>> OUR EX-OFFICIO MEMBERS,
HENDERSON WHO IS ONLINE.
WE'LL CIRCLE BACK.
MICHELLE AND SIMMONE.
>> DEPARTMENT OF DEFENSE,
EX-OFFICIO MEMBER.
>> OKAY.
LET'S GO BACK.
>> PROFESSOR UNIVERSITY OF
PENNSYLVANIA.
6:
>> GOOD MORNING, PROFESSOR AT
MIAMI.
>> AND HENDERSON.
OKAY.
WE'LL COME BACK TO HENDERSON IF
SHE POPS UP.
WE'RE GOING TO GO TO THE TABLE.
WE'LL START WITH DR. DOSS.
>> I'M THE DIVISION DIRECTOR FOR
ONE OF THE THREE EXTRAMURAL
DIVISIONS OF ENDOCRINE AND
BIOLOGICAL AND BEHAVIORAL
SCIENCES.
>> I'M THE DIRECTOR OF THE
DIVISION OF COMMUNITY HEALTH AND
POPULATION SCIENCE AT NIMHD.
>> GOOD MORNING.
I AM THE DIRECTOR OF THE
DIVISION OF CLINICAL AND HEALTH
SERVICES RESEARCH AT THE NIMHD.
>> IS THERE ANY STAFF THAT --
KIMBERLY, JIMMY, KELLY?
OKAY.
>> KIMBERLY ALLEN, EXECUTIVE
OFFICER, NIMHD.
>> ABOUT MORNING, KELLY
CARRINGTON, NIMHD COMMUNICATIONS
DIRECTOR.
>> OKAY.
WE'RE GOING TO CIRCLE BACK LATER
OR THE OTHER INTRODUCTION AND
ADDITIONAL INFORMATION.
OKAY, WE'RE NOW GOING TO REVIEW
THE MINUTES FOR THE MAY 20, 2024
COUNCIL MINUTES.
VOTING INSTRUCTIONS, THOSE IN
THE ROOM BY SHOW OF HAND WHEN WE
GET TO THAT POINT.
THOSE ONLINE WILL PUT A YES OR A
NO IN THE CHAT BOX.
THE MINUTES FROM THE MAY 2024
COUNCIL MEETING WERE POSTED IN
THE ELECTRONIC COUNCIL BOOK.
HAVING REVIEWED THE MINUTES, ARE
THERE QUESTIONS, CONCERNS OR
CORRECTIONS TO THESE MINUTES.
HEARING NONE, MAY I HAVE A
MOTION TO APPROVE THE MINUTES
FOR THE MAY COUNCIL?
>> SO MOVED.
>> MAY I HAVE A SECOND.
>> SECONDED.
>> ALL IN FAVOR SHOW MY RAISING
OF HANDS.
LET ME CHECK -- YES FROM
EVERYONE.
THE MINUTES ARE APPROVED.
WE HAVE FUTURE COUNCIL MEETING
DATES FEBRUARY 4, 2025.
THAT THERE BE A VIRTUAL MEETING.
MAY 16, 2025 WILL BE FACE TO
FACE ONCE AGAIN.
SEPTEMBER 5, 2025 -- FACE TO
FACE.
FEBRUARY 6, 2026 WILL BE VIRTUAL
MEETING.
MAY 19, 2026 WILL BE A VIRTUAL
MEETING AND WE'RE GOING TO HOLD
OFF FROM THE AUGUST 11 MEETING
WE'RE GOING TO DO SOME THINGS
AND SEE IF WE CAN ADD AN
ALTERNATIVE DATE BUT PLEASE
REMEMBER IF THERE IS ISSUES LET
ME KNOW IMMEDIATELY BECAUSE A
COUNCIL MEMBER MAY HAVE ONE
ABSENCE PER CALENDAR YEAR.
ALSO REMEMBER THAT AN INDIVIDUAL
CANNOT SERVE ON ANY NIH
PEER-REVIEWED PANELS WHILE
SERVING ON THE COUNCIL.
I'LL NOW TURN THE MEETING OVER
TO DR. PEREZ-STABLE FOR THE
DIRECTOR'S REPORT.
>> OKAY.
GOOD MORNING AGAIN.
WE'LL HOPEFULLY CATCH UP SO
WE'LL HAVE TIME FOR OUR
SCHEDULED BREAK.
I'M ELISEO PEREZ-STABLE THE
DIRECTOR OF MINORITY HEALTH AND
HEALTH DISPARITIES AND PROVIDING
YOUR ANNUAL REPORT.
LET ME SEE IF I CAN WORK THIS
SYSTEM.
>> WANT ME TO SHARE YOUR SLIDE?
>> CAN I ADVANCE THE SLIDE?
I'D LIKE TO BUT I CAN'T GET IT
TO DO IT.
I'LL START WITH UPDATES FROM NIH
IN GENERAL.
OUR COLLEAGUE JOESH -- JOSH
GORDON LEFT NIH EARLIER THIS
YEAR.
HE IS RETURNING TO COLUMBIA AS
CHAIR OF THE DEPARTMENT OF
PSYCHIATRY AND NEW YORK STATE
PSYCHIATRIC INSTITUTE, RETURNING
TO HE HAS BEEN A VERY CREATIVE
AND INNOVATIVE LEADER OF THAT
INSTITUTE.
MOST RECENTLY HE SERVED AS A
CO-CHAIR OF THE COMPASS
INITIATIVE ACROSS NIH THE
COMMUNITY-BASED RESEARCH COMPASS
REPRESENTS COMING FROM A LARGER
INSTITUTE HELPED MYSELF AND
JANINE CLAYTON IN THAT
DEVELOPMENT.
SORRY.
I'LL START OVER.
I'M ELISEO PEREZ-STABLE THE
DIRECTOR OF MINORITY HEALTH AND
HEALTH DISPARITY AND PRESENTING
MY REPORT FOR THE 67th MEETING
OF THE NATIONAL ADVISORY COUNCIL
OF OUR INSTITUTE.
SO, FIRST FOR NIH OVER ALL USE,
DR. JOSH GORDON DEPARTED FROM
THE NATIONAL INSTITUTE OF MENTAL
HEALTH IN JUNE OF THIS YEAR.
HE'D BEEN DIRECTOR SINCE THE
FALL OF 2016.
HE'S RETURNING TO COLUMBIA TO BE
CHAIR OF THE DEPARTMENT OF
PSYCHIATRY AND THE NEW DIRECTOR
OF NEW YORK STATE PSYCHIATRIC
INSTITUTE.
HE MADE CONTRIBUTIONS WHILE
DIRECTOR AT NIMHD AND WAS MY
COLLEAGUE IN CO-CHAIRING THE
COMPASS INITIATIVE AND DID A
NUMBER OF OTHER INITIATIVES AT
NIMHD AND ACCELERATING THE MODE
SINS PARTNERSHIP FOR
SCHIZOPHRENIA AND TELEMEDICINE
DURING THE PANDEMIC.
-- BACK WITH YOU IN ONE MOMENT.
>> WELL, AGAIN, APOLOGIES FOR
THE DELAY.
LET'S GO AHEAD AND GO TO JOSH
GORDON.
THIRD TIME'S A CHARM AS THEY SAY
IN ENGLISH.
HE DEPARTED IN JUNE AND WAS A
DIRECTOR SINCE 2016.
HE WENT BACK TO BEING CHAIR OF
COLOMBIA UNIVERSITY AND NEW YORK
STATE INSTITUTE AND WAS PART OF
THE COMMON FUND INITIATIVE THAT
IS FOCUSSED ON COMMUNITY ENGAGED
RESEARCH AND WE WILL MISS HIM IN
THAT ROLE.
HE ALSO LED A NUMBER OF
INITIATIVES AT NIMHD THAT REALLY
MOVED THE INSTITUTE INTO A
BROADER SPECTRUM OF RESEARCH.
DR. BERTAGNOLLI JOINED IN 2001
IN THE NIMHD INTRAMURAL PROGRAM
AND WAS PART OF THE DISORDERS
BRANCH AND WE'LL WORK WITH
DR. ABIGNOLI IN THE COMPASS
INITIATIVE AND THE ANOTHER
INSTITUTE IS THE OFFICE
STRATEGIC COORDINATION WILL BE
CARO
CAROLYN HUTTER WITH OVER 20
YEARS OF MANAGING LARGE
COLLABORATIONS.
THE COMMON FUND IS IT'S TO
CREATE SPECIAL RESEARCH
INITIATIVES OR PROGRAMS THAT ARE
CROSS-CUTTING ACROSS NIH.
I MENTIONED PREVIOUSLY THE
COMPASS INITIATIVE AS BEING PART
OF THIS A $700 MILLION IN
FUNDING AVAILABLE TO THE COMMON
FUND AND SO THIS IS A CRITICAL
ROLE.
LARGER THAN MANY INSTITUTES AS
POINTED OUT WHEN SHE WAS NAMED.
IT RUNS ABOUT 10 YEARS AND THE
EXPECTATION IS OF THE
INITIATIVES ARE SUCCESSFUL, THEY
WILL BE PICKED UP BY DIFFERENT
INSTITUTES IN ITS FUNCTION.
THE COMMON FUND HAS HAD SOME
EVOLUTION IN THE LAST COUPLE OF
YEARS INCLUDING THE DEVELOPMENT
OF VENTURE CAPITAL INITIATIVE
UNDER THE COMMON FUND THAT FOR
SHORT TERM INITIATIVES THAT MAY
OR MAY NOT BE READY FOR THE FULL
10 YEARS.
DR. HUTTER WAS PREVIOUSLY PART
OF ANOTHER CONSORTIUM.
ANOTHER ANNOUNCEMENT TO BE TUNED
INTO.
THIS WILL BE COMING FROM THE
CENTER FOR SCIENTIFIC REVIEW IN
MORE DETAIL TO LET YOU KNOW THE
SIMPLIFIED REVIEW FRAMEWORK WILL
BE NOW GOING FORWARD FOR ANY
APPLICATION THAT IS DUE ON OR
AFTER JANUARY 25 OF 2025.
THESE ARE REVISIONS THAT WILL BE
FOR MOST RESEARCH PROJECT GRANTS
OR RO1s, R21, ETCETERA.
REVISIONS OF THE NIH FELLOWSHIP
AND T32s AND OTHERS.
UPDATES ON REFERENCE LETTERS AND
APPLICATION FORMS.
AFTER MAY 25, 2025, UPDATES ON
THE BIO GRAPHICAL SKETCH AND
CURRENT OTHER SUPPORT.
DETAILS WILL BE AVAILABLE BUT
JUST TO GIVE YOU AN OVER ALL
TASTE ON THE RESEARCH PROJECT
GRANT APPLICATIONS AND THE IDEA
IS TO TRY AND MITIGATE WHAT MANY
HAVE THOUGHT ARE BIASES RELATED
TO REPUTATION AND INSTITUTION.
SO SORT OF ALWAYS COMING FROM
INSTITUTION X, THEY'RE GREAT.
THEY'LL BE FINE NO MATTER WHAT
THE CRITIQUES ARE OR THIS
INVESTIGATOR HAS BEEN VERY
SUCCESSFUL.
SO THE IDEA THAT GETS SCORED IN
A WAY THAT INFLUENCES BIAS
TOWARDS THOSE APPLICATIONS
COMING FROM THOSE INDIVIDUALS OR
INSTITUTIONS.
SO TO REALLY HELP THE REVIEWERS
FOCUS ON SCIENTIFIC AND
TECHNICAL MERIT THERE'LL BE
THREE FACTORS NOW.
THE FACTOR ONE IS IMPORTANCE OF
RESEARCH.
SO REALLY THINKING ABOUT IMPACT
AND I THINK THIS GOT A LITTLE
BIT -- I DON'T WANT TO SAY LOST
BUT DILUTED IN THE PRIOR FORMAT
WHERE PEOPLE WERE MORE FOCUSSED
ON WHAT'S THE INNOVATION OR
WHAT'S THIS AND I THINK THE
IMPACT SOMETIMES MEANS IDEAS
THAT ARE A LITTLE BIT OUT OF THE
BOX THAT MAY NOT HAVE THE MOST
SOLID METHODS YET THAT COULD BE
IMPACTFUL IF SUCCESSFUL.
FACTOR TWO IS RIGOR AND
FEASIBILITY.
ARE THE METHODS SOLID?
YOU STILL NEED SOLID METHODS NO
MATTER WHAT YOU'RE DOING IN
WHATEVER AREA OF SCIENCE YOU'RE
WORKING ON AND IS THIS FEASIBLE.
CAN YOU PULL THIS OFF?
DO YOU HAVE THE RIGHT TEAM AND
APPROACH TO RECRUITMENT OR
ANALYSIS AND EXPERTISE AND OVER
ALL IMPACT BUT DO NOT GET AN
INDIVIDUAL SCORE.
SO KEEP THIS IN MIND FROM CSR.
WE'LL HAVE MORE DETAIL AVAILABLE
AS CSR MAKES THAT AVAILABLE ON
OUR WEBSITE.
SHARING AN ANALYSIS WE'VE HAD OF
WHAT DO OUR PROGRAM
ANNOUNCEMENTS DO AND THESE ARE
SOME OF THE MORE HIGHLY APPLIED
TO PROGRAM ANNOUNCEMENTS OVER
THE LAST FIVE YEARS OR SO.
YOU CAN SEE THE SUCCESS RATE FOR
APPLICATIONS FOR THESE DIFFERENT
ONES PARTICULARLY IMMIGRANT
POPULATIONS COMBINING THE
ETIOLOGIES AND INTERVENTIONS AND
SOCIAL EPIGENOMICS ANNOUNCEMENT
AND SLEEP DISPARITIES AND LIVER
DISEASE ARE LISTED HERE.
THEY'RE ABOVE 10% SUCCESS
APPROACHING 17%.
WE'VE HAD MANY APPLICATIONS IN
HEALTH SERVICES AND ON THE
IMMIGRANT INITIATIVE AS WELL AS
THE SOCIAL EPIGENOMICS AND
SURGICAL DISPARITIES.
THE POINT IS ALSO THAT OUR
COMMUNITY, YOU, THE SCIENTIFIC
COMMUNITY FOR NIMHD HAS BEEN
MOSTLY RESPONDING TO OUR PROGRAM
ANNOUNCEMENTS.
THERE MAY BE MULTIPLE REASONS
FOR THIS.
THIS HAPPENED AROUND THE TIME
THE SWITCH FOLLOWING THE COVID
PANDEMIC SO IT WASN'T ANY
SPECIFIC TIME SO YOU SEE FROM
FISCAL '21 WE'RE IN A MORE 50/50
BALANCE THAN THE LAST TWO FISCAL
YEAR WHERE WE HAVE COMPLETE
DATA.
THE APPLICATIONS HAVE BEEN IN
RESPONSE TO PROGRAM
ANNOUNCEMENT.
I WANT TO REITERATE THAT NIMHD
IS INTERESTED IN YOUR BEST
IDEAS.
WE WANT YOUR CREATIVITY AND
APPLICATIONS.
WE'RE NOT RESTRICTED TO PROGRAM
ANNOUNCEMENTS AS LONG AS IT'S
ADDRESSING THE PRIORITIES OF
NIMHD WE WELCOME YOUR
APPLICATION FOCUSSED ON ANY OF
OUR THREE MAJOR AREAS OF
RESEARCH AS DEFINED BY OUR
DIVISIONS.
NIMHD HAS GROWN SIGNIFICANTLY.
WE'VE SHARED THE INCREASE IN
BUDGET OVER THE FEBRUARY COUNCIL
OR ONCE WE HAVE OUR BUDGET FOR
THE FISCAL YEARS.
LOOKING BACK OVER THE LAST FIVE
YEARS YOU SEE THE GROWTH IN
STAFF.
WE'RE STILL UNDER STAFFED.
WE'RE STILL RECRUITING
PARTICULARLY IN SCIENTIFIC
PROGRAMS BUT WE ARE NOW
OFFICIALLY RUNNING 117 FTEs.
WE'VE HAD A COUPLE MORE PEOPLE
AND THERE'S MORE IN THE PIPELINE
JOINING US THIS FALL.
THE DIVISION OF INTRAMURAL
RESEARCH THIS ONLY REFLECTED THE
STAFF AND TENURE TRACK
INVESTIGATORS.
THERE'S USUALLY AROUND 30 TO 40
TRAINEES IN OUR INTRAMURAL
RESEARCH DIVISION.
SWITCHING TO EX TERMING
ACTIVITIES I HAD A GOOD MEETING
WITH THE ASSOCIATION OF MINORITY
HEALTH PROFESSIONS SCHOOL
PICTURED IN THE PHOTO.
THIS GATHERS NOT EXCLUSIVELY
RESEARCH CENTERS FROM MINORITY
INSTITUTIONS AS WELL AS HBCUs WE
MET IN PERSON AND HAD A MEETING
WITH THE MOREHOUSE SCHOOL OF
MEDICINE HERE ON CAMPUS AND HAD
MEETINGS WITH THE NATIONAL
HISPANIC MEDICAL ASSOCIATION
FOUNDATION GIVING A SEMINAR,
CONVERSATION WITH FELLOWS
INTERESTED IN RESEARCH AND
FOLLOW UP MEETINGS WITH A COUPLE
AFTER THAT SESSION IN JUNE.
AND DISCUSSED THE ISSUE OF THE
INCLUSION OF RACE IN CLINICAL
ALGORITHMS.
I GAVE A VIRTUAL WEBINAR TO THE
UNIVERSITY OF HOUSTON COLLEGE OF
MEDICINE.
MOST RELEVANT PRESENTATION I
MADE SINCE LAST COUNCIL WAS THIS
COMMENCEMENT ADDRESS AT THE CITY
UNIVERSITY OF NEW YORK.
I ADDRESSED THEIR 2024
GRADUATING CLASS AND FEATURED IS
CARMEN GREEN THE DEAN OF
MEDICINE AND CARMEN AN
ANESTHESIOLOGIST BY TRAINING WAS
A SCHOLAR IN THE RESEARCH
CENTERS FOR MINORITY RESEARCH AT
THE UNIVERSITY OF MICHIGAN UNDER
JAMES JACKSON BACK 20 YEARS AGO.
SHE REACHED OUT TO ME AND IT WAS
AN IMPORTANT EVENT TO ATTEND.
ALSO A JOY REALLY TO DO THIS
WITH A VERY DIVERSE MEDICAL
SCHOOL CLASS.
THEY GAVE ME AN AWARD IN HONOR
OF JACK GEIGER AN ICON IN SOCIAL
MEDICINE.
HE WAS A WRITER AND THINKING
ABOUT ISSUES RELATED TO BOTH
CLINICAL MEDICINE AND POPULATION
HEALTH AND SOCIAL EPIDEMIOLOGY
AS AN ADVOCATE AND SCIENTIST.
I HAD THE PRIVILEGE TO MEET HIM
AND SPEAK.
AND DR. MONICA WEBB HOOPER WAS
PART OF AN INTERAGENCY COMMITTEE
ON DISABILITY RESEARCH.
A GOVERNMENT WIDE INTERAGENCY
COMMITTEE THAT FOCUSES ON
DISABILITY AND THE UNIVERSITY OF
BUFFALO HEALTH SCIENCES.
SHE ALSO PRESENTED TO THE
AMERICAN ASSOCIATION OF
PHYSICIAN ASSISTANTS AND I'M
HAPPY TO ANNOUNCE THE SELECTION
OF THE FINANCIAL MANAGEMENT
BRANCH CHIEF OUR BUDGET OFFICER
HERE IN THE ROOM.
HE CAME FROM THE NATIONAL
INSTITUTE OF DENTAL CRANIOFACIAL
RESEARCH WHERE HE WAS PREVIOUSLY
ACTING BUDGET OFFICER FOR A
NUMBER OF YEARS.
JIMMY CAME JUST IN TIME TO HELP
SET US UP FOR CLOSING UP THE
FISCAL YEAR WE'RE WORKING ON NOW
AND PART OF THE FEDERATED ASIAN
NETWORK AND WAS PART OF OTHER
ORGANIZATIONS.
WE WILL ALSO NOTE THE DEPARTURE
OF TILDA FARMHAT AND SHE CAME
BEFORE I ARRIVED.
SINCE EARLY 2020 WAS THE
DIRECTOR OF OFFICE SCIENCE,
PLANNING, EVALUATION AND
REPORTING.
WE CALL THAT OSPER AT NIMHD
SINCE 2020.
A NUMBER OF CRITICAL PROJECTS
LED FROM THAT OFFICE, ECONOMIC
BURDEN OF HEALTH DISPARITIES
PROJECT IN COLLABORATION WITH
EXTRAMURAL SCIENTISTS OR
CONTACT.
SHE FACILITATED OPERATIONALIZING
THAT AND IS COMING TO A CLOSE IN
THE NEXT FEW WEEKS.
THE EXPANSION OF HD PULSE WITH
AN INTERVENTION PORTAL WHICH
I'LL MENTION AGAIN IN A MINUTE
AND SHE CONTRIBUTED TO THE
DEVELOPMENT OF THE MINORITY
HEALTH AND HEALTH DISPARITIES
CATEGORIES UNDER THE RCDC SYSTEM
AT NIH.
SHE'S ALSO BEEN INVOLVED IN THE
PHOENIX SOCIAL DETERMINATES OF
HEALTH COLLECTION.
TILDA FOLLOWED DURAN AS THE
DIRECTOR OF THE OFFICE AND WE
ARE NOW ACTIVELY SEARCHING FOR A
NEW DIRECTOR OF THIS OFFICE.
SHE WILL BE GOING TO THE WHITE
HOUSE AS IT TURNED OUT AS A
SENIOR EXECUTIVE AND PRINCIPLE
ADVISER FOR THE OFFICE OF
TRANSLATIONAL RESEARCH AND
OFFICE OF DRUG POLICY AND
EXECUTIVE OFFICE OF THE
PRESIDENT OF THE WHITE HOUSE.
THIS IS THE POSITION BACK IN THE
DAY WAS LABELLED A DRUG CZAR
THOUGH HAS NOT HAS AS HIGH A
PROFILE THEY CONTINUE TO
FUNCTIONALITY A HIGH LEVEL
WITHIN THE EXECUTIVE BRANCH.
THEY'RE BRINGING HER ON TO
REALLY FOCUS ON THE ANALYTICAL
DATA RELATED TO HEALTH AS
OPPOSED TO THE ASPECTS OF
ENFORCEMENT THAT INITIALLY WAS
THE MAIN FUNCTION OF THAT
OFFICE.
WE WILL MISS TILDA AND WE'LL
LOOK FORWARD TO SEEING HER
ACCOMPLISHMENTS IN HER NEW ROLE.
SOME LEGISLATIVE UPDATES.
RIGHT NOW CONGRESS CONTINUES TO
BE IN RECESS UNTIL NEXT WEEK BUT
WE HAD A BRIEFING WITH STAFF OF
SENATOR HEINRICH WHERE WE
DISCUSSED A PLATFORM AND THEY
WERE INTERESTED IN WHAT WE WERE
DOING PARTICULARLY AROUND THE
INTEREST OF BIAS AND ARTIFICIAL
INTELLIGENCE.
AND IN JULY, MONICA AND MYSELF
AND FROM THE HEALTH LABOR AND
SUBCOMMITTEE ON THE RESEARCH
CENTERS IN MINORITY INSTITUTIONS
PROGRAM WHERE THEY WERE
QUESTIONS ASKED ABOUT HOW WE HAD
ALLOCATED THE FUNDS CONGRESS
PROVIDED.
THIS WAS THE MAJORITY OF STAFF
INTERESTED IN THEM.
WE HAD A COUPLE HIGHLY
SUCCESSFUL WORKSHOPS WE EITHER
LED OR CO-SPONSORED.
UNFORTUNATELY I MISSED TWO OF
THEM.
THIS WAS THE INFLUENCE OF
INTERPERSONAL BIASES THAT LED TO
THE ENHANCES MECHANISMS LINKED
TO BIAS EXPOSURE TO HELP
DISPARITIES AND OUTCOMES AND
STRATEGIES.
THE NEED FOR MEASURES AND AND
CONSIDER INTERSECTIONALITY IN
PRIORITIZING ACROSS DISCIPLINARY
COLLABORATIONS ON THIS AND
INCORPORATING PATIENT BIAS IN
EXPOSURES IN HEALTH CARE.
THE WORKSHOP IS AVAILABLE ON
VIDEOCAST AND YOU CAN LOOK FOR
IT THERE ON THE NIH VIDEOCAST
AND IT'S QUITE OUTSTANDING SET
OF PRESENTATIONS.
WE WERE ALSO VERY INVOLVED IN
THE UNITE SPONSOR WORKSHOP ON
STRUCTURAL RACISM.
THIS IS ALSO VIRTUAL HELD IN
JULY 18 AND 19.
THERE WERE NEARLY 3,000
PARTICIPANTS VIRTUAL LY THE IDE
WAS TO BRING IN SCIENTISTS,
THOUGHT LEADERS IN DISCIPLINES
THAT ARE NOT USUALLY AT THE
TABLE DISCUSSING POPULATION
HEALTH ISSUES OTHERWISE.
THE MOST SIGNIFICANT I HEARD WAS
THE PERSPECTIVE OF LAW AND
CRIMINAL JUSTICE.
MOST THE OTHER INDIVIDUALS
PEOPLE COMING FROM SOCIAL
SCIENCES OR PUBLIC POLICY,
EDUCATION AND OTHER AREAS THAT
WE DO WORK WITH WERE PRESENT.
I THINK IT DOES MANDATE THE
IMPORTANCE OF INCORPORATING ALL
THESE DIFFERENT PERSPECTIVES IN
OUR THINKING ABOUT ADVANCING
KNOWLEDGE AND DECREASING
DISPARITIES IN THIS ISSUE.
THIS IS NOT GOING TO BE AN
EASY -- IT'S GOING TO BE A HARD
LIFT LET'S PUT IT THIS WAY.
OUR EFFORT ON FUNDING GRANTS FOR
ADDRESSING STRUCTURAL RACISM
CONTINUE.
WE HAD A SUCCESSFUL RFA IN 2021
THAT WAS NIH WIDE.
WE'RE CONTINUING TO LEAD THAT
NOT AS A SET ASIDE BUT CALL WITH
AN EMPHASIS ON INTERVENTIONS
SINCE WE THINK WE HAVE TO GET
OUT OF THE MOLD OF THINKING
ABOUT DESCRIBING AND REALLY PUSH
THE ENVELOPE ON INTERVENTIONS
THAT WILL BE SOME WILL FAIL BUT
IF WE DON'T TRY WE WON'T BE ABLE
TO FIND OUT.
SO THIS WORKSHOP HELPED
CONTRIBUTE TO THE UNDERSTANDING
OF THAT.
WE DO THINK WE HAVE A WAYS TO GO
BUT IT'S A GOOD START TO GET
GOING ON THIS.
WE HAD ALSO A HIGHLY SUCCESSFUL
HEALTH DISPARITIES RESEARCH
INSTITUTE GATHERING IN AUGUST OF
2024 JUST LAST MONTH.
IN THIS VERY ROOM WE'RE SITTING
IN NOW WE SELECTED 51 EARLY
STAGE CAREER SCIENTISTS THAT
REPRESENTED 22 STATES IN THE
DISTRICT OF COLUMBIA.
I THINK IN A PALPABLE WAY WE HAD
DIVERSE INSTITUTIONS PRESENT.
WE ALWAYS HAD DIVERSE
INDIVIDUALS, MULTIPLE
DISCIPLINES.
USUALLY SOMEWHERE IN THE 20% OR
CLINICIANS, MOSTLY PHYSICIANS
BUT NOT INCLUSIVELY AND A NUMBER
OF RNs AND PHARMACIST AND
PSYCHOLOGY AND EPIDEMIOLOGY
Ph.D.s.
THIS IS I THINK A SPECIAL
PROGRAM.
I'M VERY PROUD OF.
OUR STAFF WORKED HARD TO MAKE
THIS HAPPEN.
THIS IS ON DAY ONE WHERE I GAVE
AN OPENING LECTURE TO THE GROUP
AND THIS YEAR'S WINNER IS
PICTURED THERE ON THE SLIDE, AN
AWARDEE TO ADDRESS THIS IN THE
SYSTEM PROFESSOR AT I THINK ONE
OF THE BOSTON HOSPITALS AND
CONTINUED CLAB RAGE WITH
NATIONAL NIB, NATIONAL INSTITUTE
OF BIO MEDICAL IMAGING AND
BIOENGINEERING TO PROVIDE AWARDS
FOR INNOVATIVE PROPOSALS COMING
FROM COLLEGE UNDERGRADUATES.
THE AWARDS ARE $15,000 FOR THE
FIRST PLACE.
WE PARTICIPATE WITH NIB AND A
COUPLE OTHER INSTITUTES ON THIS.
STAFF REVIEWED THEY'RE ALL
SUBMITTED AT VIDEOS.
THEY'RE FUN TO LOOK AT AND
ENCOURAGE ANYONE WHO TAKES THE
TIME TO LOOK AT THESE.
THEY'RE ONLY THREE MINUTES LONG
SO YOU'RE NOT SPENDING A LOT OF
TIME AND THEY'RE CREATIVE IN HOW
THEY PRESENT.
I ALWAYS ENJOY SEEING HOW
THEY'RE VIEWING WHAT IS OFTEN A
CLINICAL ISSUE IN COMING FROM
PEOPLE WHO HAVE NO REAL CLINICAL
BACKGROUND.
THESE ARE PRIMARILY ENGINEERING
STUDENTS JUST TO GIVE YOU THE
SENSE.
THE WINNER FROM OUR PERSPECTIVE
WAS THE RAPID LED SALIVA TEST TO
ADDRESS THE CHALLENGES THAT
PERSIST IN SOME PARTS OF THE
COUNTRY.
IT USED TO BE LED COMING FROM
PAIN AND WHEN PAIN AND WEN LEAD
REWAS REMOVED FROM PAINT THE
PROBLEM SEEMED READY TO GO AWAY
AND CAN SUNSET THE PROBLEM OF
LEAD EXPOSURE AND WE KNOW ANY
DETECTABLE LEAD IN ANYONE BUT
PARTICULARLY IN A CHILD IS
POTENTIALLY HARMFUL TO COGNITIVE
DEVELOPMENT AND CAN BE IN WATER
DUE TO AGING PLUMBING.
SO THIS IS A WORTHWHILE TEST TO
INTEREST FOR FUTURE DEVELOPMENT.
I MENTIONED EARLIER THE HD PULSE
INTERVENTIONS PORTAL LAUNCH.
THIS WAS IN CONJUNCTION OR
COLLABORATION WITH THE OFFICE OF
MINORITY HEALTH IN THE HEALTH
AND UMAN SERVICES DEPARTMENT AND
WILL PROVIDE ACCESS TO
INTERVENTIONS THAT WE HAVE
VETTED AS SUCCESSFULLY IMPROVING
MINORITY HEALTH OR REDUCING
HEALTH DISPARITIES.
THEY GO THROUGH RIGOROUS REVIEW
BY STAFF AND EVIDENCE-BASED
INTERVENTIONS TO ADDRESS
PROBLEMS WE'RE STILL WORKING OUT
AND HAPPY WITH TO THE RESULT AND
THE OFFICE OF MINORITY HEALTH
WILL CONTINUE TO PARTNER WITH US
TO POST THUR PROGRAMS THAT HAVE
EVIDENCE-BASED SUPPORT.
I'LL SWITCH TO GIVE AN UPDATE ON
A FEW SCIENCE ADVANCES ONLY
GRANTS PRODUCED OR FUNDED BY
NIMHD.
IN THIS CASE START WITH A PAPER
TWO PROGRAM STAFF A REVIEW OF
MATERNAL AN INFANT MORTALITY
LITERATURE TO DETERMINE THE
MULTI-LEVEL SOCIAL DETERMINATES
OF HEALTH THAT LEAD TO
MORTALITY.
BLACK MOTHERS AND INFANTS HAD
THE HIGHEST MORTALITY RATES DUE
AND STRUCTURAL EXPERIENCE ACROSS
THE LIFE COURSE AND UP STREAM
CONTRIBUTORS WERE IMPORTANT AND
UNLESS THEY'RE ADDRESSED THEY'RE
-- THEIR SITUATION IS UNLIKELY
TO IMPROVE.
THIS IS THE BEST PAPER AWARD
FROM THE JOURNAL ON CHILDREN IN
THE STUDY.
THERE'S A PUBLICATION COMING
FROM OUR OS PER OFFICE STAFF OF
THAT OFFICE CO-AUTHORED.
IT EXAMINED THE NIMHD PORTFOLIO
OF 675 FUNDED UNIQUE GRANTS
MOSTLY RO1s OR UR 1s IN SOCIAL
DETERMINATES OF HEALTH FROM 2019
TO 2023 USING THE NIH
CLASSIFICATION SYSTEM TO
IDENTIFY NIMHD FUNDED PROJECTS.
PARTICIPANTS AND SOCIAL
DEMOGRAPHICS AND SOCIAL MINORITY
GROUPS AND EXPECT STATUS AND SEX
AND GENDER MINORITY GROUPS WERE
THE FOUR CATEGORIES EVALUATED IN
THE PUBLICATION.
THIS IS BEFORE THE DESIGNATION
OF PEOPLE WIAND THE HEALTHY PEOE
2030 DOMAINS.
THE MOST FREQUENTLY STUDIED
TOPICS ON MENTAL HEALTH AND IN
FENG HOUSE DISEASE AND NUTRITION
AND YOUTH VIOLENCE, CANCER AND
OBESITY AND NOTABLE
CARDIOVASCULAR DISEASE IS NOT
THERE AND OBESITY IS RELATED AS
WELL AS MENTAL HEALTH.
WE'RE ALSO PROUD OF THE SPECIAL
ISSUE THAT CAME OUT IN JAMA AND
NETWORK OPEN.
THIS WAS A CONSEQUENCE OF A
VARIETY OF DISCUSSIONS WITH
STAFF AND NEUROLOGICAL AND
BEHAVIORAL SCIENCES DIVISION AND
TURNED OUT TO BE THE RIGHT PLACE
TO PROMOTE THE INITIATIVE A
BROADLY READ JOURNAL AND THE
JAMA FAMILY DISSEMINATES
EFFECTIVELY AND THIS WHOLE
COMPONENT OF BRANDING AS AN
NIMHD EPIGENOMICS RESEARCH AND
THEY CARRIED IT OUT IN THE
TITLE.
I SPOKE TO AT LEAST ONE
PREVENTION WHO LED ONE OF THESE
GRANTS WHO THOUGHT IT WAS A
GREAT WAY TO PROMOTE THE
INITIATIVE.
IT'S BEEN GOING ON A NUMBER OF
YEARS THEY DRAFTED THE EDITORIAL
I ALSO CO-AUTHORED ON THIS
ISSUE.
I'D RECOMMEND INDIVIDUALS TO
REFER TO IT.
ONE OF THE PAPERS PUBLISHED WAS
ON SLEEP AND HEALTH ON URBAN
ALASKAN AMERICANS AND WE SLEEP
IS PROTECTIVE AGAINST CHRONIC
DISEASE.
IT'S AN ASPECT OF LIFE WE SPEND
UP TO A THIRD OF OUR TIME OR
SHOULD SPEND A THIRTY OF OUR
TIME DOING AND YET WE DON'T KNOW
NOT ENOUGH WHAT IT DOES FOR
LONG-TERM HEALTH.
IT'S A STUDY OF ADOLESCENTS FROM
URBAN AREAS IN CALIFORNIA
COMPLETING A NUMBER OF SURVEYS
ON SLEEP, MENTAL AND BEHAVIORAL
HEALTH AND CARDIO METABOLIC
OUTCOMES AT BASELINE AND
FOLLOW-UP AND SHORTER SLEEP
DURATION PREDICTED MORE
DEPRESSION AND ANXIETY AND
INCREASED LIKELIHOOD OF CANNABIS
AND ALCOHOL USE AT FOLLOW.
THIS IS A USEFUL PROSPECTIVE
DESIGN AS IT CONTRIBUTES AS A
CAUSAL INFERENCE.
THERE'S A NUMBER OF STUDIES WITH
ADOLESCENTS THAT HAVE FOUND
DIFFERENT FORMS OF STRESS.
SHORT SLEEP IS A FORMED OF
STRESS AND THERE WERE SYMPTOMS
THAT ARE SIGNIFICANT ISSUES TO
ADDRESS AMONG YOUTH AND YOUNG
ADULTS AND THE ISSUE OF
CARDIOVASCULAR HEALTH IS ONE AT
LOOKING AT BODY MASS INDEX AND
OTHER MEASURES OF OBESITY.
AND LOOKING AT THE DIFFERENCES
THAT PEOPLE HAVE AND PATTERNS OF
SLEEPING LESS DURING THE WEEK
AND MORE ON THE WEEKENDS AND HOW
IT CAN HAVE EFFECT.
LOOKING AT HOW IT INFLUENCES
YOUTH IS WHAT WE LOOK AT IN THIS
POPULATION.
AGRICULTURAL FIELD WORKERS HAVE
COME UNDER SOME ATTENTION.
THEY PLAY A CRITICAL ROLE IN OUR
SOCIETY IN TERMS OF ABUNDANCE
AND VARIETY OF FRESH FOOD
AVAILABLE TO MUCH OF THE UNITED
STATES, NOT ALL.
THE EXPOSURE IS DOESN'T THAT GET
AS MUCH ATTENTION AS IT SHOULD
AND MOTHERS WORKING IN THE FIELD
AND CHILDREN WORKING IN THE
FIELD ARE EXPOSED.
IT'S A STUDY FOR THOSE WHO ARE
CONNECTED TO THAT HISTORY IN OUR
COUNTRY THIS IS THE HOME OF JOHN
STEINBACK ONE OF THE MOST
FERTILE VALLEYS IN THE COUNTRY
IF YOU WISH IN TERMS OF GROWING
FRUITS AND VEGETABLES.
THEY LOOKED AT THE SAMPLES OF
290 PREDOMINANTLY MEXICAN
MOTHER-CHILD PAIRS IN A
LONGITUDINAL COHORT AND
AGRICULTURAL FIELD WORK WAS
ASSOCIATED WITH HIGHER RISK,
GREATER EPIGENETIC AGE
ACCELERATION.
THE NOTION OF WHAT THE
ACTIVITIES DO LONG-TERM MEASURED
IN THIS CASE THROUGH THE
BIOLOGICAL METRIC OF THE
EPIGENETIC CLOCK I THINK IS ONE
OF THE KINDS OF RESEARCH THAT
NIMHD HAS BEEN FUNDING WHICH I
THINK IS IMPORTANT TO IMPORTANT
IN CONTRIBUTING TO THE KNOWLEDGE
AND MEDIATORS IN ETHNIC IDENTITY
IN RACIAL HEALTH AND SAMPLE OF
279 INDIVIDUALS.
SEE THE BREAK DOWN BY RACE AND
ETHNICITY, MAJORITY FEMALE
SURVEYED ABOUT ETHNIC AND RACIAL
IDENTITY EXPLORATION.
IT GETS TO THE ISSUE OF WHAT IN
THE END DOES THIS ALL MEAN AND
WHAT DOES RACE AND ETHNICITY.
THERE ARE PROPONENTS OF SAYING
WELL, WE'RE ALL HUMANS.
WHAT IS THIS THING ABOUT RACE.
PARTICULARLY HEAR THAT FROM SOME
IMMIGRANTS TO THE
U.S. IDENTIFIED AS ETHNIC AND
MINORITY PERSON.
IS THIS SOMETHING THAT WILL GO
AWAY WITH TIME?
AS WE INTERMINGLE MORE AND IT'S
PLAUSIBLE.
THE REALITY IN 2024 IS IT'S
LIKELY NOT GOING TO GO AWAY IN
MY LIFE TIME.
THIS IS STRESS RESPONSE MEASURED
IN YOUTH AND LOOKING AT SLEEP
QUALITY SYMPTOMS, SOMATIC
SYMPTOMS WHETHER THEY RELATE TO
HEADACHE AND NAUSEA THAT ARE
MANIFESTATIONS OF STRESS AND NOT
CALLED BY A PARTICULAR ILLNESS
AND DISCRIMINATION AND STRESS
RESPONSES DO EXACERBATE THE
NEGATIVE ASSOCIATIONS IN THESE
ETHNIC AND RACIAL IDENTITY
EXPLORATION OF ADOLESCENTS IN
THEIR SLEEP AND SYMPTOMS.
THEIR IDENTITY HELPED MEDIATE BY
BUFFERING THE POSITIVE
ASSOCIATION BETWEEN
DISCRIMINATION AND PROBLEM
SOLVING WHILE THE STRESS
EXACERBATED THE ASSOCIATIONS.
LESSON HERE IS DISCRIMINATION
AND STRESS ARE PERCEIVED BY
YOUTH HAVING THIS ETHNIC RACIAL
IDENTITY REALLY DOES HELP IN
DISCRIMINATION MAKE EXACERBATE
THESE SYMPTOMS THIS IS ON A
COVID VACCINATION AND EVERYBODY
SHOULD CONSIDER GENT VACCINATED
THIS FALL.
A SURVEY OF ALMOST 300 LATINO
AND BLACK AUMENT DIFFICULTS
ENROLLED IN AN HIV AIDS PROGRAM
UNDER THE RON WHITE PROGRAM IN
THE YEAR 2022.
STILL TOWARDS THE PERIOD PERIOD
OF COVID EMERGENCY.
FULLY VACCINATED PARTICIPANTS
WERE LIKELY TO BE OLDER,
CISGENDER MALES AND SOME COLLEGE
EDUCATION AND COMING FROM
HOUSEHOLDS UNDER 100% POVERTY.
FULLY VACCINATED PARTICIPANTS
WERE LESS LIKELY TO BE PLAQUE OR
ENDORSE VACCINE MISCONCEPTIONS
AND REPORTED MORE VACCINATION
ENCOURAGEMENT AND IT'S ONE OF
THE STUDIES THAT WE FUNDED ON
THE ISSUE OF VACCINE UPTAKE AND
WE'LL CONTINUE TO WORK ON THAT.
IN THIS PARTICULAR ANALYSIS OF
STROKE PREVALENCE THEY
SURVEILLED THE SYSTEM OVER
MULTIPLE CROSS SECTIONAL SAMPLES
TO ASK ABOUT SELF-REPORTED
STROKE AMONG AMERICAN INDIAN AND
ALASKAN NATIVE.
STROKE INCIDENTS IS SOMETHING
THAT IS A SUCCESS OF U.S. HEALTH
BECAUSE CONTROL OF HYPERTENSION
DETECTION TREATMENT AND CONTROL
OF HYPERTENSION HAVE LED TO A
DRAMATIC INCREASE OF STROKE
INCIDENCE OVER 40 YEARS.
THE LAST 10 TO 15 YEARS WE'VE
SEEN A FLATTENING TO SOME OF
EXTENT INCREASES AND MORTALITY
IS ALSO NOT JUST THE RATES HAVE
FLATTENED IN INCREASE BUT ALSO
MORTALITY DONE THE SAME THING.
THIS IS OF GREAT CONCERN TO THE
SCIENTIFIC COMMUNITY AND BOTH
THE GENERAL HEALTH ISSUES AND
NEUROLOGY RESEARCHERS.
SIMILAR TO WHAT WE'VE SEEN WITH
CARDIOVASCULAR OUTCOMES IN
GENERAL.
IN THIS PARTICULAR POPULATION WE
SAW PREVALENCE INCREASE BY
SELF-REPORT FROM 2.9 TO 3.3%.
AT BEST IT IS NOT GOING TO
CONTINUE TO GO DOWN AND IT WAS
HIGHEST IN AMERICAN INDIAN AND
ALASKAN NATIVE ADULTS IN 2011
AND 2021 COMPARED TO WHITES.
WE'RE MORE LIKELY TO HAVE A
HIGHER NUMBER OF RISK FACTORS.
WE KNOW WHAT TO DO FOR THESE
RISK FACTORS.
AND FOR STROKE AND HYPERTENSION
AND HYPERLIPIDEMIA OR VASCULAR
DISEASE, OBESITY AND LESS PAID
ATTENTION TO IS ALCOHOL USE
AMONG OTHERS THAT NEED TO BE
ADDRESSED.
THIS PERSISTENT DISPARITY IS
SOMETHING TO CONSIDER.
INDICATORS OF STRUCTURAL RACISM
AND SEVERE MATERNAL MORBIDITY
WERE EVALUATED IN THE STUDY FROM
THE U.S. THAT ABSTRACTED TO
ASSESS ASSOCIATION AT A STATE
LEVEL.
THIS IS ONE OF THE EARLY 401
GRANTS WE FUNDED LOOKING AT
BLACK TO WHITE INEQUITY ISSUES
IN SEVERE MATERNAL MORBIDITY AND
THOUGH THERE'S 1,000 DEATHS A
YEAR AND GEORGIA IS CERTAINLY AN
AREA THIS IS COMING FROM THE
STATE OF GEORGIA I THINK WHERE
WE HAVE CONCERNS ABOUT POCKETS
OF HIGH MORTALITY.
MORBIDITY IS ABOUT 50 TO 100,000
EVENTS A YEAR AND LOOKING AT THE
LARGE SAMPLE SIZE 22% WERE BLACK
WOMEN AND SEVERE MATERNAL
MORBIDITY WAS SEVERE IN BLACK
COMPARED TO WHITE WOMEN THE ONLY
COMPARISON IN THE ANALYSIS.
THE ODDS OF SEVERE MATERNAL
MORBIDITY INCREASE FOR 1%
INCREASE IN UNEMPLOYMENT AND
MORE THAN IT DID FOR WHITE WOMEN
AND THE ODDS OF SEVERE MATERNAL
MORBIDITY INCREASED PER ONE UNIT
INCREASE FOR BLACK WOMEN
INCARCERATION COMPARED TO BLACK
WOMEN.
THESE STRUCTURAL RACISM
INDICATORS OR SOCIO ECONOMIC
INDICATORS IN THE CASE OF
UNEMPLOYMENT AND INCARCERATION
REALLY ARE REFLECTED IN THE
MEDIATOR IN MATERNAL MORTALITY.
THIS IS A PUBLICATION FROM OUR
INTRAMURAL PROGRAM LED BY
DR. WILLIAMS IN ANALYZING
MULTIPLE YEARS OF THE NATIONAL
HEALTH INTERVIEW SURVEY TO
EXAMINE MODERATE TO SEVERE
PSYCHOLOGICAL DISTRESS IN
NEIGHBORHOOD COHESION STRATIFIED
BY YEARS LIVING IN THE U.S.
WE ALL LIKE ROUND NUMBERS SO 10
IS USUALLY USED THOUGH I DON'T
THINK THERE'S SIGNS IN SAYING 10
YEARS IS THE MAGICAL TIME YOU'RE
A RESIDENT IN THE COUNTRY.
LOW TO MEDIUM NEIGHBORHOOD
COHESION REGARDLESS OF RESIDENCE
WAS RELATED TO HIGHER ODDS OF
MODERATE SEVERE PSYCHOLOGICAL
DISTRESS.
THIS IS AN IMPORTANT RESEARCH
QUESTION IS WHAT IS THE ROLE OF
A GOOD NEIGHBORHOOD, QUOTE,
UNQUOTE GOOD NEIGHBORHOOD AND
HOW DO YOU MEASURE THAT?
MOST RESEARCHERS HAD TRY TO GET
AT THIS USING MACRO DATA OF
NEIGHBORHOOD COHESION AND IN
THIS CASE WAS LOOKING AT
PERCEPTION AND DISTRESS IN THE
OTHER FACTORS THAT ARE
STRATIFIED BY YEARS OF LIVING IN
THE U.S.
THIS IS I THINK AN IMPORTANT
RESEARCH AND SCIENCE QUESTION
FOR OUR COMMUNITY ENGAGEMENT
APPROACH TO RESEARCH IN THAT WE
THINK THAT BETTER MORE COHESION
IS ACTUALLY REALLY GOOD FOR
INDIVIDUAL'S HEALTH.
I THINK THE DATA NEEDS TO BE
CONSOLIDATED.
I DON'T THINK THE EVIDENCE IS
COMPELLING.
THERE'S MORE EVIDENCE THAT
PROBLEMS ARE A PROBLEM.
IF YOU HAVE A NEIGHBORHOOD WITH
PROBLEMS THAT PEOPLE HAVE
INDIVIDUALS HAVE WORSE HEALTH.
HAVING THOUGHT ABOUT THIS AND
WORKING ON THIS THROUGH
SECONDARY DATA THIS IS AN AREA
THAT NEEDS CONTINUED ATTENTION.
IN THIS PARTICULAR ANALYSIS FORN
FOREIGN-BORN INDIVIDUALS HAVE
LOWER STRESS AFTER 10 YEARS OF
RESIDENCY.
IN ONE OF THE PAPERS WE
PUBLISHED ON OUR COLLABORATION
WITH THE INSTITUTE FOR HEALTH
METRIC EVALUATION INSTITUTE OF
WASHINGTON WHAT WE CALL THE
GLOBAL BURDEN OF DISEASE,
U.S. HEALTH DISPARITIES GROUP,
THIS PAPER IS PUBLISHED ON THE
SORCIRRHOSIS MORTALITY WE LOOKET
CIRRHOSIS MORTALITY AND FOUND
HIGHEST AMONG THE AMERICAN
INDIAN ALASKAN NATIVE
POPULATIONS AND THE PROBLEM IS
WIDESPREAD AND THE MORTALITY HAS
INCREASED IN ALL COUNTY FOR
WHITE AND AMERICAN INDIAN AND
ALASKAN NATIVE AND FEWER FOR
ASIAN, BLACK AND LATINO
POPULATION.
THE IMPORTANCE.
OF TRYING TO PREVENT CIRRHOSIS
IS NOT JUST CAUSED BY EXCESSIVE
ALCOHOL CONSUMPTION WHICH IS
WHAT A LOT OF LAY INDIVIDUALS
MAY THINK, AS AN INTERN IN
MEDICINE HEPATITIS B AND C ALSO
LEAD TO CIRRHOSIS AND THESE ARE
MOSTLY PREVENTIBLE THROUGH
VACCINES OR CURABLE WITH
MEDICATIONS AT 12 WEEK COURSE
FOR HEPATITIS B AND THE
DEVELOPMENT OF INFLAMMATION FROM
FATTY INFILTRATION IN THE LIVER
WHICH IS THE LEADING CAUSE OF
CIRRHOSIS IN SOME POPULATIONS.
THIS IS THE KIND OF ANALYSIS
ANYONE CAN DOWNLOAD FROM THEIR
WEBSITE AND LOOK AT THE MAPS AND
HIGHLIGHT THIS IS WHAT WE WERE
FOCUSSED ON AMERICAN INDIAN.
SO RED IS INCREASING RATES OF
CIRRHOSIS MORTALITY AND THE
BLUE, GREEN, WHATEVER, TEAL
COLOR THIS IS IS IMPROVEMENT.
AMONG ASIAN POPULATIONS WE'VE
SEEN PREDOMINANT IMPROVEMENT
SINCE AS THE PRIMARY CAUSE OF
CIRRHOSIS RELATED TO HEPATITIS B
AND THE UPTAKE IN THIS COMMUNITY
HAS BEEN HIGH IN THE COUNTRIES
WHERE IMMIGRANTS ARE COMING FROM
AND ASIA AND SUCCESSFUL
VACCINATION AND WHEN CHRONICALLY
INFECTED MOMS VERTICALLY
TRANSMIT TO THEIR CHILD IN UTERO
OR EARLY CHILDHOOD THEY HAVE THE
HIGHEST RISK OF DEVELOPING
CIRRHOSIS OVER TIME.
WE SEE FOR BLACK AMERICAN
PINKISH RED AREAS SO WE'RE NOT
ALL MAKING PROGRESS.
SOME AREAS ARE GOOD.
AMONG LATINO HISPANICS WE SEE
THE SAME THING.
BIG PROBLEMS IN THE SOUTHWEST
AND SOUTHEAST.
IT VARIES ACROSS THE COUNTRY BUT
WHITE POPULATION BE THE LARGEST
WE SEE THE TOTAL POPULATION AND
PICTURE FOR SIR ROVES WORSENING
ACROSS THE COUNTRY.
I WANT TO CLOSE AGAIN AS WE DO
USUALLY WITH A SNAPSHOT OF OUR
SUMMER INTERNS THAT PRESENTED AT
THE SESSION.
THESE ARE SUMMER INTERNS WHO
COME TO NIMHD FOR SUPPORTED
EIGHT WEEK PERIOD AND THEN THERE
IS A POSTER SESSION THAT IS
HELD.
IT INCLUDES THE SUMMER INTERNS I
HAD IN MY LAB PICTURED HERE AS
WELL AS WELL AS THOSE FROM
NIMHD.
THANK YOU FOR YOUR ATTENTION.
ENCOURAGE ANYONE OUT THERE WHO
WANTS A CAREER IN NIMHD TO APPLY
AND WE NEED SCIENTISTS IN OUR
SCIENTIFIC PROGRAMS AND WE
WELCOME APPLICATIONS FROM ANYONE
AND THANK YOU AGAIN FOR YOUR
ATTENTION.
I'LL STOP SHARING AND TAKE A FEW
MINUTES FOR COMMENTS OR
QUESTIONS FROM THE COUNCIL
MEMBERS.
WE'RE RUNNING BEHIND BUT WE CAN
ENTERTAIN QUESTIONS.
>> LET ME LOOK ONLINE.
I SEE NONE IN THE ROOM.
I SEE NONE ONLINE.
>> OKAY.
WELL, WE CAN TAKE A WONDERFUL
EIGHT MINUTE BREAK AND GET BACK
ON TRACK.
THANK YOU VERY MUCH.
I'M NOT SWEATING AS MUCH AS I
WAS NOW ON THE TIME.
THANK YOU.
>> GOOD MORNING, AGAIN.
WE'RE GOING TO NOW GO TO OUR
FIRST PRESENTATION FOR THE
SESSION OF COUNCIL.
IT'S A PLEASURE TO INTRODUCE A
COLLEAGUE AND FRIEND,
DR. DARRELL GASKIN A HEALTH
ECONOMIST WHO HAS BEEN MOST OF
HIS CAREER AT JOHNS HOPKINS
UNIVERSITY.
HE'S AN ACCOMPLISHED
INVESTIGATOR IN HEALTH
DISPARITIES SCIENCE.
I MET HIM FIRST IN I THINK 2017
INVESTING THE INVESTIGATION OF
MICHIGAN AND WAS A SPEAKER AT A
SYMPOSIUM ON THE CENTERS OF
EXCELLENCE WITH A NUMBER OF
OTHER INVESTIGATORS.
HE WAS A MEMBER OF THE NATIONAL
ACADEMIES COMMITTEE THAT
PRODUCED THE ENDING ON UNEQUAL
REPORT WITH LISA SUMMER.
NIMHD HELPED FUND THE REPORT AND
GUIDED BY STAFF AND I THINK IT'S
GOING TO BE AN IMPORTANT
DOCUMENT.
WE DON'T WORRY SO MUCH ABOUT THE
BUZZ AND THE TREATMENT IT GETS
IN UNEQUAL TREATMENT PART 1 IS
WHAT THE COMMUNITY DOES WITH IT
AND WHAT OUR SCIENTIFIC
COMMUNITY REFERS TO WHAT IS IN
THE REPORT AS TIME PASSES.
IT'S BEEN ALMOST 20 YEARS SINCE
UNEQUAL TREATMENT 1 AND
REFLECTED BY THE EFFORTS MADE BY
ALL OF YOU IN REFERRING TO IT.
I ENCOURAGE YOU TO READ THIS AND
REFLECT ON IT.
DARRELL WILL GIVE US A
PRESENTATION AND WE'LL HAVE TIME
FOR SOME CONVERSATION.
DR. GASKIN.
>> THANK YOU, DR. PEREZ-STABLE.
I ALSO APPRECIATE THE
OPPORTUNITY TO PRESENT THE
COMMITTEE'S REPORT.
I'M LOOKING ACROSS THE ROOM AND
SEE OTHERS ON THE COMMITTEE.
I SAY IF YOU'RE ON THE COMMITTEE
WHY AREN'T YOU DOING THIS
INSTEAD OF ME BECAUSE YOU'RE
CERTAINLY AS CAPABLE OF
PRESENTING THE COMMITTEE'S
REPORT.
I WILL SAY THIS, IF YOU HAVE
DIFFICULT OR HARD QUESTIONS
PLEASE DIRECT THEM TO THE OTHER
SIDE OF THE ROOM.
ANYWAY, SO WE PRODUCED A REPORT
TO ADDRESS HEALTH UNEQUAL AND
BRING CHANGE TO NOT ONLY IMPROVE
THE HEALTH OF INDIVIDUALS AND
FAMILIES BUT THE OVER ALL
PRODUCTIVITY OF THE NATION.
WE'RE APPRECIATE OF THE SPONSORS
AND THANK THE NATIONAL INSTITUTE
OF MINORITY HEATH AND HEALTH
DISPARITIES FOR THE MEETING AND
ENCOURAGE THE NATIONAL ACADEMIES
OF MEDICINE TO LOOK TO THE
FUTURE.
THESE ARE THE COMMITTEE MEMBERS
APPOINTED TO CONDUCT THE CITY
WITH LEADERS AND EXPERTS ON
SOCIAL POLICY AND DISPARITIES
AND PUBLIC HEALTH, PRIMARY CARE,
NURSING, HEALTH TECHNOLOGY,
HEALTH CARE FINANCING,
COMMUNITY-ENGAGED RESEARCHER AND
HEALTH PROFESSIONS AS WELL AS
HEALTH ECONOMICS AND HEALTH
SERVICES RESEARCH.
THE COMMUNITY WAS LED BY GEORGE
BENJAMIN AND JENNIFER DA VOE.
EFFORTS CAN BE TRACED BACK TO
THE LATE 20th CENTURY WITH THE
PUBLICATION OF THE 1985 REPORT
OF THE SECRETARY'S TASK FORCE ON
BLACK AND MINORITY HEALTH
RESULTING IN SEVERAL ACTIONS
TAKEN TO ADDRESS THIS ISSUE.
THEN IN 2003 THE INSTITUTE OF
MEDICINE'S UNEQUAL TREATMENT
CONFRONTING BIAS AND ETHNIC
DISPARITIES DOCUMENTED
INEQUITIES AND QUALITY OF HEALTH
CARE RECEIVED BY MINORITIZED
POPULATIONS AND MAKING
PHYSICIANS AWARE OF POTENTIAL
UNCONSCIOUS BIAS IN CLINICAL ,
IMPROVING EDUCATION TO IMPROVE
CULTURAL COMPETENCY IN MEDICAL
AND STANDARDIZING COLLECTION OF
DATA AND THE THERE'S BEEN THE
QUALITY AND DISPARITIES REPORT
TO PRESENT TRENDS FOR MEASURES
RELATED TO ACCESS TO CARE,
AFFORDABLE CARE, COORDINATION OF
CARE AND EFFECTIVE TREATMENT,
HEALTHY LIVING, PATIENT SAFETY
AND PERSON-CENTERED CARE.
FOR THE PAST TWO DECADES WE'VE
SEEN THE PROLIFERATION OF
EXECUTIVE ORDERS, STRATEGIC
PLANS, POLICY STATEMENTS.
CHIEF AMONG THEM WAS THE PATIENT
AND AFFORDABILITY CARE ACT KNOWN
AS THE AFFORDABLE CARE ACT IN
2010.
THIS IS A MAJOR POLICY STRIFE
AND THE MOST COMPREHENSIVE
LEGISLATIVE MEASURE FOR REFORM
AND THERE'S INEQUITIES ACROSS
ALL STATES EVEN IN THE STATES
THAT HAVE BEEN FOUND TO HAVE
BETTER HEALTH SYSTEM PERFORMS
AND WHERE HEALTH OUTCOMES HAVE
IMPROVED OVER TIME.
RESEARCH CITED IN OUR REPORT
SHOWS INEQUITIES DUE TO MILLIONS
OF PREMATURE DEATH INVOLVING THE
LOSS OF PRODUCTIVE LIFE AND
ECONOMIC ACTIVITY AND COSTING
THE UNITED STATES HUNDREDS OF
BILLIONS ANNUALLY.
MORE LIKE CLOSE TO A TRILLION
DOLLARS ANNUALLY.
SO THE NATIONAL ACADEMIES OF
SCIENCES, ENGINEERING AND
MEDICINE CONVENED THIS EXPERT
COMMITTEE TO REVISIT THE 2003
REPORT AND THE COMMITTEE WAS
TASKED TO LOOK AT SUCCESSFUL AND
UNSUCCESSFUL INTERVENTIONS AND
IDENTIFY GAPS AND LOOK AT
STRATEGIES TOE CLOSE THESE GAPS.
CONSIDER WAYS TO SCALE AND
SPREAD EFFECTIVE INTERVENTIONS
TO REDUCE RACE AND ETHNIC
INEQUITIES IN HEALTH CARE AND
MAKE RECOMMENDATIONS TO ADVANCE
HEALTH EQUITY.
A LITTLE BIT ABOUT OUR STUDY
METHODOLOGY.
WE CONDUCTED REVIEW OF THE
LITERATURE RELEVANT TO THE
STATEMENT OF TASK.
TO SUPPLEMENT THAT REVIEW THE
COMMITTEE HAD THREE PAPERS
DOCUMENTING THE EVIDENCE ON
RACIAL AND ETHNIC INEQUITIES
MEASURED BY ACCESS, USE AND
QUALITY OF CARE.
THE EVOLUTION OF THE U.S. HEALTH
CARE AND CIVIL RIGHTS LAWS SINCE
2003 AND POLICY INITIATIVES THAT
HAVE BEEN EFFECTIVE IN PRODUCING
RACIAL INEQUITIES IN HEALTH
CARE.
THEY CONDUCTED PUBLIC WORKSHOPS
TO OBTAIN INSIGHT AND CURRENT
NEW APPROACHES TO ALLEVIATE
THEM.
THE PROCEEDINGS ARE SUMMARIZED
IN THE DISCUSSION PUBLISHED BY
THE PRESS IN JANUARY 2024.
SOME TERMS TO DIVE IN THE
FINDINGS.
TERMS CONSIDERED IN THIS REPORT
ARE HEALTH, HEALTH CARE, HEALTH
CARE SYSTEM INEQUITABLE
DISPARITIES.
THEY'RE LINKED BUT THERE'S A
STATE OF FIPHYSICAL AND MENTAL
WELL BEING AND HEALTH CARE
REFERS TO SERVICES TO
INDIVIDUALS, FAMILIES AND
COMMUNITIES FOR THE PURPOSES OF
PROMOTING, MAINTAINING AND
RESTORING HEALTH ACROSS SETTINGS
OF QUAR.
THE REPORT USES HEALTH WHEN
DISCUSSING OUTCOMES.
AND HEALTH CARE WHEN DISCUSSING
SERVICES PROVIDED TO
INDIVIDUALS, FAMILIES OR
COMMUNITIES.
THE REPORT USES THE TERM HEALTH
CARE SYSTEM, ACTIVITIES RELATED
TO THE DELIVERY OF CARE ACROSS
THE CONTINUUM OF CARE TO
DESCRIBE U.S. HEALTH CARE SYSTEM
AS A WHOLE AS WELL AS TO
DESCRIBE INDIVIDUAL HEALTH
CARES.
PE
THE REDUCTION REQUIRES
IMPROVEMENT TO HEALTH CARE AND
OTHER FACTORS THAT INFLUENCE
HEALTH.
AND TO THAT WE PRESENT THE
CONCEPTUAL FRAMEWORK.
AND SYSTEM IN CLINICAL CARE
ALONE ARE INEFFICIENT TO ADVANCE
RACIAL AND ETHNIC HEALTH EQUITY.
DISPARITIES VERSUS INEQUITY.
HEALTH DISPARITIES AS DEFINED IN
THE 2003 UNEQUAL TREATMENT
REPORT IN THE QUALITY OF HEALTH
CARE NOT DUE TO ACCESS RELATED
FACTORS OR CLINICAL NEEDS OR
PREFERENCES OR THE
APPROPRIATENESS OF INTERVENTIONS
MOREOVER, THE COMMITTEE FOCUSES
ON TWO AREAS AS DRIVERS OF
HEALTH CARE SYSTEMS AND THE
REGULATORY CLIMATE AND
DISCRIMINATION AT THE PROVIDER
LEVEL.
IN THE YEARS SINCE THE REPORT
RESEARCH HAS PROVIDED BETTER
UNDERSTANDING HOW THE DRIVERS
AND IDENTIFIED OTHER FACTORS
THAT CONTRIBUTE TO INEQUITABLE
OUTCOMES.
HEALTH CARE INEQUITIES REFER TO
THE STATE OF BEING WHERE SOMEONE
IS DENIED THE POSSIBILITY OF
BEING HEALTHY BELONGING TO A
GROUP THAT'S BEEN HISTORICALLY
DISADVANTAGED.
IT'S AN AVOIDABLE AND
UNNECESSARY AND UNJUST HEALTH
DIFFERENCE.
HEALTH DISPARITIES INTEREST THE
METRICS FOR MEASURING PROGRESS
TOWARDS HEALTH EQUITY AND
REDUCING THEM IS A STEP TOWARDS
GREATER HEALTH EQUITY BUT
ACHIEVING HEALTH EQUITY REQUIRES
VALUING EVERYONE EQUALLY WITH
FOCUS AND ONGOING SOCIAL EFFORTS
TO ADDRESS AVOIDABLE ANYONE
EQUALITIES AND HISTORICAL ANDIN
JUSTICES AND TO ELIMINATE HEALTH
AND HEALTH DISPARITIES DUE TO
PAST AND PRESENT QUALITIES.
THIS REPORT USES INEQUITY AND
PUBLICATIONS THAT USE IT FOR
DISPARITIES.
NOW, ONE LAST BIT ABOUT
DISPARITY INEQUITABLE AND
UNEQUAL SOUND INTERCHANGEABLE
BUT INEQUITY CAPTURES DIFFERENT
INDIVIDUALS NEED DIFFERENT
SUPPORTS OR TREATMENTS TO
ACHIEVE SIMILAR OUTCOMES.
I'LL SAY IT AGAIN.
EQUITY CAPTURES THE FACT THAT
DIFFERENT INDIVIDUALS NEED
DIFFERENT SUPPORTS AND
TREATMENTS TO ACHIEVE SIMILAR
OUTCOMES.
WHEREAS EQUALITY CENTRAL TO
FOUNDATIONAL PURPOSE OF CIVIL
RIGHTS LAW AND POLICY COULD LEAD
PEOPLE TO MISTAKENLY BELIEVE
EQUAL OPPORTUNITY OR OPTIMAL
HEALTH IS ACHIEVED ONLY WHEN
EVERYONE RECEIVES IDENTICAL
SUPPORT AND TREATMENT.
THE USE OF UNEQUAL TREATMENT IN
THE 2003 REPORT IMPLIES HEALTH
CARE INEQUITIES COULD BE
ELIMINATED BY PROVIDING THE SAME
TREATMENT TO ALL REGARDLESS OF
RACE AND ETHNICITY.
HOWEVER, WITH THE AVAILABILITY
OF E.H.R. SYSTEMS AND THE
ABILITY TO OBSERVE POPULATION
DATA IT IS CLEAR THAT EQUAL
TREATMENT IS NOT NECESSARILY
EQUITABLE.
FOR EXAMPLE, DIFFERENT
INDIVIDUALS CAN HAVE THE SAME
CONDITIONS SUCH AS HYPERTENSION
AND DIABETES AND HAVE DIFFERENT
PROGNOSIS, RESPOND TO TREATMENT,
DIFFERENT RESPONSES TO TREATMENT
AND LARGER RESULTING FROM
GENOTYPIC OR PHENOTYPIC
VARIATIONS OR SOCIAL AND
ENVIRONMENTAL DIFFERENCES.
SO APPLYING THE SAME TREATMENT
TO ALL PATIENTS WITH THE SAME
CONDITION OVERLOOKS THOSE
CRUCIAL FACTORS.
AND UNDER SCORING THE NEED FOR
PERSONALIZED TREATMENT THAT MAY
NOT BE THE SAME TREATMENT FOR
EVERYONE.
SO TO ADDRESS THIS OUR COMMITTEE
FOCUSSED ON EQUITABLE PROCESSES
TO MAKE TREATMENT DECISIONS.
THIS ENTAILS A FULL
UNDERSTANDING OF THE
DETERMINATES OF HEALTH.
MANY OF WHICH ARE SOCIAL
DETERMINATES MAKING TREATMENT
RECOMMENDATIONS THAT DO NOTING
DISADVANTAGE AN INDIVIDUAL BASED
ON THEIR RACE OR ETHNICITY OR
SOCIAL ISSUE.
I SAID JUST ONE BUT I HAVE ONE
MORE.
RACIALLY AND ETHNICALLY
MINORITIZED POPULATIONS.
SO, IN MARCH OF 2024, THE OFFICE
OF MANAGEMENT AND BUDGET
RELEASED REVISED STANDARDS FOR
COLLECTING RACE, ETHNICITY AND
UPDATED THOSE IN USE BY THE
FEDERAL GOVERNMENT SINCE 1997.
CHANGES IN THE REVISED STANDARDS
INCLUDE COMBINING RACE AND
ETHNICITY IN ONE QUESTION ADDING
THE CATEGORY OF MIDDLE EASTERN
AND NORTH AFRICAN WHICH WAS
PREVIOUSLY IN THE WHITE
CATEGORY.
RACIALLY AND ETHNICALLY
MINORITIZED USES THE REPORT IN
RACIAL AND ETHNIC MINORITIES ARE
MEMBERS OF MINORITY GROUPS OR
UNDER REPRESENTED MINORITIES TO
USE THE TERM MINORITIZED TO
REFER TO PEOPLE FROM GROUPS
HISTORICALLY AND SYSTEMICALLY
MARGINALIZED OR UNDER SERVED
BASED ON THEIR RACE OR ETHNICITY
AS A RESULT OF RACISM.
MINORITIZED IS NOT ABOUT THE
NUMBER OF PEOPLE IN THE
POPULATION.
IT'S ABOUT POWER AND IT'S ABOUT
EQUITY.
SO, WE HAVE A CONCEPTUAL
FRAMEWORK.
THE CONCEPTUAL FRAMEWORK IS A
HOLISTIC APPROACH TO CONSIDER
THE HEALTH SYSTEM IN THE CONTEXT
OF COMMUNITY IN WHICH IT EXISTS.
THIS MEANS WE BELIEVE YOU HAVE
TO ADDRESS THE SOCIAL, POLITICAL
AND FINANCIAL DETERMINATES THAT
INFLUENCE HEALTH AND
UNDERSTANDING THIS REALITY THE
COMMITTEE DEVELOPED A CONCEPTUAL
FRAMEWORK THAT FORMS THE REPORT
ORGANIZATION AND RECOMMENDED
ACTION.
THE CONCEPTUAL FRAMEWORK
INCLUDES FACTORS OR FORCES THAT
IMPACT HEALTH AND THE HEALTH
CARE SYSTEM AND FOUR
INTERSECTING MECHANISMS WITHIN
THE HEALTH CARE SYSTEM THAT CAN
REINFORCE OR MITIGATE
INEQUITIES.
SO OPPRESSION AND STRUCTURAL
RACISM WHICH IS HISTORICALLY
CONTINUED POLICIES SUCH AS
RESIDENTIAL SEGREGATION,
SYSTEMIC OPPRESSION, BIAS OF ANY
FORM.
THESE THINGS WHICH ADVERSELY
AFFECT PHYSICAL, SOCIAL,
BEHAVIORAL AND ECONOMIC NEEDS OF
COMMUNITIES.
SOCIAL DETERMINATES OF HEALTH.
THE CONDITIONS IN WHICH PEOPLE
LIVE, WORK, PLAY, WORSHIP AND
AGE.
THERE'S SOCIAL SERVICE AGENCIES
WHICH HAVE PRIORITY AND PROGRAMS
THAT IMPACT HEALTH CARE SYSTEMS
EVEN NEGATIVELY OR EXACERBATE
AND WIDEN INEQUITABLE GAPS.
THE FIFTH FACTOR WHICH ARE
IMPORTANT IS SOCIETY'S
COMMITMENT TO THIS EFFORT.
SOMETIMES SOCIETY IS
ENTHUSIASTIC AND SOMETIMES IT
PULLS BACK FROM TRYING TO
ADDRESS THIS EFFORT.
RACIAL AND ETHNIC INEQUITIES ARE
DRIVEN BY A COMPLEX AND
INTERACTION BETWEEN HEALTH CARE
AND KEY SOCIETAL SOCIAL FORCES
THAT SERVE AS ENABLERS OR
BARRIERS TO ACHIEVING EQUITABLE
HEALTH CARE AND OPTIMAL HEALTH.
SO, I WANT TO SPEND TIME TALKING
ABOUT THE HEALTH CARE SYSTEM
ITSELF AND WHAT MAKES AN
EQUITABLE HEALTH CARE SYSTEM.
THE COMMITTEE IDENTIFIED FOUR
KEY INTERSECTING DOMAINS.
THESE ARE CRITICAL MECHANISMS BY
WHICH THE SYSTEM CAN REINFORCE
OR MITIGATE INEQUITIES.
THE FIRST ARE THESE HEALTH CARE
LAWS AND PAYMENT POLICIES.
THESE POLICIES SUPPORT EQUITABLE
HEALTH CARE ACCESS, QUALITY AND
AFFORDABILITY SERVE AS A
FOUNDATION FOR REMOVING
PERSISTENT BARRIERS AND ENSURE
INDIVIDUALS RECEIVING EQUITABLE
HEALTH CARE SERVICES.
THE HEALTH CARE DELIVERY SYSTEM.
THIS DOMAIN IS DELIVERING HIGH
QUALITY CULTURALLY SENSITIVE
CARE TO ALL AND MAXIMIZING A
HEALTH CARE'S POTENTIAL TO
ELIMINATE RACIAL AND ETHNIC
INEQUITIES IN HEALTH CARE.
THIS DOMAIN INCLUDES HEALTH CARE
DELIVERY MODELS, HEALTH CARE
WORKFORCE, CLINICAL DECISION
MAKING, IMPLICIT BIAS,
INTEGRATING HEALTH AND SOCIAL
CARE, INDIVIDUAL CARE SEEKING
BEHAVIOR, MEDICAL MISTRUST,
HEALTH LITERACY AND HEALTH
INFORMATION TECHNOLOGY.
THE THIRD DOMAIN IS DISCOVERING
EVIDENCE GENERATION WHICH NIH IS
A MAJOR PARTICIPANT IN.
DATA AND RESEARCH THAT'S
CRITICAL RESOURCE NEEDED TO
IMPLEMENT AND EVALUATE FOUR
STRATEGIES THAT ELIMINATE RACIAL
AND ETHNIC HEALTH CARE AND
INEQUITIES AND ADVANCE HEALTH
EQUITY.
FACTORS IN THIS DOMAIN INCLUDES
ADVANCING HEALTH EQUITY
RESEARCH, HISTORICAL AND CURRENT
HEALTH EQUITY RESEARCH FUNDING,
RESEARCH WORKFORCE, HEALTH CARE
EQUITY RESEARCH DATA AND
RESEARCH INFRASTRUCTURE AND
MOVING HEALTH EQUITY RESEARCH
FROM OBSERVATIONAL TO
INTERVENTION RESEARCH.
AND THEN THE LAST DOMAIN IS
ACCOUNTABILITY.
THESE ARE THE GOALS TO ACHIEVE
INEQUITABLE HEALTH CARE SYSTEM
NEED TO BE ACHIEVED IN THE
SYSTEM TO REMAIN RESPONSIVE TO
THE THESE OF COMMUNITY.
THIS MEANS LEGISLATIVE OVERSIGHT
TO ENSURE LAWS HAVE THEIR
INTENDED IMPACT AND IDENTIFY
ACTIONS NECESSARY TO IMPROVE
PERFORMANCE.
IT ALSO MEANS DEVELOPING
SYSTEMATIC STANDARDS THAT SHOULD
EXIST TO ENABLE PERIODIC
COMPREHENSIVE REVIEWS AND
INTERVENTIONS AND THEIR
IMPLEMENTATION.
ALL FOUR OF THESE DOMAINS
INTERSECT AND WITHIN LOCAL
COMMUNITIES WHERE HEALTH CARE
SYSTEMS OPERATE AND I THINK ONE
OF THE THINGS THAT WE HAVE TO
AND WILL KEEP AT THE FOREFRONT
IS THAT ULTIMATELY THE SYSTEMS
ARE THERE TO SUPPORT AND BENEFIT
COMMUNITIES AND INDIVIDUALS.
AND SO THEY'RE NOT JUST SYSTEMS
UNTO THEMSELVES.
AND OPTIMAL HEALTH OUTCOME
REGARDLESS OF NECESSITY OR OTHER
FACTORS INFLUENCING THEIR
ABILITY TO RECEIVE EQUITABLE
HEALTH CARE AND ACHIEVE OPTIMAL
HEALTH.
OPTIMAL HEALTH FOR ALL.
THE FIRST REPORT WAS UNEQUAL AND
THIS IS STRATEGIES TO ACHIEVE
EQUITABLE HEALTH CARE AND
OPTIMAL HEALTH FOR ALL.
RACIAL AND ETHNIC INEQUITIES
REMAIN A FUNDAMENTAL FLAW OF OUR
HEALTH CARE SYSTEM WHICH BY ITS
DESIGN DELIVERS DIFFER OUTCOMES
FOR DIFFERENT POPULATIONS AND
THE MOVEMENT HAS BEEN SLOW,
UNEVEN AND INCONSISTENT.
THE POOR PERFORMANCE OF THE
SYSTEM AFFECTS EVERYBODY BUT
DISPROPORTIONATELY AFFECTS
ETHNIC POPULATIONS.
ELIMINATE BEING HEALTH CARE
INEQUITIES IS ACHIEVABLE GOAL
AND IMPROVING THE HEALTH OF
COMMUNITIES IMPROVES THE QUALITY
OF CARE FOR EVERYONE.
THIS ISN'T A ZERO SUM GAME.
TOO OFTEN PEOPLE WHO OPPOSE
HEALTH CARE EQUITY THINK OF IT
AS A ZERO SUM GAME.
SOMEHOW -- TAKING SOMETHING AWAY
FROM SOMEONE ELSE.
REINFORCING THE NOTION THIS IS
TO ACHIEVE THE OPTIMAL CARE FOR
ALL.
THIS HIGHLIGHTS THE FIVE GOALS
THE REPORT RECOMMENDS.
BEFORE I LAUNCH INTO THEM.
OVER THE FIVE YEARS WE HAVE DONE
A LOT OF RESEARCH AND DEVELOPED
A LOT OF SOLUTIONS.
WE UNDERSTAND HOW THIS PROBLEM
IN MANY WAYS WORKS AND WHAT CAN
HAPPEN, HOW WE CAN IMPROVE THE
HEALTH OF MINORITIZED
POPULATIONS.
THE CHALLENGE ISN'T THAT WE
DON'T KNOW IT ALL.
WE CAN'T IMPLEMENT WHAT WE KNOW
BECAUSE OUR SYSTEM DOES NOT
SUPPORT THE IMPLEMENTATION OF
THE THINGS WE KNOW WORK.
THE THINGS WE THINK WE KNOW ARE
THINGS THAT SCIENTISTS DEVELOP
AND KNOWLEDGE THAT THEY GENERATE
AND HELP MAKE A MORE EQUITABLE
HEALTH CARE SYSTEM.
IT'S NOT THAT WE DON'T KNOW
ANYTHING OR THE LAST 20 YEARS
HASN'T HELPED BUT WE HAVE A BIG
ROAD BLOCK AND THAT'S THE HEALTH
CARE SYSTEM AND THE WAY IT'S
ORGANIZED.
SO WE HAVE THESE FIVE
RECOMMENDATIONS, GENERATE BEING
DATA ON INEQUITIES, EVIDENCE TO
GENERATE INTERVENTIONS, ENSURE
ADEQUATE RESOURCES TO ENFORCE
LAWS AND BUILD SYSTEMS OF
RESPONSIBILITY AND ACCESS AND
QUALITY.
SO LET ME GO TO THE FIRST GOAL
THE FIRST IS ACCURATE AND TIMELY
DATA.
YOU CAN'T MEASURE IT, YOU CAN'T
SOLVE IT.
THERE'S RACE AND ETHNICITY IN
UNIFORM AND COMPREHENSIVE TIMELY
MANNER.
I'LL PAUSE TO SAY EVEN THOUGH
RACE AND ETHNICITY ARE NOT
BIOLOGY, IT DOESN'T MEAN THEY'RE
NOT REAL AND THAT THEY DON'T
IMP
IMPACT EXPOSURE TO HARM AND
ACCESS TO RESOURCES.
FOR SOMEONE TO SUGGEST BECAUSE
IT'S NOT BIOLOGY IT'S NOT
INFORMATION IS LIKE TRYING TO
CLOSE YOUR EYES AND TRYING TO
WALK.
IT DOESN'T NEED TO BE BIOLOGY TO
BE REASONABLE TO COLLECT.
THE DATA SHOULD BE A PRIORITY.
THE REPORT RECOMMENDS THE
U.S. DEPARTMENT OF HEALTH AND
HUMAN SERVICES SHOULD IMPLEMENT
EXECUTIVE ORDER 13 985 AND
ACCOUNTABLE DATA REPORT BEING TO
AGENCIES AND AGENCIES UNDER HHS
OVERSIGHT.
THE THUD INCLUDE HOSPITAL
BILLING FORMS FOR THE OFFICE OF
BUDGET STATUS AND INSTITUTE A
PROCESS OF RACE AND ETHNICITY
DATA ON HEALTH CARE WORKFORCE.
MOREOVER THE OFFICE OF MANAGING
BUDGETS SHOULD SET AN
ADMINISTRATIVE WIDE REQUIREMENT
OF ROUTINE COLLECTION OF DATA BY
ALL AGENCIES OVERSEEING HEALTH
CARE AND RESEARCH PROGRAMS AND
SHOULD REGULAR MONITOR AND
REPORT ON AGENCY COMPLIANCE.
I'LL ALSO SAY I'VE BEEN THINKING
WHAT IS A FLUID ANALOGY FOR THIS
AND IT WOULD BE TELLING FOR
HEALTH CARE PROVIDERS NOT TO
COLLECT ETHNICITY DATA IS LIKE
TELLING A SHOE COMPANY NOT TO
COLLECT THE SIZES OF THE SHOES
THEY'RE CUSTOMERS WEAR.
YOU NEED THAT TO DEVELOP
CULTURALLY COMPETENT CARE.
IT'S LIKE TELLING THE SHOE
COMPANY YOU JUST PRODUCE ONE
SHOE AND IT JUST WORKS FOR
EVERYBODY.
THEY NEED JUST AS MUCH ANYONE
BECAUSE THEY NEED IT TO MAKE
GOOD CLINICAL DECISIONS.
GOAL TWO IS TO EQUIP THE HEALTH
CARE SYSTEM AND EXPAND A
SUSTAINABLE AND EFFECTIVE
INTERVENTION.
THERE'S MANY KNOWN SOLUTIONS AND
SUSTAINED EFFORTS TO IMPROVE
HEALTH CARE ACROSS THE CONTINUUM
OF CARE.
FOR EXAMPLE LARGE AND WELL
TRAINED CADRES OF WORKFORCE SUCH
AS COMMUNITY HEALTH WORKERS,
NURSES, MENTAL AND BEHAVIORAL
HEALTH PROFESSIONALS AND CASE
MANAGERS AND SOCIAL WORKERS
IMPORTANT FOR RESTORING
INDIVIDUAL AND COMMUNITY HEALTH.
WE DISCUSSED THE NEED FOR
DIVERSE HEALTH AND SCIENCE
WORKFORCE REPRESENTING
COMMUNITIES AS BEING ESSENTIAL
FOR HEALTH CARE EQUITY AND ALSO
EMERGING APPROACHES TO ACHIEVING
HEALTH CARE EQUITY SHOW PROMISE
AND POISED FOR INCREASED
INVESTMENT, IMPLEMENTATION AND
EXPANSION SO THE PROGRESS IS
TRANSLATED INTO LONG-TERM
IMPROVEMENTS IN HEALTH.
I WANT TO BE MINDFUL OF TIME.
I DON'T WANT TO GO OVER.
WHERE AM I ON TIME?
I'M CLOSE?
OKAY.
I'LL HIGHLIGHT THE ONES I THINK
ARE MOST IMPORTANT TO AT LEAST
HAVE SOME TIME FOR YOU TO ASK
DR. JERNIGEN SOME QUESTIONS.
THE THIRD GOAL IS TO INVEST IN
RESEARCH AND EVIDENCE GENERATION
TO IDENTIFY AND WIDELY IMPLEMENT
INTERVENTIONS THAT ELIMINATE
HEALTH CARE INEQUITY.
PROGRESS BEEN SLOW DUE TO
FUNDING AND EXCLUSION OF
ETHNICALLY MINORITIZED
POPULATIONS FROM WORKFORCE AND
PERSISTENT LIMITATIONS ON DATA
ON RACIAL ETHNICITY AND CONDUCT
TYPES AND SCALES OF HEALTH
EQUITY RESEARCH AND TO TRANSLATE
POLICY INTO.
GIVEN THE MAGNITUDE OF PROBLEMS
AND YEARS OF LIFE LOST DUE TO
INEQUITY THE PLAUSIBILITY OF
RESEARCH RESOURCES DEVOTED TO
THE STUDY OF SUCCESSFUL
TREATMENT FOR SCALING UP
INTERVENTIONS IS PROFOUND.
TO HIGHLIGHT WE DO THESE
ESTIMATES OF ECONOMIC BURDEN OF
HEALTH INEQUITY AND SHOW IT'S
MORE THAN A TRILLION DOLLARS
DEPENDING ON IF YOU LOOK AT RACE
AND ETHNICITY OR LOOK AT
EDUCATIONAL RELATED THE AMOUNT
OF MONEY WE'RE SPENDING ON
RESEARCH AND DEVELOPMENT IN THIS
AREA, PAYOUTS AND COMPARISON AND
WE DO NEED TO DO MORE.
AND LOOK AT LAWS CURRENTLY IN
THE AFFORDABLE CARE ACT, THE
ENVISION FOR ADVANCING RACIAL
AND ETHNIC INEQUITY ARE
ENFORCED.
THE PROBLEMS ARE MANY PROVISIONS
ARE NOT BEING ENFORCED.
IN SECTION 1557 OF THE AACA
REENFORCES THE LONG STANDING
PROTECTION FOR PROHIBITION OF
RACE, NATIONAL ORIGIN, AGE,
DISABILITY OR SEX.
THE ACCOUNTABILITY AT ALL LEVELS
IS IMPORTANT.
AND I HAVE TO SAY MY OWN
PERSONAL FAVORITE GOAL IS GOAL
NUMBER FIVE.
I'M AN ECONOMIST AND RESEARCHER.
THIS IS ELIMINATING INEQUITIES
IN HEALTH CARE AND ACCESS AND
QUALITY.
THERE'S DIFFERENT STRUCTURES OF
PAYMENT FOR SAME SERVICES
AMONGST INSURANCE PAYERS.
THIS IS ONE OF THE BARRIERS THAT
PRE FRIENDS US FROM
DISSEMINATING, IMPLEMENTING THE
GOOD WORK THAT'S BEEN DONE OVER
THE LAST 20 YEARS.
RIGHT NOW OUR HEALTH CARE SYSTEM
WHEN YOU ENTER INTO IT, IT
ALLOCATES RESOURCES BASED ON
AFFLUENCE.
AND WHEN SOMEONE ENTERS THE
HEALTH CARE SYSTEM THE ACTORS IN
THAT SYSTEM RESPOND TO THEIR
AFFLUENCE.
THEY TRY TO SOLVE THE PROBLEM
AND HAVING THE BEST AND
BRIGHTEST MINDS WORKING ON
PROBLEMS OF HEALTH NEED AND THE
ROUTE CAUSE OF THAT IS BECAUSE
IN OUR SYSTEM, WE DON'T ONLY
HAVE DISCRIMINATION IN THE SENSE
THAT TWO PEOPLE CAN HAVE THE
SAME HEALTH NEEDS BUT BECAUSE OF
WHAT THEIR INSURANCE COVERAGE IS
THEY'LL PAY DIFFERENT PRICES.
MARKETS DO WHAT THEY DO.
THEY SERVE THE ONES THAT ARE
AFFLUENT.
WE DON'T HAVE THE BEST AND
BRIGHTEST WORKING ON THE HEALTH
NEEDS BUT THE BEST AND BRIGHTEST
OF THOSE MOST AFFLUENT OR THE
BEST PAYERS.
NOW, SOMETIMES IT WORKS OUT FOR
OUT BUT MOST TIMES IT DOESN'T.
YOU HAVE INSTITUTIONS NOT TAKING
CARE OF THE SICKEST.
THE REASON IS BECAUSE MEDICARE
PAYS LESS THAN COMMERCIAL AND
COMMERCIAL AND MEDICAID PAYS
LESS THAN THEM BOTH.
AS A RESULT YOU HAVE SAFETY NET
PROGRAMS WE DON'T FUND VERY
WELL.
THE INDIAN HEALTH SERVICES YOU
NEVER FUND AT THE APPROPRIATE
LEVEL.
THESE THINGS -- EVEN IF YOU
BUILD A BETTER MOUSE TRAP, YOU
HAVE THE SOLUTION, WE DON'T HAVE
A SYSTEM IN PLACE THAT WOULD GET
THE SOLUTION TO THE PEOPLE THAT
NEED THE SOLUTION BECAUSE OUR
SYSTEM IS DESIGN TO SERVE
AFFLUENCE AND THE HEALTH NEEDS
OF THE AFFLUENCE FIRST OPPOSED
TO THE REST OF THE WORLD ARE
EVERYONE HAS TO PAY THE SAME
THING.
INSTEAD OF TRYING TO MAKE
CHASING DOLLARS I'M TRYING TO
SOLVE THE PROBLEM AND BRING MY
EXPERTISE.
I ENCOURAGE YOU TO VISIT AND
READ THE REPORT.
IT'S A NICE READ.
IT'S LOTS OF GOOD INFORMING AND
SORRY FOR TAKING TOO LONG BUT
IT'S AN IMPORTANT ISSUE.
IN 20 YEARS SOMEBODY ELSE WILL
BE HERE TO TELL YOU WE ENDED
UNEQUAL TREATMENT.
>> OKAY.
ARE THERE ANY COUNCIL MEMBERS
THAT HAVE COMMENTS?
>> I HAVE A QUESTION.
I ENJOYED YOUR PRESENTATION.
VERY THOROUGH EXPLANATION OF
WHERE WE'VE COME OVER THE LAST
20 YEARS.
I'LL DIRECT THIS TO -- SO WHAT
IS THE FIX?
HOW DO WE REBUILD THE SYSTEM IN
A STEP WISE FASHION?
DO YOU HAVE A HUGE DREAM MODEL
OF REBUILDING FROM A STRUCTURAL,
PERSONAL AND HSH BASE?
>> NOT SO MUCH WE NEED TO
REBUILD IT.
ON THE COVERAGE SIDE WE NEED TO
FINISH THE EXPANSION OF
MEDICAID.
WE NEED TO DO THE EQUALIZATION
OF MEDICAID AND MEDICARE AND
WHEN THE PATIENT ENTERS INTO THE
MARKETPLACE THEY'RE NOT RAT A
DISADVANTAGE AND THEN NEED TO DO
THE ENFORCEMENT AND HOLD
THEMSELVES ACCOUNTABLE AND
GOVERNMENT NEEDS TO HOLD THEM
ACCOUNTABLE FOR THE ACTIONS AS
WELL AS HEALTH PLANS AND I'M
ABLE TO MEASURE THE THINGS IN
WHICH I DO AND DO IT THE RIGHT
WAY.
IF I DON'T HOLD MYSELF
ACCOUNTABLE I CAN'T.
THE DATA COLLECTION IS CRUCIAL.
THE RECOMMENDATIONS AROUND DATA
GENERATION ARE CRITICAL.
WE CAN'T ACHIEVE IT OTHER THAN
WE SEE ITS OTHER THAN SEEING THE
TRAIN WRECKS THAT OCCUR.
THIS IS A NOTION OF TRYING TO
TAKE WHAT WE HAVE AND SAY THESE
ARE THE PROBLEMS THAT NEED TO BE
PLUGGED UP.
WE NEED DATA.
WE NEED TO CONTINUE TO DO
RESEARCH IN THE AREA BECAUSE WE
DON'T KNOW EVERYTHING WE NEED TO
CHANGE THE WAY IN WHICH WE'RE
PAYING FOR HEALTH CARE AND
ENFORCE THE LAWS AND MY KWLEEGZ
THAT DO RESEARCH FOR THIS
INSTITUTE DEVELOPED LOTS OF
GREAT INTERVENTIONS.
THE PROBLEMS IS WE OFTEN HAVE A
WRONG POCKET PROBLEM.
THE PERSON WHO IS SAVING MONEY
ISN'T THE PERSON MAKING MONEY.
THE PERSON MAKING MON STANDS IN
THE WAY OF THE PERSON SAVING
MONEY.
WE KNOW DIABETES PREVENTION
PROGRAMS WORK.
WE KNOW THEY WORK.
WE CAN'T GET THEM OUT AND
PROMULGATE IT SO PEOPLE WHO ARE
AT RISK OF DEVELOPING DIABETES
ARE REFERRED TO THEM, ENROLLED
IN THEM AND THE INSURANCE
COMPANY PAYS FOR THEM BUT WE CAN
FIGURE OUT HOW TO PAY FOR THE
BILL.
THEN WE SAY IT'S THE PATIENT'S
FAULT BECAUSE THEY DON'T WANT
IT.
BUT THEY DON'T EVEN HAVE THE
OPPORTUNITY TO DO LIFESTYLE
CHANGES.
>> THANK YOU VERY MUCH FOR THE
REPORT.
SOME OF THESE ISSUES I DON'T
KNOW HOW EEL BE ABLE TO RESOLVE
IT.
AND AS SOON AS THEY HEAR THIS
THEY SAY HERE THEY GO AGAIN WITH
EQUITY, EQUITY AND INCLUSION.
WE SHOULD DO THIS AND THAT NOW
IF YOU LOOK AT THE POPULATION
THERE'S INCENTIVES FUNDED BY
NIMHD.
IF YOU DON'T HAVE INSURANCE YOU
WILL NOT BE ADMITTED.
YOU MAY SPEND YOUR LIFE TIME
WORKING ON INCENTIVES YOU DON'T
SET FOOT IN THOSE AREAS.
HOW DO WE ADDRESS AND LOOK AT
THINGS THAT NIH HAS CONTROL.
>> I TEND TO BE A GLASS HALF
FULL GUY OPPOSED TO GLASS HALF
EMPTY.
I LOOK FROM A HISTORICAL
STANDPOINT.
WE'RE NOT WHERE WE NEED TO BE
BUT NOT WHERE WE WERE 20 YEARS
AGO.
THIS IS A GENERATIONAL FIGHT.
THOUGH RIGHT NOW VIA CONGRESS
AND CERTAIN LEGISLATURE SEEM TO
HAVE THE UPPER HAND.
THEY WON'T HAVE IT ALWAYS.
IF YOU LOOK OVER THE ARC OF
TIME, WE'RE IMPROVING.
HAVING SAID THAT, THERE ARE SOME
THINGS IN WHICH WE CAN CONTINUE
TO DO.
I ENCOURAGE FOLKS -- WILLIAM
SHAKESPEARE SAID THROUGH JULIET,
A ROSE BY ANY OTHER NAME STILL
AS SWEET.
SO EQUITY, WE KNOW WHAT WE MEAN
BY EQUITY SOMETIMES WE TELL
OTHER FOLKS WHAT THEY ARE MEAN
BY IT AND THEY DECIDE THEY WANT
US TO CHANGE OUR TERMS.
CALL THE QUESTION WHAT
INEQUITIES ARE YOU FOR?
WHO SHOULD HAVE LESS HEALTH
CARE?
WHO SHOULD HAVE POORER QUALITY
CARE?
IS IT POOR PEOPLE?
LESS EDUCATED PEOPLE?
RACIAL AND ETHNIC MINORITY
PEOPLE?
WHO SHOULD HAVE LESS?
THE OPPOSITE OF EQUITY WHERE WE
SAY OPTIMAL HEALTH CARE FOR ALL
REGARDLESS OF WHERE YOU WORK,
LIVE AND PLAY AND IF YOU'RE
AGAINST THAT YOU MUST BE FOR
THIS, WHO SHOULD BE LEFT OUT OF?
CALL IT INTO QUESTION OPPOSED TO
RUNNING TO ANOTHER TERM BECAUSE
EQUITY SMELLS SWEET TO ME.
>> I APPRECIATE THE SUMMARY.
I ENCOURAGE EVERYONE TO READ THE
REPORT.
AND BECAUSE OUR COLLEAGUES ARE
NINDS ARE HERE WE'LL MOVE ON.
THERE'S REGIONAL DIFFERENCES IN
THE COUNTRY AND HOW HEALTH CARE
IS DONE.
LET'S PUT IT THAT WAY.
I WAS ACTUALLY SHOCKED IN A WAY
WHEN I MOVED TO THIS AREA AND
SAW THE ENORMOUS DIFFERENCES
WITH THE PLACE I'D SPENT MY
ENTIRE PROFESSIONAL CAREER AS A
HEALTH CARE CLINICIAN.
I THINK THE MODELS ARE OUT THERE
AND ARE BEING DONE IN OTHER
PARTS OF THE COUNTRY THAT ARE
MUCH BETTER THAN WHAT IS
EXPERIENCED HERE.
I WONDER IF AND IF THE FIXES ARE
BUILT IN AND A MATTER OF
POLITICAL WISH AND COMMITMENT TO
THESE ISSUES.
THERE'S A THE EMERGENCE OF
CONCIERGE AREA.
EMERGED MORE THEN A DECADE AGO
AND BECOME MORE WIDESPREAD AND
HOW IT'S CATERING TO THE
AFFLUENT.
OKAY.
THANK YOU SO MUCH.
LET ME OVER ON TO THE NEXT
PRESENTER.
IS IT GOING TO BE, YOU WALTER
AND RICHARD OR BOTH?
YOU'RE GOING TO START?
OKAY.
LET ME SAY A COUPLE THINGS ABOUT
MY COLLEAGUE, DR. WALTER
KOROSHETZ -- NO?
DIRECTOR OF THE NATIONAL
INSTITUTE OF NEUROLOGICAL
DISORDERS AND STROKE.
WE START THE SAME YEAR AS
DIRECTORS.
YOU'D BEEN AT NIH HAVING BEEN
KEEP OUT DIRECTOR.
WALTER IS A COLLEGIATE THE
DIRECTOR'S TABLE BUT HE DOES
BRING A PERSPECTIVE THAT I
SHARED AS A PRACTICING CLINICIAN
WHO CAME TO NIH, RAN NOT SKWHUFT
THE DEPARTMENT BUT HB IN THE
HOSPITAL AND HAD THE PROSPECTIVE
OF THE PATIENT ALWAYS ON HIS
MIND AS WELL AS HOW CLINICIANS
ARE FUNCTIONING AND TO
ADDRESSING NOT JUST THE SCIENCE
AND DISCOVERY SIDE OF WHICH
THERE'S MANY TO LEARN AND
ACHIEVEMENTS BUT IN THE HEALTH
CARE DELIVERY OF THESE ISSUES.
WALTER AND THEN YOU'LL INTRODUCE
RICHARD.
>> WE'RE HERE TO TELL YOU WHAT
WE'RE DOING AND LOOKING FOR HELP
AND OBVIOUS WHAT WE NEED IN A
SECOND.
I'M THE DIRECTOR AND DR. BENSON
IS THE DIRECTOR OF OFFICE OF
HEALTH EQUITY AND GLOBAL HEALTH
AND WHEN I CAME OUT OF TRAINING
IN THE '80s, IT WAS
OBSERVATIONAL AND NOT
INTERVENTIONAL.
MY CAREER HAS BEEN ALWAYS TO
REVERSE THE TREND AND SEEING IF
WE CAN TAKE IT INTO THE HEALTH
DISPARITIES PROBLEM IN THE
NEURAL SPHERE.
ABOUT OUR INSTITUTE WE'RE
RESPONSIBLE FOR ABOUT 200 TO 400
DIFFERENT NEUROLOGICAL
DISORDERS.
MOST OF THAT NUMBER ARE THESE
RARE NEUROGENETIC DISORDERS.
THERE'S A TREMENDOUS POTENTIAL
FOR THE FUTURE TO GET GENOMIC
THERAPIES TO HAVE BIG EFFECT
SIZES IN THOSE DISORDERS WHICH
ARE CURRENTLY NOW UNTREATABLE TO
SEVERE NEUROLOGICAL PROBLEMS AND
EPILE
EPILEPSY.
THAT'S COMING AND WILL PRESENT
ISSUES WITH REGARD TO
AFFORDABILITY.
STROKE IS THE FIFTH LEADING
CAUSE OF DEATH IN THE UNITED
STATES.
TRAUMATIC BRAIN INJURY IS
SOMETHING THAT CAN CHANGE
SOMEONE'S LIFE IN A SECOND.
AND THERE'S DIFFERENT DEMENTIAS.
WE TRIED TO DO RESEARCH THAT
WILL FLOAT ALL BOATS AS WE CAN'T
PUT ALL THE RESOURCES INTO THE
DISEASES THEY REQUIRE.
AND HAVE SOME PROJECTS FROM
CONGRESS.
AND TRYING TO ADVANCE HEALTH
EQUITY.
THERE'S THE HEAL INITIATIVE.
HELPING END ADDICTION LONG-TERM.
THERE'S TWO COMPONENTS TO THAT.
A MAJOR COMPONENT GOES TO THE
NATIONAL INSTITUTE OF DRUG
ABUSE.
AND SIGNIFICANT PROPORTION OF
THE FUNDS COMES TO NINDS ARE WE
HAVE ALL THE INSTITUTES
INTERESTED IN PAIN INCLUDING
ELISO AT THE TABLE AND MAKE
DECISIONS ON FUNDING PROJECTS
THAT ARE GOING TO TRY TO I AM --
IMPROVE THE MANAGEMENT,
TREATMENT AND PAIN AND RISK OF
ADDICTION.
AND MODELS OF PAIN MANAGEMENT
AND UNDER SERVED POPULATIONS IN
RURAL HEALTH AREAS AND NEXT WEEK
WE'RE GOING TO LAUNCH A PROGRAM
IN NATIVE PERSON POPULATIONS.
-- NATIVE AMERICAN POPULATIONS.
WE ALSO HAVE FUNDING ABOUT $3.5
BILLION A YEAR CAME TO THE NIH
MOSTLY TO THE AGING INSTITUTE
FOR DEMENTIA INSTITUTE AND
MANAGE 10% NOW OVER $300 MILLION
A YEAR AND HAVE PROGRAMS THAT
HAVE BEEN DESIGN TO TRY AND
ATTACK THE PROBLEMS PARTICULARLY
THE PROBLEMS OF THE VASCULAR
CONTRIBUTIONS OF DEMENTIA WHICH
WE THINK IS REALLY
DISPROPORTIONATELY AFFECTING THE
AFRICAN POPULATION IN THE UNITED
STATES THE MAJOR DRIVERS ARE
HYPERTENSION.
WE NOW HOW TO TREAT
HYPERTENSION.
THERE'S NO REASON WHY EVERYONE
IN THE WHOLE UNITED STATES CAN'T
HAVE THEIR BLOOD PRESSURE
CONTROLLED.
SOME MAY HAVE IT DIFFICULT TO
CONTROL BUT EVERYBODY SHOULD GET
THE SAME OPPORTUNITIES AND FROM
THE MAJORITY OF PEOPLE IT'S
GOING TO WORK.
WE FUNDED A PROJECT AT KAISER TO
TRY AND REDUCE DISPARITIES IN
BLOOD PRESSURE CONTROL AND I'M
SURE WE WEREN'T THE ONLY FORCE
IN THAT BUT KAISER COMPLETELY
GOT RID OF THEIR HEALTH
DISPARITIES IN THEIR POPULATION.
THAT BROUGHT THE POINT TO ME IF
WE CAN WORK WITH THE HEALTH CARE
SYSTEMS AND SHOW SOMETHING WORKS
AND WORK WITH THE SYSTEM THAT
SAYS, YEAH, IF IT WORKS, AND
IT'S REASONABLE COST WELL ADOPT
IT, THAT IS THE GOAL.
THAT'S THE HOLEY GRAIL WE'RE
AFTER.
I'D SAY THAT WE HAVE AS I SAID,
400 DIFFERENT DISEASES.
EVERY DISEASE WOULD LIKE TO DO A
STUDY TO COLLECT DATA.
WE DON'T HAVE THE DATA TO DO
THAT.
INSTEAD AND I THINK FOR HEALTH
DISPARITIES WE'RE MOVING THIS
DIRECTION AS WELL.
WE RUN PROGRAMS THE REGARDS
PROGRAM IS A GOOD EXAMPLE.
IT'S BEEN LOOKING AT THE STROKE
BELT FOR 30 YEARS AND THE DATA
IS COMING BACK AND IT'S BAD.
IT'S REALLY BAD.
AND NO ONE'S DOING ANYTHING IT'S
FRUSTRATING TO DO THAT.
OUR VANDERBILTERS WOULD LIKE TO
JUST KEEP COLLECTING DATA AND
PUSH THEM TO DO AN INTERVENTION
IS LIKE PULLING TEETH.
BUT WE HAVE TO PULL TEETH.
WE'D LIKE TO DO HEALTH
DISPARITIES RESEARCH AND RICH
WILL TALK ABOUT IT TO IMPROVE
HEALTH EQUITY BUT IT'S GOT TO
HAVE AN INTERVENTION.
YOU HAVE TO THINK ABOUT THE END
GOAL.
IF THE END GOAL ESPECIALLY FOR
AN INSTITUTE LIKE US, YOU GUYS
HAVE THE BIG PROBLEMS.
OUR PROBLEM IS HOW WE CONTROL
BLOOD PRESSURE AND TREAT
EPILEPSY.
YOU HAVE THE BIG SYSTEMIC
PROBLEMS WHICH I WE APPRECIATE
YOU WORKING ON AND CERTAINLY
CULTIVATING THE FIELD TO BE MORE
SUCCESSFUL WHEN WE COME IN.
WE WOULD LIKE TO DO THINGS THAT
ARE WHEN YOU COLLECT THE DATA
IT'S CLINICAL TRIAL READINESS.
YOU COLLECT DATA FOR THE PURPOSE
OF DOING A TRIAL IN THE SYSTEM
THAT WE HAVE NOW.
WE DON'T LIKE THE SYSTEM BUT WE
HAVE PEOPLE -- I HAVE BEEN A PRO
AT GETTING AROUND SYSTEMS IN THE
PAST AND MAKING THEM WORK FOR ME
AND I THINK THERE'S OTHER PEOPLE
WHO CAN LOOK AT THE SYSTEM AND
FIGURE OUT HOW TO GAIN THE
SYSTEM TO GET WHAT YOU WANT TO
HAVE HAPPEN.
THAT'S WHAT TO LOOK FOR.
IT'S NOT EASY.
AND WE HAVE THE KEY THING TO
PUSH AND WITH THAT I WOULD LIKE
TO TURN IT OVER TO RICHARD TO
DESCRIBE WHERE WE ARE RIGHT NOW
AND HIS VISION FOR WHERE WE
MIGHT GO.
SO DR. BENSON.
>> THANK YOU, DR. KOROSHETZ FOR
THE INTRODUCTION AND GIVING THE
CONTEXT.
I THINK I'LL BE ABLE TO MAKE UP
SOME TIME GOING THROUGH THE
SLIDES BECAUSE OF THE EXCELLENT
PRESENTATION FROM DR. GASKINS
AND THE INTRODUCTION
DR. KOROSHETZ JUST MADE.
DR. KOROSHETZ TALKED ABOUT THE
MISSION OF THE NINDS AND THE WAY
WE'RE DIVIDED.
AND OUR OFFICE IS WITHIN THE
DIVISION OF CLINICAL RESEARCH.
THIS LIST HERE THE PEOPLE THAT
ARE IN THE OFFICE THAT DO ALL OF
THE WORK.
MY OFFICE AND WE HAVE NEGATIVE
OUTCOMES ASSOCIATED WITH
NEUROLOGICAL DISORDERS HAVE BEEN
DESIGNATED AS THE POPULATIONS
THAT EXPERIENCE HEALTH
DISPARITIES AND I'LL HAVE THEM
LISTED ON THE SLIDE.
AND WE HAD A STRATEGIC PLAN AN
PUT TOGETHER A WORKING GROUP OF
OUR NATIONAL ADVISORY COUNCIL.
WE HAD OVER 30 EXPERTS.
DR. GASKINS WAS AN EXPERT ON THE
WORK WE DID AS WELL AS
DR. MANSON WHO WAS PREVIOUSLY ON
THE COUNCIL.
WE LEARNED HOW OTHER INSTITUTES
DID THEIR STRATEGIC PLANNING FOR
GLOBAL HEALTH AND HAD
DR. STINSON AND OTHERS
PARTICIPATING IN THE TRANS NIH
GROUP.
WE STARTED A HEALTH EQUITY WORK
GROUP FOR THE EXTRAMURAL STAFF
THAT WORKED ON A PORTFOLIO
ANALYSIS OF WHAT THE NINDS
FUNDED IN THE GLOBAL HEALTH
EQUITY SPACE FROM 2016 TO 2022.
WE HAD A REQUEST FOR INFORMATION
AND IN THE HEART OF THE PANDEMIC
WE DID THIS VIRTUALLY.
THE CAP STONE WAS A VIRTUAL
THREE AND A HALF DAY, TWO AND A
HALF DAY WORKSHOP WHERE WE GOT
MORE UNPUT FROM THE PUBLIC AND
HAD RESULTS PRESENTED TO OUR
WORKING GROUP OF OUR NATIONAL
ADVISORY COUNCIL AND PUT
TOGETHER RECOMMENDATIONS.
WE HAD RECOMMENDATIONS PUBLISHED
IN THE SERIES, DEDICATED SERIES
IN THE NEUROLOGY JOURNAL THAT
LISTED ALL THE OUTPUTS OF OUR
STRATEGIC PLANNING PROCESS.
WE USED THE HEALTHY PEOPLE 2030
DEFINITION OF HEALTH
DISPARITIES.
I WON'T GO THROUGH THAT.
I THINK DR. GASKINS TALKED ABOUT
AND THE DEFINITION OF HEALTH
EQUITY AND DID AN EXCELLENT JOB
TALKING ABOUT HEALTH EQUITY AND
EQUALITY.
THIS IS OPEN ACCESS AND WANTED
TO BE TRANS PARENT TO THE
PUBLIC.
-- TRANSPARENT TO THE PUBLIC AND
YOU DON'T NEED TO HAVE ACCESS TO
THIS BUT LOOK AT THE MANUSCRIPTS
HERE.
HE WANTED TO START THE
SUPPLEMENT WITH SOMETHING
SHOWING THE BANG OF DISPARITIES
AT NEUROLOGICAL DISORDERS.
THEY ASKED A QUESTION, WHAT
WOULD BE THE -- WHAT IS THE
ACCESS THAT OCCURS IN OTHER
RACIAL AND ETHNIC GROUPS USING
WHITES AS THE COMPARATOR IF THE
OTHER GROUPS HAD THE SAME
MORTALITY RATE AS WHITES.
WE CHOSE TO USE WHITES
INITIALLY, A PRIORITY THAT'S
USUALLY WHAT IS USED AS A
COMPARATOR AND WE LOOKED AT
OTHER GROUPS.
WE LOOKED AT THE C.D.C. DEATH
COUNTS AND ICD10 COUNTS AND
LOOKED THROUGH THOSE AND PULLED
OUT DISEASES THAT ARE
NEUROLOGICAL DISEASES AND THOSE
RELATED TO LIKE HYPERTENSION AND
USED NON-HISPANIC WHITE AS THE
REFERENCE.
WE LOOKED AT THE DEATH RATES
FROM 2010 TO 2019 AND THE
AGE-ADJUSTED MORTALITY RATE DUE
TO NEUROLOGICAL DISEASES BY RACE
AND ETHNICITY.
FOR NON-HISPANIC WHITES THERE'S
A SLIGHT DECLINE IN MORTALITY
DUE TO NEUROLOGICAL DISEASES AND
WE NOTICED A DECREASE IN THE
STROKE RATE IN THE UNITED STATES
HAUFR WE'RE STARTING TO SEE
YOUNGER STROKES IN AFRICAN
AMERICAN POPULATIONS.
THOUGH THERE'S BEEN A DECREASE,
THE MORTALITY RATIO COMPARING
NON-HISPANIC WHITES WITH
NON-HISPANIC BLACKS HAS BEEN THE
SAME.
THE DISPARITY HAS CONTINUED
DESPITE THE DECREASE.
THAT'S ALSO INCREASING FOR
AFRICAN AMERICANS.
INTERESTINGLY WHAT WE FOUND IS
THERE'S OTHER RACE ETHNIC GROUPS
IN THE UNITED STATES THAT HAVE
LOWER RATES THAN FOR WHITE
AMERICANS.
THIS IS WHY THE CONCEPT OF
HEALTH EQUITY IS IMPORTANT.
WE CAN LEARN FROM OTHER GROUPS
WHAT IS DIFFERENT IN THESE
POPULATIONS THAT THEY HAVE LESS
MORTALITY FROM NEUROLOGICAL
DISORDERS THAN WHITE PERSONS.
TO SUM THIS UP THERE WERE A
TOTAL OF EXCESS OF NEARLY 30,000
DEATHS THAT OCCURRED DURING THIS
PERIOD OF TIME IF THEY'D HAD THE
SAME MORTALITY RATES AS WHITES
THEY WOULD HAVE BEEN PRESERVED.
IF WE USED THE LOWER MORTALITY
RATES THE NUMBERS WOULD BE
HIGHER AND IN THE MANUSCRIPT WE
TALK ABOUT THAT AS WELL.
WE HAD A FRAMEWORK AND THERE'S
UPSTREAK BARRIERS TO HEALTH
EQUITY WE SEE IN NEUROLOGICAL
DISEASES.
WE HAD A COMMITTEE THAT FOCUSSED
ON THIS AND THIS WAS
SPECIFICALLY RELATED TO
NEUROLOGICAL DISEASES.
WE WANTED THE FRAMEWORK TO BE
COMPATIBLE WOMEN OTHER FRAME
WORKS AND IT'S COMBATABLE WITH
THE NIMHD FRAMEWORK.
AND SHOWED THE FACTORS.
THIS NINDS SOCIAL DETERMINATES
FRAMEWORK IS COMPATIBLE WITH
OTHERS AND WANT THE FUTURE
FUNDING ANNOUNCEMENTS FOR
ADVOCATORS TO CONSIDER THE
UPSTREAM BARRIERS IN IN HOW THEY
IMPACT HEALTH EQUITY MOVING
FORWARD.
THERE WERE RECOMMENDATIONS IN
PROBABLY SIX OF THE 10
MANUSCRIPTS PUBLISHED HERE.
OUR CHAIR OF OUR WORKING GROUP,
DR. KAREN JOHNSON AND OTHERS
CONDENSED THEM TO 18 HIGH-LEVEL
RECOMMENDATIONS PRESENTED TO OUR
NATIONAL ADVISORY COUNCIL AND
VOTED ON THIS AS BEING THE
RECOMMENDATIONS FROM THE
COMMITTEE WE SHOULD CONSIDER IN
TERMS OF ADDRESSING HEALTH
EQUITY.
WE TOOK THOSE 18 RECOMMENDATIONS
AND ACTUALLY TRANSFERRED THOSE
INTO AN IMPLEMENTATION MAN A
AND -- PLAN AND CREATED FOUR
BUCKETS INCLUDING EXPANDING
SUPPORT FOR HEALTH EQUITY
RESEARCH, PROMOTE COMMUNITY
ENGAGEMENT WITH THE NIMHD BY
POPULATION AND THE WORKFORCE
WHICH IS AN UNDERLYING THEME AND
EXPAND COMMUNICATION AND
OUTREACH AND WE LOOKED AT THE
POLICY LEVERS AND RELATED THINGS
TO ENACT OUR HEALTH EQUITY
STRATEGIC PLANS.
I'M GOING TO HIGHLIGHT A FEW OF
THE THINGS WE'RE DOING IN THIS
PARTICULAR SPACE.
ONE IS A PUBLIC HEALTH CAMPAIGN
THAT WAS A REFRESH OF A PREVIOUS
CAMPAIGN INITIATED THROUGH THE
NINDS CALLED THE MIND YOUR RISK
CAMPAIGN.
THIS WAS GEARED SPECIFICALLY TO
AFRICAN AMERICAN MEN BETWEEN 28
TO 45.
THAT POPULATION IS THE PONG THAT
IS AT HIGHEST RISK FOR
DEVELOPING IMPAIRMENT AND
DEMENTIA LATER ON LIFE BASED ON
THE SPRINT TRIAL AND A SUB STUDY
CALLED THE SPRINT MIND STUDY
THEY LOOKED AT THE STUDY LOOKING
AT MODERATE CONTROL VERSUS
HAWAHIGH
CONTROL AND OUTCOMES AND IT WAS
INCREASED IN PEOPLE WITH HIGH
BLOOD PRESSURE AND THEY HAD
LOWER RATES OF COGNITIVE
IMPAIRMENT WHICH IS THE FIRST
STEP TOWARDS DEVELOPING DEMENTIA
LATER IN LIFE.
SO WE PUT TOGETHER FOCUS GROUPS
AND WE CAME UP WITH TAG LINES
RELATED TO THIS THAT WOULD BE
MOTIVATE BEING TO OUR TARGET
POPULATION TO ADDRESS THIS.
THAT GROUP IS AT HIGHEST RISK
FOR UNCONTROLLED HYPERTENSION.
WE ESTABLISHED COMMUNITY
PARTNERS.
WHERE HE HAD THE AMERICAN STROKE
ASSOCIATION CENTER FOR BLACK
HEALTH INEQUITY AND OTHERS AND
WORKED WITH HBCUs AND ALUMNI
NETWORKS AND DID A LOT OF
WEBINARS WITH MOREHOUSE COLLEGE
AND THE WORK WITH HEALTH CENTER
AND HBCU ALLIANCE AND
PHILADELPHIA HBCU ALLIANCE AND
ATLANTA HBCU ALLIANCE AND DID
SEVERAL RADIO STATIONS AND DID
SEVERAL WEBINARS WITH THEM AS
WELL.
AND THERE WAS THE NATIONAL
ASSOCIATION OF BLACK JOURNALISTS
WELL ATTENDED.
SEVERAL PEOPLE PARTICIPATED.
I TALKED ABOUT THIS PUBLIC
COMMENT CAMPAIGN AND WE LOOKED
AT MEASURES OF SUCCESS AND WE
IMPROVED PEOPLE'S BLOOD PRESSURE
AND DECREASED THE RATES OF
DEVELOPING STROKE.
WHAT WE DID AS IS LOOK AT THE
NUMBER OF VIEWS AND CLIKDZ TO
THE WEBSITE AND PEOPLE THAT --
CLICKS TO THE WEBSITE AND PEOPLE
THAT LOOKED AT THE INFORMING AND
I APOLOGIZE FOR THE SLIDES.
FOR SOME REASON THEY'RE NOT
TRANSFERRING WELL.
WE DID SOMETHING CALLED THE
COMMUNITY ENGAGED HEALTH EQUITY
RESEARCH INITIATIVE.
IT WAS AN INITIATIVE TO INCREASE
OUR POTENTIAL FUNDING PORTFOLIO
RELATED TO HEALTH EQUITY
RESEARCH.
WITH THIS INITIATIVE WE HAD
THREE COMPONENTS.
ONE WAS COMMUNITY ENGAGEMENT.
THE OTHER HEALTH EQUITY RESEARCH
HAD TO BE A HEALTH EQUITY
RESEARCH AND MULTI-DISCIPLINARY
TEAM.
THE COMMUNITY ENGAGEMENT I'LL
TALK ABOUT IN TERMS OF MAKING
SURE THIS WAS AN EFFECTIVE
COMMUNITY ENGAGEMENT WITH THE
POPULATIONS IDENTIFIED TO
EXPERIENCE HEALTH DISPARITIES.
DR. KOROSHETZ WAS CLEAR HE
WANTED US TO MOVE FROM
CONTINUING TO ADMIRING THE
PROBLEMS OF DISPARITIES AND MOVE
TOWARDS INTERVENTION.
ONE WAS CLINICAL TRIAL.
WITH THE INTENTION OF CLINICAL
TRIAL READINESS FOR FUTURE
CLINICAL TRIALS IN THIS
PARTICULAR AREA.
I TALKED ABOUT THE COMMUNITY
ENGAGEMENT.
WE WANTED TO HAVE EFFECTIVE
COMMUNITY ENGAGEMENT.
WE ASKED IN THEIR APPLICATION
THEY PUT IN WHAT WE CALL A
COMMUNITY ENGAGEMENT AND
INCLUSION PLAN AND PLAN TO
ENHANCE DIVERSE PERSPECTIVES.
THOSE WERE SEPARATE ATTACHMENTS
THEY INCLUDED IN THEIR
APPLICATION.
THEY HAD TO INCLUDE PEOPLE WITH
LIVED EXPERIENCE OR PEOPLE THAT
ARE FAMILY MEMBERS RELATED TO
THE DISEASE THEY'RE STUDYING
FROM ONE OF THE POMPS THAT
EXPERIENCE HEALTH DISPARITIES.
HAD TO HAVE A COMMUNITY PARTNER
AS WELL THEY WORKED WITH.
HOPEFULLY YOU CAN SEE THAT ON
THE SLIDE.
ESTABLISH AND ASKED SPECIFICALLY
FOR THEM TO ESTABLISH A
PARTNERSHIP AGREEMENT WITH THE
COMMUNITY PARTNER AS WELL.
AND TO WRITE THIS DOWN IN TERMS
OF HOW THEY'LL INCORPORATE THIS
BI-DIRECTIONAL INPUT BACK TO THE
RESEARCH.
AND WE WANTED THIS TO BE
COMMUNITY-ENGAGED RESEARCH AND
INCLUDE SUCCESS METRICS SHOWING
THE COMMUNITY ENGAGEMENT AND
OUTCOMES ARE A SUCCESS AND
WORKING.
THE OTHER THING WE'VE DONE IS
WE'RE TRULY TRANS NINDS.
WE WORKED WITH OTHER PROGRAM
DIRECTORS.
MY IS STROKE BUT WE HAVE OTHER
EXPERTS WITH OTHER NEUROLOGICAL
DISEASES ACROSS THE NINDS.
WE WORK WITH THEM THROUGH THE
STROKE NETWORK AND HAD SOMEONE
WORK WITH THE HEAL INITIATIVE
DOING EQUITY WITH THAT AND THE
UNDIAGNOSED NETWORK PREVIOUSLY A
COMMON FUND NETWORK THAT WAS
RECENTLY TRANSFERRED TO THE
NINDS AS WELL.
THAT'S ANOTHER NETWORK I WORKED
WITH.
NOW I'LL BRIEFLY TALK ABOUT THE
CONCEPT OF GLOBAL HEALTH EQUITY.
AGAIN THE MISSION IS TO DECREASE
THE BURDEN OF NEUROLOGICAL
DISEASE FOR ALL NATIONALLY AND
INTERNATIONALLY.
ONE OF THE THINGS WE'RE
CURRENTLY GOING THROUGH THE
STRATEGIC PLANNING PROCESS FOR
GLOBAL HEALTH.
WE MET WITH VARIOUS INSTITUTES
ACROSS THE NIH THAT DO GLOBAL
HEALTH RESEARCH AND WANTED TO
DEFINE GLOBAL HEALTH RESEARCH.
THE DEFINITION WE'RE USING IS
RESEARCH SPECIFICALLY GEARED
TOWARDS LOW AND MIDDLE INCOME
COUNTRIES AND SEPARATED THAT
FROM INTERNATIONAL RESEARCH WITH
HIGH INCOME COUNTRIES AS WELL.
WHEN WE FOCUS WE'LL LOOK AMOUNT
OUR WHOLE PORTFOLIO OF
INTERNATIONAL RESEARCH AND
GEARING OUR RESEARCH TO LOW AND
MIDDLE INCOME COUNTRIES.
I WANTED TO SHOW DATA IN TERMS
OF THE BURDEN OF NEUROLOGICAL
DISEASES.
THIS WAS PUBLISHED IN MARCH OF
THIS YEAR AND NEUROLOGICAL
CONDITIONS ARE THE LEADING CAUSE
OF DISEASE BURDEN WORLDWIDE.
IN 2023 THERE WERE 3.4
INDIVIDUALS IN THE WORLD WITH
CONDITIONS AFFECTING THEIR
NERVOUS SYSTEM KEY EQUIVALENT OF
THE WORLD'S POPULATION AND LOOK
AT ADJUSTED LIFE YEARS THAT'S
443 MILLION OF DAILIES THERE.
I HAVE SOME DISEASES ON THE
RIGHT SIDE.
STROKE IS THE FIFTH MOST COMMON
CAUSE OF DEATH IN THE UNITED
STATES.
IT'S THE SECOND MOST COMMON
CAUSE OF DEATH WORLDWIDE.
IT'S MAJOR AND THEN WE HAVE
OTHER NEUROLOGICAL CONDITIONS.
SO NEUROLOGICAL CONDITIONS ARE
BIG GLOBALLY AS WELL.
WE SEE LOW AND MIDDLE INCOME
COUNTRIES AND OTHER AREAS WELL.
I APOLOGIZE WE PUT A LOT OF TIME
IN THE SLIDES AND THEY'RE NOT
SHOWING WELL.
A LOT OF OUR FUNDING IS IN
SUB-SAHARAN AFRICA.
WE ALSO FUND WORK IN SOUTH
AMERICA AND ASIA AS WELL.
THERE'S LOW AND MIDDLE INCOME
COUNTRIES AS WELL.
JUST LISTING VARIOUS COUNTRIES
WHERE WE FUND GLOBAL HEALTH
RESEARCH.
A LOT OF OUR FUNDING IS THROUGH
THE FOGARTY GLOBAL BRAIN AND
HAVE AN R21 AND RO1 I WON'T GO
INTO FOR TIME AND WE TRAIN
PEOPLE AND RESEARCH WE FUND TO
CONSORTIA THAT FOCUS ON
NEUROLOGICAL DISORDERS AND FUND
INDIVIDUALS UNDER THESE TWO
PROGRAMS.
WITH THIS PROGRAM WE HAVE A NICE
MIXTURE OF TRAINING WHERE WE CAN
SEND PEOPLE FROM THE U.S. OR
FROM THESE COUNTRIES CAN COME TO
THE U.S. TO TRAIN TO DO
BIOMEDICAL RESEARCH IN
NEUROLOGICAL DISORDERS.
LASTLY I'LL TALK ABOUT THE WORK
WE'RE DOING IN ZAMBIA WITH TWO
OF OUR FUNDED ADVOCATORS,
DR. SAILOR AND DR. GRETCHEN
BURK.
THEY'VE BEEN WORK BEING IN
ZAMBIA FOR A LONG PERIOD OF
TIME.
UP TO 2018 THERE WERE NO ZAMBIAN
TRAINED BIOLOGISTS IN THE
COUNTRY.
I EXPLAINED THE BURDEN OF
NEUROLOGICAL DISEASE THERE AND
THEY STARTED A NEUROLOGY
RESIDENCY TRAINING PROGRAM IN
THE COUNTRY WHERE THEY WORKED
WITH THEM THROUGH THEIR RESEARCH
PROGRAMS BUT ALSO TAUGHT THEM
HOW TO BE A NEUROLOGIST AND TOOK
INTERNISTS AND OTHER SPECIALTIES
AND TRAINED THEM TO BE
NEUROLOGISTS.
WE TRAVELED THERE WITH THE
DIVISION DIRECTOR FOR OUR
DIVISION OF CLINICAL RESEARCH
AND MYSELF AND ONE OTHER PERSON
AND STACY CHAMBER AND WENT TO I
AGRADUA GAR
TO A GRADUATION AND YOU SHOULD
HAVE A CLEAR PICTURE OF THE
SYMPTOMOLOGY AND YOU SHOULD GET
A GOOD MENTAL PICTURE.
INTERESTINGLY THERE WERE SEVERAL
WHO TRAINED ZAMBIAN NEUROLOGISTS
AND SAID THEY DID AN EXCELLENT
JOB AND WE HAVE IT IN THE RECORD
LISTED.
WE'RE CURRENTLY GOING THROUGH
THE SAME PROCESS WE WENT THROUGH
FOR HEALTH EQUITY.
WE'RE GOING THROUGH THE SAME
PROFESSION FOR GLOBAL HEALTH AS
WELL.
I WON'T GO EACH OF THOSE IN
DETAIL.
THIS COULD NOT BE DONE ALONE.
WE HAVE A SMALL OFFICE BUT
PROFESSIONAL STAFF FOCUSSED ON
THIS RESEARCH.
WE ALSO WORK ACROSS OUR
INSTITUTE WITH OTHER PEOPLE.
I'D LIKE TO HIGHLIGHT THEIR
NAMES HERE IN THEIR PARTICULAR
SLIDE AS WELL.
WE HAVE A NEWSLETTER MY OFFICE
PUTS OUT AND SEND OUT
INFORMATION RELATED TO HEALTH
EQUITY AS WELL AS GLOBAL HEALTH
AND HAVE FUNDING ANNOUNCEMENT ON
THE WEBSITE AS WELL.
SO THAT'S MY LAST SLIDE.
I'M GOING TO STOP HERE AND SEE
IF YOU HAVE QUESTIONS FOR
DR. KOROSHETZ AND I.
>> THANK YOU, RICHARD THAT WAS
TERRIFIC AND WALTER AS WELL.
I APPRECIATE THE AND IMPORTANCE
OF THE DIMENSION OF THE PROBLEM.
I'M GLAD YOU MENTIONED THE STUDY
IN KAISER WHICH IS WHAT I WAS
IMPLYING ABOUT MODELS WE KNOW
WORK THAT HAVE NOT BEEN
DISSEMINATED AS WIDELY IN OTHER
PARTS OF THE COUNTRY.
COMMENTS AND QUESTIONS FROM OUR
COUNCIL MEMBERS?
YES, VALERIE.
>> THANK YOU FOR THE SCLEPT
PRESENTATION.
I'M CURIOUS ABOUT EFFORTS TO
TRAIN AND SUPPORT MEDICAL
STUDENTS WHO WOULD LIKE TO GO
INTO THIS AREA IN OUR TRIBAL
POPULATIONS.
THERE'S LIMITED ACCESS TO
NEUROLOGISTS.
6:
AS THE POPULATION AGES WE'RE
SEEING YEAR-PLUS WAITS TO SEE
NEUROLOGISTS.
I'M WONDERING IF THERE'S BEEN AN
EMPHASIS ON TRAINING PHYSICIANS
WOULD WOULD LIKE TO WORK IN
TRIBAL HEALTH.
>> I DON'T KNOW ANYTHING IN THAT
SPACE.
WE HAVE AT NINDS A PROGRAM THAT
BRINGS IN STUDENTS INTO
NEUROSCIENCE IN THE SUMMER AND
THEY'RE MINTED OVER THE YEAR.
THE PROBLEM HAS BEEN DOING ON
PROBABLY 15, 20 YEARS.
MANY OF THOSE FOLKS GO ON TO
CAREERS IN MEDICINE.
DO YOU HAVE THOUGHTS IN HOW TO
DO THAT IF IT HAPPENED?
>> WITH OUR MEDICAL SCHOOL
PLACED ONE IN RESERVATION AND
GEKT THEM TO GO TO GENERAL HAS
BEEN SUCCESSFUL SO FAR IN
GETTING PHYSICIANS TO STAY IN
THESE RURAL LOCATIONS.
WHEN THEY'RE TRAINED THERE THEY
TEND TO MARRY AND STAY LOCAL BUT
I HAVEN'T SEEN ANYTHING THAT
ENCOURAGES CONTINUED TRAINING IN
THE AREAS OF NEUROLOGY AND
CANCER ARE THE BIG AREAS WHERE
YOU SEE A LOT OF WEIGHT AND
PEOPLE FALLING THROUGH THE
CRACKS AND NOT GETTING THE CARE
THEY NEED.
>> I WAS GOING TO ADD TO WHAT
DR. KOROSHETZ MENTIONED THERE'S
LEVERS IN PLACE IN TERMS OF OUR
DIVERSITY SUPPLEMENT PROGRAM
WHICH IS A WAY IT TRAIN PEOPLE
BUT IN ORDER TO DO THAT WE HAVE
TO HAVE ONE OF THE NIH GRANTS TO
DO THAT.
WE HAVE DISCUSSED OTHER
POTENTIAL TRAINING PROGRAMS AND
THAT'S ONE WAY TO THINK OF HOW
TO DO THAT AND LIKE
DR. KOROSHETZ MENTIONED THROUGH
THE HELE PROGRAM AND MAY IN A
MECHANISM TO DEAL WITH THE
NATIVE AMERICAN PONG.
THAT'S A MAJOR GAP IN OUR
PORTFOLIO.
GIVEN WITH THAT THE IMPROVE
PROGRAM AND HEAL HOPEFULLY PE
CAN ADDRESS THAT BUT IT'S A
GREAT POINT.
DR. KOROSHETZ MENTIONED WE'RE
OPEN TO SUGGESTIONS.
>> I'M TRYING TO THINK OF A
QUICK FIX.
CERTAINLY CAN McI THINK THERE
ARE PROBABLY PEOPLE REALLY
INTERESTED IN TRYING TO MAKE A
DIFFERENCE IN THE NATIVE
AMERICAN POPULATIONS.
THE QUESTION IS IF THEY DON'T
LIVE THERE IS THERE WAY A TO USE
TECHNOLOGY TO HOOK THEM UP SO IF
SOMETHING HAPPENED TOMORROW
OPPOSED TO TRYING TO TRAIN
PEOPLE WHO THEN GO IN THE
COMMUNITY WHICH MAY TAKE 20
YEARS.
THAT'S A PROJECT THAT WOULD
DEFINITELY BE SOMETHING WE WOULD
FUND TO IMPROVE HEALTH EQUITY.
THAT COULD MAKE A DIFFERENCE IN
THE SHORT TERM IF YOU CAN PULL
IT OFF BUT IF YOU GO TO THE
YOUNG NEUROLOGISTS THERE'S
PEOPLE WHO WANT TO DO THE RIGHT
THING.
SO WE KEEP TALKING ABOUT MONEY
BUT THERE'S ALSO SOME PEOPLE
JUST REALLY WANT TO DO THE RIGHT
THING.
SO FINDING THOSE PEOPLES AND
GIVING THEM OPPORTUNITIES AND WE
SEE THAT IN THE GLOBAL HEALTH.
NO ONE GETS RICH.
BUT PEOPLE VOLUNTEER TO DO IT
AND THEY MAKE A HUGE DIFFERENCE.
I THINK THAT'S A REALLY GOOD
POINT AND NEED TO FOLLOW UP.
THERE'S A BASE WE CAN WORK WITH.
>> I JUST WANT TO SUPPORT SOME
AT THE UNIVERSITY OF NEW MEXICO
WITH THE ECHO MODEL NOT JUST
INCLUDING HUBS AND ECHO HUBS AND
REGISTERED HUB BUT EXPANDED TO
EDUCATION AND TRAINING IN THE
WORKFORCE SO THAT COULD BE A
POSSIBLE COLLABORATION WITH THE
ECHO HUB AND MODEL.
I JUST WANT TO OFFER THAT AND
WITH OUR COLLEAGUES HERE.
>> ANY OTHER COMMENTS?
>> I WOULD THINK VALERIE'S
COMMENT COULD BE ADDRESSED WITH
GOOD WILL AND SOME ARRANGEMENTS
IN TELEMEDICINE.
I REALIZE THERE'S NOTHING LIKE
THE EXAM IN NEUROLOGY BUT YOU
CAN DO A LOT WITH A GOOD
GENERALIST WITH A QUESTION AND
THE BIGGEST ISSUES IS
GENERALISTS AND MANAGING
PARKINSON'S DISEASE AND THE
THINGS I SAW AS AN INTERNIST IN
NEUROLOGY CONSULTS WERE ALMOST
EXTREMELY HELPFUL RATHER THAN
WAIT BEING 20 YEARS TO GET
NEUROLOGISTS TO GET THERE.
>> I WAS TRAINED ON THE STRONG
HEART STUDY WHICH TRAINED A
WHOLE GENERATION OF US IN
CARDIOVASCULAR DISEASE AND RISK
REDUCTION.
THERE'S AN ESTABLISHED NETWORK
THERE THAT HAS BEEN A STRONG
NETWORK OF DATA COLLECTION AND
NOW THAT THEY'VE MOVED INTO
INTERVENTIONS I WONDER IF SOME
OF THESE LONG-TERM COHORT TRIALS
NIH FUNDS, THOSE RELATIONSHIPS
CAN THEN BE TURNED INTO
INTERVENTIONS WITH THE SAME
PARTNERS.
THE PARTNERSHIP NETWORKS THEY'VE
ESTABLISHED AND THE TRIBES TRUST
THOSE RESEARCHERS AND THEY HAVE
A STRONG VERY LONG RELATIONSHIP.
I MEAN, HOW LONG IS THAT STUDY
GOING ON SINCE THE '80s, I
THINK.
>> WE CAN TELL A STORY AND
ELISEO MENTIONED TELEMEDICINE.
THE HOSPITALS OFTEN START
AFFLUENT PEOPLE.
WHEN HEAT STROKE CAME ON AND THE
PEOPLE IN MARTHA'S VINEYARD WERE
HEALTHY AND WANTED STROKE CARE
AND SET UP A TELEMEDICINE SYSTEM
WITH MARTHA'S VINEYARD AND IT
WAS SO SUCCESSFUL IT SPREAD
AROUND NEW ENGLAND.
AND HAD LICENSES IN 10 STATES
BUT IT WORKED.
AND WE EXAMINED THE PATIENT IN
TELEMEDICINE AND ADVISED WHAT TO
DO.
THE TECHNOLOGIES CAN CHANGE THE
GAME AND SOME TRAINEES DID IT
AROUND THE COUNTRY AND SAT AT
THE COMPUTER ALL DAY AND TOOK
CARE OF STROKES ALL OVER THE
COUNTRY SO THESE THINGS CAN
HAPPEN.
>> WELL, THANK YOU SO MUCH FOR
TAKING THE TIME ON A FRIDAY TO
CO MANY HERE AND WE'VE TALKED
BEFORE WITH THIS PROGRAMS YOU
BEGIN TO LAUNCH AND SELE AND WE
LOOK FORWARD TO SEEING THAT
DEVELOP FURTHER AND I SEE A LOT
OF OPPORTUNITY FOR SYNERGY.
>> WE NEED ALL THE HELP WE CAN
GET.
PLEASE HELP.
>> OKAY.
OUR FINAL PRESENTATION TODAY FOR
COUNCIL IS FROM COUNCIL MEMBER
DR. JANE SIMONI THE ASSOCIATE
DIRECTOR FOR BEHAVIORAL AND
SOCIAL SCIENCE RESEARCH AT THE
NATIONAL INSTITUTES OF HEALTH
AND THE DIRECTOR OF THE OFFICE
OF BEHAVIORAL AND SCIENCE
RESEARCH OR OPS AND SAR.
SHE HAS MORE THAN 30 YEARS OF
EXPERIENCE FOCUSSED ON DISPARITY
AND RESILIENCE AMONG GROUPS
SOCIALLY MARGINALIZED INCLUDING
THOSE WITH HIV AND LATINO LGBTQ
AND IS A PSYCHOLOGIST BY
TRAINING AND SHE CAN NO LONGER
CLAIM BEING A NEWBIE FROM THE
UNIVERSITY OF WASHINGTON.
SHE WAS PROFESSOR AND DIRECTOR
OF CLINICAL TRAINING IN THE
DEPARTMENT OF PSYCHOLOGY AND
FOUNDING DIRECTOR OF THE
UNIVERSITY OF WASHINGTON
BEHAVIORAL RESEARCH CENTER FOR
HIV OR BIRCH AND CO-DIRECTED THE
FRED HUTCHINSON CENTER FOR HIV.
>> THEY TOLD ME IT TAKE THREE
YEARS SO I KNOW I'M THE LAST
PRESENTATION BEFORE LUNCH SO
I'LL STICK TO TIME.
START RUBBING YOUR STOMACHS IF I
GET CLOSE TO TIME I'M HAPPY IT
GIVE YOU THE TIME AND WAS HAPPY
TO SEE THE PRESENTATIONS BEFORE
ME.
I'LL TALK ABOUT THE ROLE OF
SOCIAL SCIENCE IN TERMS OF
HEALTH AND DISPARITIES.
LET ME TELL YOU ABOUT MY OFFICE
AND WHAT WE ARE DOING.
THIS IS A QR CODE TO OUR
WEBSITE.
HAPPY IT CLICK ON THAT NOW.
WE CAN GET MORE CLICKS FOR OUR
WEBSITE.
YOU CAN LOOK IN MORE DETAIL
ABOUT SOME OF THE THINGS THAT
I'M GOING TO BE TALKING ABOUT
TODAY FOR THE OFFICE OF
BEHAVIORAL AND SOCIAL SCIENCES
AT THE NIH.
IN A WORD AND WE CAN LOOK AT
SOME OF THE DETAILS OF THIS IN
TERMS OF INFANT AND MORTALITY
AND THE AVERAGE AND MATERNAL
MORTALITY IS PARTICULARLY
SHAMEFUL, 23.8 WHEN THE AVERAGE
IS ONLY 9.8 IN HIGH INCOME
COUNTRIES.
IN TERMS OF OBESITY AND MULTIPLE
CHRONIC ILLNESS A THIRD OF US
ARE OBESE IN THE UNITED STATES.
SORRY, 42% AND DOUBLE THE
AVERAGE AND MULTIPLE CHRONIC
CONDITIONS' AFFECT A THIRD.
DEATH FROM ASSAULT A LOT FROM
FIREARMS RECENTLY IN GEORGIA,
7.4 PER 100,000 WELL ABOVE WHAT
IT SHOULD BE FOR A HIGH INCOME
COUNTRY.
MOST TELLINGLY, LIFE EXPECTANCY.
WE DON'T LIVE AS LONG AS FOLKS
IN OTHER COUNTRY.
THE LOWEST ACROSS THE LARGE AND
WEALTHY COUNTRIES.
IT'S NOT JUST THAT OUR HEALTH IS
NOT GOOD, IT'S THAT THERE ARE
MAJOR DISPARITIES IN HEALTH
OUTCOMES.
THESE ARE PREVENTIBLE
DIFFERENCES IN HEALTH BASED ON
NON-BIOLOGICAL FACTORS.
BY RACE, ETHNICITY AND SES AND I
CAN'T TALK ABOUT THIS WITHOUT
TALKING ABOUT INTERSECTIONALITY.
THEY INTERSECT WITH GENDER AND
STATUS AND OTHER DISABILITY
STATUS.
INTERSECTIONALITY IS A KEY POINT
OF DISPARITIES.
I'M PREACHING TO THE CHOIR HERE
BUT YOU CAN NEVER SEE THE SLIDES
TOO OFTEN.
LIFE EXPECTANCY BY RACE, LONG
STANDING INEQUALITIES
CONTRIBUTED TO DISEASE OUTCOME
FOR RACIAL AND ETHNIC MINORITY
GROUPS WITH AMERICAN ALASKAN
INDIAN AND ALASKAN NATIVES DOING
THE WORSE IN TERMS OF LIFE
EXPECTANCY.
ASIAN, WHITE AND EVEN HISPANIC
DOING BETTER.
YOU ARE SEE DIFFERENCES AND IT
REALLY HASN'T IMPROVED MUCH.
IN 20 YEARS WE'D LIKE TO COME
BACK AND SEE AT LEAST MORE EQUAL
CARE, I HOPE.
IT HASN'T GONE WELL THE PAST 70.
WE HAVEN'T MADE STRIDES WITH
LIFE EXPECTANCY AND MISSING
AFRICAN AMERICANS AND THEY
SHOULD BE HERE WITH THEIR
FAMILIES, WORKING, LIVING IN
COMMUNITY BUT THEY'RE IN THE
HERE BECAUSE OF DISPARITIES.
NOT BECAUSE OF THINGS WE
COULDN'T PREVENT OR COULDN'T
ADDRESS.
AND SES WAS A FUNDAMENTAL HEALTH
OF HEALTH INEQUITY AND SOCIAL
DISTRIBUTION OF RISK FACTORS
MARK BY MONETARY INCOME.
THIS HAS BEEN WELL DESCRIBED.
WHEN YOU LOOK AT THE RELATIVE
RISK OF ALL-CAUSE MORTALITY BY
INCOME IT'S CLEAR MANY IF YOU
MAKE LESS THAN $25,000 YOU'RE
THREE TIMES THE RISK OF
ALL-CAUSE MORTALITY.
MEDIAN HOUSEHOLD INCOME SHOWS
SOME GROUPS ARE MORE LIKELY TO
BE SUBJECT TO THESE INCOMES AS
BLACK, NATIVE AMERICAN, HISPANIC
AND HAVE WORSE OUTCOMES IN THOSE
CATEGORIES.
AGAIN, NOT MUCH IMPROVEMENT OVER
TIME.
THERE NEEDS TO BE SOME
DISRUPTION TO MAKE CHANGES
BECAUSE IT'S NOT GOING IN THE
DIRECTION WE WANT.
IS IT WE'RE NOT SPENDING ENOUGH
MONEY?
WE NEED TO THROW MORE MONEY AT
IT?
THAT'S NOT IT.
WE'RE SPENDING ALMOST DOUBLE
WHAT OTHER COMPARABLE NATIONS
ARE DOING IN 2022, OVER 4,000
PER CAPITA ON HEALTH COMPARED TO
THE NEXT HIGHEST COUNTRY YET YOU
SEE THIS GAP.
I'M NOT SURE HOW THIS THING
WORKS.
YOU SEE THE GAP.
WE SPEND MORE BUT WITH NOTHING
TO SHOW FOR IT.
IT ISN'T WE'RE NOT JUST SPENDING
ENOUGH ON HEALTH CARE.
WHAT LITERALLY IS KILLING US?
WHAT ARE THE TOP TEN LEADING
CAUSES OF MORTALITY IN THE
UNITED STATES?
NOT SURPRISINGLY, HEART
DISEASE -- I'M MISSING A COUPLE
HERE.
CANCER, UNINTENTIONAL INJURIES,
OTHER FACTORS THAT ARE
CONTRIBUTING IN HOMICIDE,
SUICIDE, FIREARMS IS NOT FAR
BEHIND ON THE LIST ACTUALLY.
WHEN I LOOK AT THE LIST, TO ME
IT SCREAMS BEHAVIORAL, SOCIAL
FACTORS AND STRUCTURAL
DETERMINATES.
POOR DIET, INADEQUATE NUTRITION,
PHYSICAL INACTIVITY, ALCOHOL
CONSUMPTION, SUN EXPOSURE AND
EXCESSIVE RISKY BEHAVIOR, UNSAFE
SEX PARTICULARLY FOR HIV, STIs,
NOT WEAR SEAT BELTS, DRIVING
UNDER THE INFLUENCE, LACK OF
VACCINE UPDATE YOU SAW DURING
THE COVID EPIDEMIC AND SOCIAL
ISOLATION.
WE'RE SEEING ISOLATION KILLS.
IT CORRELATES WITH MORTALITY.
AND THE STRUCTURAL FACTORS AND
LIMITED ACCESS.
IT'S NOT THAT PEOPLE DON'T JUST
CHOOSE IT DO THESE THINGS.
THEY DON'T HAVE ACCESS TO FOOD
DESERTS AND OTHER RURAL AREAS.
SAFE PLACES FOR PHYSICAL
ACTIVITY.
I HAVE NOWHERE TO MOVE AROUND.
SHOULD I MOVE UP AND DOWN AND
PREVENTIVE SERVICES AND
ENVIRONMENTAL OCCUPATIONAL
EXPOSURES.
THERE'S ENVIRONMENTAL RACISM AND
TOXICANTS AND POLLUTANTS AND
SES, INCOME AND EDUCATION LEVELS
WHICH AFFECT ALL OF THE FACTORS.
IT'S NOT LIKE WE CAN'T MEASURE
THESE THINGS.
THESE ARE PREVENTIBLE THINGS WE
CAN DO.
PEOPLE AREN'T BORN BEING
DESTINED TO HAVE 20 YEARS LEFT
TO LIVE THEIR LIFE.
YOU CAN LOOK AT THE NEIGHBORHOOD
AND OPPORTUNITY INDEX LOOK AT
INSTITUTIONS AND QUALITY OF
SCHOOLS, EARLIER CHILDHOOD
INFLUENCES AND WHAT SHAPES NORMS
AND EXPECTATIONS AND GRADUATION
RATES AND PLOID EMPLOYED ADULTS
AND HOME OWNERSHIP, EMPLOYMENT,
PUBLIC ASSISTANCE, THE QUALITY
OF THE ENVIRONMENT IN TERMS OF
AIR, WATER, SOIL, HAZARDOUS
WASTE SITES AND GREEN SPACE AND
WALKABILITY.
THESE ARE MEASURABLE THINGS TO
INTERVENE AND THESE DIFFER BY
RACE.
YOU CAN SEE IN THE HIGH LEVELS
OF NEIGHBORHOOD OPPORTUNITY YOU
CAN SEE MOSTLY 65% OF WHITE
PEOPLE FALL IN THAT CATEGORY BUT
WHEN YOU LOOK AT LOW LEVELS FOR
OPPORTUNITY IT'S THE SAME
DISPARITY, BLACK, AMERICAN,
NATIVE HISPANIC THAT FALL IN
THAT CATEGORY.
WE CAN MEASURE THESE THINGS AND
KNOW WHAT'S CAUSING THE PROBLEMS
AND DIFFERENCES BY RACE AND
ETHNICITY AND WE KNOW IT'S
EVERYDAY DISCRIMINATION
ASSOCIATED WITH INFLAMMATION,
HEART DISEASE, BLOOD PRESSURE,
BIRTH WEIGHT AND COGNITIVE
FACTORS LIKE SLEEP AND DIET AND
HAS AN EFFECT ON ALL-CAUSE
MORTALITY AS WELL.
IN TERMS OF BEHAVIORAL AND
SOCIAL SCIENCE.
WE'VE BEEN INTERESTED IN BEDSIDE
LAB AT THE FOREFRONT OF
BEHAVIORAL RESEARCH AND LET'S
START WITH THE DEFINITION WE USE
AT NIH.
THE SYSTEMATIC STUDY OF THE
BEHAVIORAL AND SOCIAL
PHENOMENON.
OBSERVABLE ACTIONS AND THE
MENTAL PHENOMENON.
YOU CAN'T SEE BUT IT'S IMPORTANT
FOR BEHAVIOR AND KNOWLEDGE,
ATTITUDES, BELIEFS, MOTIVATIONS,
PERCEPTIONS, COGNITION, VALUES,
CULTURAL BELIEFS AND PRACTICES.
AND SOCIAL PHENOMENON.
INTERACTIONS BETWEEN AND AMONG
INDIVIDUALS.
THE LARGER CHARACTERISTICS AND
FUNCTIONS OF SOCIAL GROUPS AND
INSTITUTIONS.
SUCH AS FAMILIES, COMMUNITIES,
SCHOOLS, WORKPLACES AND THAT
INVOLVES PHYSICAL AND POLICY
ENVIRONMENT AND A BROAD ARRAY OF
STUDIES AND HEALTH NOT JUST
PHYSICAL OR KEEPING YOU ALIVE
BUT PHYSICAL, MENTAL AND SOCIAL
WELL BEING.
THAT'S A W.H.O. METRIC AND
RESEARCH CAN ADDRESS HEALTH
OUTCOMES AND HEALTH DISPARITIES.
THEY CAN ANSWER SUCH QUESTIONS.
THERE'S WORK IN ALL THESE AREAS
BUT MORE NEEDS TO BE DONE.
WHAT ARE THE PSYCHOLOGICAL AND
CULTURAL DETERMINATES OF HEALTH
BEHAVIORS AND OUTCOMES.
WE'RE INTERESTED IN GENETICS.
EVERY PERSON WHO COMES IN THE
CLINICAL CENTER AND IF YOU ASK
ANY ARE YOU FEELING SAFE?
HAVE YOU BEEN DOWN, SAD OR
DEPRESSED?
THESE FACTORS WE CAN ASSESS AND
HAVE AN IMPORTANT OUTCOMES.
THESE INCLUDE STRESS,
DISCRIMINATION AND STIGMA.
WHAT ARE THE MOST EFFECTIVE
STRATEGIES FOR CHANGING
UNHEALTHY BEHAVIORS AND
INITIATING HEALTHY BEHAVIORS AND
IT'S NOT JUST INDIVIDUAL BUT
CHANGING THE ENVIRONMENT.
HOW DO SOCIAL DETERMINATES SUCH
AS INCOME, DISCRIMINATION IMPACT
OUTCOMES AND HOW CAN WE ADDRESS
THEM?
THERE'S A REASON WE HAVEN'T
FOCUSSED ON SOCIAL DETERMINATES.
IT'S HARD RESEARCH.
IT'S HARD TO DO AT MULTIPLE
LEVELS.
AND ONCE WE IDENTIFY THE
FACTORS, HOW DO WE DO HEALTH
DISPARITIES?
DO WE NEED TAILORED OR
CULTURALLY RELEVANT MATERIAL AND
MAKE SURE INTERVENTIONS ARE
RELEVANT AND SUSTAINABLE.
HOW CAN WE MOST EFFECTIVELY
IMPLEMENT AND DISSEMINATE THE
INTERVENTIONS TO HAVE
SUSTAINMENT?
THOSE WILL BEND THE CURVE ON THE
ISSUES.
AND THESE ARE SOME EXAMPLES NOT
JUST HEALTH DISPARITIES BUT
SMOKING CESSATION, HIV
PREVENTION, PHYSICAL ACTIVITY,
PROMOTION, DIET, VACCINE
CAMPAIGNS, MENTAL HEALTH
INTERVENTION AND ADHERENCE TO
MEDICATION TREATMENT.
GET DOWN DEEPER AND HAVE IT IN
COPIES OF THE SLIDE AND WHEN YOU
LOOK AT VACCINE CAMPAIGNS WHAT
DOES BEHAVIORAL SOCIAL SCIENCE
DO AND WAS NOT ASKED TO DO
DURING THE PANDEMIC WHICH YOU
SHOULD HAVE DONE.
UNDERSTANDING THE FACTORS
INFLUENCING VACCINE ACCEPTANCE.
ADDRESSING VACCINE HESITANCY.
AND VACCINATION RATES TO PREVENT
THE SPREAD OF INFECTIOUS
DISEASE.
WE HAVE GOOD VACCINES BUT IN THE
END IT WAS PEOPLE NOT TAKING
THEM THAT WAS THE BIGGEST ISSUE.
THERE'S 24 INSTITUTES AND WE
NEED TO DO TEAM SCIENCE AND LOOK
AT ENVIRONMENTAL CONTEXTUAL
RESEARCH TO UNDERSTAND HOW
PHYSICAL AND SOCIAL ENVIRONMENTS
INFLUENCE HEALTH AND LOOK AMOUNT
STUDIES IN THE ENVIRONMENT AND
FOOD DESSERTS AND QUANTIFY
ASSOCIATIONS WITH COHORT
ANDCATION CONTROL STUDIES TO
UNDERSTAND PREVALENCE AND RISK
AND DO THIS BY RACE ETHNICITY
AND OTHER DISPARITY FACTORS AND
HEALTH SERVICES AND NOT A HUGE
PRIORITY AT THE HIP -- NIH AND
LOOKING AT HEALTH CARE ACCESS
AND POLICY AND CHANGES IN HEALTH
OUTCOMES.
WE NEED TO DEVELOP AND ASSESS
EDUCATIONAL PROGRAMS TO LOOK AT
HEALTH LITERACY AND BEHAVIOR
CHANGE.
AND GRADUATE WORK WAS IN THAT
AREA IN STUDIES IN HEALTH CARE
PROVIDERS AND WHAT DO WITH NEED
TO TEACH AND CHANGE THE
WORKFORCE AND BEHAVIORAL SCIENCE
NEEDS TO GET IN IN TERMS OF
M.V.P. LEARNING AND WHAT CAN
SOCIAL SCIENCE TEACH US?
HOW CAN IT INFORM THE PROGRAMS
AND HOW CAN A.I. BENEFIT WHAT WE
DO?
AND THEN ECONOMIC RESEARCH
ASSESSING THE IMPACT AND
BEHAVIORAL INCENTIVES AND THE
COST EFFECTIVENESS OF
INTERVENTION AND POLICY
RESEARCH.
WE DON'T DO ADVOCACY AT THE HIP
BUT IT DOESN'T MEAN WE CAN'T
LOOK AT THE IMPACT OF POLICIES
AND CHANGE POLICIES TO INFORM
THEM FOR THE BETTER AND WE'VE
DONE THIS WITH TOBACCO AND
ALCOHOL RATES.
WE CAN CONTRIBUTE TO IDENTIFYING
AND ADDRESSING DISPARITY AND
ULTIMATELY LEADING TO MORE
EQUITABLE HEALTH OUTCOMES IN A
FRAMEWORK AND APPROACH AND IN AN
INTERDISCIPLINARY AND
MULTI-LEVEL APPROACH AND
INTEGRATE INSIGHTS IN SCIENCE
AND PUBLIC COMMENT EFFORTS AND
HOW WE'LL HAVE A BIG IMPACT.
LOOKING TO THE FUTURE.
WHAT CAN WE DO IN TERMS OF
BEHAVIORAL AND SOCIAL SCIENCE.
I FEEL AT THIS MOMENT A SENSE OF
URGENCY AND WINDOW OF
OPPORTUNITY.
THE COVID PANDEMIC CLAIMED OVER
A MILLION LIVES AND I LEFT
ACADEMIA AND I LEFT TO HAVE A
BROADER IMPACT BECAUSE I SEE A
WINDOW OF OPPORTUNITY AND PART
OF THIS IS EVEN AT THE NIH
THERE'S AN INCREASED FOCUS ON
BEHAVIOR.
I LOOK FOR AN NIH STRATEGIC PLAN
UPDATE.
WE HAVEN'T OFFICIALLY CHANGED
THE MISSION YET BUT IN THE
STRATEGIC PLAN WE CHANGED
EXPANDED BIO MEDICAL RESEARCH TO
INCLUDE BIO MEDICAL AND
BEHAVIORAL RESEARCH.
CAN'T TELL YOU HOW BIG THIS WAS.
IT WAS A REAL SHIFT.
SOME PEOPLE POSTED SAID I'M
INCLUDING IT ANYWAY.
WHEN WE SAW AND ADDED THE WORDS,
WE GOT MORE GRANT APPLICATIONS
AND BEHAVIORAL AND SOCIAL
SCIENCES INVOLVED.
WE HAD TO MAKE A CATEGORY FOR
THE WORKFORCE AT NIH AND SAW AN
UPTAKE IN THE BEHAVIORAL
SCIENCE.
THERE'S A REPORT ON BEHAVIORAL
AND SOCIAL SCIENCE DURING COVID
AND CONGRESS SAID WHAT THE HECK.
WHERE IS BEHAVIORAL SOCIAL
SCIENCE?
IT'S DECENTRALIZED.
WHY ISN'T IT INTEGRATE AND THEY
SAID YOU HAVE TO INTEGRATE IT AT
EVERY LEVEL.
YOU HAVE THE OFFICE HERE BUT HAS
TO BE INTEGRATED.
THE IT HAS TO BE INCORPORATED.
AND WORKING WITH THE OFFICE OF
SCIENCE AND TECHNOLOGY BLUE
PRINT.
PRESIDENT BIDEN HAD A PUSH FOR
DOING EVIDENCE-BASED POLICY
ABOUT USING SCIENCE AS A BASE OF
EVIDENCE TO IMPACT POLICY.
THREE THINGS THAT ARE HUGE AND
PROVIDE A WINDOW OF OPPORTUNITY.
LET ME TELL YOU ABOUT OUR OFFICE
AND I'LL GET YOU OUT ON TIME, I
PROMISE.
WE OPENED UP BY CONGRESSIONAL
MANDATE TO COORDINATE ALL THE
HEALTH RELEVANT AND IDENTIFY
GAPS AND CHALLENGES AND WE HAVE
A STRATEGIC PLAN AND VISION
THERE'S SYNERGISTIC INTEGRATION
OF SCIENCE INTO HEALTH RESEARCH
AND IT WORKS BOTH WAYS.
IT'S BI-DIRECTIONAL RELATIONSHIP
AND THINK IT WILL GIVE
ACCELERATED DISCOVERY FOR
TREATMENTS FOR HEALTH PROMOTION
AND INTERVENTIONS AND STRATEGY
TO IMPROVE HEALTH.
THAT'S OUR VISION VERY BROAD AND
WIDE.
WE ENHANCE AND ELEVATE THE
IMPACT OF THE S SR AND IDENTIFY
GAPS AND DEVELOP A COORDINATED
INITIATIVES.
I'LL TELL YOU ABOUT A FEW WE'RE
DOING AND COMMUNICATE THESE WITH
NIN AND BEYOND.
AND MY DIRECTORSHIP IS TO TALK
MORE WHAT WE'RE DOING AND
COMMUNICATE THAT AND BEYOND.
WITH OUR NEW STRATEGIC PLAN WE
HAVE RESEARCH PRIORITIES AND
CAPACITY DEVELOPMENT AREAS AND
OPERATION FOR RESEARCH AND
COLLABORATIVE SCIENCE.
WE WANT TO DO MORE COLLABORATE
RATION AND TEAM SCIENCE.
TWO, BASIC AND APPLIED.
THERE'S BASIC RESEARCH AND
BEHAVIORAL AND SOCIAL SCIENCES.
NON INTERVENTION.
IT'S A MECHANISTIC WAY AND THIS
CAME UP THE MECHANISMS OF
LOOKING AT WHAT ARE SOME OF THE
EFFECTS OF INTERVENTIONS.
THEN FINALLY OUR ONTOLOGIES AND
THE WAY WE THINK OF KNOWLEDGE
AND INVESTING IN BEHAVIORAL AND
SOCIAL SCIENCE AND HAVE A
CONTEXT FOR VOCABULARY AND FOCUS
ON SCIENTIFIC INVESTIGATION AND
I CARE ABOUT MEASURES AND THE
DESIGNS WE USE AND ABOUT HOW WE
ANALYZE THE DATA.
ALL THREE CAN BE IMPACTED BY
A.I. AND HOW TO CHANGE THE
SCIENCE.
AND IMPLEMENTATION AND
DISSEMINATION AND EQUITABLE
IMPACT.
IF WE HAVE THE INTERVENTIONS
WE'RE NOT DONE UNTIL PEOPLE
EXPERIENCE THEM AND CAPACITY, DK
COLLABORATIVE PARTNERSHIPS IN
NIH AND OUTSIDE, WE COMMUNICATE
OUTREACH.
I WANT TO SAY QUICKLY OUR OFFICE
WAS PUT IN THE OFFICE OF THE
DIRECTOR BY CONGRESS,
SPECIFICALLY.
WITHIN PROGRAM COORDINATION,
DPCPSI IN THE O.D. WHERE OUR
OFFICE IS.
I DON'T WANT TO BE IN ANY ONE OF
THE INSTITUTES.
I WANT TO BE IN THE O.D. TO WORK
ACROSS THE OTHER INSTITUTES.
WE HAVE A SMALL STAFF OF 25,
WE'RE THE MIGHTY ENGINE THAT
COULD, WHO WORK ON INITIATIVES
WITH THE I.C.s.
WE'RE TRYING TO HELP THE ICOS
FACILITATE AND ACHIEVE THEIR
AIMS, AND YOU CAN'T DO THAT
OFTEN WITHOUT INCLUDING
BEHAVIORAL AND SOCIAL SCIENCE,
THAT'S WHAT WE SAW IN THE PAST
AGAIN, KEEP BRINGING UP THE
COVID EPIDEMIC IN THAT REGARD.
$50 BILLION IS THE OVERALL
BUDGET.
WE'RE THE BUDGET WITH THE M,
SMALLER BY SEVERAL ORDERS OF
MAGNITUDE BUT DOESN'T MEAN WE
CAN'T USE MONEY TO SEED AND
INVEST.
A FRIEND SAID YOU'RE LIKE A
VENTURE CAPITAL FIRM, YES, A
SMALL ONE.
WE'RE INVESTING IN BROADER
PROJECTS TO HOPEFULLY HAVE AN
IMPACT.
WE GIVE ABOUT 80%, WE INVEST 80%
OF THIS BUDGET DIRECTLY INTO
P.I.-FUNDED RESEARCH.
FISCAL YEAR, WE GOT A BUMP IN
COVID THANKS TO ADVOCACY OUTSIDE
OUR AGENCY, WE FUND ACROSS ALL
ICOS.
IT'S HIGHER FOR NIMH, NIA HAS
HUGE BEHAVIORAL AND SOCIAL
SCIENCE COMPONENT, NIMHD AS
WELL, MY GOAL TO MAKE SURE THE
INSTITUTES, WE INTEGRATE HERE IS
THE ISSUE.
IT IS SOMETHING ABOUT THIS ROOM.
I TRY THE PDF.
THIS IS UNFORTUNATE.
IT STARTED FINE, BUT THESE ARE
INITIATIVES, WANTED TO SHOW
YOU -- I'LL SKIP AND SEE IF WE
CAN GET BACK ON TIME, WORKING IN
BASIC BEHAVIORAL SCIENCE.
WE WANT TO WORK IN A.I., ANOTHER
AREA, SOCIAL CONNECTEDNESS AND
HEALTH, A BIG PART IS SOCIAL
DETERMINANTS.
SOCIAL AND STRUCTURAL
DETERMINANTS, LOOKING AT
MULTI-LEVEL WE SEARCH AND
BEHAVIOR CHANGE AND MAINTAINING
THIS BEHAVIOR CHANGE.
KEY CORE AREAS OF BEHAVIORAL AND
SOCIAL SCIENCE.
AND THEN SOME OF THE INITIATIVES
I CAN TELL YOU BRIEFLY SOME WORK
WE'RE DOING, THE BRAIN
INITIATIVE IS A HUGE
MULTI-BILLION DOLLAR INITIATIVE.
WE SEED MONEY, A BRAIN WITHOUT
BEHAVIOR WON'T HAVE AN IMPACT ON
WHAT WE DO OR HEALTH OUTCOMES.
WE HAVE TO MEASURE THE IMPACT.
WE HAVE A HUGE VIOLENCE RESEARCH
INITIATIVE, VICKIE AMENDMENT,
YOU CAN'T STUDY SPECIFICALLY GUN
CONTROL BUT THERE'S A LOOSENING,
YOU CAN LIKE AT FIREARM VIOLENCE
PREVENTION.
THAT'S WHAT WE'RE DOING WITH
$12.5 MILLION IN CONGRESSIONAL
APPROPRIATION EVERY YEAR, THE
OFFICE WAS INSTRUCT AND TITLED
WITH THE PRIVILEGE ACTUALLY OF
DISTRIBUTING THIS AND SEEING
THIS HAVE AN IMPACT ON GUN
VIOLENCE.
WE HAVE -- IT'S FUNNY, I CAN SEE
THE SLIDES ON MY END, BUT NOT
WHERE THEY COME UP.
INITIATIVES LED OR CO-LED
INCLUDE RESEARCH, APPLICATION,
TEAM SCIENCE.
AGAIN, WE HAVE THE ENTIRE
NETWORK OF BASIC RESEARCH THAT
WE'RE DOING.
ONE THING TO LOOK AT NEXT, GOP-1
AGONIST WITH BEHAVIORAL
COMPONENTS, STIGMA, USING OR NOT
USING, BEHAVIOR CHANGE THAT
NEEDS TO HAPPEN.
WE'RE INTERESTED IN THE
BEHAVIORAL ASPECT OF THAT.
AND THEN COVID COORDINATING
COMMITTEE MORE MORE INTO A PANC
PREPAREDNESS, WHAT WAS THE
IMPACT OF CLOSING SCHOOLS, LIKE
MY HIGH SCHOOLER KNEW THE IMPACT
WAS LARGE, THIS REPORT DOCUMENTS
EFFECTS THAT HAPPENED.
ALSO WORKING IN TEAM SCIENCE, AS
I MENTIONED, IN THE ONTOLOGIES.
COMING UP WITH A UNIFORM
STRUCTURE IN VOCABULARY, SO
THINKING HOW WE STUDY BEHAVIORAL
AND SOCIAL SCIENCE MECHANISMS
AND OUTCOMES.
I MENTIONED THE FIREARMS
VIOLENCE PREVENTION,
$12.5 MILLION IN CONGRESSIONAL
APPROPRIATION, WE HAVE A NETWORK
VIOLENCE PREVENTION AWARDS
TRYING TO DEVELOP A WORKFORCE IN
THIS AREA.
NOT MANY PEOPLE TOLD THEIR
STUDENTS TO GO INTO THIS
RESEARCH WHEN CONGRESS SAID WITH
THE DICKEY COMMANDMENT IT --
AMENDMENT IT WASN'T GOING TO BE
FUNDED BUT WE'RE DEVELOPING A
WORKFORCE.
WE HAVE A MATILDA WHITE RILEY
LECTURE, AND EARLY-STAGE
INVESTIGATOR COMPETITION OPEN TO
JUNIOR INVESTIGATORS TO COME TO
THE NIH, PRESENT THEIR WORK,
TALK ABOUT HOW THEY CAN BECOME
NIH-FUNDED RESEARCHERS.
WE HAVE A FESTIVAL IN TERMS OF
BEHAVIORAL AND SOCIAL SCIENCE
RESEARCH, WORK WITH THE OTHER
INSTITUTES, LET'S SHOWCASE THE
BEST BEHAVIORAL AND SOCIAL
SCIENCE WE'VE DONE, EVERY YEAR,
IN NOVEMBER, A BIG FOCUS ON A.I.
THIS YEAR AS WELL FOR THIS
FESTIVAL.
WE OFFER TRAININGS.
WE HAVE A RESEARCH AND DOCTORAL
TRAINING PROGRAM FOR BEHAVIORAL
ANALYTICS, R25 SHORT COURSES
PROGRAM ON METHODOLOGY.
SOME OF YOU PARTICIPATED IN SOME
OF THESE.
AND WE HAVE FOR OUR FIREARMS
FUNDING A K18 SO MID-CAREER
INVESTIGATORS GOING INTO THIS
RESEARCH.
WE HAVE TRAINING RESOURCES, GOOD
PRACTICE, THOSE OF YOU WHO HAVE
DONE CLINICAL TRIALS PROBABLY
TOOK THIS COURSE.
REVAMPING COMMUNICATION,
SOMETHING I WANT TO DO MORE OF.
WE A DIRECTOR SPOTLIGHT,
TECHNICAL ASSISTANCE WEBINARS,
HIGHLIGHT FUNDING OPPORTUNITIES,
NEWSLETTER, WE HIGHLIGHT
RESEARCH.
NEXT COUPLE MONTHS WE HAVE A
TALK BY DR. WANG IN SEPTEMBER,
RESEARCH FESTIVAL IN NOVEMBER,
STAY TUNED, 30th BIRTHDAY NEXT
YEAR, WE HAVE FUN PLANS TO DO.
I WILL END WITH A CALL TO
ACTION, WHAT CAN YOU DO FOR THE
FUTURE.
I SAID I'M OPTIMISTIC ABOUT THE
FUTURE.
I SEE A WINDOW OF OPPORTUNITIES
FOR BEHAVIORAL AND SOCIAL
SCIENCE RESEARCH, I'VE BEEN
DOING THIS 30, 35 YEARS, LIVED
THROUGH THE DECADE OF THE
BRAIN, fMRI RESEARCH,
NEUROSCIENCE, GENETICS,
PSYCHOLOGY PROGRAMS, CHANGING
THE PSYCHOLOGY AND NEUROSCIENCE
BUT I SEE AN OPPORTUNITY NOW TO
BALANCE OUT THAT FOCUS AND
REALLY LOOK AT THE GAPS FOR
BEHAVIORAL AND SOCIAL SCIENCE TO
PUSH FORWARD ALL THESE SCIENCES.
FOR RESEARCH, THESE ARE THEMES I
BROUGHT UP.
TEAM SCIENCE, MULTI-DISCIPLINARY
SCIENCE, THIS NEEDS TO BE PART
OF IT.
WE NEED BASIC AND APPLIED
BEHAVIORAL AND SOCIAL SCIENCE,
THE MYTH NIH DOES INTERVENTION,
NOT TRUE, WE DO BASIC BEHAVIORAL
RESEARCH ESPECIALLY IN THE
INSTITUTES BIOMEDICALLY GEARED.
WE NEED TO ADDRESS STRUCTURAL
AND SOCIAL DETERMINANTS OF
HEALTH IN A MULTI-LEVEL WAY, NOT
EASY BUT IT'S IMPORTANT TO DO.
WE NEED METHODOLOGICALLY
INNOVATIVE AND RIGOROUS
RESEARCH.
I SAY EVEN MORE SO FOR
BEHAVIORAL AND SOCIAL SCIENCE,
SO-CALLED SOFT SCIENCE.
WE'RE NOT SOFT.
WE'RE HARD.
WE'RE DIFFICULT.
TO DO THAT WELL IS ALSO THIS,
IT'S HARD TO MEASURE CONSTRUCTS
BUT IMPORTANT, AND WE CAN HOLD
OUR OWN WITH LONGER STANDING
BIOMEDICAL SCIENCES.
ADDRESSING HEALTH DISPARITIES,
IMPLANTS FOR FEASIBILITY AND
IMPACT, WHAT GOOD IS SCIENCE IF
NO ONE READS IT?
IT HAS TO BE CONNECTED TO
COMMUNITY.
NOT JUST DO RESEARCH BUT
COMMUNICATE, OUTREACH, PUBLISH
WIDELY NOT JUST IN TYPICAL
JOURNAL, PUBLISH OP-ED PIECES,
UNIVERSITY NEWSLETTERS.
SHOW BEHAVIORAL SOCIAL SCIENCE
WORKS, EDUCATE PEERS, LEADERS,
BIOMEDICAL COLLEAGUES.
HALF DON'T KNOW WHAT BEHAVIORAL
SOCIAL SCIENCE IS.
A DIRECTOR REMAINING NAMELESS
CALLED IT THAT QUALITATIVE
STUFF.
WE NEED TO EDUCATE COLLEAGUES
ABOUT WHAT IT IS AND WHAT IT CAN
DO.
AND ENGAGE WITH DECISION MAKERS,
I CAN'T TELL YOU WHAT TO SAY TO
YOUR ELECTED REPRESENTATIVES BUT
I CAN TELL YOU TO TALK TO THEM,
TO USE YOUR VOICE AND MAKE YOUR
OPINION KNOWN.
IT HAS A BIG IMPACT ON WHAT
WE'RE ABLE TO DO AT NIH.
FINALLY MENTORING AND TRAINING,
QUANTITATIVE SKILLS, A.I., MIXED
METHODS ARE VERY IMPORTANT IF
WE'LL HAVE AN IMPACT FOR
BEHAVIORAL AND SOCIAL SCIENCE
RESEARCH.
COLLABORATIONS WITH PARTNERSHIPS
IN RESEARCH OUTSIDE PUBLIC,
PRIVATE, IN A TEAM-ORIENTED
SCIENCE APPROACH.
I'LL END LOOKING AT THIS CURVE
AGAIN.
DR. MARTIN LUTHER KING KING SAID
THE ARC OF THE MORAL UNIVERSE
BENDS TOWARDS JUSTICE, LET'S
HOPE IT CAN BEND TOWARD HEALTH.
WE HAVE TO DO SOMETHING
DIFFERENT.
IT'S NOT GOING IN THAT
DIRECTION.
THANK YOU VERY MUCH.
>> THANK YOU SO MUCH, JANE.
WE HAVE TIME FOR COMMENTS OR
QUESTIONS FROM THE COUNCIL
MEMBERS.
>> THANK YOU VERY MUCH FOR THE
PRESENTATION.
SO, THE LAST SLIDE WHICH SHOWED
THE LIFE EXPECTANCY I THINK YOU
SHOWED EARLIER ON.
I WAS WONDERING, DO YOU THINK
THE FACT UNITED STATES HAS ALL
THESE DIVERSE ETHNIC GROUPS, WE
LEARNED TODAY AND KNEW
PREVIOUSLY WE'RE NOT TAKING CARE
WITH THE HEALTH CARE SYSTEM,
WOULD THAT CONTRIBUTE?
>> YES, I THINK IT DOES.
I LIKE TO THINK OF DIVERSITY AS
A STRENGTH, IN SOME WAYS WE HAVE
TO WORK HARDER THOUGH TO REACH
DIFFERENT GROUPS.
THE DISPARITIES ARE IMPORTANT
PART OF WHY THIS IS LOWER, I
THINK.
HISTORY, HISTORIC AND CURRENT,
SYSTEMIC PROBLEMS IN OUR
HEALTHCARE STRUCTURE AND SOCIAL
STRUCTURE, ECONOMIC STRUCTURE
THAT ALL CONTRIBUTE TO THIS.
SO CERTAINLY, I THINK IT DOES.
DID YOU HAVE IDEAS WHY?
WERE YOU THINKING OF SOMETHING?
NO?
>> OTHER COMMENTS OR QUESTIONS?
SO THANK YOU FOR BRINGING THE
CONTEXT OF THE OFFICE INTO VIEW
WITH OUR PROGRAMS.
I THINK THAT NIMHD WAS HIGH ON
THE LIST OF BENEFICIARY OF YOUR
CO-FUNDING EFFORTS.
AND YOUR PREDECESSOR BILL RILEY
WAS SOMEONE I KNEW FOR MANY
YEARS BEFORE EVEN COMING TO NIH.
I THINK OBSSR CO-FUNDED ONE OF
OUR RESEARCH CENTERS FOR
MINORITY AGING RESEARCH THAT WE
HAD BACK IN TWO THOUSAND
SOMETHING, THE SECOND ROUND, ONE
OF THOSE.
AT THE TIME I DON'T THINK I KNEW
WHAT OBSSR WAS.
I ALSO WILL NOTE THAT NORMAN
WAS -- ANDERSON WAS PART OF
OUR -- I WAS ON NIA COUNCIL WHEN
HE WAS ALREADY OUT OF NIH, SO HE
HAD BEEN THE FOUNDING DIRECTOR
OF THE OFFICE, SO 25 YEARS AGO,
I GUESS.
OR 30?
THIRTY YEARS.
SO THANK YOU, JANE.
I THINK WE NOW HAVE THE LUNCH
BREAK?
>> YES.
YES, WE HAVE LUNCH.
WE ACTUALLY HAVE AN EXTRA 30 OR
40 SECONDS FOR LUNCH.
PLEASE BE BACK IN YOUR SEATS AT
1:00 P.M.
THOSE THAT HAVE ORDERED LUNCHES,
THE LUNCHES ARE OVER IN THE
BREAKOUT ROOM F.
AND WE'LL BE BACK AT 1:00 P.M.
>> WELCOME BACK.
I HOPE EVERYONE HAD A FULFILLING
LUNCH.
UNDERSTOOD.
WE'RE GOING TO GO AHEAD AND GET
STARTED WITH OUR ANNUAL
STATEMENT OF UNDERSTANDING.
BY OUR CHIEF GRANTS MANAGEMENT
OFFICER.
PRISCILLA, TAKE IT AWAY.
>> I'M GOING TO BRIEFLY OUTLINE
STATEMENT OF UNDERSTANDING
BETWEEN NIMHD AND COUNCIL AND
HIGHLIGHT PARTS OF IT.
THE STATEMENT IS IN YOUR
e-FOLDER, SUMMARIZES OUR
UNDERSTANDING WITH YOU ABOUT HOW
OUR INTERACTIONS WILL PROCEED
OVER THE NEXT YEAR.
I'LL GO THROUGH IT IN THE ORDER
THE SECTIONS APPEAR IN THE
DOCUMENT,WHY I WILL MENTION SOME
SECTIONS THAT DIDN'T MENTION TO
THE GRANTS REVIEWED THIS ROUND.
AFTER THE MEETING IF YOU HAVE
QUESTIONS FEEL FREE TO CONTACT
ME.
MY CONTACT INFORMATION IS ON THE
LAST SLIDE.
TO HELP ACHIEVE THE GOALS, THIS
COUNCIL IS RESPONSIBLE FOR
ADVISING, CONSULTING WITH, AND
MAKING RECOMMENDATIONS TO THE
DIRECTOR OF NIMHD ON MATTERS
RELATING TO RESEARCH ACTIVITIES
AND FUNCTIONS OF THE NIMHD.
COUNCIL MEMBERS SERVE AS
NATIONAL RESOURCE IN DEVELOPING,
RECOMMENDING, SETTING THE
INSTITUTES'S POLICY AND RESEARCH
PRIORITIES.
ON OCCASION SPECIAL WORKING
GROUPS MAY BE FORMED BY OUR AT
THE REQUEST OF COUNCIL TO
EXAMINE AND ADDRESS CRITICAL
SCIENTIFIC OR POLICY ISSUES OF
IMPORTANCE TO THE INSTITUTE AND
ITS CONSTITUENCIES.
THE NIMHD WILL INFORM COUNCIL OF
CURRENT SCIENTIFIC BUDGETARY,
LEGISLATIVE, OR OTHER ISSUES
THAT MAY HAVE AN IMPACT ON THE
NIMHD AND ITS CONSTITUENCIES.
THERE ARE TWO COUNCIL SESSIONS.
ONE IS OPEN TO THE PUBLIC, THE
OTHER IS CLOSED TO THE PUBLIC.
IN THE OPEN SESSION, THERE'S
DISCUSSION OF SCIENTIFIC AND
POLICY ISSUES, AND CONCEPT
CLEARANCE OF SPECIAL
INITIATIVES.
CONCEPT CLEARANCE IS DESCRIBED
IN THE STATEMENT OF
UNDERSTANDING IN MORE DETAIL.
IN THE CLOSED SESSIONE THERE'S
SECONDARY REVIEW OF GRANT
APPLICATIONS, STATEMENT PROVIDES
MORE DETAILS ON THIS.
CERTAIN ACTIONS MUST BE
CONSIDERED INDIVIDUALLY BY
COUNCIL, AND WE BRING TO YOUR
ATTENTION ANY THAT APPLY TO
GRANTS BEING REVIEWED.
SO, TWO MOST IMPORTANT FUNCTIONS
ARE CLEARANCE OF NEW INITIATIVES
IN THE OPEN SESSION AND
SECONDARY REVIEW OF GRANT
APPLICATIONS IN THE CLOSED
SESSION.
ACTIONS CONSIDERED INDIVIDUALLY
INCLUDE PLANS FOR FUNDING UNDER
RFAs, APPLICATIONS OF HIGH OR
LOW PROGRAM PRIORITY,
APPLICATIONS FROM FOREIGN
INSTITUTIONS WITHIN A FUNDABLE
RANGE, SUMMARY STATEMENTS OF
SPECIAL INTERESTS OR NEEDING
DISCUSSION OR ACTION, FOR
EXAMPLE IF SOME ASPECT OF THE
SRG'S RECOMMENDATION HAS BEEN
QUESTIONED.
CO-FUNDING APPLICATIONS FOR
WHICH OTHER I.C.s HAVE PRIMARY
RESPONSIBILITY, IF THE NIMHD DID
NOT HAVE PRIMARY OR DUAL
ASSIGNMENT ON THE COMPETING
APPLICATIONS.
AND SOME INVESTIGATORS INITIATED
APPLICATIONS OF P.I.s
RECEIVING OVER $2 MILLION TOTAL
COST PER YEAR FROM ACTIVE OR
RESEARCH PROJECT GRANTS AWARDS.
THERE'S A SECTION ON REVIEW AND
RESOLUTION APPEALS.
NIH-PUBLISHED RFAs DON'T ALLOW
PEER REVIEW.
IF WE HAVE APPEALS OF REVIEW OF
UNSOLICITED APPLICATIONS WE'LL
INFORM YOU.
THE STATEMENT HAS A SECTION THAT
LISTS ADMINISTRATIVE DECISIONS
AND ACTIONS THAT DON'T REQUIRE
COUNCIL RECOMMENDATION.
THE ITEMS LISTED IN THIS SLIDE
ARE EXAMPLES OF ACTIONS THAT
ONCE BE BROUGHT BEFORE COUNCIL,
SUCH AS CHANGING PI, CHANGE OF
DOMESTIC ADMINISTRATION,
ADMINISTRATIVE COSTS WITHIN THE
SCOPE OF A GRANT.
A SECTION DESCRIBED OPTIONS
AVAILABLE TO THE COUNCIL WHEN
REVIEWING GRANT APPLICATIONS
DURING THE CLOSED SESSION, THE
COUNCIL MAY NOT CHANGE THE
SCORES ASSIGNED BY THE
SCIENTIFIC REVIEW GROUP, SRG,
HERE ARE THE OPTIONS AVAILABLE.
CONCURRENCE WITH SRG'S
RECOMMENDATION, NON-CONCURRENCE
BASED ON SCIENTIFIC OR TECHNICAL
MERIT OR POLICY CONSIDERATIONS,
RECOMMENDATION OF HIGH OR LOW
PROGRAM PRIORITY, OR DEFERRAL TO
OBTAIN ADDITIONAL INFORMATION
FOR CONSIDERATION AT ANOTHER
MEETING.
A REPORT OF THE EN BLOC
RECOMMENDATIONS IS PRESENTED.
SUMMARY STATEMENTS NOT REQUIRING
INDIVIDUAL DISCUSSION ARE
TREATED EN BLOC.
ANY COUNCIL MEMBER MAY REQUEST
THAT AN INDIVIDUAL SUMMARY
STATEMENT BE DISCUSSED
INDIVIDUALLY BY THE COUNCIL.
THE EXPEDITED REVIEW PROCESS IS
NOT MENTIONED IN THESE SLIDES
BECAUSE IT DESCRIBES AN OPTIONAL
PROCESS THAT DIDN'T APPLY TO
THIS ROUND'S APPLICATIONS.
IF WE WERE TO FOLLOW THIS
PROCESS IN THE FUTURE, FOR
CERTAIN APPLICATIONS, YOU WOULD
BE PROVIDED WITH DETAILS IN
ADVANCE.
A SECTION DESCRIBED OPTIONS
AVAILABLE TO THE COUNCIL WHEN
REVIEWING NEW CONCEPTS FOR
CLEARANCE DURING THE OPEN
SESSION, APPROVAL, DISAPPROVAL,
DEFERRAL, OR APPROVAL WITH
RECOMMENDATIONS FOR SPECIFIC
MODIFICATIONS.
TO SUMMARIZE, THE STATEMENT OF
UNDERSTANDING WAS WRITTEN TO BE
COMPREHENSIVE, NOT ALL THE
SECTIONS IN IT WERE APPLICABLE
TO THE PARTICULAR GRANTS AND
ITEMS DISCUSSED AT THIS COUNCIL
ROUND.
HOWEVER, WE BRING TO YOUR
ATTENTION ANY GRANTS OR OTHER
MATTERS REQUIRING YOUR
CONSIDERATION OR THAT MAY HAVE
AN IMPACT ON THE NIMHD AND ITS
CONSTITUENCIES.
AND MY CONTACT INFORMATION IS
THERE IN CASE THERE ARE
QUESTIONS.
>> WE ARE OPEN FOR QUESTIONS
NOW, ARE THERE ANY QUESTIONS OR
COMMENTS REGARDING THE STATEMENT
OF UNDERSTANDING?
THANK YOU, PRISCILLA.
WE WILL NOW MOVE TO THE
CONCEPTS.
THERE ARE TWO CONCEPTS FOR
APPROVAL THAT WE WERE PREVENTED
AND REVIEWED IN ABBREVIATED
FORM.
OTHER MEMBERS WERE ASKED TO
SHARE COMMENTS WITH AN ASSIGNED
REVIEWER, AND REVIEWERS ASKED TO
INCLUDE THESE THOUGHTS AND THEIR
OWN BRIEF COMMENTS.
THERE WILL BE AN OPEN DISCUSSION
PERIOD FOR ADDITIONAL COMMENTS
FROM COUNCIL MEMBERS WITH ANY
MEMBER AND A MOTION TO APPROVE
OR DISAPPROVE AND A VOTE BY ALL
VOTING MEMBERS.
REVIEWERS WILL MOVE AND SECOND
THE CONCEPTS.
FIRST CONCEPT WILL BE BY DR.
LUKA CARZONE.
>> THANK YOU.
GOOD AFTERNOON.
I'M A DIVISION DATA SCIENTIST
AND PROGRAM OFFICER AT NIMHD.
I'M BEEN WORKING WITH DR. MONICA
WEBB HOOPER ON DEVELOPING
CONCEPTS TO ADVANCE DATA SCIENCE
APPROACHES HEALTH DISPARITIES,
A.I., MACHINE LEARNING,
COMMUNITY ENGAGED RESEARCH.
HEALTH DISPARITIES PERSIST
GLOBALLY AND IN THE U.S.
ESPECIALLY.
AND THE SOCIAL DETERMINANTS OF
HEALTH CONTRIBUTE SIGNIFICANTLY
TO THESE DISPARITIES.
A.I. AND MACHINE LEARNING
APPLICATIONS IN HEALTH CARE
OFFER NEW AVENUES TO EXPLORE AND
ADDRESS THESE HEALTH
DISPARITIES, AND THEY ARE
PROMISING.
THEY SHOW PROMISE IN PREDICTION,
PERSONALIZED MEDICINE,
OPTIMIZING HEALTH CARE, BUT
THESE SAME TOOLS THAT CAN HELP
ADDRESS DISPARITIES CAN ALSO
EXACERBATE THEM BECAUSE OF
INHERENT BIASES THAT THEY OFTEN
CONTAIN.
THESE BIASES CAN STEM FROM
PRESENTATION OF DIVERSE
POPULATIONS IN TRAINING DATA OR
FROM DESIGN FLAWS, IN THE
ALGORITHMS, OR FROM ISSUES IN
IMPLEMENTATION.
AND THEY CAN RESULT IN
DIAGNOSTIC ERRORS, AND UNEQUAL
ACCESS TO HEALTH CARE,
EXACERBATING HEALTH DISPARITIES
THIS WAY.
SO WE NEED TO ADDRESS THESE
BIASES TO ENSURE EQUITABLE
OUTCOMES.
ONE WAY TO DO THAT IS THROUGH
COMMUNITY-ENGAGED RESEARCH WHICH
IS A COLLABORATIVE METHODOLOGY
TO INVOLVE COMMUNITY MEMBERS IN
ALL ASPECTS OF THE RESEARCH
PROCESS.
SO THE EMPHASIS IS ON
COLLABORATION, CULTURE
SENSITIVITY, BIDIRECTIONAL
LEARNING WHERE RESEARCHERS LEARN
FROM COMMUNITY MEMBERS AND
COMMUNITY MEMBERS LEARN FROM
RESEARCHERS, AND CAPACITY
BUILDING WITHIN THOSE
COMMUNITIES.
THE OBJECTIVES OF THE INITIATIVE
ARE TO ADDRESS BIAS BY
INTEGRATING WITH COMMUNITY
ENGAGED RESEARCH, FOSTER
INCLUSIVITY, CULTURE
SENSITIVITY, AND EFFECTIVE
HEALTH INTERVENTIONS.
AND TO EMPOWER COMMUNITIES TO
TAKE AN ACTIVE ROLE AND SHAPE
THEIR HEALTHCARE LANDSCAPE.
I'D LIKE TO ILLUSTRATE HOW A.I.
BIAS EXACERBATES HEALTH
DISPARITIES.
IF YOU TAKE A LOOK AT THE
ILLUSTRATION HERE, IT'S A CYCLE.
AND EVERYTHING STARTS WITH THE
DATA, WHICH MAY CONTAIN SAMPLING
BIAS OR MAY NOT BE
REPRESENTATIVE ENOUGH.
AND PATTERNS OF BIAS AND
DISCRIMINATION ARE OFTEN BAKED
INTO DATA DISTRIBUTIONS.
SO WHAT HAPPENS IN THE NEXT
PHASE WHICH IS THE DESIGN PHASE,
THERE COULD BE POWER IMBALANCES
IN SETTINGS, AND PROBLEM
FORMULATION, THE DESIGN OF THESE
ALGORITHMS CAN BE BIASED, OR THE
WAY THESE MODELS ARE BUILT OR
TESTED.
AND FINALLY, THERE COULD BE
BIASES IN THE DEPLOYMENT OF
THESE MODELS IN THE WAY THEY ARE
EXPLAINED, WHICH OFTEN LACKS
TRANSPARENCY, AND IN THE WAY
THEY ARE MONITORED.
SO, BIAS BY A.I. DESIGN AND
DEPLOYMENT TRANSLATES INTO
APPLICATION WHICH DEEPEN DIGITAL
DIVIDE, CAN EXACERBATE GLOBAL
HEALTH INEQUALITY AND TREATMENT
GAPS AND THEY COULD ALSO HAVE TO
DO WITH SCRIM DISCRIMINATORY PE
OF BIAS.
THESE INJUSTICES RESULT IN REAL
WORLD PATTERNS OF HEALTH
INEQUALITY AND DISCRIMINATION,
WHERE WE HAVE UNEQUAL ACCESS IN
LOCATION, DISCRIMINATORY
PROCESSES, OR BIASED CLINICAL
DECISION MAKING.
THE CYCLE CONTINUES BECAUSE
THESE PATTERNS OF HEALTH
INEQUALITY AND DISCRIMINATION
ARE IN DATA DISTRIBUTIONS.
SO, I'D LIKE TO GIVE AN EXAMPLE
TO MAKE THINGS MORE CONCRETE,
A.I.-DRIVEN DERMATOLOGY IS
LEAVING DARK SKINNED PATIENTS
BEHIND BECAUSE MACHINE LEARNING
TOOLS DISTINGUISH IMAGES OF
BENIGN AND MALIGNANT MOLES.
MODELS ARE TRAINED ON FAIR
SKINNED POPULATIONS MOSTLY SO
THEY MISDIAGNOSE LESIONS ON
PATIENTS OF COLOR.
BIAS HER FROM DATA REFLECTS
HISTORICAL INEQUALITIES.
THERE ARE MANY MORE EXAMPLES I
WOULD GIVE YOU.
SO, I CONDUCTED LITERATURE
REVIEW FROM WHICH IT WAS CLEAR
CURRENT MODELS FAIL TO REFLECT
THE DIVERSITY OF THE POPULATIONS
THEY SERVE, AND THIS LEADS TO
DISPARITIES.
AND THIS ISSUE IS COMPOUNDED BY
THE LACK OF STANDARD FRAMEWORKS
TO DETECT AND MITIGATE BIAS.
COMMUNITY ENGAGEMENT IS CRUCIAL
IN THESE TOPICS.
WE NEED TO BUILD CAPACITY WITHIN
COMMUNITIES, AND WE NEED TO
ESTABLISH BEST PRACTICES FOR
INTERPRETING DATA INPUTS.
ONLY THIS CAN LEAD TO MORE
EFFECTIVE A.I. SOLUTIONS.
BUT THIS REQUESTS CONCERTED
EFFORT TO FOSTER
INTERDISCIPLINARY COLLABORATION
WHICH IS LACKING RIGHT NOW.
SO TO BRIDGE THIS GAP TO DEVELOP
A.I. TOOLS THAT ARE INNOVATIVE
AND INCLUSIVE.
THESE TOOLS STRUGGLE TO
GENERALIZE ACROSS POPULATIONS.
SO, THIS REFLECTS THE NEED TO
BETTER CON CONTEXTUALIZE AND
VALIDATION OF THESE TOOLS.
IN TERMS OF NIH-FUNDED RESEARCH,
I RAN A SEARCH OF GRANTS FUNDED
2017 TO 2024, TWO SEPARATE
SEARCHES ACTUALLY.
I FOUND OUT LIMITED RESEARCH
EXISTS ON PROJECTS THAT
INTEGRATE COMMUNITY ENGAGED
RESEARCH WITH HEALTH DISPARITIES
RESEARCH AND A.I.
MOST PROJECTS FOCUS ON GENOMICS,
TRANSLATIONAL RESEARCH, MOBILE
HEALTH, AND CANCER.
AND ONLY SEVEN PROJECTS FOCUS ON
COMMUNITY ENGAGED RESEARCH,
HEALTH DISPARITIES, AND A.I.
BIAS.
AND TWO OF THEM IN PARTICULAR
ARE AN INITIATIVE ON DEVELOPING
AND EVALUATING COMMERCIALIZING
MONITORING TOOLS FOR PEOPLE WITH
ALZHEIMER'S DISEASE AND
DEMENTIA, AND SECOND PROJECT IS
A PROJECT FOCUSED ON BUILDING
MACHINE LEARNING MODELS OF
APPROPRIATE MEDICAL UTILIZATION
IN ALASKA.
SO, THERE ARE TWO CATEGORIES OF
INTERDISCIPLINARY PROJECTS THAT
THIS INITIATIVE COULD SUPPORT.
YOU COULD ACTUALLY -- I BROKE
DOWN, BUT YOU COULD READ THE
SLIDE LIKE THIS.
SO RESEARCH, RESEARCH
INITIATIVES, SO EPIDEMIOLOGICAL,
BEHAVIORAL, SOCIAL APPLIED AND
SURVEILLANCE RESEARCH TO
UNDERSTAND IMPACT OF SOCIAL
DETERMINANTS OF HEALTH ON HEALTH
DISPARITIES.
AND HEALTH INTERESTS, SO
PREVENTIVE SCREENING, DIAGNOSTIC
AND THERAPEUTIC BEHAVIORAL
HEALTH INTERVENTIONS AIMED AT
REDUCING THOSE HEALTH
DISPARITIES.
AND THE THIRD PART IS A.I.
TOOLS, SO VALIDATION ENHANCEMENT
OF EXISTING A.I. TOOLS AND
MODELS, CONTEXTUALIZATION AND
DEVELOPMENT OF NEW BIAS
DETECTION AND MITIGATION
STRATEGIES, BOTH IN DATA AND IN
MODELS.
AND I ADDED THIS PART BECAUSE
IT'S REALLY IMPORTANT THAT WE DO
NOT FORGET ABOUT BIAS.
SO, THERE ARE TWO IMPORTANT
COMPONENTS OF THIS INITIATIVE.
FIRST, THERE MUST BE COMMUNITY
ENGAGEMENT COMPONENT FROM DESIGN
TO IMPLEMENTATION.
SO RESEARCHERS CAN EXPLAIN BIAS
IN A.I. MODELS TO COMMUNITY
MEMBERS, AND COMMUNITY MEMBERS
CAN SHARE CONTENT AND INFORM THE
DEVELOPER OF THOSE TOOLS.
AND SECOND ESSENTIAL COMPONENT
IS DIVERSE RESEARCH SCHEMES.
DIVERSITY IN TERMS OF SCIENTIFIC
DISCIPLINE, SO BEHAVIORAL,
CLINICAL, PUBLIC HEALTH AND DATA
SCIENCE SHOULD COME TOGETHER AND
COLLABORATE ON PROJECTS.
DIVERSITY ALSO IN TERMS OF
COMMUNITY PARTNERS SHOULD BE
INVESTIGATORS AND DECISION
MAKERS IN THOSE TEAMS.
SO HERE ARE SOME AREAS OF
INTEREST THAT CAN INCLUDE BUT
ARE NOT LIMITED TO FIRST
CATEGORIES OF RESEARCH AND
HEALTH INTERVENTIONS WITH FOCUS
ON CHRONIC DISEASES SO FOR
EXAMPLE THEY COULD PREDICT
PROGRESS, IDENTIFY RISK FACTORS,
PERSONALIZED TREATMENT PLANS FOR
CONDITIONS LIKE DIABETES AND
HYPERTENSION, WHICH AFFECT
MARGINALIZED COMMUNITIES IN A
SPECIAL WAY, COULD FOCUS ON
MENTAL HEALTH, INCLUDING
DEPRESSION, ANXIETY, SUBSTANCE
ABUSE.
MATERNAL AND INFANT HEALTH,
MONITORING HIGH RISK PREGNANCY,
AND OUTCOMES.
INFECTIOUS DISEASES, TOOLS THAT
ENHANCE DISEASE SURVEILLANCE,
PREDICT OUTBREAKS, AND OPTIMIZE
RESOURCE ALLOCATION FOR
PREVENTION AND CONTROL OF
DISEASES LIKE COVID-19 AND HIV.
AND ENVIRONMENTAL HEALTH, SO
TOOLS THAT HELP ANALYZE
ENVIRONMENTAL DATA AND ASSESS
HEALTH RISKS IN MARGINALIZED
COMMUNITIES EXPOSED TO HAZARDS
LIKE POLLUTION.
FOR THE SECOND PART OF THE
PROJECTS, FOCUSED ON VALIDATING
AND ENHANCING EXISTING A.I.
TOOLS AND MACHINE LEARNING
MODELS FOCUS ON BIAS DETECTION
AND MITIGATION IN BOTH DATA AND
MODELS.
ON ENSURING COMMUNITY ACCESS TO
A.I. AND MACHINE LEARNING
TECHNOLOGY BY ADDRESSING COSTS,
INFRASTRUCTURE, AND EXPERTISE
BARRIERS.
AND PROMOTE RESPONSIBLE A.I. USE
AND TRUST IN A.I.
AND SECOND FOCUS HERE COULD BE
ON A.I. TOOLS CONTEXTUALIZATION
AND VALIDATION IN TERMS OF
VALIDATING A.I. TOOLS IN
CULTURAL SETTINGS.
THAT CONCLUDES MY PRESENTATION.
I THANK YOU FOR YOUR ATTENTION
AND LOOK FORWARD TO RECEIVING
YOUR FEEDBACK.
THANK YOU.
>> THANK YOU, DR. CALZONE.
IT'S A MUCH NEEDED STEP TO
DEVELOPING EQUITABLE HEALTHCARE
TECHNOLOGIES.
THE INTEGRATION OF COMMUNITY
BASED PERSPECTIVES INTO A.I. AND
MACHINE LEARNING MODELS AS
PRESENTED IN THIS CONCEPT WAS --
I FOUND TO BE INNOVATIVE AND
TIMELY, HOLDING GREAT VALUE,
PARTICULARLY THINKING ABOUT
ADDRESSING HEALTH DISPARITIES
AND INEQUITIES.
I FOUND THE CONCEPT TO BE
RESPONSIVE TO PRESSING ISSUES AS
YOU NOTED HOW TO ADDRESS BIASES
IN TRADITIONAL A.I. AND MACHINE
LEARNING MODELS THROUGH
COMMUNITY ENGAGEMENT, SETTING
THE STAGE FOR PROGRESS IN HEALTH
CARE AND ARTIFICIAL INTELLIGENC.
BY ENSURING A.I. TOOLS ARE
VALIDATED AGAINST REAL WORLD
SCENARIOS PARTICULARLY IN
MULTICULTURAL AND UNDERSERVED
POPULATIONS THE CONCEPT
DEMONSTRATES FORWARD THINKING
APPROACH TO CREATING SYSTEMS IN
A.I. AND MACHINE LEARNING TOOLS
TO GENERALLY WORK FOR ALL OF US.
TO ACHIEVE THESE GOALS THE
CONCEPT HIGHLIGHTS POWER OF
COMMUNITY ENGAGED RESEARCH TO
COMBAT BIAS IN THESE MODELS, BY
INVOLVING COMMUNITIES FROM
INCEPTION AND REFINEMENT OF
THESE TOOLS THE CONCEPT ENSURES
CULTURALLY COMPETENT AND
CONTEXTUALLY RELEVANT MODELS
ACCURATELY REFLECT DIVERSITY OF
THE POPULATION SERVED.
TO THIS END EXPANDING THE
CONCEPT MAY BE WARRANTED IN TWO
AREAS.
THE FIRST IS TO ENSURE EMPHASIS
IN INTERSECTIONALITY AND
POSITIONALITY WHEN DEVELOPING
AND REFINING TOOLS.
SECOND, ADDRESSING BOTH PROVIDER
AND SYSTEM LEVEL PROCESSES THAT
MAY CONTRIBUTE TO BIAS, FOR
EXAMPLE OMITTED DATA IN EHR
SYSTEMS MAKING SURE WE'RE BEING
EXHAUSTIVE IN MODELS AND
INITIATIVES.
THE CONCEPT ENSURES THE
ADVANCEMENT OF SCIENCE IS NOT
ONLY TECHNICALLY PROFICIENT BUT
HIGHLIGHTS IMPORTANCE OF
GROUNDING THE WORK BY THOSE
IMPACTED, I THANK YOU AND YOUR
TEAM FOR THIS CONCEPT.
>> THANK YOU.
>> THANK YOU, DR. CALZONE, FOR
YOUR EXCELLENT PRESENTATION, AND
TO MY COLLEAGUE FOR THE COMMENTS
THAT HAVE BEEN SHARED SO FAR
REGARDING THIS MARVELOUS CONCEPT
THAT CONSIDERS ADVANCING DATA
SCIENCE APPROACHES TO ADDRESS
DISPARITIES THROUGH A.I. AND
MACHINE LEARNING.
AND COMMUNITY ENGAGED RESEARCH.
I BELIEVE THAT THIS CONCEPT AIMS
AT BRIDGING THE GAP BETWEEN DATA
SCIENCE AND COMMUNITY ENGAGEMENT
TO ADDRESS HEALTH DISPARITIES,
USING A.I. AND MACHINE LANGUAGE.
THE CONCEPT ENCOURAGES
DEVELOPMENT OF SELF-AGENCY AND
EMPOWERS COMMUNITIES
PARTICULARLY THOSE OF COLOR OR
UNDERREPRESENTED COMMUNITIES TO
ACTIVELY PARTICIPATE IN
DEVELOPING A RICH AND DIVERSE
HEALTHCARE LANDSCAPE THROUGH
INCLUSIVE AND CULTURALLY
SENSITIVE RESEARCH, THIS EFFORT
HOPES TO TRANSFORM RESEARCH
FINDINGS INTO MEANINGFUL AND
ACTIONABLE COMMUNITY-BASED
SOLUTIONS.
SCIENCE APPEARS TO BE BASED ON
SOUND METHODOLOGY AND IT
RECOGNIZES PROMISES OF DISEASE
PREDICTION, PERSONALIZED OR
INDIVIDUALIZED CARE, HEALTHCARE
DELIVERY, WHILE AT THE SAME TIME
ACKNOWLEDGING INHERENT BIASES
THAT COULD AGGRAVATE, WORSEN THE
CURRENT HEALTH DISPARITIES.
THE INHERENT BIASES STEM FROM A
VARIETY OF THINGS NOT TO MENTION
THE LACK OF DIVERSITY IN THE
DATA WHEN IT COMES TO
UNDERREPRESENTED COMMUNITIES, SO
RESEARCHERS PROPOSE TO OVERCOME
THIS CHALLENGE BY COLLABORATING
WITH THE COMMUNITY AND GROUPS
AND PERSONS SO THAT ADDRESSING
ISSUES LIKE DIGITAL DIVIDE,
TECHNOLOGY GAPS, AND PARTICULAR
DYNAMICS THAT OCCUR IN THE
CONTEXT OF UNDERREPRESENTED
COMMUNITIES BECOME PARAMOUNT FOR
DISCUSSION AND FURTHER
DEVELOPMENT OF A.I. AND MACHINE
LEARNING.
THE CONCEPT HELPS US IDENTIFY
THE KNOWLEDGE AND RESEARCH GAPS,
BIASES IN A.I., AND ML MODELING,
COMMUNITY INCLUSION IN ITS
DEVELOPMENT AND
INTERDISCIPLINARY COLLABORATION
AS WELL AS A.I. TOOLS WITH
REGARD TO CONTEXTUALIZATION AND
VALIDATION.
I USE THAT AS SORT OF A
FRAMEWORK OR LAUNCHING PAD TO
DISCUSS A COUPLE AREAS THAT I
BELIEVE ARE OF CRITICAL
IMPORTANCE.
NUMBER ONE IS THE SCIENCE OF
TRUST, BUILDING TRUSTWORTHINESS
AND TRUTH IS ALL IMPORTANT IN
TERMS OF COMMUNITY ENGAGEMENT.
I THINK THE PROJECT DOES WELL IN
TERMS OF IT'S TRYING TO
COMMUNICATE WITH COMMUNITY,
COLLABORATE WITH IT, WITH THE
COMMUNITY AS WELL AS WITH
RESEARCHERS, PROVIDE
INCLUSIVITY, BUT ONE OF THE
IMPORTANT THINGS IS ALSO
COMMUNITY EMPOWERMENT, BUILDING
A SENSE OF SELF-RESPECT,
SELF-AGENCY, AND BEING ABLE TO
SUPPORT THE COMMUNITY WHEN IT
NEEDS THE REQUISITE SUPPORT.
AND ALSO UNDERSTANDING WITH THE
COMMUNITY FROM WHEN A.I. IS
SUCCESSFUL AND WHEN IT'S NOT,
AND BEING ABLE TO CELEBRATE THE
WINS.
I THINK THIS BRINGS US TO A
POINT OF SENSE OF BELONGING AND
SELF-IDENTIFICATION.
WE ALSO WANT TO MAKE SURE THAT
IN BUILDING TRUST WE EMBRACE
TRUST IN CLINICAL DECISION
MAKING.
WHAT ARE THE CHALLENGES FOR GOOD
DATA COLLECTION?
HOW DO WE ENSURE THIS
INTERSECTIONALITY THAT MY
COLLEAGUE HAS DISCUSSED?
I THINK THESE ARE VERY IMPORTANT
THINGS THAT WE NEED TO ALSO
CONSIDER.
I WOULD ALSO RECOMMEND THAT WE
DO MORE ROUND AND MAKE SURE
WE'RE INTENTIONAL AROUND
BEHAVIORAL SORT OF MATTERS,
PARTICULARLY FOR ME AS I BELIEVE
IT'S INFORMED -- TRAUMA-INFORMED
STRATEGIES THAT GO ALONG WITH
THE MENTAL HEALTH AND RESEARCH
PRIORITIES.
YES, WE WANT TO TALK ABOUT
DEPRESSION AND ANXIETY AND
STRESS AND OTHER EFFECTS OF
OPPRESSION TO WHICH -- BUT WE
NEED TO GET UNDERNEATH AND SEE
WHAT IS THERE SO THAT GOES INTO
THE PROGRAMMING MODELS THAT ARE
ASSOCIATED WITH A.I.
THE OTHER PART THAT IS ESSENTIAL
IS TO MAKE SURE THAT WE HAVE
TECHNOLOGY THAT IS ACCESSIBLE,
TECHNOLOGY THAT WE HAVE GOOD
TECHNOLOGY TRANSFER, IN THE
CONTEXT OF COMMUNITY, SO THAT
THE COMMUNITY STAYS WELL
INFORMED AND ABREAST OF ALL OF
THE THINGS THAT IT IS
EXPERIENCING WITH REGARD TO THE
TECHNOLOGICAL SHIFT THAT
HAPPENED WITH REGARD TO A.I.
IN A NUTSHELL, WE WANT
TECHNOLOGY TO BE AN ABLE TOOL IN
THE CONTEXT OF COMMUNITY SO THAT
COMMUNITIES CAN HAVE BETTER
HEALTH OUTCOMES, AND WITNESS THE
UNDERSTANDING THAT DISPARITIES
DISPARITIES
CLOSE BY USE OF A.I. AND TOOLS.
I CONCUR WITH MY COLLEAGUE AND I
JUST HOPEFULLY AND WISHFULLY
UNDERSTAND THAT THIS CONCEPT IS
ONE THAT I WOULD LOOK FORWARD TO
GOING A VERY LONG WAY AND THANK
YOU FOR THE EXCELLENT
PRESENTATION, AND THE DETAILED
DATA THAT HAS GONE ALONG WITH
IT.
SO THANK YOU VERY MUCH, AND I
LOOK FORWARD TO SEEING MORE
REGARDING THIS PARTICULAR
CONCEPT.
>> ARE THERE ANY OTHER COUNCIL
MEMBERS THAT HAVE COMMENTS OR
QUESTIONS REGARDING THIS
CONCEPT?
>> GREAT, I LOVE IT, I SECOND
EVERYTHING THAT'S BEEN SAID.
CURIOUS HOW YOU'RE GOING TO GO
ABOUT INVOLVING -- SO
RESEARCHERS, COMMUNITY-BASED
GROUPS, OR COMMUNITIES, AND THE
A.I., THE TECHNOLOGY DEVELOPERS,
IT SEEMS LIKE THOSE WOULD BE
OVERLAPPING IN SOME WAY BUT
THAT'S GOING TO BE TRICKY, AND
I'M WONDERING, CURIOUS TO SEE
WHAT KIND OF MECHANISM YOU'RE
GOING TO SET UP TO DO THAT
BECAUSE COMMUNITY MEMBERS DON'T
GENERALLY WRITE THESE MODELS,
RIGHT?
HOW ARE YOU GOING TO DO THIS?
>> THROUGH CAPACITY BUILDING
INITIATIVE.
I'M SEEING CONSCIOUS EFFORTS
BECAUSE I'M DEVELOPING THIS WITH
OTHER COLLEAGUES AT NIMHD AND
RESEARCH COLLABORATION PLATFORM
FOCUSED ON A.I. BIAS MITIGATION
AND HEALTH DISPARITIES RESEARCH,
TRYING TO INVOLVE THOSE
COMMUNITIES, THOSE STAKEHOLDERS,
AND I SEE THE CHALLENGES BUT
WE'RE MAKING PROGRESS SO I'M
CONFIDENT THAT THERE ARE WAYS TO
DO THAT.
AND I LOOK FORWARD TO DISCUSSING
THE DETAILS.
>> THANK YOU.
>> OTHERWISE I GENERALLY LOVE
THE DIRECTION.
IS THIS A SBIR GRANT OR OUR
LEVEL GRANT, INTERESTING TO SEE
HOW YOU CAN DO THAT.
IT WON'T BE EASY.
THERE'S DIFFERENT GROUPS OF
PEOPLE THAT DON'T TRADITIONALLY
WORK TOGETHER ON NIH-FUNDED
RESEARCH THAT I KNOW OF.
>> OTHER COMMENTS FROM COUNCIL
MEMBERS?
YES?
>>> SO, IT OCCURRED TO ME, THIS
IS DIRECTED MORE AT JOSE AND
KENDRICK, YOU MENTIONED TRUST
AND CLINICAL DECISIONS SO I
GUESS YOU IMPLY THAT, YOU KNOW,
A.I. IS GOING TO MAKE CLINICAL
DECISIONS OR CREATE ALGORITHMS
THAT ARE GOING TO MAKE CLINICAL
DECISIONS WHICH I ASSUME SOME
PEOPLE THINK WE SHOULD GO THERE.
SO I DON'T THINK SO.
I DON'T KNOW WHAT CLINICAL AREA
A CLINICIAN MAKES A DECISION ON
THAT BASIS, YOU KNOW, SITTING
NEXT TO A PATIENT.
BUT, YOU KNOW, I CAN SEE THAT
HAPPENING POTENTIALLY SOMETIME
IN THE NOT TOO DISTANT FUTURE.
SHOULD RACE AND ETHNICITY BE
FACTORED INTO THOSE ALGORITHMS,
AND IF SO HOW?
OR SOCIOECONOMIC STATUS, SHOULD
IT BE FACTORED IN?
LUCA.
AND WE'LL HAVE OPPORTUNITY TO
DISCUSS THIS AND OPERATIONALIZE
FUNDING OPPORTUNITY BUT I'M
ASKING MY COLLEAGUES ON THE
COUNCIL.
>> MY TWO THOUGHTS ON THIS,
WOULD LOVE TO HEAR KENDRICK, A
LOT OF SOCIAL DETERMINANTS OF
HEALTH WHICH WE KNOW MATTER WHEN
WE THINK ABOUT INEQUITIES AND
DISPARITIES ARE OFTEN COLLECTED
OR SHOULD BE COLLECTED, THEY ARE
AVAILABLE IN MOST MAJOR EHR
PLATFORMS SO IT'S A
RECOMMENDATION TO NOT OMIT THAT
PART OF THE DATA STREAM, RIGHT?
AS PEOPLE ARE MODIFYING THEIR
TOOLS AND I THINK IN ITSELF THAT
MIGHT LEAD TO SOME POLICY CHANGE
BECAUSE IF FOLKS KNOW THIS DATA
IS GOING TO BE USED FOR
REFINEMENT OF ALGORITHMS, THEY
MAY BE MORE LIKELY TO ACTIVATE
IT IN PATIENT CHARTS.
>> I TOTALLY AGREE WITH WHAT DR.
BURMEISTER JUST SAID, IT BECOMES
FROM A COMMUNITY STANDPOINT
SOMETHING THAT IS NEEDED BECAUSE
WE HAVE -- HELLO?
OKAY.
WE HAVE TO BE ABLE TO LOOK AT
DATA ACCORDING TO RACE AND
ETHNICITY AS WELL AS
DISAGGREGATED DATA ACROSS
SOCIOECONOMIC FACTORS BECAUSE I
JUST BELIEVE AND I THINK THAT
WE'RE LOOKING AT SOMETHING THAT
IS SORT OF -- WILL BE CORRELATED
BUT WE HAVE TO ESTABLISH SOME
SENSE OF WHAT CAUSATION WOULD
GIVE, AND I THINK THAT AS WE
LOOK AT DISAGGREGATED DATA WE'LL
BE ABLE TO THINK THROUGH HOW WE
USE IT TO BETTER HELP IN
CLINICAL DECISIONS IN THE LONG
RUN.
I THINK THAT DOES INFLUENCE THE
PATIENT CHART, THAT DOES ALLOW
YOU TO SIT DOWN AND LOOK AT
THINGS THAT ARE IMPORTANT TO
COMMUNITY MEMBERS, PARTICULARLY
AS YOU START TO DRILL DOWN NOT
JUST LOOKING AT COMMUNITY AS A
BLOB BUT LOOKING IT AS SOMETHING
THAT BUILD BLOCKS, BLOCKS BUILD
NEIGHBORHOODS, NEIGHBORHOODS
BUILD COMMUNITIES.
BECAUSE I BELIEVE THAT
ULTIMATELY AT THE VARIOUS LEVELS
YOU'LL BEGIN TO START TO SEE HOW
THINGS ARE CHANGING IN THE
RESPECTIVE BLOCKS.
IF WE HAVE THE DATA AVAILABLE,
THE MORE WE CAN BEGIN TO LEARN.
AS WE BEGIN TO LEARN, THE MORE
WE CAN BEGIN TO HELP PROVIDE
DECISIONS AND MAYBE EVEN
TREATMENT FOR THOSE THAT ARE
FROM THE CONTEXT OF COMMUNITY.
I SAY THAT BECAUSE I'M HOPEFUL
THAT THIS SORT OF RESEARCH WILL
ONE DAY BE ABLE TO HELP, FOR
EXAMPLE, IN DISTRICT OF
COLUMBIA, THOSE RECOMMEND
TREATMENT SOLUTIONS FOR WHY AND
EXPLAIN WHY THOSE THAT ARE IN
CERTAIN PARTS OF THE CITY HAVE
HIGH INCIDENCE OF KIDNEY DISEASE
THAN THE OTHER.
AND GIVE THEM OPPORTUNITIES TO
HAVE BETTER UNDERSTANDING.
I'M ALSO HOPEFUL THAT AT THE END
OF THE DAY WE'LL BE ABLE TO
BEGIN TO LOOK AT WHY HIGH
MORTALITY RATES WITH REGARD TO
CANCERS ARE FOUND IN PARTICULAR
WARD 7.
IT'S THOSE SORTS OF THINGS THAT
I THINK A.I. STARTS TO HELP US
WITH, IF WE'RE STARTING TO
COLLECT ALL OF THE DATA BASED ON
RACE SO THAT WE CAN BEGIN TO
BREAK IT OUT AND DIS AGGREGATE
TO THE EXTENT WE CAN USE DATA TO
GUIDE OUR DECISION MAKING.
I ALSO THINK THAT WITH THE
NUMBER OF MEDICATIONS THAT SOME
IN THE COMMUNITY TAKE, I THINK
WE CAN REFINE EVEN THE ISSUES
WITH REGARD TO OVERMEDICATING,
GIVEN INDIVIDUALS.
SO I THINK THERE'S A LOT WE CAN
DO WHEN WE START DRILLING A
LITTLE DEEPER IN TERMS OF THE
CONTEXT OF COMMUNITY, IN TERMS
OF THE NATURE OF THE PERSON, SO
THAT WE CAN HAVE MORE
PERSONALIZED CARE.
AND I THINK THAT'S THE VALUE OF
JUST DISSING AGGREGATED DATA TT
DRILLS DOWN AS DEEP AS POSSIBLE.
>> THANK YOU.
>> THANK YOU, LUCA.
MAY I HAVE A MOTION TO MOVE THE
CONCEPT FORWARD FOR NOTICE OF
FUNDING OPPORTUNITY DEVELOPMENT?
>> I MOVE TO ADVANCE THE
CONCEPT.
>> MAY I HAVE A SECOND?
>> I SECOND.
>> ALL IN FAVOR?
VOTING MEMBERS, RAISE YOUR HAND.
ONLINE, LET'S SEE.
OKAY, THE MOTION CARRIES.
>> THANK YOU VERY MUCH.
>> WE'RE GOING TO MOVE INTO OUR
SECOND CONCEPT.
>> GOOD AFTERNOON.
MY NAME IS PRISCAH MU JURU, THAK
YOU FOR THE OPPORTUNITY TO
PRESENT THIS CONCEPT ADDRESSING
TOBACCO CESSATION ISSUES IN
POPULATIONS THAT EXPERIENCE
HEALTH DISPARITIES.
BEFORE I START, I WANT TO
ACKNOWLEDGE MY CO-AUTHORS WHO
ARE ALSO AT NIMHD, YEWANDE,
GABRIELLE, LIGIA, AND MONICA
WEBB HOOPER, FOR THEIR
PARTICIPATION ON THIS CONCEPT.
SO, THE OBJECTIVES OF THIS
CONCEPT IS TO SUPPORT INNOVATIVE
INTERVENTION RESEARCH TO ADDRESS
TOBACCO-RELATED CESSATION AMONG
POPULATIONS THAT EXPERIENCE
HEALTH DISPARITIES.
THE INITIATIVE SEEKS TO ADDRESS
GAPS IN SCIENTIFIC KNOWLEDGE AND
SUPPORT RESEARCH ON HEALTH
DISPARITIES FROM TOBACCO
EXPOSURE, USE, AND CESSATION
TREATMENT.
AND ALSO WANT TO ADDRESS
MULTI-LEVEL FACTORS AND
MECHANISMS THAT FACILITATE OR
CHALLENGE EFFECTIVE TOBACCO
CESSATION.
AND ALSO SUPPORT SUSTAINABLE
INNOVATIVE STRATEGIES TO IMPROVE
HEALTH AND HEALTH OUTCOMES FOR
POPULATIONS DISPROPORTIONATELY
IMPACTED BY TOBACCO USE AND
EXPOSURE.
SO BY WAY OF BACKGROUND,
CIGARETTE SMOKING REMAINS
LEADING CAUSE OF PREVENTIBLE
DISEASE DISABILITY AND DEATH IN
THE U.S. INCLUDING 25% OF ALL
CARDIOVASCULAR DISEASE DEATHS,
AND 30% OF ALL CANCER DEATHS.
PROGRESS HAS BEEN MADE OVER THE
LAST SIX YEARS IN DRIVING RATES
DOWN OF CIGARETTE SMOKING.
HOWEVER, THESE GAINS MADE OVER
THE PAST SEVERAL DECADES HAVE
NOT OCCURRED EQUALLY ACROSS ALL
POPULATIONS, AND HAVE LED TO
TOBACCO-RELATED HEALTH
DISPARITIES ACROSS THE LIFE
COURSE.
IN THE DATA OF 2021, FROM THE
NATIONAL HEALTH INTERVIEW SURVEY
IT SHOWED THE PREVALENCE OF
COMBUSTIBLE TOBACCO USE WAS
HIGHEST AMONG BLACK OR AFRICAN
AMERICANSS.
BECAUSE OF THE SMALL SAMPLE OF
SURVEY, OTHER RACIAL GROUPS ARE
NOT SHOWN IN THE SAME DATA OF
THE 2021, HOWEVER OTHER REPORTS
WE SCOURED OUT SHOW THAT THE
PREVALENCE AMONG AMERICAN
INDIANS AND ALASKA NATIVES IS
GREATER THAN 29%.
AND AMONG NATIVE HAWAIIANS AND
PACIFIC ISLANDERS, PREVALENCE IS
GREATER THAN 26%.
OVER 73% COMPARED TO OTHERS,
OTHERWISE, AND SO ON, WHO SHOW
19% IN ADULTS USE OF MENTHOLS.
RATES INCREASED OVER THE YEARS
IN NON-DAILY SMOKING PEOPLE.
DISPARITIES IN TERMS OF TOBACCO
USE AND QUITTING IN RURAL
POPULATIONS, SEXUAL GENDER
MINORITIES, AND THOSE WHO
EXPERIENCE SEVERE PSYCHOLOGICAL
OR MENTAL HEALTH ISSUES.
AND IN THIS GRAPH ON THE LEFT I
SHOW THAT THE PREVALENCE OF
COMBUSTIBLE USE OF TOBACCO BY
RACIAL GROUPS IS HIGHER IN THE
BLACKS BUT I WANT TO EMPHASIZE
ON THE RIGHT GRAPH THAT ABOUT
THE QUIT RATE THAT THE BLACKS
EXPERIENCE HIGHEST PREVALENCE OF
SMOKING, QUIT RATES ARE VERY
LOW, COMPARED TO OTHER RACIAL
GROUPS.
53%, COMPARED TO OTHER GROUPS
WITH QUIT RATES WHICH ARE HIGHER
LIKE THE ASIAN AMERICANS,
HISPANICS, AND THE WHITES.
AND AGAIN HERE THE AMERICAN
INDIAN AND ALASKA NATIVES
ESTIMATES STATISTICALLY
UNRELIABLE BECAUSE OF SMALL
SAMPLES.
QUIT RATIO, WE MEAN PERCENTAGE
OF PERSONS WHO EVER SMOKED
HUNDRED OR MORE CIGARETTES
DURING THEIR LIFETIME WHO HAVE
QUIT SMOKING.
AND ALSO SIMILARLY WE DO NOT
SHOW HERE IN THIS CHART THE
RURAL, THE SEXUAL GENDER
MINORITY POPULATIONS, THOSE WITH
DISABILITIES, INCLUDING THOSE
WITH PSYCHOLOGICAL ISSUES, IN
TERMS OF QUIT RATES, BUT
STATISTICS ARE QUITE DIRE.
SO, WE PERFORMED PORTFOLIO
ANALYSIS TO UNDERSTAND WHAT
NIMHD IS CURRENTLY FUNDING.
MOST OF THE AWARDS FOCUSED ON
STUDYING BIOLOGICAL BEHAVIORAL
AND SOCIAL FACTORS, INFLUENCING
THE ETIOLOGY OF TOBACCO USE OR
TOBACCO-RELATED OUTCOMES.
BUT VERY FEW FOCUS ON EVALUATION
OF SMOKING CESSATION
INTERVENTIONS.
AND NONE FOCUSED ON NON-DAILY
SMOKING PEOPLE.
I WANT TO MENTION HERE THAT
OTHER NIH I.C. FUNDED TOBACCO
RESEARCH, FEW HAVE FOCUSED ON
COMMUNITY ENGAGED APPROACHES OR
COOPERATED WHOLE PERSON
APPROACHES.
AND I WANT TO ACKNOWLEDGE THAT
THE NCI PROGRAM OFFICIALS AND AT
NIDA HAVE PARTICIPATED IN GIVING
US INFORMATION TO THESE
CONCEPTS.
SO, THEREFORE NEED FOR NOVEL
STRATEGIES TO ADDRESS HEALTH
DISPARITIES IN POPULATIONS
DISPROPORTIONATELY IMPACTED BY
CESSATION DISPARITIES, FOR
EXAMPLE AFRICAN AMERICANS, THOSE
WHO LIVE IN RURAL AREAS, SEXUAL
GENDER MINORITIES, AND THOSE WHO
EXPERIENCE PSYCHOLOGICAL --
SEVERE PSYCHOLOGICAL EFFECTS OR
MENTAL HEALTH ISSUES AND THOSE
WHO HAVE DISABILITIES.
EVEN THOSE WHO SMOKE
INTERMITTENT AND AND USE TOBACCO
AND OTHER SUBSTANCES.
THIS INITIATIVE WILL SUPPORT
INTERVENTIONS THAT WILL DEVELOP,
IMPLEMENT, AND EVALUATE
INNOVATIVE INTERVENTIONS TO HELP
PEOPLE WHO SMOKE TOBACCO
PRODUCTS SUCCESSFULLY QUIT
INCLUDING NON-DAILY SMOKING.
THE INITIATIVE WILL SUPPORT
STUDIES INCLUDING ARTIFICIAL
INTELLIGENCE AND MACHINE
LEARNING TO CUSTOMIZE PLANS,
PREDICT RELAPSE RISKS AND
SUPPORT STUDIES THAT TEST
EVIDENCE-BASED LINKAGE MODELS OF
CARE DELIVERY VIA DIFFERENT
PLATFORMS TO FACILITATE
INTERVENTIONS INCLUDING
TELEMEDICINE, MOBILE UNITS,
COMMUNITY ORGANIZATIONS.
ALSO WANT TO SUPPORT STUDIES
THAT ADDRESS THE IMPACT OF
NATIONAL AND LOCAL POLICIES ON
POPULATIONS WHO EXPERIENCE THE
GREATEST IMPACT OF TOBACCO USE
AND BURDEN AND CESSATION
TREATMENT DISABILITIES.
AND THAT'S IT.
I'LL STOP HERE AND LOOK FORWARD
TO YOUR SUGGESTIONS AND
COMMENTS.
THANK YOU.
>> OKAY.
THANK YOU VERY MUCH.
FIRST FOR THE OPPORTUNITY TO
REVIEW THIS INITIATIVE.
I THINK IT'S AN IMPORTANT
INITIATIVE BECAUSE IT FOCUSES ON
HEALTH DISPARITIES.
THE OBJECTIVE IS TO SUPPORT
NOVEL AND INNOVATIVE
INTERVENTIONS TO REDUCE
TOBACCO-RELATED CESSATION AMONG
THESE POPULATIONS.
OVERALL, FEW AWARDS HAVE
OBVIOUSLY HAVE FOCUSED ON
EVALUATION OF SMOKES CESSATION
INTERVENTIONS, NONE ON NOVEL
STAGES, BUT TO ADDRESS HEALTH
DISPARITIES IN POPULATIONS
IMPACTED BY TOBACCO-RELATED
DISEASES, I BELIEVE THE
STRENGTHS ARE SEEN IN THE
RESEARCH PRIORITIES AS OUTLINED
IN THE INITIATIVE.
THERE'S A NEED TO CONSIDER
HOLISTIC CESSATION
INTERVENTIONS.
I THINK THIS COULD BE UNPACKED
MORE AT WHAT LEVEL ARE WE
TALKING ABOUT FROM A SYSTEMIC
CONTEXTUAL INDIVIDUAL LEVEL
BASIS.
BUT I DO LIKE INCLUSION OF
HOLISTIC FRAMEWORK.
ANOTHER STRENGTH MENTIONED THE
NEED TO CONSIDER SOCIAL
DETERMINANTS OF HEALTH IN
DESIGNING INTERVENTIONS.
THE NEED TO CONSIDER INNOVATIVE
METHODS STRATEGIES, DATA SCIENCE
APPROACHES, A.I., MACHINE
LEARNING.
THE CONSIDERATION OF ENGAGEMENT
OF COMMUNITY BASED CLINICS TO
TEST INTERVENTIONS IS VERY
IMPORTANT FROM ENGAGEMENT AND
EDUCATION AND IMPLEMENTATION
STANDPOINT.
I BELIEVE THAT'S VERY IMPORTANT.
I ALSO ALSO CONSIDERATION OF HOW
COMORBID PHYSICAL AND MENTAL
CONDITIONS MAY INTERSECT WITH
TOBACCO USE AND INTERVENE ON
THESE INTERSECTING AREAS TO
REDUCE TOBACCO-RELATED
DISPARITIES.
I THINK THERE'S AN OPPORTUNITY
HERE FOR AN INTERSECTIONALITY
APPROACH TO LOOK AT VARIOUS
IDENTITIES AND NARROW DOWN WHAT
APPROACHES ARE BEST TO ADDRESS
THESE DISPARITIES, GIVEN THESE
INTERSECTING IDENTITIES.
I ALSO APPRECIATE THE MENTION OF
DIGITAL MOBILE INTERVENTIONS,
APPS, TELEHEALTH, ET CETERA.
BUT I THINK A FEW THINGS TO
CONSIDER, I LIKE THE FACT THAT
YOU MENTIONED SOME INCLUSION OF
CONSIDERING DISCRIMINATION
INDUCED STRESS, I THINK THIS
NEEDS TO BE UNPACKED, WHAT IS
MEANT BY THIS, IS IT ATTRIBUTION
OF DISCRIMINATION TO RACE OR IT
COULD BE A NUMBER OF THINGS,
ETHNICITY, AS WELL AS AGE OR
SEX, SEXUAL GENDER STATUS,
GENERALIZED OR PERCEIVED RACIAL
DISCRIMINATION, EVERYDAY OR
LIFETIME BASIS?
RESEARCH WE'VE DONE SHOWS
EVERYDAY DISCRIMINATION,
INTERPERSONAL DISCRIMINATION
ASSOCIATED WITH TOBACCO USE
WHICH HAS BEEN RISK FACTOR FOR
HEART DISEASE SAND MANY OTHER
CHRONIC ILLNESSES, SO I THINK
OTHER FORMS OF DISCRIMINATION
ARE IMPORTANT TO MENTION,
PARTICULARLY STRUCTURAL
DISCRIMINATION DIRECTLY RELATEED
TO STRESS, OTHER FACTORS, OTHER
FORMS OF DISCRIMINATION IF YOU
WANT TO GET NOVEL LOOK AT
DIFFERENT DIMENSIONS OF
DISCRIMINATION, COLORISM,
INTERNALIZED RACISM AND THE
LIKE.
ANOTHER FACTOR AUTHORS MAY WANT
TO CONSIDER INTERSECTION OF
PSYCHOSOCIAL RISK FACTORS WHICH
ARE CONTRIBUTORS TOWARDS
PRACTICE OF TOBACCO USE AND
SUBSTANCE ABUSE AS WELL.
CHRONIC AND ACUTE STRESS,
DEPRESSION, HOSTILITY, AND HOW
THEY INTERSECT WITH TOBACCO USE
AND IMPACT TOBACCO USE
DISPARITIES.
ATTENTION TO THESE FACTORS COULD
DEVELOP MINDFULNESS BASED
INTERVENTIONS, FOR EXAMPLE
VARIOUS TRIALS HAVE BEEN USED TO
MITIGATE THE IMPACTS OF
BEHAVIORAL, SUCH AS YOGA TRIALS,
MEDITATION ON OPTIMISTIC
ORIENTATION, TO MITIGATE STRESS,
THAT MITIGATES NEGATIVE EFFECT
WHICH POTENTIALLY REDUCES
SMOKING, QUIT RATES, LOWER
PREVALENCE, RISK OF CHRONIC
DISEASES, DOWNSTREAM FACTORS
SUCH AS CARDIOVASCULAR DISEASE
OR CANCER, PARTICULARLY AMONG
HEALTH DISPARITY POPULATIONS.
MORE OF A FOCUS ON CESSATION
INTERVENTIONS AMONG SPECIFIC
HIGH RISK UNDERSTUDIED ETHNIC
POPULATIONS SUCH AS NATIVE
AMERICANS AND ALASKA NATIVES
GROUPS, NATIVE HAWAIIAN AND
PACIFIC ISLANDER, DO WE NEED TO
PARSE OUT INITIATIVES FOR EACH
GROUP OR UNPACK THEM WITH ONE
INITIATIVE SO MORE THOUGHT NEEDS
TO BE DEVELOPED IN THAT REGARD.
SO THAT WE CAN STRETCH OUT AND
HAVE MORE OF A CULTURALLY
TAILORED HOLISTIC INTERVENTION,
WHERE FACTORS ARE DRIVERS OF
TOBACCO USE DISPARITIES AND
STRUCTURAL AND POLICY
INTERVENTIONS MAY HELP REDUCE
TOBACCO USE DISPARITIES AMONG
HIGH BURDEN HISTORICALLY
UNDERSERVED RACIAL AND ETHNIC
GROUPS.
A FOURTH FACTOR THE
CONSIDERATION OF THE BUILT
ENVIRONMENT MAY PLAY AN
IMPORTANT ROLE IN IMPACTING
CESSATION INTERVENTIONS, WHAT
ARE SOME OF THE INTERVENTION
TARGETS IN THE BUILT
ENVIRONMENT?
POVERTY, SAFETY, CRIME,
ADVERTISING, ET CETERA, THAT CAN
BE FOCUSED TO REDUCE PREVALENCE,
INCREASE CESSATION EFFORTS, QUIT
RATES AMONG HIGH RISK DISPARITY
POPULATIONS.
ALSO CONSIDERATION TALKING ABOUT
NOVEL FACTORS TO SORT OF LOOK AT
THIS ISSUE, LOOK AT INTERVENING
ON SPECIFIC BIOLOGICAL FACTORS
ON THE PATHWAY BETWEEN
DETERMINANTS, BEHAVIORS, CHRONIC
DISEASES, A PRECISION MEDICINE
APPROACH WHERE YOU CAN INTERVENE
USING SPECIFIC THERAPEUTICS,
GENOMIC THERAPEUTICS, WHERE, FOR
EXAMPLE, DNA METHYLATION SHOWS
SPECIFIC GENES, ASSOCIATED WITH
CHRONIC DISEASES, ALTERED DUE TO
SMOKING.
AS WELL AS IN THAT REGARD
CHANGING OF BEHAVIORS, AS WELL
AS ENVIRONMENTAL CIRCUMSTANCES.
ALSO, I THINK THIS COULD BENEFIT
BY CONSIDERING IF NOT IN THIS
INITIATIVE DOWN THE ROAD OTHER
THAN PROJECTS RELATED, CONSIDER
TRAINING EFFORTS TO MENTOR AND
DEVELOP TOBACCO DISPARITIES AND
CESSATION RESEARCHERS, TO BUILD
CAPACITY, ETHNIC AND RACIAL
UNDERSERVED SCHOLARS IN THIS
AREA OF WORK.
ALSO, UNDERSTANDING CESSATION
EFFORTS AMONG THOSE WHO USE
VAPING PRODUCTS.
I UNDERSTAND THIS IS STILL A
NEWER AREA OF STUDY AND MUCH
DATA MAY NOT EXIST IN THIS AREA.
AND SO OVERALL I THINK IT'S A
VERY IMPORTANT INITIATIVE.
THE OFFICE DID A NICE JOB
UNDERLYING NEED FOR INNOVATIVE
RESEARCH STRATEGIES IN THIS
AREA.
THOSE ARE MY COMMENTS AND I
THANK YOU.
>> THANK YOU.
GREAT PRESENTATION.
AN IMPORTANT CONCEPT.
I WANT TO UNDERSCORE COMMENTS
REGARDING USE OF
INTERSECTIONALITY FRAMEWORK,
TOBACCO PREVENTION AND CONTROL
IS A GOOD EXAMPLE OF SUPPORTING
DIS AGGREGATED FRAMEWORK FOR
RACIAL MINORITIES AND IMMIGRANT
POPULATIONS.
FOR EXAMPLE, IN THE PRESENTATION
YOU NOTE THAT OVERALL PREVALENCE
FOR ASIAN AMERICANS IS 7%
NATIONALLY, SEVERAL STUDIES WITH
GOOD EVIDENCE HAVE SUGGESTED
THAT THERE'S SURVEY BIAS FOR
UNDERREPORTING SMOKING RATES,
MANY SURVEYS ARE CONDUCTED IN
ENGLISH, SOMETIMES IN SPANISH.
THERE'S CONSIDERABLE
HETEROGENEITY AND DIFFERENCES IN
THE PROPORTION WHO ARE FIRST
GENERATION IMMIGRANT FROM
COUNTRIES WITH HIGH TOBACCO
PREVALENCE RATES.
SO FOR EXAMPLE AMONG EAST ASIAN
AMERICAN SUBGROUPS, INDIVIDUALS
FROM CHINA AND KOREA MAY HAVE
RATES AS HIGH AS 20 TO 35%, MAY
NOT BE CAPTURED IN THE NATIONAL
POPULATION BASED SURVEYS.
NET PREVALENCE OF SMOKING,
THINKING THROUGH TOBACCO
CESSATION FOR FIRST GENERATION
IMMIGRANT OPPORTUNITIES, TO
ACCOUNT FOR DIFFERENCES BY
ACCULTURATION STATUS AND GENDER
WITH RESPECT TO BOTH PREVALENCE
AND INTERVENTION DEVELOPMENT.
IMPLICATIONS FOR MANY
COMMUNITIES THAT MIGHT
EXPERIENCE LANGUAGE ACCESS OR
LIMITED ENGLISH PROFICIENCY,
HIGH RATES.
TO ENCOURAGE APPLICATIONS TO
TAKE A LIFE COURSE AND
INTERGENERATIONAL APPROACH
REGARDING TOBACCO CONTROL,
MAJORITY OF ADULT SMOKERS BEGIN
YOUNG, ADOLESCENCE, AND THAT
IMPACTS ABILITY TO INTERVENE
EFFECTIVELY.
INTERVENTIONS THAT TARGET
ADOLESCENTS AND YOUNG ADULTS MAY
HAVE GREATEST PROMISE REDUCING
DISPARITIES IN TOBACCO
CESSATION.
I ALSO ENCOURAGE USE OF
IMPLEMENTATION SCIENCE FRAMEWORK
TO GUIDE EVALUATIONS OF WHAT
WORKS ACROSS POPULATIONS AND
DIFFERENT SETTINGS, AND WHETHER
PROMISING STRATEGIES CAN IMPROVE
THE REACH, ENGAGEMENT,
EFFECTIVENESS OF EVIDENCE-BASED
INTERVENTIONS FOR EXAMPLE USING
COMMUNITY HEALTH WORKER
APPROACHES FOR DIFFERENT RACIAL
AND IMMIGRANT POPULATIONS.
IN TERMS OF DATA SCIENCE
APPROACHES I THINK THAT'S AN
AREA OF INNOVATION.
MACHINE LEARNING COULD BE USEFUL
IN THE CONTEXT OF HEALTH CARE
FOR IDENTIFYING INDIVIDUALS WITH
COMORBIDITIES SUCH AS DIABETES,
HYPERTENSION, AND CANCER, AND
ALSO SUPPORTING MORE PRO-ACTIVE
OUTREACH TO ENGAGE INDIVIDUALS
EARLY ON, SO NOT ONLY SUPPORT
THEIR DISEASE MANAGEMENT AND
ALSO HELP SUPPORT TOBACCO
CESSATION IN ORDER TO IMPROVE
HEALTH AND SURVIVORSHIP
OUTCOMES.
I DO WANT TO NOTE THE CHALLENGE
OF MACHINE LEARNING IS THAT IT
IS GOOD -- AS GOOD AS DATA THAT
IS AVAILABLE.
SO THERE ARE INHERENT OR
SYSTEMIC BIASES OR OMISSIONS
THAT MIGHT PERPETUATE EXCLUSION
EVEN IN HEALTH CARE SETTINGS, SO
I THINK ONE PIECE ABOUT THE DATA
SCIENCE IS TO REINFORCE NEED TO
EMPLOY COMMUNITY AND PATIENT
ENGAGEMENT STRATEGIES REALLY
THINKING THROUGH HOW TO USE
MACHINE LEARNING AND ARTIFICIAL
INTELLIGENCE TO INTERVENE.
PARTICULARLY IN THIS AREA.
AND THEN FINALLY I WANT TO ECHO
DR. SIMS' OTHER POINT.
I THINK THIS IS AN AREA WHERE
NIMHD COULD ACTUALLY ADVANCE THE
SCIENCE TO SUPPORT RESEARCH TO
ACCOUNT FOR SOCIAL AND
STRUCTURAL FACTORS INCLUDING
BUILT NEIGHBORHOOD ENVIRONMENTS
THAT MAY ENCOURAGE OR FACILITATE
ACCESS TO TOBACCO PRODUCTS,
PARTICULARLY TARGETING CHILDREN,
ADOLESCENTS, YOUNG ADULTS IN LOW
INCOME NEIGHBORHOODS.
OFTEN NEIGHBORHOODS THAT ARE
ALREADY CHRONICALLY HISTORICALLY
DISINVESTED AND HEAVILY
DISPROPORTIONATELY COMPRISED OF
RACIAL AND ETHNIC MINORITY
POPULATIONS.
THANK YOU.
>> DO COUNCIL MEMBERS HAVE
COMMENTS, QUESTIONS?
GO AHEAD.
>> SO NEEDED.
I HOPE TO LOOK AT POLICY LEVEL
THINGS.
YOU DON'T NECESSARILY ADVOCATE
BUT WE CAN LOOK AT POLICY
IMPLICATIONS, AND LOOK AT
POLICY, I KNOW FINALLY WENT
THROUGH THE NEW LABELING THEY
CAN HAVE, SITES ARE SELLING
TOBACCO, I DON'T KNOW IT'S NEWS
TO ANYBODY THAT CIGARETTES
AREN'T HELPFUL BUT IT WOULD BE
SOMETHING TO INVESTIGATE.
THERE MIGHT BE ONGOING WORK IN
THAT AREA BUT SOMETHING TO LOOK
AT.
AND I HOPE THEY LOOK AT
COMMUNITY LEVEL FACTORS, TRUST,
SOURCES FOR THIS OPINION.
I KNOW THERE'S A LOT OF WORK ON
APPS, FOR A LOT OF PEOPLE THEY
DON'T WORK.
THERE'S REALLY LOW ENGAGEMENT
RATE IN THEM SO I HOPE THERE'S
SOME KIND OF CREATIVE WORK THAT
CAN BE DONE WITH COMMUNITIES OF
COLOR.
ESPECIALLY AROUND THE POLICY
LIKE WHAT REALLY HELPED IS
INCREASING TAX, THAT CUT THINGS
DOWN, NATURALLIVE COMMUNITY
THERE'S DIFFERENT RULES ABOUT
CHARGING SO MUCH TAX, A TERRIBLE
THING TO DO TO YOUR COMMUNITY TO
MAKE CIGARETTES CHEAP BUT I JUST
HOPE HIGHER LEVEL -- SOME THINGS
I TALKED ABOUT IN MY
PRESENTATION, HIGHER LEVEL
FACTORS CAN BE LOOKED AT, REALLY
THINK WHERE THE MONEY IS.
>> THANK YOU VERY MUCH.
ON THE POINT NUMBER 4, OBVIOUSLY
THIS CONCEPT WOULD ATTRACT TO
WORK WITH CENTERS, DEPARTMENTS,
POLICY.
FOR EXAMPLE IF YOU LOOK AT
CIGARETTE OR TOBACCO TAXATION,
RIGHT?
IF YOU LOOK AT TENNESSEE, 19%
COMPARED TO NATIONAL AVERAGE.
BUT TAXATION RATE IS 6 CENTS -S
PER PACK, CONNECTICUT IS $4.
YET TENNESSEE HAS HIGHER, SO
HOPING THAT THAT POINT NUMBER 4,
WORKING WITH THE DEPARTMENTS TO
POLISH UP POLICIES WHICH
EVENTUALLY WILL HELP TO REDUCE
THE TOBACCO CONSUMPTION.
>> LET ME CHECK ONLINE.
OKAY.
NOTHING IN THE CHAT BOX.
SO, THANK YOU, PRISCAH, FOR A
WONDERFUL PRESENTATION.
MAY I HAVE A MOTION TO MOVE THE
CONCEPT FORWARD FOR NOTICE OF
FUNDING OPPORTUNITY DEVELOPMENT?
>> MOVE FOR APPROVAL OF THE
CONCEPT.
>> MAY I HAVE A SECOND?
>> I SECOND.
>> OKAY.
ALL IN FAVOR SHOW OF HANDS, AYE,
IN THE ROOM.
ONLINE?
MOTION IS APPROVED.
THANK YOU.
AND WE HAVE COMPLETED OUR
CONCEPTS FOR TODAY.
I'M GOING TO TURN THE MEETING
OVER TO DR. PEREZ-STABLE.
>> WE HAVE NO PUBLIC COMMENT,
RIGHT?
OKAY.
ALL RIGHT.
SO THANK YOU, EVERYONE.
I THINK THIS CONCLUDES OUR WORK
FOR OUR SESSION, OPEN SESSION OF
COUNCIL.
I WANT TO AGAIN APPRECIATE
EVERYONE WHO ATTENDED.
AND COMMENTS THAT WERE MADE.
AND REMIND EVERYONE THAT AFTER
WE APPROVE A CONCEPT THAT'S WHEN
OUR WORK BEGINS IN TERMS OF
DEVELOPING FUNDING
OPPORTUNITIES.
BUT EVEN AS WE SPEAK, WE HAVE
ALREADY FUNDED APPLICATIONS IN
THESE AREAS, OR WILL BE FUNDING
APPLICATIONS IN THIS AREA, SO
KEEP GOOD IDEAS COMING.
I WANT TO THANK DR. COTTON AND
HIS TEAM FOR ORGANIZING US, AND
THOSE AT THE TABLE FROM NIMHD
AND ALL COUNCIL MEMBERS AND THE
TWO ONLINE.
IN FEBRUARY YOU'LL ALL BE ON THE
ZOOM MEETING, WE'LL DO IT
VIRTUALLY.
THANKS, EVERYONE.
HAVE A GOOD REST OF YOUR FRIDAY.
>> BYE, EVERYONE.
[END OF PROGRAM]