEY WANTED MORE QUESTIONS.
PEOPLE DON'T WANT TO ANSWER MORE
AND THE MODULE BUILDS FROM
STANDARD QUESTIONS SHARED
THROUGH OTHER TOOL SETS AND THE
DATA SET IS AVAILABLE AS WELL.
YOU CAN LOOK THROUGH THE
QUESTIONS ONLINE.
OUR QUESTIONNAIRES ARE PUBLIC
AND QUESTIONS CAN BE REUSED.
WE ENCOURAGE THAT NATIONALLY AND
INTERNATIONALLY BECAUSE IT
INCREASES COMPARABILITY OF OUR
STUDIES FOR META-ANALYSES AND
THINGS LIKE THAT AND FOR
RESEARCH PURPOSES AND AS WELL AS
LOOK AT HOW PEOPLE ANSWERED
THEM.
>> THANK YOU FOR YOUR
PRESENTATION.
WONDERFUL TO SEE IT.
WE LOOKED AT THE SOCIAL
DETERMINATES OF HEALTH
QUESTIONNAIRE SO THANK YOU FOR
INCLUDING THE INDEX AND THEY'RE
RICH AND POWERFUL.
I'M GOING TO GO BACK FROM A WISH
LIST PERSPECTIVE TO WHAT
DR. AGUILAR STARTED US WITH AND
THE ABILITY TO HAVE STATISTICAL
SAMPLING WEIGHTS AS A VARIABLE
TO ADJUST HOW MUCH A PARTICIPANT
OF DATA CONTRIBUTES TO THE
POPULATION AND HEALTH ANALYSES
SOME OF US ARE INTERESTED IN AND
ADVANCE THE CURRENT LIMITATIONS
WE HAVE POPULATIONS WHERE THE
CRITIQUES COME BACK AND SAY
CAN'T YOU MAKE THIS LOOK A
LITTLE BIT MORE REPRESENTATIVE
AND LOOK AT THE SGM COMMUNITIES,
FOR INSTANCE.
WILL THERE BE A PLACE OR
INTEREST IN THINKING AND PULLING
IN DEMOGRAPHERS --
>> WE HAVE A PARTNERSHIP WITH
THE CDC AND IS DEVELOPING
POPULATION WEIGHTS YOU COULD USE
TO JUST SOME METRICS AND THERE'S
A COUPLE ANALYSES -- OTHERS HAVE
DONE THAT BUT WE LOOK FORWARD TO
INCLUDING SOME OF THOSE METRICS
IN THE DATA SET AS WELL.
>>
>> THERE'S OVERLAP --
>> WHICH COHORT?
>> THE WORK IN MAG 3 AND 4.
DO THEY OVERLAP THE WORK WITH
THIS NOW?
>> I'M NOT SURE ACTUALLY.
WHICH COHORT.
>> EMERGE
>> OH, EMERGE, I KNOW THAT
REALLY WELL.
THERE'S PROBABLY SOME OVERLAP
WITH EMERGE AND SOME SITES.
LESS THAN YOU'D EXPECT.
THAT KIND OF ANALYSIS HIGHLIGHTS
AN INTERESTING TAKE BECAUSE YOU
WOULD HAVE TO THINK ABOUT
DE-DUPLICATING THE DATA SET AND
DON'T HAVE A CLEAR WAY YET.
THAT FROM A GENETIC DATA SET IS
ONE CASE THAT WOULD COME.
SOME SITES ARE IN VOGUE AND THE
BEST WAY TO DO EMERGE ANALYSIS
NOW IS TO REMOVE THE SITES THAT
OVERLAP IN THE EMERGE DATA SET
AND JUST USE THE ONES THAT DON'T
OVERLAP.
>> AND I DO RECALL WHERE YOU
GUYS LOOK AT THE RESULTS.
HOW COMPLICATED IS THIS ONE HERE
WITH ALL OF US AND THE RETURN OF
THE RESULTS?
>> SO WITH EMERGE WE SPENT FOUR
YEARS WE DID ACMG58 AND 59 AND
IN EARLIER EMERGE AWARD AND WITH
THAT WE BASICALLY IT WAS EACH
SITE DOING ABOUT 4,000 PEOPLE
AND WE'RE DOING ABOUT THAT PER
WEEK INSTEAD OF OVER FOUR YEARS.
AND SO IT'S A MUCH BIGGER SCALE
OF WHAT WE'RE DOING.
BUT IN SOME WAYS IT'S EASIER TOO
BECAUSE WE HAVE THREE CLINICAL
VALIDATION HATS THAT WORK IN
CONCERT.
WE BUILT ONE RE-HARMONIZATION
PIPELINE FOR DOING THE
PROTOCOLING AND EVERYTHING TO DO
THE SCALE WE'RE DOING AND HAD TO
BE LIKE SO PIPELINE.
SO IN SOME WAYS I THINK THE
EFFORT IS PROBABLY EASIER AFTER
WE GOT IT INSTRUMENTED FOR
SCALE.
THAT PART TOOK LONGER.
I THINK WHAT WE DON'T HAVE THAT
EMERGE HAD YET IS FOLLOW UP WITH
THE OUTCOMES.
AND THAT WILL BE DONE IN TWO
WAYS.
ONE IS PROBABLY THE MOST
DEFINITIVE FOLLOW-UP IS HOW WE
PUT THAT INTO THE RESEARCH
PLATFORM SUCH THAT RESEARCHERS
CAN ASK ALL KIND OF QUESTIONS
THE OUTCOMES AFTER THEY GET
SUBSEQUENT PROCEDURES AND THINGS
LIKE THAT.
>> AND A FOLLOW-UP QUESTION IS
LOOKING AT THE STATE OF
TENNESSEE AND LOOKING AS THE
REPRESENTATION BASED ON THE
STATE OF TENNESSEE AND 200 OR
SO.
>> SO TENNESSEE WE HAVE
RECRUITMENT FROM A COUPLE HBCs
AND MY HUNCH IS THE
REPRESENTATIVE OF AFRICAN
AMERICANS IN TENNESSEE IS
PROBABLY GREATER THAN YOU'D
EXPECT BUT THE
OVERREPRESENTATION IN TENNESSEE
BECAUSE WE DON'T HAVE A LARGE
RECRUITING PLATFORM IN TENNESSEE
LIKE A BIG MAJOR HOSPITAL IS
PROBABLY LESS THAN POPULATION
SPECIFIC REPRESENTATIONS IN
OTHER LOCATIONS AVANDERBILT AND
MEHARRY YOU CAN INCLUDE AND
KNOXVILLE AND JACKSON.
>> THANK YOU, JOSH.
WE HAVE OTHER OPPORTUNITIES TO
TALK SO I'LL DEFER ON SPECIFIC
QUESTIONS BUT YOU MENTIONED
SOMETHING I THOUGHT I WANTED TO
CLARIFY FROM OUR COMMUNITY.
SO IN THE RECENT ETHNIC DATA
AVAILABLE YOU ONLY MAKE
AVAILABLE RIGHT NOW THE BIG
CATEGORIES IS THAT RIGHT WITH
AMERICAN INDIAN AND ALASKAN
NATIVE NOT BEING IDENTIFIED
UNTIL YOU SORT THROUGH THE FINAL
PHASES.
IS THAT CORRECT?
>> CORRECT.
RIGHT FLOU IT'S HIGH-LEVEL
CLASSIFICATION AND THE NEXT
RELEASE FALL-WINTER '24 WILL
INCLUDE SUB CATEGORIZATIONS AND
THOSE WHO SELF-IDENTIFIED IB
AMERICAN INDIAN AND ALASKAN
NATIVE.
>> IN THE HISPANIC COMMUNITY
HEALTH CENTER WE LEARNED TO SAY
SUB POPULATIONS.
YOU REFERRED TO THE NATIONAL
HERITAGE AND AS YOU SAW EARLIER
TODAY WE TALKED ABOUT THE NEW
OMB CATEGORIZATION AND THE FIRST
LEVEL, SECOND LEVEL ARE REQUIRED
AND SECOND LEVEL IS THE NATIONAL
HERITAGE IS MOST COMMON WITH
OPTION TO ADD AND THIS IS TRUE
FOR ALL GROUPS.
WAS ALL OF US SET UP THAT WAY OR
NOT AND THAT WOULD BE A QUESTION
IF IT WASN'T WOULD THERE BE A
POSSIBILITY FOR A PROPOSAL TO
ADDRESS THAT IN A SUBSEQUENT
WAY?
>> WE WERE DESIGN LARGELY AROUND
THE ORIGINAL PLAN OF THE 2020
CENSUS FOR A SINGLE QUESTION.
>> I'M AWARE.
>> OKAY.
>> I DON'T KNOW HOW MUCH WE'RE
ALIGNED TO THE NEW QUESTIONS AND
WOULD BE GREAT TO TALK ABOUT
THAT FURTHER.
>> YOU HAVE A MIDDLE EASTERN AND
NORTH AMERICAN CATEGORY AND A
SINGLE QUESTION OPPOSED TO THE
TWO-PART QUESTION.
BUT I THINK IN MY THINKING AND
THIS IS NOT SET INTO THE NEW
CATEGORIES BUT THERE ARE
PROBABLY FOR RESEARCHERS IN
PARTICULAR NOT SUPPOSED TO
REQUIRE FOR THE FEDERAL
WORKFORCE OR AGENCIES
SUBCATEGORIES, SUBPOPULATIONS
THAT WOULD BE GOOD TO BE ABLE TO
IDENTIFY PARTICULARLY IN THE
HET
HETTER -- HETEROGENEOUS
CATEGORIES.
>> THERE'S INDIVIDUAL COUNTRIES
IN THERE AND SAME FOR THE ASIAN
SUBPOPULATIONS AND IN TERMS OF
THE EXACT ALIGNMENT I DON'T KNOW
THAT.
IT WOULD BE GREAT TO EXPLORE
THAT AND WE ARE LOOKING FOR
FILING IF NEEDED.
>> THANK YOU FOR THE
PRESENTATION AND UPDATE AND
TAKING THE TIME ON A FRIDAY
AFTERNOON TO SPEND AN HOUR WITH
US.
I'LL NOW TURN TO EMMA TO SAY A
FEW WORDS.
SHE'S BEEN A MEMBER OF OUR
COUNCIL FOUR YEARS.
YOU STARTED WITH THE PANDEMIC
AND HAVE NOW CLOSING IN PERSON
AND WE EXTENDED YOU FOR ONE YEAR
SO WE COULD SEE YOU AGAIN AND
JOIN US.
SO EMMA.
>> THANK YOU.
I WROTE SOMETHING VERY BRIEF.
I'LL BE QUICK SO I KNOW
EVERYBODY'S IN A HURRY.
I WOULD LIKE TO ESPECIALLY THANK
ELISEO AND MONICA TO BE PART OF
THE NATIONAL ADVISORY COUNCIL.
IT'S BEEN TRULY INSPIRING TO
WITNESS YOUR LEADERSHIP AND
COMMITMENT TO IMPROVING MINORITY
HEALTH RESEARCH.
ALSO SUPPORTING MINORITY
RESEARCHERS AND STRENGTHENING
THE INFRASTRUCTURE RESEARCH
ACROSS THE COUNTRY.
REFLECTING ON THE PAST YEARS'
EXPERIENCE ON THE COUNCIL HAS
BEEN A MILE STONE IN MY CAREER
AS A HEALTH ECONOMIST OUR
RESEARCH IS GUIDED BY METHODS
AND THERE'S NOT A STRONG FOCUS
NOR TRAINING ON SPECIFIC
POPULATIONS.
AT THE COUNCIL I HAVE LEARNED
RESEARCH IN A WIDE RANGE OF
TOPICS CRUCIAL FOR MINORITY
POPULATIONS AND HAS HAD A
PROFOUND EFFECT ON MY RESEARCH
AND WIDENED MY VIEW OF THE
IMPORTANCE OF MULTI-DISCIPLINARY
RESEARCH AND WOULD LIKE TO THANK
THE OTHER COUNCIL MEMBERS AND
DR. COTTON FOR ALL THE SUPPORT
AND DR. STINSON AND ALL THE
STAFF FOR THE EXCEPTIONAL WORK.
IT HAS BEEN A PRIVILEGE TO WORK
WITH ALL OF YOU.
THANK YOU.
>> OKAY.
I DON'T BELIEVE WE HAVE PUBLIC
COMMENT SUBMITTED, RIGHT?
OKAY.
SO WITH THAT I WILL THANK
EVERYONE FOR ATTENDING AND THOSE
ONLINE FOR LISTENING AND THIS
WILL BE ARCHIVED ONCE WE GET IT
ALL SET UP AND FOR THE COUNCIL
MEMBERS TO HAVE A SAFE TRIP HOME
ACROSS THE CITY FOR ONE AND
WHEREVER ELSE YOU'RE ALL HEADED.
TO SEE YOU IN SEPTEMBER.
SO THIS MEETING IS ADJOURNED.