LET'S GET STARTED. I'LL TURN IT OVER TO DR. HUNTER SO SHE CAN REVIEW THE CONFIDENTIALITY AND CONFLICT OF INTEREST. >> INTRODUCTIONS FIRST. >> THAT'S NOT WHAT IT SAYS HERE. ARE. >> GOOD MORNING, EVERYONE. THIS IS JUST TO REMIND YOU THAT THE OVERALL MATERIALS AND DISCUSSIONS THAT OCCUR IN THIS MEETING ARE CONFIDENTIAL. WHEN WE ARE REFERRING TO THE GRANT APPLICATIONS. THIS IS ALSO TO REMIND YOU THAT IF THERE ARE ANY DETAILED DISCUSSIONS, THAT IF YOU ARE IN CONFLICT AND WE HAVE NOT PREVIOUSLY NOTIFIED YOU OF THAT BUT YOU DISCOVER THAT YOU'RE IN CONFLICT, PLEASE LET US KNOW AND WE WILL TAKE CARE OF THAT IMMEDIATELY. I WANTED TO VERY QUICKLY GO OVER SOME OF THE ITEMS IN YOUR FOLDER. THERE'S A BLUE FOLDER. IN PARTICULAR, THE MINUTES FROM THE JUNE 26 COUNCIL ARE IN THERE. THESE MINUTES WERE ALSO POSTED ON THE ELECTRONIC COUNCIL BOOK TO GIVE YOU AN OPPORTUNITY TO REVIEW THEM. AT THIS TIME I WOULD LIKE TO NOTE, ARE THERE ANY QUESTIONS, CORRECTIONS OR COMMENTS ON THE MINUTES FROM THE JUNE 2016 MEETING? HEARING NONE, MAY I HAVE A MOTION TO APPROVE THE MINUTES FROM THE JUNE 2016 MEETING? >> MOVE. >> AND A SECOND? ALL IN FAVOR? >> AYE. >> ANY OPPOSED? THE MOTION CARRIES, MINUTES FROM THE JUNE 2016 MEETING ARE APPROVED. THERE'S ANOTHER ITEM IN YOUR FOLDER, AND THAT IS YOUR CONFIDENTIAL ROSTER. PLEASE CHECK YOUR NAME AND CONTACT INFORMATION AS WELL AS YOUR ADMINISTRATIVE ASSISTANT'S INFORMATION, AND IF THERE ARE ANY CHANGES THAT NEED TO BE MADE, PLEASE JUST PENCIL THEM ON THAT AGENDA, AND MS. KINA HENDRICKS WHO IS OUTSIDE BUT WILL BE INSIDE IN A MINUTE, IF YOU WOULD JUST GIVE THOSE TO HER, OR YOU CAN GIVE THEM TO ME, SO WE CAN MAKE SURE THAT WE MAKE THOSE CORRECTIONS AND CAN BE ABLE TO REACH YOU AT ALL HOURS OF THE DAY AND NIGHT. AND THEN FINALLY, I WOULD LIKE TO REMIND YOU THAT IT IS OUR POLICY THAT MEMBERS ARE ONLY ALLOWED TO MISS ONE MEETING PER CALENDAR YEAR. ARE THERE ANY QUESTIONS OR ANYTHING FOR ME? IF NOT, I'LL TURN THE MEETING BACK OVER TO DR. PEREZ-STABLE. >> Dr. Eliseo Perez-Stable: LET' S GO AROUND AND REINTRODUCE OURSELVES TO EACH OTHER. NATHAN? >> NATHAN STINSON, DIRECTOR OF THE DIVISION OF EXTRAMURAL SCIENCE PROGRAMS AT THE INSTITUTE. >> LINDA THOMPSON ADAMS DLRKS WESTCHESTER UNIVERSITY. >> ROCHESTER, NEPHROLOGY. >> CT DLRKS CHICAGO, HPC. >> PROFESSOR OF EPIDEMIOLOGY, UNIVERSITY OF CALIFORNIA, SAN DIEGO. >> CAROL, ETHICS AND PATIENT ADVOCACY, OFFICE OF THE SECRETARY OF DEFENSE. HEALTH AFFAIRS. >> GREG TELEVERA PROFESSOR OF GRADUATE SCHOOL OF PUBLIC HEALTH, SAN DIEGO STATE UNIVERSITY. >> FERNANDO MEN DOUGH ZARKS PROFESSOR OF PEDIATRICS AND ASSOCIATE DEAN, STANFORD, UNIVERSITY. >> BILL RILEY, NIH DIRECTOR, OFFICE OF BEHAVIORAL AND SOCIAL SCIENCES RESEARCH. >> VALERIE MONTGOMERY-RICE PRESIDENT DEAN MOREHOUSE SCHOOL OF MEDICINE. >> BRIAN RIVERS, ARE. >> MAIRN NATIONAL CANCER INITIATIVES, FOUNDER AMERICAN NATIONAL RESEARCH CORPORATION. >> PROFESSOR HARVARD MEDICAL SCHOOL AND DIRECTOR OF THE RESEARCH DISPARITIES UNIT MASSACHUSETTS GENERAL HOSPITAL. >> I'M LINDA GREENE, UNIVERSITY OF WISCONSIN LAW SCHOOL. >> JOYCE HURNLT, DEPUTY DIRECTOR OF THE NATIONAL ADVISORY COUNCIL ON MINORITY HEALTH AND HEALTH DISPARITIES AND YOUR PERSON WHO ENTER UPTSZ YOU TO LET YOU KNOW >> Dr. Eliseo Perez-Stable: OKAY I'M GOING TO GO AHEAD AND DO OUR PRESENTATION. WE HAVE AN EXCITING AGENDA TODAY. I'M HOPING THAT WE'LL HAVE A LITTLE BIT OF FLEXIBLE TIME FOR MORE OPEN DISCUSSION AS WE DISCUSS THE LAST MEETING IN ADDITION TO THE TIME WE DEDICATED YESTERDAY. SO WITHOUT FURTHER DELAY, I'M GOING TO -- OKAY. SO SEPTEMBER IS ONLY THREE MONTHS FROM JUNE, SO THIS ACTUALLY IS A CONDENSED THREE-MONTH PERIOD, ALSO IT'S SUMMER, SO IT TENDS TO BE A LITTLE BIT LESS ACTIVE, BUT IT'S ALSO END OF THE FISCAL YEAR, SO EVERYONE IS SCRAMBLING TO MAKE SURE THAT WE GET EVERYTHING CLOSED. LET ME START BY A COUPLE OF HIGHLIGHTS OF NIH BROAD NEWS. FIRST, VERY SOON I WILL NO LONGER BE THE NEWEST INSTITUTE DIRECTOR ON CAMPUS. DR. JOSHUA GORDON WAS NAMED DIRECTOR OF THE NATIONAL INSTITUTE OF MENTAL HEALTH. HE WILL BE JOINING NIH A LITTLE BIT LATER THIS YEAR. HE WAS PREVIOUSLY PROFESSOR, ASSOCIATE PROFESSOR OF PSYCHIATRY AT COLUMBIA AND LED BOTH A RESEARCH PROGRAM IN THE NEW YORK STATE PSYCHIATRIC INSTITUTE FOCUSED ON NEURAL ACTIVITY IN MICE AND GENETICS, LOOKING AT A VARIETY OF MENTAL DISORDERS AS WELL AS ASSOCIATE DIRECTOR OF THE PSYCHIATRY PROGRAM. HE ALSO PARENTHETICALLY SPENT SOME TIME AT UCSF AS PART OF HIS RESIDENCY TRAINING. AT THE END OF OCTOBER, DR. DIANA BIANKE WILL START APPEARS THE NEW DIRECTOR OF THE EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH AND MUM DEVELOPMENT AND SHE WILL BE OVERSEEING ALL THE PROGRAMS AT NICHD, BOTH ARE MIDSIZE INSTITUTES IN THE OVER BILLION DOLLAR BUDGET CATEGORY AND BOTH OBVIOUSLY COVER AREAS OF GREAT INTEREST TO NIMHD SO THESE ARE BOTH IMPORTANT APPOINTMENTS. DR. BIANKE WAS PREVIOUSLY OR IS CURRENTLY AT THE MOTHER-INFANT RESEARCH INSTITUTE AND VICE-CHAIR OF PEDIATRIC RESEARCH AT TUFTS, ALSO IF HE IS SORE OF PEDIATRICS AND OBSTETRICS AND GYNECOLOGY, RESEARCH HAS BEEN IN PRENATAL GENOMICS TO ADVANCE NONINVASIVE PRENATAL SCREENING AND DIAGNOSIS OF PRENATAL TREATMENTS OF GENETIC DISORDERS AND WILL BRING NEW LEADERSHIP TO THAT INSTITUTE. I DON'T THINK WE HAVE A SEPARATE SLIDE, BUT THE NATIONAL LIBRARY OF MEDICINE'S NEW DIRECTOR, I MAY HAVE ANNOUNCED THIS IN JUNE, IS GOING TO ACTUAL BE SWORN IN ON MONDAY, AND SHE WILL BE I THINK A TERRIFIC ADDITION TO THE CAMPUS AS WELL. YESTERDAY WE DID TALK SOME ABOUT PRECISION MEDICINE. THIS WHOLE COHORT PROGRAM WAS LAUNCHED WITH A KICKOFF MEETING IN THIS BUILDING, OR ACTUALLY UP IN NEUROSCIENCES IN JULY. ERIC DISHMAN TOLD ME THAT HE STARTED AND THREE DAYS LATER HE WAS ROUGHENING THIS MEETING. AND THEY BROUGHT IN ALL THE AWARDEES AT THAT POINT BESIDES THE BIOBANK AND THE DEVELOPMENT OF THE WEBSITE, THERE WERE FOUR OR FIVE HEALTH PROFESSIONAL ORGANIZATIONS THAT HAD RECEIVED AWARDS. THE GROUP MOAT INVOLVED AT NIH IN RUNNING THE PMI WAS ALSO THERE, AND THE PLANNING WAS LAUNCHED. AS BILL RILEY MENTIONED YESTERDAY, THEY'RE STILL WORKING ON WRITING PROTOCOLS, ON DEVELOPING PROTOCOLS FOR THE COHORT. THE COUPLE OF IMPORTANT ADDITIONAL POINTS THAT WOULD BE MENTIONED THERE IS THAT COLLABORATION WITH THE HRSA TO SELECT THE SIX MODEL, IF YOU WISH, OR INITIAL FEDERAL QUALIFIED HEALTH CENTERS AS COMMUNITY BASED ORGANIZATIONS TO ENHANCE OR ENRICH THE RECRUITMENT OF BOTH MINORITY AND UNDERSERVED INDIVIDUALS INTO THE COHORT AND I'LL SHOW YOU THAT IN A MINIMUM NUT, AS WELL AS WHAT'S NOT LISTED HERE IS AN AGREEMENT WITH THE VA TO HAVE AN ADDITIONAL RECRUITMENT TO THE EXISTING VA COHORT HAS THEIR OWN PROTOCOL, BUT THIS IS GOING TO BE IN COLLABORATION WITH THE VA TO ENHANCE THE PMI. AGAIN, THE VA BRINGS MORE DIVERSE, MORE WORKING CLASS PATIENT POPULATION TO THE POTENTIAL RECRUITMENT GROUP, AND AT THE MEETING NOT ONLY WAS DR. COLLINS PRESENT FOR MUCH OF IT, BUT ALSO SYLVIA BURWELL MADE A PRESENTATION AND MADE SOME REMARKS. HERE IS A LIST OF THE FQHC'S THAT WERE SELECTED, AND I THINK OUR OWN REGINA JAMES IS THERE IN THE PHOTO. THE CHEROKEE HEALTH SYSTEM IN KNOXVILLE, COMMUNITY HEALTH CENTER IN MILCON, CONNECTICUT, EUCLAIRE COOPERATIVE HEALTHCARE IN SOUTH CAROLINA, PEAKSVILLE, NEW YORK NO, TR HEALTH CENTER IN JACKSON, MISSISSIPPI MISS AND HEALTH CENTER IN SAN DIEGO AREA THAT OUR COUNCILMEMBER GREGORY TALAVEDA HAS A LONG TIME RESEARCH ASSOCIATION WITH AND THEY'RE QUITE SET UP FOR DOING RESEARCH. SO WE'RE VERY EXCITED ABOUT THIS PROGRESS AND I THINK AS I MENTIONED EARLIER, ONE OF OUR CHALLENGES AND ONE OF OUR CHARGES AND CHALLENGES IN THE NEXT YEAR IS TO ACTUALLY DEVELOP IDEAS, RESEARCH IDEAS THAT WE WILL SEND OUT TO THE COMMUNITY, TO YOU AND YOUR PEERS TO SAY WHAT KIND OF RESEARCH QUESTIONS CAN WE BE ASKING OF THE PMI COHORT WHEN THEY HAVE 100,000 PEOPLE ENROLLED IN A COUPLE OF YEARS. SINCE IT TAKES A WHILE TO DEVELOP THESE CONCEPTS AND HAVE THEM APPROVED, I THINK THE TIMING IS IN THE NEXT YEAR FOR SURE. SIMILARLY, WE'LL BE POISED TO ACTIVATE OUR NETWORKS TO ENHANCE THE RECRUITMENT BOTH AT THE SITES THAT HAVE BEEN AWARDED AS WELL AS THE VOLUNTEERS WHO CAN BE GUIDED TO THE WEBSITE ONCE IT IS FUNCTIONAL. I DON'T THINK WE'LL SEE LAUNCHING OF THE PMI BEFORE JANUARY, BUT WE'RE OPTIMISTIC AND THEY GET EVERYTHING PULLED TOGETHER, IT WILL LAUNCH, ERIC IS VERY OPERATIONALLY FOCUSED AND HE WANTS FULL BUY-IN FROM EVERYBODY, HE'S NOT GOING ON JUST MAKE IT LAUNCH BECAUSE OF A DEADLINE. HE WANTS TO MAKE SURE EVERYBODY IS READY FOR THE LONG RUN HERE. THE OTHER, I GUESS, NOTE IS THAT THERE WERE RECENT REVIEWS OF MORE APPLICATIONS AND I DON'T KNOW WHAT THE OUTCOMES OF THOSE ARE, BUT THERE WERE GOING TO BE AT LEAST THREE MORE AWARDS MADE FOR HEALTH PROFESSIONAL ORGANIZATIONS. ANOTHER STUDY BEING LAUNCHED THIS MONTH, IN FACT, TODAY, IS THE ADOLESCENT BRAIN COGNITIVE DEVELOPMENT STUDY. THIS IS MORE OF A REGULAR COHORT STUDY BEING LED BY NIDA ENROLLING ABOUT 10,000 HEALTHY CHILDREN FROM AGES 9-10 WITH THE GOAL OF FOLLOWING THEM ABOUT TEN YEARS. ABOUT HALF OF THE CHILDREN, I BELIEVE, BASED ON THEIR RECRUITMENT TARGETS IN THE SCHOOLS THAT HAVE BEEN RECRUITED SHOULD BE FROM RACE/ETHNIC MINORITIES, WHICH IS AN APPROPRIATE REFLECTION OF THE DEMOGRAPHICS OF CHILDREN IN THE U.S. TODAY. I THINK IT IS ABOUT 25 OR 30 SCHOOLS THAT HAVE BEEN AWARDED OR AREAS THAT HAVE BEEN AWARDED GRANTS TO RECRUIT. IT'S A SCHOOL-BASED RECRUITMENT WITH ENRICHMENT FROM TWIN REGISTRIES GIVEN THE PARTICULAR SET OF QUESTIONS THAT CAN BE ADDRESSED WITH TWINS, AND IT IS REALLY DESIGNED TO UNDERSTAND ENVIRONMENTAL, SOCIAL AND GENETIC FACTORS. THERE'S A FAIR AMOUNT OF IMAGING GIVEN THAT NIDA IS INVOLVED, BUT IT ALSO INCLUDES ALL SORTS OF SOCIAL DETERMINANTS AS WELL AS BIOLOGICAL SAMPLES, DATA ON SUBSTANCE USE, MENTAL HEALTH AND OTHER ISSUES RELATED TO PUBLIC HEALTH STRATEGIES. SO I THINK THIS IS AN EXCITING STUDY. WE ARE SUPPORTING IT, AND WE HAVE BEEN INVOLVED IN SOME OF THE DISCUSSIONS AND PLANNING, AGAIN, DR. JAMES HAS BEEN OUR LEAD ON THAT, ALTHOUGH I ALSO HAVE BEEN PART OF AT LEAST ONE PHONE CALL WHERE WE DISCUSSED IT. THERE'S PLANNED TO BE A HILL BRIEFING NEXT WEEK WITH A NUMBER OF HIGH-LEVEL DIRECTORS. DR. VOCHOU FROM NIDA AND DR. KOOB FROM NIAAA WILL BE INVOLVED. BRAIN DEVELOPMENT IS HIGH ON THE PRIORITY LIST OF SCIENCE AT NIH, AT DIFFERENT LEVELS, AND THIS STUDY WILL BE A SPECIAL CONTRIBUTION TO OUR ADVANCEMENT OF KNOWLEDGE THERE. I'LL MENTION THIS, HHS OFFICE FOR CIVIL RIGHTS, SORT OF A DECLARATION OF RESPONSE, RECOVERY FROM PREPAREDNESS, IN PART AS A STATEMENT OF MAKING SURE THAT WE DO NOT HAVE ANY LEVEL OF DISCRIMINATION ON THE BASIS OF RACE, COLOR OR NATIONAL ORIGIN. SOME OF YOU MAY HAVE ALSO SEEN THE FINAL RULE LINKED TO THE ACA, THE REITERATION AND STATEMENT OF TITLE VI RELATED TO PROHIBITING DISCRIMINATION IN THE HEALTHCARE SETTING, NOT ONLY ON THE BASIS OF RACE, COLOR, GENDER, NATIONAL ORIGIN, BUT ALSO SEXUAL ORIENTATION OR IDENTITY, AS WELL AS LANGUAGE PROFICIENCY, AND I THINK THIS IS A PARTICULARLY IMPORTANT DOCUMENT TO REFER TO WHEN WE FACE POTENTIAL CONFLICTING ISSUES IN THE HEALTHCARE SETTING. AND THIS WAS PUBLISHED THROUGH HHS THROUGH THE OFFICE OF MINORITY HEALTH IS HOW I LEARNED ABOUT IT. AGAIN, PICKING UP ON A TOPIC WE TOUCHED ON YESTERDAY, SORT OF THE ISSUES AROUND BIAS IN RESEARCH FUNDING, THIS WAS A PAPER PUBLISHED BY DONNA GINTHER AND HER COLLABORATORS THIS MONTH, IS THERE EVIDENCE OF DOUBLE-BLIND FOR WOMEN OF COLOR, WASN'T THE DETERMINING FACTOR OF BEING FUND UNDERSTAND BUT WOMEN OF COLOR LED LOWER PROBABILITY OF BEING FUNDED AND I THINK IT ADDS EVIDENCE TO WHAT WE HAVE NOW INCREASINGLY DOCUMENTED TO BE A SYSTEMATIC NOT ONLY -- I THINK THE FIRST BIG PROBLEM IS THE LOW NUMBERS COMING IN, NOT TO FORGET THAT, YOU KNOW, 5% OF ALL NIH PRINCIPAL FROM INVESTIGATORS ARE EITHER AFRICAN AMERICAN OR LATINO, AND THEY'RE VERY UNDERREPRESENTED AND THE APPARENT BIAS IN FUNDING OF AFRICAN AMERICAN PRINCIPAL INVESTIGATORS WHICH HAS PERSISTED IN THE REVIEWS THAT WE HAVE DONE INTERNALLY. THIS IS BEING ADDRESSED AT THE NIH LEVEL WITH A VARIETY OF INTERVENTIONS THAT DR. HANNA VALENTINE IS LEADING, AND WE EXPECT TO HAVE MORE TO SAY ON THIS AFTER PROBABLY A YEAR OR SO OF TRIALS. AND THESE ARE KIND OF GOING TO BE SMALLER STUDIES TO LOOK AT BOTH ENCOURAGING RESUBMISSION, SOME STUDIES THAT THE CENTER FOR SCIENTIFIC REVIEW IS GOING TO DO ON DOUBLE-BLIND REVIEW AS WELL AS ADDRESSING CONCERNS OF MENTORING THROUGH THE NORMAN NETWORK AND THEN EVENTUALLY THE BUILD PROGRAM THAT IS GOING TO INCREASE THE PIPELINES. OTHER BROAD ISSUES AT NIH, JUST TO LIST A FEW THAT WE'VE BEEN INVOLVED WITH OR YOU'VE HEARD ABOUT, EVERYONE HAS HEARD ABOUT THE CANCER MOONSHOT. THERE ARE RECOMMENDATIONS MADE BY THE BLUE RIBBON COMMITTEE THAT ARE POSTED ON THE NCI WEBSITE. ONE OF THE REMARKABLE THINGS ABOUT THE INITIAL SET OF RECOMMENDATIONS PRESENTED TO THE NATIONAL CANCER ADVISORY BOARD WAS THE LACK OF FOCUS ON ANY ISSUES RELATED TO MINORITY HEALTH OR HEALTH DISPARITIES. THIS WAS ACTUALLY W HE AVED IN SUBSEQUENTLY IN DISCUSSION. IN TALKING TO ONE OF THE DIVISION DIRECTORS THIS WAS POINTED OUT. THERE WERE REPRESENTATIVES ON THE BLUE RIBBON COMMITTEE, THIS IS INDEPENDENT OF THE VICE PRESIDENT'S EFFORTS OUT OF THE WHITE HOUSE, THE VICE PRESIDENT JOE BIDEN IS LEADING AND WILL CONTINUE TO STAY COMMITTED TO THE CANCER MOONSHOT. THE NCI PROCESS WAS ON A SCIENTIFIC BASIS. THESE ARE MAJOR QUESTIONS WE WANT TO ADDRESS. AND EVEN THOUGH THERE IS NO APPROPRIATION FOR THIS YET AND THERE MAY NOT BE IN THE NEAR FUTURE, THE IDEA IS THAT BY PUTTING FORTH THESE CROSS-CUTTING CANCER-RELATED QUESTIONS FOR THE FUTURE, THE COMMUNITY WILL RESPOND AND REACT TO IT. THE OFFICE OF THE DIRECTOR OF NIH ESTABLISHED AN OFFICE OF SEXUAL GENDER MINORITIES, KAREN PARKER WAS NAMED THE DIRECTOR. I WAS INVOLVED IN THAT PROCESS. KAREN AND I HAVE TALKED ON SEVERAL OCCASIONS RELATED TO OUR COMMON ISSUES, AND I THINK THAT WE WILL HAVE A STRONG ALLY TO PROMOTE THIS VERY IMPORTANT AREA OF RESEARCH FOR THE FUTURE, AND I'M VERY PLEASED THAT THE NIH IS ENDORSING THIS. THERE'S ALSO A TRIBAL AFFAIRS OFFICE. I'M NOT SURE WHAT THE OFFICIAL NAME OF IT YET, THAT IS YET WITHOUT A DIRECTOR. I THINK JOYCE HURNLT, DR. HUNTER IS ON THE SEARCH COMMITTEE, AND THAT IS PRESSING ON. NIMHD HAS HAD A LONG-STANDING RELATIONSHIP WITH AMERICAN INDIAN RESEARCH AND THE COMMUNITIES. WE ACTUALLY SUPPORT THE INDIAN HEALTH SERVICE TO SUPPORT THE TRIBAL EPIDEMIOLOGY CENTERS. I HAVE REVIEWED THAT COMMITMENT THIS YEAR, AND I HAVE PROPOSED SOME REVISIONS IN THE WAY WE SUPPORT THEM. WE WANT TO MAKE SURE THAT WE'RE PROMOTING RESEARCH IN THEIR CENTERS, BUT WE HAD A VERY GOOD, OPEN DISCUSSION WITH REPRESENTATIVES FROM THE INDIAN HEALTH SERVICE ON THIS ISSUE, AND WE ALSO, OF COURSE, ARE VERY INVOLVED IN REPORTING ON THE RESEARCH IN AMERICAN INDIAN HEALTH, WHICH IS AN IMPORTANT COMPONENT OF OUR PLANNING AND REPORTING OFFICE. THE DEVELOPMENTS WITH CUBA CONTINUE TO MOVE FORWARD IN THIS LAST THREE MONTHS, IN JUNE, ABOUT TEN DAYS AFTER OUR LAST COUNCIL, THERE WAS A HIGH-LEVEL DELEGATION FROM THE CUBAN MINISTRY OF HEALTH IN WASHINGTON. THEY CAME TO SIGN A MEMORANDUM OF UNDERSTANDING WITH THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, AND THIS MOU ESSENTIALLY PROVIDES AN UMBRELLA AGREEMENT TO SAY WE ARE INTERESTED IN COLLABORATING. AS YOU'RE AWARE, THERE ARE NOW DIPLOMATIC RELATIONS BETWEEN CUBA AND THE UNITED STATES AFTER, WHAT IS IT, 50-PLUS YEARS OF COLD WAR. HOWEVER, THERE CONTINUES TO BE AN ECONOMIC EMBARGO FROM THE UNITED STATES TO CUBA WHICH PROHIBITS FINANCING OR EXCHANGE OF FUNDS. SO THAT CAN ONLY BE CHANGED BY AN ACT OF CONGRESS, SO THAT HAS NOT HAPPENED AND MAY NOT HAPPEN FOR A WHILE. THERE IS A LOT OF INTEREST AMONG THE CUBANS ABOUT SCIENTIFIC EXCHANGES. THEY ARE PARTICULARLY INTERESTED IN CANCER, AGING, MATERNAL HEALTH, AND OF COURSE THE INFECTIOUS DISEASES, AND THE UNITED STATES IS VERY INTERESTED IN WHAT CUBA'S ROLE IS IN THE ZIKA EPIDEMIC NOW ESPECIALLY GIVEN WHAT'S HAPPENED IN PUERTO RICO IN THE LAST SIX, SEVEN MONTHS. SO I THINK THIS IS AN EXCITING AREA. NIMHD OF COURSE, THEY LOOK AT ME AND SAY, WELL, WHAT IS THAT? AND WE HAD SOME VERY GOOD CONVERSATIONS. I SPENT A LITTLE WHILE TALKING TO THE DIRECTOR OF THE ONCOLOGY PROGRAM AT THEIR MAIN HOSPITAL IN HAVANA, AND AFTER ABOUT 15 MINUTES I THINK HE GOT IT, OF WHERE HE SAW THE OVERLAP AND THE INTEREST OF WHAT WE DO COMPARED TO WHAT THE CUBANS HAVE. WE ACTUALLY TOOK THE OPPORTUNITY TO SPONSOR AND SUCCESSFULLY BRING A CUBAN SCIENTIST HERE. SHE'S HERE RIGHT NOW, ON ANOTHER ROOM IN THIS BUILDING, AT THE CLINICAL GENETICS SUMMIT. THIS IS AN INTERNATIONAL SUMMIT THAT WAS PLANNED BY GENOME WITH THE IDEA OF SUPPORTING LOW AND MIDDLE-INCOME COUNTRIES AT CAPACITY AND BUILDING CLINICAL GENETICS, AND THERE ARE MOST OF THE SCHOLARS WHO ARE HERE ARE EITHER FROM AFRICA, THERE ARE A FEW FROM SOUTHEAST ASIA AND THEN THERE ARE TWO FROM LATIN AMERICA, AND THERE'S A SCIENTIST PULMONOLOGIST FROM PERU AND THEN THIS CUBAN MEDICAL GENETICIST WHO IS HERE FROM HAVANA, SO I THINK WE'RE ESPECIALLY PROUD TO HAVE BEEN INVOLVED IN SUPPORTING THIS. I THINK THAT CUBA IS AN INTERESTING PLACE, LIKE PUERTO RICO, IT'S A VERY IMPORTANT PLACE, IT HAS PROVIDED A LOT OF IMMIGRANTS TO THE UNITED STATES, LIKE PUERTO RICO, IT'S A MIXED POPULATION WITH A SIGNIFICANT AFRICAN INFLUENCE, MODEST OR NOT HIDDEN INDIGENOUS PRESENCE AS WELL, AND BECAUSE CUBA HAS BEEN THROUGH SUCH A DIFFERENT SOCIAL AND POLITICAL HISTORY OVER THE LAST 50 YEARS, I THINK SOME COMPARISON RESEARCH MAY BE OF SPECIAL INTEREST. NOT YET ABLE TO DO IT, BUT I THINK WE WILL BE PURSUING THAT AND MORE TO COME AT A FUTURE MEETING. I THINK YESTERDAY WE AGAIN FOCUSED ON THIS. I WANT TO SORT OF REEMPHASIZE WHAT WE'RE DOING WITH THE DEFINITIONS OF MINORITY HEALTH, HEALTH DISPARITIES, INCLUSION AND DIVERSITY, REALLY IMPORTANT TO DEFINE THE AREA OF MINORITY HEALTH AS RESEARCH AMONG MINORITY GROUPS OR WITHIN MINORITY GROUPS, WHETHER THE OUTCOMES ARE BETTER OR NOT OR WORSE OR NOT, SO IN AREAS WHERE A MINORITY GROUP DOES BETTER, WE ARE INTERESTED IN MECHANISMS AND DEFINING WHY THAT IS. IN AREAS WHERE MINORITIES ACTUALLY HAVE WORSE OUTCOMES, WHICH ARE MANY, THEN IT OVERLAPS WITH HEALTH DISPARITIES, AND AS A HEALTH DISPARITIES FOCUS, WE'RE ALSO INTERESTED IN INDIVIDUALS OF LOCALLY SOCIOECONOMIC STATUS AND RURAL POPULATIONS AS MANDATED BY NIMHD. INCLUSION REFERS TO DIVERSITY IN THE SAMPLES OF PARTICIPANTS AND STUDIES AND IS NOT IN AND OF ITSELF MINORITY HEALTH RESEARCH AND DIVERSITY OF COURSE WE'RE USING TO LOOK AT WORKFORCE DIVERSITY, AND THERE CAN AGAIN BE RESEARCH IN THAT AREA, BUT IT IS MORE OF A SOCIAL JUSTICE ISSUE TO HAVE A DIVERSE BIOMEDICAL WORKFORCE AND ALSO FOR A NUMBER OF OTHER REASONS THAT CARING FOR OUR POPULATION WILL BE A HUGE PROBLEM IF OUR SCIENTIFIC WORKFORCE LOOKS VERY DIFFERENT THAN THE GENERAL POPULATION. SO I THINK THAT THESE ARE MESSAGES THAT WE'VE BEEN -- WE'VE SETTLED ON, WE'RE FOCUSING ON, AND REPEATING EVERYWHERE THAT WE GO. NIMHD NEWS, JUST LAST WEEK I WAS IN CONGRESS FOR A BRIEFING THAT WAS SPONSORED BY THE UNIVERSITY OF MARYLAND, STEVEN THOMAS HOSTED IT, JOHN SARBANES, THE REPRESENTATIVE FROM THE BALTIMORE AREA WAS THE MAIN CONGRESSPERSON PRESENT, ALTHOUGH REPRESENTATIVE HOYER ALSO SHOWED UP, STENY HOYER, WHO IS A DEMOCRATIC, SHOWED UP AT THE END AND MADE A FEW COMMENTS. WE HAD A GOOD PANEL DISCUSSION. NADINE GRASIAS STANDING NEXT TO ME, THE DIRECTOR OF THE OFFICE MINORITY HEALTH, AND I WERE THE TWO FEDERAL REPRESENTATIVES. JULIA HUGGINS, WHO IS THE PRESIDENT OF CIGNA HEALTHCARE WAS ALSO THERE, AND THEN MARGO EDMUNDS WHO IS THE VICE PRESIDENT FOR ACADEMYHEALTH AND INVOLVED WITH OUR FRIENDS AT NIMHD AND FINALLY KOLA OKUYEMI FROM MINNESOTA, THE BIG 10 ALLIANCE, I GUESS, RELATED TO THE GROUP OF UNIVERSITIES RELATED TO THE BIG 10 AND UNIVERSITY OF MARYLAND WHERE STEPHEN THOMAS, DIRECTOR OF THE CENTER FOR HEALTH EQUITY IN THE SCHOOL OF PUBLIC HEALTH LED THIS. THEY HAVE DONE THESE BRIEFINGS, THIS IS THE THIRD OR FOURTH ONE, THIS WAS FOCUSED ON HEALTH EQUITY, SO THAT'S WHERE THE INVITATION FOR ME CAME ALONG, AS WELL AS THE MEMBERS OF THE PANEL. ON THE POLITICAL SIDE, YOU CAN FOLLOW THE NEWS. THE APPROPRIATIONS SUBCOMMITTEE ON LABOR PUT OUT AN APPROPRIATIONS BILL, PROPOSED BUDGET FOR NIMHD SHOWS 2% INCREASE OVER FISCAL YEAR 16 FROM THE HOUSES. ON THE SENATE SIDE THERE'S A PROPOSAL TO INCREASE NIH BUDGET BY 2 BILLION, TO 34 BILLION, WITH PRESUMABLY SOME PROPORTIONAL INCREASES FOR THE INSTITUTES THAT DO NOT HAVE SPECIFIC PROGRAMS OUTLINED IN THESE PROPOSED BILLS. THESE ARE PROPOSED BILLS. LIKE WHETHER IT BE CANCER, PMI, OR ALZHEIMER'S DISEASE. THE BUDGET FOR THE SENATE'S PROPOSAL IS HIGHER THAN THE HOUSE GIVEN THE OVERALL INCREASE. WE EXPECT THAT THIS MONTH THE BEST WE CAN HOPE FOR OR EXPECT TO GET IS A CONTINUING RESOLUTION, PRESUMABLY FOR THREE MONTHS, AND THAT AFTER THE NOVEMBER ELECTION CONGRESS WILL COME BACK IN SESSION AND FUND THE GOVERNMENT ON A MORE REGULAR BASIS. SO STAY TUNED. THE ONLY OTHER CHARGE THEY'RE SUPPOSED TO WORK ON THIS MONTH IS ZIKA, SO HOPEFULLY THEY'LL BE ABLE TO DO SOMETHING WITH THAT. THIS IS JUST AN OUTLINE OF A BILL OF INTEREST THAT REPRESENTATIVE ROBIN KELLY FROM ILLINOIS INTRODUCED, HEALTH EQUITY AND ACCOUNTABILITY ACT. IT WOULD DO A VARIETY OF IMPORTANT THINGS IN A NUMBER OF AREAS THAT MATTER TO US, AND ALSO CONTINUES TO INCLUDE REPORTING PROVISIONS RELATED TO NIMHD'S EX-PANNED PLANNING, COORDINATING, REVIEW AND EVALUATION AUTHORITY, AS WELL AS AN ANNUAL REPORT ON OUR ACTIVITIES, SO WE ALWAYS KEEP TRACK OF THESE BILLS OF INTEREST. I ACTUALLY MET WITH REPRESENTATIVE KELLY EARLIER THIS YEAR, SHE'S PARTICULARLY INTERESTED IN ISSUES AROUND VIOLENCE, BEING FROM THE CHICAGO AREA, I THINK THAT'S BEEN HEIGHTENED IN RECENT MONTHS, BUT CLEARLY A VERY ENGAGING AND PERSONABLE POLITICIAN, REPRESENTATIVE. THIS IS OUR BUDGET FOR FISCAL '16 THAT WE'RE FURIOUSLY TRYING TO BRING TO A CLOSE. YOU CAN SEE FROM THIS ABOUT COMBINING THE CENTERS OF EXCELLENCE AND THE TRANSDISCIPLINARY COLLABORATIVE CENTERS, ABOUT 29% OF OUR BUDGET IS FOCUSED ON GRANTS, ANOTHER 20% IS THE RCMI PROGRAM, BETWEEN THOSE TWO, IT'S ABOUT HALF OF OUR BUDGET FOCUSED ON SERPTS. ABOUT 23% IS RESEARCH GRANTS, AND THEN THE OTHER PROGRAMS ARE THERE, ENDOWMENTS, INTRAMURAL RESEARCH, LOAN REPAYMENT AND THEN OPERATIONS FOR RUNNING THE INSTITUTE, AND THEN THE VARIETY OF OTHER PROGRAMS INCLUDED. THE AREAS I THINK FOR CHANGE, FIRST RCMI WILL STAY THE SAME, THE CENTERS OF EXCELLENCE ARE COMING TO AN END, MOST OF THEM, NEXT YEAR. WE'RE CURRENTLY REVIEWING WHAT NIMHD WILL DO WITH CENTERS. MY OWN PREFERENCE IS THAT WE SET UP SOME SORT OF A PROGRAM THAT COMBINES OUR CENTERS, SDMI ON ONE SIDE FOR THE INSTITUTIONS THAT HAVE LESS RESOURCES, AS WE DISCUSSED YESTERDAY, THEN THE CENTERS OF EXCELLENCE, THE OVERALL CENTERS PROGRAM BEING OPEN FOR COMPETITION TO WHOEVER COMES IN WITHOUT A PARTICULAR FLAVOR. BUT DR. HUNTER IS LEADING THAT EFFORT, THERE ARE A COUPLE OF YOU INVOLVED IN THAT REVIEW INTERNALLY AS COUNCILMEMBERS AND WE HAVE A COUPLE OF EXTERNAL ADVISORS, AND HOPEFULLY BY FEBRUARY WE'LL HAVE A PLAN TO SUMMARIZE AND PRESENT TO COUNCIL FOR DISCUSSION. THE ENDOWMENT PROGRAM WAS REVIEWED A COUPLE YEARS AGO AND HAS CONTINUED. THE INTRAMURAL RESEARCH PROGRAM WILL NEED TO GROW. WE ARE IN THE MIDST OF RECRUITING A SCIENTIFIC DIRECTOR, AND WE HAD A NUMBER OF EXCITING APPLICATIONS, AND NEXT MONTH WE'LL BE INTERVIEWING THE FIRST GROUP OF APPLICANTS, SO THERE WILL BE EIGHT APPLICANTS COMING OR BEING INTERVIEWED BY SKYPE FOR THIS ROLE. I EXPECT THAT MAYBE BY FEBRUARY, BY OUR NEXT COUNCIL MEETING, WE'LL BE CLOSE TO HAVING A NAMED SCIENTIFIC DIRECTOR FOR OUR INTRAMURAL PROGRAM. THE LOAN REPAYMENT PROGRAM I DISCUSSED LAST TIME. I THINK IT'S A VERY IMPORTANT PART OF WHAT NIMHD CONTRIBUTES, AND DOLLARWISE, AND THIS SHOWS THE DOLLAR AMOUNTS, OUR LOAN REPAYMENT PROGRAM IS ALMOST THE LARGEST AT NIH, EVEN THOUGH WE HAVE ONE OF THE SMALLEST INSTITUTES. SO THIS IS I THINK AN IMPORTANT MECHANISM BY WHICH WE ARE SUPPORTING RESEARCH IN MINORITY HEALTH AND HEALTH DISPARITIES BUT ALSO INDIVIDUAL SCIENTISTS, YOUNG SCIENTISTS WHO ARE DISADVANTAGED IN SOCIOECONOMIC STATUS, AND ABOUT 60%, 55 TO 60% OF OUR AWARDEES ARE UNDERREPRESENTED MINORITIES IN THE LOAN REPAYMENT PROGRAM. WE DID AWARD FIVE NEW CENTER GRANTS UNDER THE PRECISION MEDICINE INITIATIVE. THIS WAS LAUNCHED, THIS IS AN RFA THAT WAS LAUNCHED BY DR. MADDOX. HOWEVER, THE GRANTS CAME IN AND WERE REVIEWED AND FUNDED THIS YEAR. THE FUNDED INSTITUTIONS ARE LISTED THERE, VANDERBILT, MEDICAL UNIVERSITY OF SOUTH CAROLINA, YALE AND NORTHWESTERN WERE ALL LED BY MINORITY PRINCIPAL INVESTIGATORS, SO I THINK THIS WAS SOMETHING I'M ESPECIALLY PROUD OF, AND THEY ARE GOING TO FOCUS ON DIFFERENT AREAS. THEY'VE ALL, I THINK, BEEN AWARDED OR ARE VERY CLOSE TO BEING AWARDED. NCI IS CO-FUNDING THE MEDICAL UNIVERSITY OF SOUTH CAROLINA GRANT, AND WE SHALL SEE HOW THIS PLAYS OUT. THIS GOT A LOT OF NOTICE LOCALLY WITH MY PEERS AND DR. COLLINS, GIVEN THAT WE'RE FUNDING THESE HEAD OF THE PMI -- AHEAD OF THE PMI BEING LAUNCHED. THERE'S NO PLAN OF SORT OF HOW THEY'RE GOING TO RELATE, BUT CLEARLY IF WE'RE LOOKING AT THIS WITH DISPARITIES, I LOOK FORWARD TO HAVING THESE FIVE CENTERS REALLY GIVE US GUIDANCE AND ADVICE AND CONTRIBUTIONS TO THE OVERALL DIRECTION OF THE PMI COHORT. THAT'S AT LEAST AN UNINTENDED GOOD CONSEQUENCE OF HAVING THIS FUNDED EARLY. WE ALSO FUNDED TWO CENTERS ON COLLABORATIVE RESEARCH CENTERS ON HEALTH DISPARITIES OF CHRONIC DISEASE, MANAGEMENT OF CHRONIC DISEASE, WASHINGTON STATE UNIVERSITY THAT IS FOCUSED ON AMERICAN INDIANS AND PACIFIC ISLANDERS AND THEN MICHIGAN STATE UNIVERSITY WITH A SPECIAL EMPHASIS ON FLINT AND LOOKING AT CHRONIC DISEASE. SO WE WILL BE LOOKING FORWARD TO SEEING HOW THEY DEVELOP AND IMPLEMENT THEIR PLAN. SO THESE SEVEN CENTERS JUST STARTING WILL CONTINUE OBVIOUSLY FOR FIVE YEARS. A COUPLE OF NOTES, DR. MARGE RIL MAU, WHO IS ONE OF OUR PRINCIPAL INVESTIGATORS AND DREK TOFER A CENTER IN HAWAII -- AND DIRECTOR OF A CENTER IN HAWAII WAS RECOGNIZED AS A MASTER PHYSICIAN BY THE AMERICAN COLLEGE OF PHYSICIANS, AND SHE IS THE FIRST NATIVE HAWAIIAN TO BE SO RECOGNIZED BY THAT PRESTIGIOUS ORGANIZATION OF INTERNAL MEDICINE. IT IS THE LARGEST ACTUALLY MAYBE AFTER THE AMA, THE LARGEST PHYSICIAN ORGANIZATION IN THE UNITED STATES, SO VERY INFLUENTIAL AND IMPORTANT, ALTHOUGH NOT RESEARCH FOCUSED, HAS BEEN VERY ENGAGED IN POASM AROUND HEALTHCARE -- IN POLICY AROUND HEALTHCARE AND ALSO IN EDUCATION. I'M ESPECIALLY PROUD OF THE FIRST ITERATION OF THE NIMHD HEALTH DISPARITIES RESEARCH INSTITUTE. SOME OF YOU WERE INVOLVED. SO THANK YOU. AND THOSE OF YOU WHO CAME TO TEACH. THE WEEK ON THE CAMPUS DURING ONE OF OUR WARMER WEEKS WAS A TERRIFIC SUCCESS, AT LEAST BY IMPRESSION. WE SELECTED 51 SCHOLARS, AND YOU CAN SEE FROM THIS PHOTOGRAPH WITHOUT HAVING DATA IN FRONT OF ME, THE VAST MAJORITY ARE MINORITIES. SCIENTISTS FROM AROUND THE COUNTRY, AND I'LL SHOW YOU MORE DATA IN A MINUTE, TO COME AND SPEND A WEEK TO LISTEN TO SELECTED LECTURES ON TOPICS, SORT OF MORE IN DEPTH TALKS ON DIFFERENT ISSUES. DR. THOMAS IS THERE STANDING NEXT TO JOAN WASSERMAN AND THEN NEXT TO JOYCE HUNTER IS NANCY KRIEGER WHO IS FROM HARVARD AND WE PRESENTED THE FIRST DAY. THE AFTERNOONS WERE MOSTLY POPULATED BY INTERACTIVE ACTIVITIES WITH NIH PROGRAM OFFICERS, OUR OWN NIMHD STAFF, PARTICULARLY AROUND THE DIFFERENT THEMES OF RESEARCH IN THE FUNCTIONAL BRANCHES. THERE WAS A VERY SUCCESSFUL AND HIGHLY, ALTHOUGH SOMEWHAT SCARY, BUT MUCH APPRECIATED SESSION ON A MOCK REVIEW OF A GRANT THAT TOM WOHLBERG AND OUR STAFF ORGANIZED, WHICH WAS A VERY GOOD EXPERIENCE TO GO THROUGH, AS WELL AS OPPORTUNITY FOR THEM TO REALLY INTERACT WITH EACH OTHER AND NETWORK, AND I THINK I TOLD THEM ON FRIDAY THAT WHAT I WANT THIS GROUP TO DO IS TO BE THAT NEXT, YOU KNOW, GENERATION OF PRINCIPAL INVESTIGATORS, RO1 GRANTS COMING TO NIMHD, ALTHOUGH OF COURSE THEY SHOULD TRY TO GET FUNDED WHEREVER THEY CAN BE, AND MANY OF THEM ARE CURRENTLY LOOKING AT K AWARDS, SO WE'RE NOT IN THAT POSITION YET TO PROVIDE THAT. THIS IS JUST A DISTRIBUTION GEOGRAPHICALLY WHERE THEY CAME FROM, NEW YORK PROVIDED A BIG BOLUS AS WELL AS DID CALIFORNIA. WE ACTUALLY PROVIDED TRAVEL SUPPORT FOR THE SELECTED SCHOLARS, AND I DIDN'T MENTION BUT WE HAD ABOUT 500 APPLICATIONS, SO THFSZ A SELECTED -- SO THIS WAS A SELECTED GROUP, AS OPPOSED TO JUST AN ANYBODY COULD COME. AMONGST THE 51 THERE WERE ABOUT 13 PHYSICIANS, WHICH IN THE CURRENT, ONE OF THE OTHER ISSUES THAT THE INSTITUTE DIRECTORS HAVE BEEN DISCUSSING IS THE LACK OF DEVELOPMENT OF PHYSICIAN SCIENTISTS, AND ALTHOUGH I HAVE ASKED FOR MORE DATA, I DON'T THINK IT'S BEEN READILY AVAILABLE. I THINK THIS IS PREDOMINANTLY A PROBLEM OF PHYSICIAN SCIENTISTS IN THE LABORATORY AND THE BENCH RESEARCH AS OPPOSED TO IN CLINICAL OR POPULATION SCIENCES. MOST OF THE PHYSICIAN SCIENTISTS THAT WE'RE GOING TO ATTRACT ARE GOING TO BE IN THE CLINICAL POPULATION SCIENCE AREA, SO IT MAY BE LESS OF AN ISSUE, I THINK, IN THOSE AREAS. WE ALSO HAD FIVE NURSES AND ONE PHARMD BE SELECTED TO BE IN THE RESEARCH INSTITUTE AND WE PLAN TO CONTINUE IT NEXT YEAR. WE'RE GOING THROUGH A FORMAL EVALUATION AS PART OF THEIR CONTRACT AGREEMENT. YOU CAN SEE SOME OF THE STORIES. WE'RE VERY POSITIVE. A LOT OF PRAISE FOR DIFFERENT LECTURES. I ACTUALLY WAS MOVING THAT WEEK, SO I WASN'T THERE FOR MOST OF THE WEEK. I WAS THERE THE FIRST DAY AND THE LAST DAY, BUT FOR THOSE OF YOU WHO WERE THERE MOST OF THE WEEK, I THINK YOU GOT A GOOD SENSE OF THE EXCITEMENT THAT WAS GENERATED BY THE GROUP. THERE WAS ALSO AN ACTIVITY IN EARLY JULY OF TRANS-NIH CONFERENCE FOR NATIONAL NATIVE AMERICAN YOUTH INITIATIVE IN BIOMEDICAL RESEARCH, AND WE WERE ACTIVE AND PRESENT IN THIS ACTIVITY. DOLORES HUNTER WAS PRESENT AND SUPPORTIVE. I WAS NOT AS BUSY THESE LAST THREE MONTHS AS IN OTHER TIMES OR AS I'M GOING TO BE THE NEXT THREE MONTHS, BUT I DID GO AROUND AND DO SOME TALKS. I WENT TO THE FDA IN LATE JUNE, SPONSORED BY THE OFFICE OF MINORITY HEALTH. MY FORMER RESIDENCY CLASSMATE, ROB KALIFF WHO IS NOW THE COMMISSIONER WAS THERE AND WE HAD A NICE CONVERSATION AFTERWARDS AS WE TALKED ABOUT POTENTIAL OVERLAP, AREAS OF INTEREST, ACTIVITIES, NIMHD, NIH. THE AAMC HELD A MID CAREER FACULTY DEVELOPMENT PROGRAM DOWNTOWN THAT I WAS INVITED TO BE A MENTOR AND SAY A FEW WORDS. ACTUALLY WHAT I DID WAS GIVE FEEDBACK ON THEIR ONE-MINUTE PRESENTATIONS OF THEMSELVES, OF WHICH I WOULD SAY LESS THAN A THIRD OF THE FACULTY PRESENT WERE ABLE TO PRESENT THEMSELVES IN LESS THAN A MINUTE OR IN A MINUTE OR LESS. SO THAT WAS KIND OF FUN. AND HOW DO YOU PITCH YOURSELF TO SOMEONE KIND OF IDEA. THEN WE HAD A FABLE WHERE WE TALKED ABOUT CAREERS. THESE ARE MID CAREER FACULTY, SO THESE ARE ASSOCIATE PROFESSOR LEVEL, A VARIETY OF ROLES, ALMOST ALL FAX YOU TILL OF COLOR -- ALMOST ALL FACULTY OF COLOR. I THINK THERE WERE EDUCATORS, BENCH SCIENTISTS, POPULATION SCIENTISTS, PEOPLE FUNDED BY NIH, PEOPLE WHO WERE LOOKING TO DO SOME RESEARCH EVEN THOUGH THEY'RE DOING OTHER THINGS, AND MOSTLY PHYSICIANS BUT NOT EXCLUSIVELY. THERE WERE ALSO SOME Ph.D.'S PRESENT. AT THE ACADEMY OF HEALTH ANNUAL MEETING I WAS AT THEIR PLENARY. IT WAS ON A SUNDAY MORNING IN BOSTON. WE DID SORT OF A SIT-DOWN, SORT OF ONE OF THESE CONVERSATION STYLE IN FRONT OF A COUPLE THOUSAND PEOPLE. IT WAS ME, JOAN RE, D, PAULA BRAVEMAN AND MODERATED BY ONE OF THE ACADEMY'S LEADERS, AND PAULA DID SHOW SLIDES, WHICH I THOUGHT WE AGREED NOT TO DO, BUT IT WAS A VERY OPEN AND FUN DISCUSSION. JOAN, WHO SOME OF YOU PROBABLY KNOW, IS A LEADER IN DIVERSITY OF THE WORKFORCE, AND SHE AND I HAVE SHARED A LOT OF COMMON ACTIVITIES OVER THE LAST BUNCH OF YEARS, SO SHE FOCUSED A LOT ON THE DIVERSITY OF THE WORKFORCE AND WOMEN. I WAS EMPHASIZING SOME OF THE AREAS OF RESEARCH AND PAULA ALSO EMPHASIZED A PARTICULAR AREA OF RESEARCH. SO I THOUGHT IT WAS A VERY GOOD ACTIVITY. BACK ON CAMPUS, I WENT TO SPEAK TO THE FOE GARR TI SCHOLAR -- FOGARTY SCHOLARS OR FELLOWS. IT WAS QUITE EXCITING. ROGER GLASS BRINGS ALL THE FUNDED FELLOWS UNDER FOGARTY, MOSTLY INTERNATIONALLY BASED SCIENTISTS, MANY FROM AFRICA, SOME FROM LATIN AMERICA, THERE WERE A NUMBER FROM PERU, THERE WERE PEOPLE FROM ARGENTINA, CENTRAL AMERICA, AND THEY WOULD COME AND SPEND A WEEK AT NIH WHERE THEY GET SOME DIDACTIC, SOME OPPORTUNITY TO INTERACT. I GAVE THEM A LECTURE AS WELL AS THEN WENT TO A RECEPTION THAT THEY HELD WHERE I WAS ABLE TO INTERACT WITH THEM MORE, ALSO INDIVIDUALS FROM THE U.S., BASED IN THE U.S., WHO ARE GOING TO GO SPEND A YEAR OVERSEAS. NHLBI SPONSORED A SCIENTIFIC WORKSHOP ON PERSONALIZED MEDICINE IN HISPANIC HEALTH. I GAVE SOME OPENING REMARKS. OUR STAFF, A COUPLE OF OUR STAFF ATTENDED, AND I WAS IN AND OUT FOR SOME OF THOSE PRESENTATIONS, AND LA RISSA OUR MAIN PROGRAM SERVICE FROM THE SOL STUDY WAS THE ONE WHO ORGANIZED THAT. IN LATE JULY I WENT TO SAN FRANCISCO FOR THE LATINO CANCER SUMMIT. THIS IS AN INTERESTING CONFERENCE THAT I'VE BEEN INVOLVED IN MOSTLY SINCE THE BEGINNING, ALTHOUGH I HAVEN'T TENDED EVERY OTHER YEAR. IT'S HELD EVERY OTHER YEAR. ISABELLE DUROM IS THE ORGANIZER, SHE'S A REAL GO-GETTER, ACTUALLY WE NOMINATED HER AND SHE IS NOW ON I THINK SORT OF THE ADVISORY, THE COMMUNITY ADVISORY COMMITTEE FOR PMI. I DON'T KNOW IF IT'S RELATED TO LIKE IRB OR RELATED TO JUST BEING A COMMUNITY ADVISOR, AND SHE REMARKED TO ME, I THINK I'M LIKE THE ONLY REAL COMMUNITY PERSON ON THAT GROUP. ISABELLE IS A FORMER NEWSCASTER WHO WAS ACTUALLY AT ONE POINT IN THE WASHINGTON AREA BUT MOST OF HER CAREER WAS SPENT IN THE SAN FRANCISCO BAY AREA AND IS A CANCER SURVIVOR, SO SHE STARTED THIS CONFERENCE WLT WITH THE IDEA OF BRINGING ADVOCATES AND PEOPLE NAVIGATORS, PEOPLE ON THE GROUND, TOGETHER WITH SCIENTISTS, AND ALTHOUGH SKEPTICAL AT FIRST, I SEE THAT SHE MAKES IT WORK. SO THE LEVEL OF SCIENTIFIC PRESENTATIONS IS HIGH ENOUGH TO MAKE IT INTERESTING FOR SCIENTISTS TO ATTEND, AS WELL AS ENOUGH ACTIVITIES AND WORKSHOPS AND SORT OF HANDS-ON SESSIONS WITH SCIENTISTS AND COMMUNITY ADD VIDEO -- ADVOCATES TO MAKE IT RELEVANT TO THE COMMUNITY ADD VIDEO CATS. SO I THINK IT'S -- ADVOCATE TION. SO I THINK IT'S A REAL SUCCESSFUL MODEL TO EMULATE IN OTHER SETTINGS. FINALLY, I WENT TO A COUPLE OF NIA WORKSHOPS INCLUDING ONE ON FUNCTIONAL IMPAIRMENT WHERE I CHAIRED A PANEL ON DISPARITIES. IT'S AN INTERESTING AREA, YOU KNOW, THE NATIONAL -- NIA DOESN'T HAVE A PARTICULAR DISEASE, ALTHOUGH THEY'RE HEAVILY FOCUSED NOW ON ALZHEIMER'S, FOR OBVIOUS REASONS, BUT THEY HAVE A LOT OF THE CROSS-CUTTING ISSUES THAT WE FACE, THEY'RE HEAVY ON THE BEHAVIORAL, SOCIAL SCIENCES, AND IN THE CLINICAL WORLD, THE RESEARCH THAT INCORPORATES MINORITY HEALTH AND HEALTH DISPARITIES IN THE AGING ARENA IS REALLY QUITE SPARSE, BOTH FROM, YOU KNOW, THERE IS SOME EPIDEMIOLOGY ON AGING THAT WOULD INDICATE SOME INTERESTING OBSERVATIONS, BUT THE IDEA OF HOW DO YOU INCORPORATE AND W HE IS AVE IN ALL THE ISSUES OF MINORITY HEALTH AND HEALTH DISPARITIES INTO WHAT IS DONE IN GERIATRIC RESEARCH OR AGING RESEARCH IS NOT SO CLEAR ACCIDENT EVEN THOUGH I WAS INVOLVED WITH NIA FOR A NUMBER OF YEARS IN MY PRIOR LIFE AT UCSF. A FEW UPDATES ON OUR STAFF. MOST OF THESE ARE AROUND THE INTRAMURAL PROGRAM. MICHELLE EVANS, WHO IS AN NIA INVESTIGATOR AND ACTUALLY A MEDICAL ONCOLOGIST, DEPUTY SCIENTIFIC DIRECTOR AT NIA'S INTRAMURAL RESEARCH PROGRAM IS FORMALLY NOW ADJUNCT INVESTIGATOR OF NIHD. PART OF OUR STRATEGY OF NIHD INTRAMURAL PROGRAM IS TO BUILD A NETWORK OF LIKE MINDED INVESTIGATORS AT NIH WHO ARE BASED AT OTHER INSTITUTES BUT WILL CONTINUE TO BE COLLABORATIVE WITH OUR INTRAMURAL PROGRAM AS WE BUILD IT. MICHELLE LEADS A STUDY CALLED THE HANDLE STUDY, WHICH IS A COMPARISON OF AFRICAN AMERICAN AND WHITE RESIDENTS IN BALTIMORE RECRUITED FROM DIFFERENT NEIGHBORHOODS, SO MORE WORKING CLASS NEIGHBORHOODS TO MORE MIDDLE CLASS NEIGHBORHOODS, AND THE EVALUATION OF LONGITUDINAL EVALUATION OF BOTH BIOLOGICAL FACTORS AS WELL AS SOCIAL DETERMINANTS IN THIS STUDY AND HAS MADE SOME IMPORTANT CONTRIBUTIONS TO OUR UNDERSTANDING OF RACIAL AND SOCIOECONOMIC STATUS DIFFERENCES. ANN SUMNER IS AN ENDOCRINOLOGIST BASED AT NIDDKD, APPROACHED ME IN COLLABORATING, SHE'S AN ADJUNCT INVESTIGATOR WITH NIMHD AS WELL AND ANN HAS A COHORT STUDY OF AFRICAN IMMIGRANTS IN THE WASHINGTON, D.C. AREA WHERE SHE'S LOOKING AT DIABETES ISSUES AND INTERESTINGLY THE PROFILE OF AFRICAN IMMIGRANTS, ALTHOUGH THEY'RE SMALL COMPARED IN NUMBER COMPARED TO OTHER IMMIGRANTS, HAS EVOLVED OVER TIME, WHEREAS IT USED TO BE SORT OF THE UPPER MIDDLE CLASS OR UPPER CLASS EDUCATED GROUP THAT WOULD SOMETIMES END UP IN THE U.S., IT'S NOW MUCH BROADER SOCIOECONOMIC SPECTRUM OF IMMIGRANTS. TIFFANY POWELL WILEY IS A CARDIOLOGIST IN NIHLBI, NOT TENURED TRACK APPOINTMENT YET, BUTTHEADED THAT WAY, INTERESTED IN COMMUNITY BASED RESEARCH, PRESENTED AT THE INTRAMURAL RESEARCH PROGRAMS SEMI NARP A COUPLE MONTHS AGO AND LOOKING AT NEIGHBORHOOD INFLUENCES ON THE DEVELOPMENT OF OBESITY, DIABETES, LOOKING AT OTHER THINGS LIKE NEIGHBORHOOD FACTORS AND WALKABILITY AND ACCESS TO HEALTHY FOOD. CHANDRA JACKSON WHOM I HAVE ONLY MET BY PHONE IS A NEWLY APPOINTED EARL STADTMAN INVESTIGATOR, THE NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES, I WAS ACTIVE WITH GARDNER IN RECRUITING HER AND SHE'LL BE ALSO AFFILIATED WITH NIMHD AND WILL I BELIEVE BE PRESENTING AT OUR INTRAMURAL SEMINAR AT THE END OF THE MONTH, WE'LL GET AN OPPORTUNITY TO GET TO MEET HER. HER AREA OF INTEREST IS AROUND SLEEP AS A MAJOR, MODIFIABLE CONTRIBUTOR TO RACIAL/ETHNIC DAIRTSZ AND I THINK IT SORT OF FITS IN WITH SOME OF THE INTERESTS THAT WE ARE BEGINNING TO GENERATE IN THAT AREA. FINALLY, DR. FASIL TEKOLA AYELE IS ALSO A STADTMAN INVESTIGATOR, HE HAD BEEN AS A GENOME SCIENTIST POST-DOC AND NOW HAS BEEN HIRED BY NICHD AND WE AGREED TO SUPPORT HIM AS WELL. HE'S ALSO NEWLY APPOINTED. SO AS YOU CAN SEE FROM THESE, OUR EFFORTS AT PROMOTING DIVERSITY OF THE SCIENTIFIC WORKFORCE INCLUDE THE INTRAMURAL RESEARCH PROGRAM. I WILL ADD THAT ACTUALLY BEGINNING TODAY, THERE'S ALSO, AND I'LL TALK ABOUT THIS NEXT TIME BECAUSE IT'S JUST STARTING TODAY, THE FUTURE LEADERS CONFERENCE IS HAPPENING HERE ON CAMPUS. THIS IS A PROGRAM THAT HANNA VALENTINE STARTED LAST YEAR WHERE SHE REQUESTS NOMINATIONS AND APPLICATIONS OF WHAT SHE CALLS FUTURE LEADERS, SO THESE ARE SCIENTISTS, USUALLY ASSISTANT PROFESSORS OR POST DOCS AROUND THE COUNTRY TARGETING AGAIN UNDERREPRESENTED MINORITIES WITH THE IDEA OF BRINGING INTO NIH FOR TWO OR THREE DAYS TO HAVE THE SCIENTIFIC DIRECTORS AT NIH BE EXPOSED TO THEM SO THAT POTENTIALLY THEY WILL RECRUIT ONE OF THEM, TO COME AND BE IN THE INTRAMURAL PROGRAM HERE, AS WELL AS I THINK NEXT YEAR HANNA WILL START TO MAKE IT MORE FOCUSED ON EXTRAMURAL SO THAT WILL BRING SCIENTISTS HERE TO HAVE THEM BE EXPOSED TO NIH SO THEY'LL BECOME BETTER SCIENTISTS AND GETTING GRAN, ET CETERA. WE, MEANING KEVIN GARDNER AND I, REVIEWED THE LIST THAT HANNA PROVIDED US, WE RANKED THEM AND NOMINATED A CERTAIN NUMBER OF PEOPLE. I THINK THERE ARE FOUR OR FIVE YOUNG SCIENTISTS THAT WE RECOMMENDED THAT ARE HERE, SHOULD BE HERE AND WILL BE PRESENTING THIS AFTERNOON IF ANYBODY IS INTERESTED, THEY'LL BE OVER IN THE CLINICAL CENTER PRESENTING THEIR RESEARCH IN TEN-MINUTE SESSIONS EACH AT 4:00 IN THE SO RT OF HEALTH DISPARITIES AREA, INCLUDING SOMEONE FROM UT SOUTHWESTERN, UNIVERSITY OF OREGON, SOMEONE FROM NEW YORK AND ONE FROM THE SOUTHEAST, AND I DON'T REMEMBER ALL THE INSTITUTIONS, BUT MORE ON THAT NEXT TIME. THERE'S ALSO BEEN EFFORT TO BRING IN POST-BACS, I THINK THE POST-BAC POSTER DAY WAS HELD EARLIER THIS SUMMER, IT'S ORGANIZED BY NIH AND I THINK IT GIVES AN OPPORTUNITY TO BRING ALONG INTERESTED -- IN THE PIPELINE, SCIENTISTS WHO ARE POTENTIALLY INTERESTED IN PURSUING YOUNG PEOPLE PURSUING A CAREER IN SCIENCE. THE SUMMER INTERNS ALSO, KELVIN CHOI IN PARTICULAR HAS BEEN ABLE TO PROVIDE TRAINING OPPORTUNITIES FOR SUMMER INTERNS, AS OUR STADTMAN INVESTIGATOR AT NIMHD AS YOU CAN SEE ON THIS PHOTOOWE ON ON THE POSTER DAYS PRESENTING THEIR WORK. KEVIN IS VERY ACTIVE IN DOING RESEARCH ON TOBACCO, AND HE WAS IN PRESENTING AT AN EPIDEMIOLOGY CONGRESS OF THE AMERICAS IN JUNE ALONG WITH SHARON JACKSON, AND PRESENTING HER RESEARCH ON INFLAMMATION AND DIABETES, AND THEN LAUREN AMABLE WHO IS A SPECIALIST IN METALS ALSO PRESENTED AT A WEBINAR THAT WAS ATTENDED BY 700 PEOPLE FROM DIFFERENT, 74 DIFFERENT COUNTRIES. SPENDING A YEAR HERE AT NIH, STARTING IN JULY, IS DR. JEAN NEPO UTUMATWISHIMA, IF I SAID THAT RIGHT, WHO IS AN INTERESTING MAN WHO IS ACTUALLY A GENERAL SURGEON FROM RWANDA WHO LEARNED TO BE A NECK SURGEON FROM A CUBAN SURGEON WHO SPENT A YEAR IN AFRICA AND TAUGHT HIM HOW TO DO OPERATIONS ON THE THYROID, PARTICULARLY AROUND GOITERS, WHICH IS VERY PREVALENT IN THAT PART OF THE WORLD, AND HE APPLIED AND WAS RECOMMENDED BY THE RWANDAN MINISTRY OF HEALTH AS A VISITING SCIENTIST, AS AN ADJUNCT INVESTIGATOR, HE'S ACTUALLY LIKE A POST DOC EQUIVALENT WORKING WITH ANNE SUMNER ON HER AFRICAN I AM GRABT STUDY, AND HE'S A DELIGHTFUL PERSON WHO HAS DONE REMARKABLE WORK. HE WAS DREK TOFER A HOSPITAL IN SEMI RURAL AREA OF RWANDA AND WAS ABLE TO ESSENTIALLY ELIMINATE THE TRANSMISSION OF HIV IN THAT HOSPITAL BY IMPLEMENTING A PROGRAM, SO WE'RE DELIGHTED TO HAVE HIM AROUND FOR THIS YEAR. A FEW NOTEWORTHY PUBLICATIONS. SHARINE EL-TOUKHY ALONG WITH KEVIN PUBLISHED A PAPER ON NICOTINE RESEARCH, TOBACCO USE AMONG U.S. YOUTH TOBACCO USERS. I WAS ASKED TO WRITE AN EDITORIAL ON A PAPER PUBLISHED BY A GROUP FROM MICHIGAN, AND ROSARIO HELPED ME TALK ABOUT NEIGHBORHOODS GOOD FOR YOUR HEALTH IN THE JOURNAL CIRCULATION. THEN THERE WAS A GROUP PUBLICATION THAT ZHANG X WAS CO-AUTHOR ON, TRANSLATIONAL RESEARCH TO ADDRESS HEALTH INEQUITIES AND WE'RE WORKING ON ANOTHER PAPER THAT ZHANG X IS WORK OG RELATING TO BIG DATA IN HEALTH DISPARITIES AND SUMNER HAS PUBLISHED A PAPER ON ALLOSTALT I CAN LOAD WHICH IS CONCEPTUALLY A BIOLOGICAL CONSTRUCT PULLED TOGETHER FROM DIFFERENT MEASURES TO TRY AND REFLECT A SORT OF RISK IN THE PATHWAYS TO CARDIOVASCULAR ENDPOINTS, COULD BE A REFLECTION OF STRESS OF DIFFERENT KINDS, AND AS A CONSEQUENCE OF COLLABORATION WITH MARIANA STERN, DAS AND I, REVIEWED A PAPER ON OUTCOMES WITHIN U.S. LATINOS BY NATIONAL ORIGIN AND GENETIC ANCESTRY AND GOT US MORE INTERESTED IN LOOKING AT ISSUES AROUND LIVER CANCER, SO YOU'LL HEAR MORE ABOUT THAT LATER. SOME IMPORTANT ACHIEVEMENTS, LAUREN, WHO IS A STAFF SCIENTIST, WAS ACCEPTED INTO THE SOCIETY OF TOXICOLOGY. XINZHI WAS RECENTLY PROMOTED FROM LIEUTENANT TO LIEUTENANT COMMANDER IN THE U.S. PUBLIC HEALTH SERVICE COMMISSIONED CORPS EFFECTIVE NEXT MONTH. I'M ESPECIALLY PROUD OF THE AWARDS RECEIVED BY STAFF AT THE NIH DIRECTORS AWARD HELD ON JULY 19. JESSICA ESCOBEDO, HEALTH SCIENCE POLICY ANALYST, RECEIVED 2016 DIRECTOR'S AWARD FOR SIGNIFICANT CONTRIBUTIONS TOWARDS DEVELOPING THE NIH-WIDE STRATEGIC PLAN THAT WAS PUBLISHED LAST DECEMBER, AND LIGIA ARTILES, A PROGRAM ANALYST IN THE EXTRAMURAL SCIENTIFIC PROGRAMS RECEIVED THE HARVEY J. BULLOCK AWARD FOR EQUITY, DIVERSITY AND INCLUPTION IN THE OFFICE OF EQUITY, DIVERSITY AND INCLUSION, AND I THINK THIS IS AN EXCEPTIONALLY IMPORTANT, GIVEN A VARIETY OF ISSUES AT NIMHD, AND HER EXCEPTIONAL VISION, DEDICATION AND LEADERSHIP IN LEADING THIS HAS BEEN HELPFUL FOR THE ENTIRE INSTITUTE AND PARTICULARLY HELPFUL FOR ME AS A NEW DIRECTOR A YEAR AGO. LET ME FINISH UP WITH SOME COMMENTS ABOUT OUR GRANTS. THESE ARE JUST A LIST OF SOME OF THE GRANTS THAT WE HAVE FUNDED SINCE JUNE 2016. YOU CAN PERUSE THIS IN TERMS OF RO1'S, THERE WAS A PARTICULAR GRANT ON FIREARM VIOLENCE, R21 GRANT, WE MENTIONED THE TRANSCOLLABORATIVE CENTERS ON PRECISION MEDICINE ON CHRONIC DISEASE. PEOPLE ASK WHAT WAS YOUR SUCCESS RATE, KEEP IN MIND OUR TOTAL N IS SMALL FOR THE YEAR. WE'RE SOMEWHERE IN THAT 25% SUCCESS, SLIGHTLY HIGHER FOR ESTABLISHED INVESTIGATORS COMPARED TO NEW OR EARLY STAGE INVESTIGATORS, BUT AGAIN, THE DENOMINATOR IS SMALL, SO AS THAT GROWS, WE WOULD EXPECT THAT SUCCESS RATE TO DROP SOME, ALTHOUGH WE ARE STILL VERY CONSCIOUS OF WANTING TO SUPPORT NEW SCIENTISTS IN PARTICULAR TOPICS THAT WE'RE INTERESTED IN AND SEEING ADVANCE. F31 IS ALSO FUNDED. WE HAVE THE SMALL BUSINESS TECHNOLOGIES GRANT, AND THEN TECHNOLOGY TRANSFER GRANTS. I THINK YOU ALL ARE FAMILIAR WITH THESE. I CONSOLIDATED THE RO1 AND R21, SO THE ENGAGING YOUTH AND YOUNG ADULTS FROM HEALTH DISPARITY POPULATIONS IN THE HIV TREATMENT CASS CASCADE THAT WAS PREVIOUSLY APPROVED BY COUNCIL WAS JUST RELEASED LAST WEEK, THIS IS A SET ASIDE, IT'S RFA, AIDS RESEARCH, LOOK FORWARD TO SEEING APPLICATIONS. SURGICAL DISPARITIES RESEARCH WAS PUBLISHED A LITTLE OVER A MONTH AGO, AS WELL AS THE SOCIAL EPIGENOMICS RESEARCH, THE LAST ONE ON THIS SLIDE, FOCUSED ON MINORITY HEALTH AND HEALTH DISPARITIES THAT CAME OUT IN EARLY JULY, BIG DATA TO KNOWLEDGE, ENHANCING DIVERSITY IN BIOMEDICAL RESEARCH WE'RE PART OF AND AND THE CRECD R25 PROGRAM THAT IS LINKED TO THE RCMI PROGRAM ALSO WAS PUBLISHED IN AUGUST, AND WE LOOK FORWARD TO THERE ARE A COUPLE MORE IN THE PIPELINE THAT ARE NOT WORKED THEIR WAY THROUGH THE GUIDE YET, AND THEN WE'LL BE HEARING SOME MORE CONCEPTS BEING PRESENTED A LITTLE LATER THIS MORNING. ONE OF YOU, I THINK IT WAS LINDA, RIGHT, YEAH, YOU ASKED ABOUT UPDATES ON SCIENCE AND DISPARITIES. I DIDN'T QUITE GET AROUND TO IT. BUT I'LL MAKE A COUPLE OF BROAD COMMENTS. ONE I GUESS WOULD BE DONNA GINTHER'S PAPER THAT I MENTIONED EARLIER. A SECOND ONE THAT I MAY HAVE MENTIONED LAST TIME IS THE JAMA PAPER PUBLISHED IN APRIL BY THE GROUP OF ECONOMISTS, CHEDY BEING THE FIRST AUTHOR, SHOWING THE ECONOMIC GRADIENT IN LIFE EXPECTANCY IN THE UNITED STATES WHERE YOU SEE THAT PEOPLE IN THE TOP 5% OF INCOME HAVE A 14-YEAR LIFE EXPECTANCY ADVANTAGE OVER THOSE IN THE BOTTOM 5% AMONG MEN AND ABOUT A 10-YEAR LIFE EXPECTANCY ADVANTAGE AMONG WOMEN, AGAIN REFLECTING THE BIOLOGICAL ADVANTAGE THAT WOMEN HAVE IN GENERAL COMPARED TO MEN IN TERMS OF MORTALITY. HOWEVER, EQUALLY INTERESTING TO ME WAS THE GEOGRAPHIC EFFECTS OF DIFFERENCES, WHERE YOU WOULD SEE THAT IN THE AREAS WITH THE BIGGEST GAPS, THE LOWEST QUARTILE OF SEF INDIVIDUALS ACTUALLY LIVED 4 TO 4½ YEARS LONGER IN CERTAIN URBAN AREAS, AND I'LL GIVE YOU A COUPLE EXAMPLES. BIRMINGHAM, ALABAMA, OR MANHATTAN OR SAN FRANCISCO, COMPARED TO MANY RURAL AREAS OR CERTAIN OTHER URBAN AREAS THAT DON'T DO AS WELL, SUCH AS DETROIT, AND I DON'T MEAN TO PICK ON THOSE PARTICULAR AREAS, JUST TO ILLUSTRATE. SO WHAT IS GOING ON THAT IS GOOD IN THESE AREAS WHERE THE POOREST, THE MOST VULNERABLE GROUP IN OUR SOCIETY ACTUALLY LIVE THREE TO FOUR YEARS LONGER COMPARED TO OTHER AREAS, AND I THINK THIS IS AN EMPHASIS ON THE IMPORTANCE OF PLACE THAT IS IN NEED OF SCIENTIFIC INQUIRY. ANOTHER PAPER THAT PROMPTED THIS SUGGESTION WAS IN THE NEW ENGLAND JOURNAL JUST LAST MONTH, I BELIEVE, AND IT WAS A SPECIAL ARTICLE ON THE GENETIC PROFILING OF HYPERTROPHIC CARDIOMYOPATHY, WHERE THE GENE PANEL THAT WAS DEVELOPED FOR THAT WAS INITIALLY USED, A SAMPLE OF INDIVIDUALS THAT WERE PREDOMINANTLY AFRICAN AMERICAN, AND THEREFORE, THEY INCLUDED GENES IN THAT PROFILE THAT WERE INADVERTENTLY PLACED AS HIGH-RISK GENES, WHEN THEY REALLY WERE JUST MARKERS OF BEING OF AFRICAN ANCESTRY. AND THEREFORE, WERE NOT REALLY RENDERING AN INCREASED RISK, AND HOW THIS ERROR HAD BEEN CONTINUED OVER YEARS. NOW, THIS IS ONE UNCOMMON, NOT TERRIBLY RARE DISEASE, BUT IMPORTANT ENOUGH BECAUSE PEOPLE DIE FROM SUDDEN DEATH AS A YOUNG ADULT IF YOU'RE NOT DIAGNOSED BECAUSE YOU DO GET THESE ELECTRICAL ABNORMALITIES AND YOU CAN DEVELOP MALIGNANT ARRHYTHMIAS AND HAVE SUDDEN DEATH, AND THERE HAVE BEEN SOME ATHLETES WHO HAVE SUFFERED FROM THIS AND DIED AND IT GETS NOTICED WHEN THIS HAPPENS. SO AGAIN, AN ILLUSTRATION OF WHY INCORPORATION OF RACE AND ETHNICITY AS WELL AS SOCIOECONOMIC STATUS AND THE OTHER CONCEPTS THAT WE HAVE SPENT SO MUCH TIME THINKING ABOUT OVER THE LAST 15, 20 YEARS IN THE SCIENCE OF MINORITY HEALTH AND HEALTH DISPARITIES IS SO IMPORTANT TO CONTINUE TO HOLD FRONT AND CENTER, NOT JUST BECAUSE OF OUR INTEREST OF OUR INSTITUTE, BUT BECAUSE OF SCIENTIFIC ADVANCEMENT AND KNOWLEDGE IN GENERAL, SO JUST I THINK I'LL TRY TO DO A LITTLE BIT MORE FOR THE NEXT COUNCIL ON THESE TOPICS. THESE ARE A COUPLE OF ARTICLES THAT PROGRAM SCIENTISTS SENT TO ME, THESE ARE NOTICEABLE FROM OUR GRANTEES, THIS CAME FROM CRUZ-CORREA IN PUERTO RICO, LOOKING AT NECK CIRCUMFERENCE. EVERYONE SHOULD GET WEIGHED WHEN THEY GO SEE THE DOCTOR SO YOU CAN DO A QUICK CALCULATION OF BMI AND IN FACT THE ELECTRONIC MEDICAL RECORDS AUTOMATICALLY CALCULATE IT FOR YOU IF YOU PROGRAM IT JUST SLIGHTLY, SO YOU CAN GO START FOCUSING ON THAT AS A RISK FACTOR. SKINFOLD TEST, I'M NOT SURE THAT WE CAN GET OUR MEDICAL ASSIST ANLTS TO DO THAT, BUT THAT MIGHT BE AN INTERESTING ONE. THE OTHER ONE HAS BEEN CIRCUMFERENCE, THE WAIST CIRCUMFERENCE, YOU HAVE TO MEASURE IT AT THE RIGHT PLACE IN ORDER TO GET THE RIGHT RISK, SO IT'S THE OLD APPLE/PEAR ISSUE. SO IF YOU GET MORE FAT DEPOSITS HERE, THAT'S BAD FAT, VERSUS OTHER PARTS OF THE BODY WHERE IT IS LESS BAD. AND THIS IS NECK. SO NECK CIRCUMFERENCE SEEMS A LITTLE EASIER, SO THAT WOULD BE INTERESTING. IF YOU MEASURE NECK CIRCUMFERENCE AS A RISK FACTOR, WOULD THAT BE BETTER THAN DOING PMI AND AT LEAST THIS DATA WOULD IMPLY THAT IT MAY BE AN ALTERNATIVE TO OTHER MORE CHALLENGING ANTHROPOMETRIC. THE NEXT THREE ARE ALL FOCUS ODD HIV-RELATED ISSUES. THIS IS RESEARCH FOR SGM YOUTH IN TERMS OF INFORMATION ABOUT PREVENTION AND UNDERSTANDING HEALTH BENEFITS AND SIDE EFFECTS OF USING PREP FOR PREVENTING HIV AND PREVENTING OTHER SEXUALLY TRANSMITTED INFECTIONS, ALTHOUGH IT WON'T PREVENT THOSE UNLESS YOU USE BARRIERS, AND I THINK THAT IT'S A RELEVANT ISSUE AROUND ATTITUDES AND BELIEFS ABOUT BEING STIGMATIZED OR BEHAVIORAL ISSUES AMONG YOUTH, AND WE LOOK FORWARD TO SEEING MORE OF THIS FUNDED. THIS IS BRIAN MUSTANSKI WHO LED THIS RESEARCH GROUP. RELATED TO STIGMA AND HIV INFECTION AMONG AFRICAN AMERICAN MEN IN THIS GRANT LED BY DR. BOGART AND LOOKED AT SOCIAL NETWORKS AND STIGMA AND HAVING SEX WITHOUT CONDOMS IN A SAMPLE OF 125 AFRICAN AMERICAN MEN WITH HIV IN THE LOS ANGELES AREA, AND THE ROLE OF SOCIAL NETWORKS AND WHAT THEY DO BOTH TO ENHANCE HEALTH AS WELL AS TO POTENTIALLY BE A VEHICLE FOR WORSE HEALTH OR WORSE HEALTH BEHAVIOR IN PARTICULAR I THINK ARE RELEVANT MECHANISMS THAT WE NEED TO -- >> PLEASE PARDON THE INTERRUPTION. YOUR CONFERENCE CONTAINS LESS THAN 3 PARTICIPANTS AT THIS TIME. IF YOU WOULD LIKE TO CONTINUE, PLEASE PRESS STAR 1. >> Dr. Eliseo Perez-Stable: FINA LLY THIS HIV AND VIELSZ RISK REDUCTION IN LATINAS, THIS IS FOCUSED ON, FROM THE GROUP IN MIAMI, THAT VICTORIA MITRANI LEEPPEDZ AT ONE OF OUR CENTERS OF EXCELLENCE, CULTURALLY TAILORED GROUP GROUP OF HIV RISK REDUCTION INTERVENTION FOR LATINAS THAT RUSMSED HIGH RISK HIV BEHAVIORS, LOOKED AT REDUCING LEVEL OF PARTNERS, OFTEN FUELED BY ALCOHOL INTOXICATION. >> PLEASE PARDON THE CO-INTERRUPTION. YOUR CONFERENCE CONTAINS LESS THAN 3 PARTICIPANTS AT THIS TIME. IF YOU WOULD LIKE TO CONTINUE, PRESS STAR 1 NOW OR THE CONFERENCE WILL BE TERMINATED. >> Dr. Eliseo Perez-Stable: OUR CONFERENCE IS TERMINATED. SO THAT IS THE END OF MY PRESENTATION. I THINK WE HAVE TIME FOR A FEW QUESTIONS, JOYCE, THEN I MADE A SLIGHT MODIFICATION IN THE SCHEDULE, I'LL ASK PRISCILLA TO DO HER PRESENTATION TO YOU AGAIN NOW, THEN WE'LL TAKE ABREAK BEFORE DR. COLLINS GETS HERE. THANK YOU FOR YOUR ATTENTION. [APPLAUSE] >> Ms. Priscilla Grant: THANK YOU FOR THAT REPORT. THAT WAS VERY COMPREHENSIVE. WHAT THE DELINEATION OF ADJUNCT INVESTIGATOR, WHAT DOES IT MEAN AND WHAT IS THE BENEFIT THAT COMES ALONG WITH IT? >> Dr. Eliseo Perez-Stable: SO THAT'S A GOOD QUESTION. THANK YOU. IT MEANS THAT WE ARE SUPPORTING THE SCIENTISTS, RIGHT NOW IN THE FORM OF FUNDING POST DOC WHERE WE HAVE USUALLY A TWO-YEAR COMMITMENT, TWO TO THREE YEARS AT THE MOST, WHICH IS RELATIVELY INEXPENSIVE, NOT PERMANENT, AND PROVIDES POTENTIAL FUTURE SCIENTISTS FOR EITHER NIH OR OUR ACADEMIC INSTITUTIONS, POTENTIALLY NIMHD, AND I THINK IT HELPS US BUILD A NETWORK WITHIN CAMPUS WHERE THE INTRAMURAL PROGRAM WAS DECIMATED BY BOTH THE TRAGIC DEATHS OF BOTH THE SCIENTIFIC DIRECTOR AND THE CLINICAL DIRECTOR SHORTLY AFTER DR. ROLFIN RETIRED ACCIDENT AS YOU MAY REMEMBER, AND DR. GARDNER WAS LEFT SORT OF AS AN ACTING INITIALLY DEPUTY, SCIENTIFIC DIRECTOR, AND THEN ACTING DIRECTOR, AND I ARRIVED AND HE SAID YOU CAN DO WHATEVER YOU WANT, YOU CAN GET RID OF ALL OF US OR YOU CAN -- YOU KNOW, BUT DO YOU WANT -- I MEAN, DR. COLLINS ASKED ME, DO YOU WANT ONE OR NOT, AND WHEN I FIGURED OUT WHAT WE COULD POTENTIALLY DO WITH IT, I SAID YES, I DEFINITELY WANT ONE, AND THE FIRST PLACE TO START IS TO RECRUIT A NEW DIRECTOR. SO I DON'T WANT TO MAKE TOO MANY SORT OF CHANGES WITHOUT HAVING A NEW DIRECTOR AND SHORTLY THEREAFTER HELP RECRUIT ANOTHER ESTABLISHED SCIENTIST TO BE FULLY NIMHD SCIENTISTS TO SEE WHAT KIND OF WORK WE WANT TO DO. AND HAVING PEOPLE LIKE MICHELLE AND LIKE ANNE AND LIKE CHARLES RUTIMI WHO IS IN GENOME BE AT LEAST RELATED TO US AND THEN I'VE HAD A NUMBER OF INTERESTING MEETINGS WITH FOLKS AT CANCER, YOU KNOW, THEY HAVE A HUGE PROGRAM, AND THEY DON'T HAVE ANYBODY WHO DOES LIKE DISPARITIES KIND OF STUFF, BUT THEY'RE VERY SUPPORTIVE OF THE KIND OF SCIENCE WE WANT TO DO. THIS IS THE POPULATION SCIENCE BRANCH OR DIVISION OF THEIR INTRAMURAL PROGRAM. SO I THINK THAT THAT'S A WAY TO SORT OF BUILD COMMUNITY AND TO BUILD A CRITICAL MASS. >> I AGREE. I THINK IT'S A GREAT WAY TO CREATE A PIPELINE. I HAVE A QUESTION, AND THIS IS MORE OF AN EDUCATION QUESTION FOR ME TO UNDERSTAND. IN THE NIH INTRAMURAL PROGRAM, IS THERE ANY REQUIREMENT OF THE COMMITMENT, ARE WE RECRUITING A PERSON FROM ALL OVER THE GLOBE, OR ARE THERE ANY REQUIREMENTS FOR PERMANENT RESIDENCY OR U.S. CITIZENS SUCH THAT THE DOLLARS THAT ARE BEING USED ARE SUPPORTING SCIENTISTS WHO COME FROM MULTIPLE DIFFERENT PLACES FROM THE UNITED STATES, OR IS IT OPEN GLOBALLY? >> Dr. Eliseo Perez-Stable: I DON'T KNOW ALL THOSE RULES. I THINK -- OPEN GLOBALLY? OKAY. YEAH. >> AND I ASK THAT QUESTION BECAUSE THAT'S WHAT I HAD HEARD, BUT I DON'T KNOW THAT FOR SURE. SO A LOT OF TIMES IT SEEMS LIKE WE ARE NOT, AGAIN, INVESTING SOME OF THE TAXPAYERS' DOLLARS TO SUPPORT SCIENTISTS WHO COME FROM THE MULTIPLE DEMOGRAPHIC REGIONS IN THE UNITED STATES, SO I HOPE THAT WE ARE GOING TO BE INTENTIONAL LIKE YOU ARE TO RECRUIT A PIPELINE OF PEOPLE SO THAT WE HAVE THE BREADTH AND DEPTH AND THE DIVERSITY OF DEMOGRAPHICS FOR PEOPLE WHO ARE COMING FROM MULTIPLE PLACES IN THE UNITED STATES TO RECEIVE TAXPAYERS' SUPPORT FOR THEIR INTRAMURAL RESEARCH. >> Dr. Eliseo Perez-Stable: I TOTALLY AGREE. YES? >> I GUESS I WAS STRUCK BY LOOKING AT THE NUMBERS OF GRANTS THAT THE INSTITUTE FUNDS AND ONE OF MY BIGGEST CONCERNS IS THAT IT SEEMS TO DISCOURAGE PEOPLE FROM APPLYING IF ONLY ONE IS GOING TO BE SELECTED FROM, I DON'T KNOW, 50 OR 100, SO I WONDER IF THERE WAS A WAY TO, IN BUILDING THE PIPELINE, CREATE SOME MECHANISM FOR LESS MONEY BUT MORE FUNDING, BECAUSE IF NOT, I WORRY THAT WE'RE NOT GOING TO HAVE A LOT OF PEOPLE APPLYING TO THE INSTITUTES IF THEY THINK SO MANY PEOPLE APPLY BUT ONLY ONE IS GETTING FUNDED AND WHETHER THERE'S A WAY TO DO SMALLER, A LOT OF SMALLER GRANTS, THAT PEOPLE CAN START THERE, AND IF THEY LOOK SUCCESSFUL, THEN WILL BE FUNDED FURTHERMORE. >> Dr. Eliseo Perez-Stable: I THINK THAT YOU'RE RIGHT AND THAT'S OUR PLAN. REMEMBER, THOSE ARE THREE-MONTH DATA THAT YOU SAW. OVERALL, EACH OF THE CYCLES WE'VE LOOKED AT, WE'VE GOTTEN ABOUT 50 OR SO GRANTS, I'LL LOOK OVER TO MAKE SURE I'M NOT OFF, 50 TO 60 GRANTS, ABOUT NOT QUITE HALF ARE SCORED, SO THINK IN TERMS OF ABOUT 25 TO 30 GRANTS THAT WE ARE CONSIDERING. SO OUT OF ABOUT 90 GRANTS, LET'S SAY, 80 TO 90 GRANTS OVER THE COURSE OF THE PAST FISCAL YEAR, WE'RE FUNDING ABOUT A QUARTER OF THOSE, SO 25%. THESE ARE RPG'S. SO I THINK OUR SUCCESS RATE ACTUALLY IS PRETTY GOOD BECAUSE IF YOU LOOK AT ALMOST ANY OTHER INSTITUTE, THEY'RE MORE LIKE IN THE TEENS. NCI IS PROBABLY CLOSE TO 10%, FOR EXAMPLE. SO I THINK -- BUT WE DON'T HAVE A WHOLE LOT COMING IN YET, AND THESE ARE -- MY GOAL IS TO INCREASE THAT NUMBER AND THEN TO BE ABLE TO GET THE BEST SCIENTISTS TO ACTUALLY THINK OF NIMHD AS A PLACE TO SEND GRANTS. WE HAD A PROGRAM ANNOUNCEMENT FOR THE HEALTH SERVICES RESEARCH, AND I THINK WE THERE WERE LIKE 30 APPLICATIONS THAT CAME IN FOR THAT. SO THAT'S ENCOURAGING. THAT WAS OUR FIRST PROGRAM ANNOUNCEMENT IN THIS RECENT NUMBER THAT WE PUT OUT. SO I THINK WE'RE ON THE SAME PAGE. THIS IS PART OF THE STRATEGY, AND HOPEFULLY WE'LL SEE WHERE THAT LEADS US. >> I JUST WANT TO APPLAUD YOU FOR GETTING OUT INTO THE LARGER WORLD TO PROMOTE NIMHD, NUMBER ONE, AND ESPECIALLY TO POTENTIALLY NEW RESEARCHERS, AND JUST GETTING BACK TO PIPELINE ISSUES, YOU KNOW, THE COURSE THAT'S PUT ON, YOU SAID YOU HAD ABOUT 500 APPLICANTS AND CHOSE ABOUT 50, IT SOUNDS LIKE, AND THAT NEXT TIER OF PEOPLE PROBABLY ARE THOSE WHO ARE DEEPLY INTERESTED IN HEALTH DISPARITIES RESEARCH, JUST DIDN'T QUITE MAKE THE CUT. ARE THERE ANYWAYS TO SORT OF KEEP THEM ENGAGED? BECAUSE YOU'VE GOT 500 PEOPLE THAT TOOK THE TIME TO PUT AN APPLICATION IN. IF YOU REALLY WANT TO KEEP THIS ENGORGED. AND THEN ESPECIALLY THAT GROUP OF FOLKS THAT YOU WORKED WITH AT THE AAMC AS YOU TRAVELED TO VARIOUS UNIVERSITIES AND THAT KIND OF THING, I THINK THIS IS VERY ENCOURAGING FROM THE STANDPOINT OF GETTING FOLKS INTERESTED IN THESE GRANTS. AND IF THEY CAN'T GET IT FUNDED THROUGH HERE, THEY SHOULD KNOW THAT THERE'S OTHER OPPORTUNITIES AT NIH AS WELL, SO THIS IS IMPORTANT TO JUST GET THEM ON THE RADAR SCREEN THINKING ABOUT APPLYING FOR RESEARCH GRANTS AND HEALTH DISPARITIES ESPECIALLY. >> Dr. Eliseo Perez-Stable: RIGH T. WELL, THANK YOU, EDDY. I THINK THAT, YEAH, WE SHOULD DO MORE WITH THE PEOPLE WHO ARE INTERESTED, AND I THINK A MATTER OF SETTING UP A MECHANISM WHERE WE CAN TRY TO TRACK PEOPLE WHO APPLY. RIGHT NOW IT WAS NOT SET UP FOR THAT, AND HOPEFULLY WE CAN FOLLOW THE 51 WHO DID GET ACCEPTED AND ATTENDED, BUT IN THE FUTURE THAT'S A GREAT SUGGESTION. I'M ENCOURAGED BY THE FACT THAT THERE WAS THAT MUCH INTEREST WHEN WE VERY SPECIFICALLY SAID WE DON'T WANT SENIOR PEOPLE, AND THIS IS NOT AN A TO Z LEARN ABOUT HEALTH DISPARITIES COURSE, LIKE WE HAD DONE IN THE PAST FOR TWO WEEKS. THIS WAS A MORE INTENSIVE, IN DEPTH FOR JUNIOR PEOPLE TO GET SOME SCIENTIFIC KNOWLEDGE BUT ALSO TO REALLY NETWORK AND LEARN WHAT NIH IS ABOUT AND GET THE EXPERIENCE, AND I THINK THE STAFF DID A GREAT JOB OF SETTING UP A VERY GOOD EXPERIENCE AND WE'LL SEE WHAT THE FORMAL EVALUATION SHOWS. AND ALSO THE FACT THAT, YOU KNOW, WITHOUT KNOWING THE NUMBERS IN FRONT OF ME, THE VAST MAJORITY OF PEOPLE WHO ATTENDED WERE CLEARLY FROM UNDERREPRESENTED MINORITY GROUPS OR AT LEAST MINORITIES. AND I DIDN'T MENTION IN MY PRESENTATION, BUT KAREN PARKER ALSO SUPPORTED OUR EFFORTS AND THERE WERE ABOUT FOUR OR FIVE SGM FOCUSED RESEARCHERS IN THE GROUP. SO I THINK, AGAIN, PARTNERING ACROSS THE INSTITUTE OR ACROSS THE AGENCY WILL BE HELPFUL. I SENT FRANCIS COLLINS THAT PHOTO JUST TO SAY HERE IS THE PEOPLE WE WERE ABLE TO BRING TO CAMPUS ABOUT DIVERSE FIEPG THE WORKFORCE -- DIVERSE FIEPG THE WORKFORCE. >> DO YOU HAVE A DIRECTORY OF ALL OF THEM AT SOME POINT, LIKE THEY COULD IN NAMORY, FOR EXAMPLE? PER PR ON THE AAMC, MARK DUVAY WAS THERE FOR SIX YEARS, HE'S NOW A PROVOST IN UT SOUTHWESTERN, SO I LOOK FORWARD TO CONTINUING TO WORK WITH AAMC HERE ON THE PHYSICIAN SIDE OF THINGS, AND THEY'RE RECRUITING, IN CASE YOU HAVE ANY NOMINATIONS FOR THAT POSITION TO REPLACE MARK, AND WE'LL CONTINUE TO WORK WITH THEM ON THESE ISSUES. >> WE HAD TWO STUDENTS FROM UCSC WHO WERE VERY IMPRESSED WITH THE SUMMER INSTITUTE AND HAD ATTENDED NIH TRAININGS FOR POST DOCS AND WERE ESPECIALLY PLEASED WITH THE SUMMER INSTITUTE AND VERY INSPIRED BY YOUR STATEMENT, SO OF THE 450 WHO DIDN'T GET IN, SOME OF THEM REAPPLIED. ONE OF OUR STUDENTS APPLIED FOR A THIRD TIME AND WAS HAPPY TO GET IN, BUT I RECOGNIZE THE IMPORTANCE OF FOLLOWING THOSE WITH HEALTH DISPARITIES INTERESTS. MY COMMENT HAS TO DO WITH WHAT ABOUT FOLLOW-UP ON THE SUMMER INSTITUTE STUDENTS FROM THE LAST FOUR YEARS? I TAUGHT A SECTION OF THE COURSE LAST YEAR, AND IN CONTINUING TO RECEIVE E-MAILS FROM STUDENTS LAST YEAR WHO ARE BEING DISCOURAGED BY THEIR INSTITUTES TO WORK ON HEALTH DISPARITIES AND DISCOURAGED, SO I DO THIS REMOTE COACHING BY E-MAIL WITH SOME OF THE SUMMER STUDENTS FROM LAST YEAR. ANOTHER CHALLENGE IS THE LIMITATION OF INSTITUTION SUPPORT FOR K GRANTS, ESPECIALLY IN FISCALLY CHALLENGED STATES LIKE THE UNIVERSITY OF CALIFORNIA, SO THERE'S A LOT OF RELUCTANCE TO SECURE A POSITION FOR A POST DOC, SO THEY'RE PURSUING RO3'S INSTEAD, AND IF THERE'S AN OPPORTUNITY TO EXPAND RESOURCES FOR RO3 POOL, THAT WOULD HELP FUND SOME OF OUR 51 AND THE 250 FROM THE PREVIOUS YEARS. >> Dr. Eliseo Perez-Stable: I DON'T THINK WE CAN DO ANYTHING ABOUT FOLLOWING UP THE PRIOR ATTENDEES, BUT FOR REASONS THAT I DON'T FULLY UNDERSTAND, THERE'S BEEN A HESITATION ON THE PART OF NIH TO DO MUCH INQUIRY OF PEOPLE WHO APPLY AND COLLECT DATA. THERE'S SOMETHING ABOUT YOU NEED PERMISSION FROM THE OFFICE OF MANAGEMENT AND BUDGET AND NOBODY WANTS TO DO THAT. SO IN REALITY, IT IS A LOST OPPORTUNITY TO EVALUATE THESE PROGRAMS. WHEN I WAS AT NIA COUNCIL, THEY SHOWED DATA ABOUT THE SUMMER INSTITUTE AT NIA, WHICH IS A PROGRAM THAT WE TRY TO -- I TRY TO INCORPORATE SOME OF THE COMPONENTS OF THAT TO THIS, AND THIS IS IN 2012, AND THEY HAD NO REAL DATA ON THE PARTICIPANTS BECAUSE THEY WEREN'T ALLOWED, THEY HAD NOT GOTTEN THE PERMISSION TO COLLECT DATA ON THEM. SO THE KIND OF THING THAT IS BASIC, YOU KNOW, EPIDEMIOLOGISTS OR CLINICIAN SCIENTIST YOU LOOK AT JUST TO COLLECT DATA OR EVEN HEALTHCARE PROFESSIONAL, EMR, YOU'VE GOT ALL THIS DATA, WE DON'T DO. SO I THINK WE NEED TO BREAK THAT BARRIER AND COLLECT DATA ON APPLICANTS AS WELL AS PARTICIPANTS AND GET FOLLOW-UP AND TRACK THEM. YOU CAN DO A LOT OF TRACKING NOW WITH PUBLIC DATA, SO WHETHER NIH REPORTER OR PUBMED TO SEE WHAT THEIR SUCCESS RATE IS, SO I THINK THIS IS A -- YOU KNOW, WE NEED TO DO THAT. SO I THINK YOUR SUGGESTION, I CAN'T COMMENT MORE ABOUT THE FUNDING OF UC K AWARDEE TION, THAT'S LIKE A WHOLE OTHER PROBLEM. >> SO ONE OF THE THINGS I WOULD SUGGEST IS THE IDEA OF NOT JUST NETWORKING BUT CONTINUING TO HAVE THOSE DISCUSSIONS AMONG THAT GROUP OVER TIME. WE RUN A PROJECT CALLED RAPID WHERE GLEN FLORES, PROFESSOR AND I, KIND OF MENTOR A GROUP OF YOUNG SCHOLARS THROUGHOUT A PROCESS, AND THAT GROUP HAS BEEN VERY EFFECTIVE GETTING K AWARDS, SO I THINK ONE OF THE OPPORTUNITIES IS ONCE YOU FIND WHO IS GOING TO BE POSSIBLY SUCCESSFUL AND THE FACT THAT THEY GET HERE, TO LET THEM GO AND NOT TO BE ORGANIZED IS REALLY A LOST OPPORTUNITY. I THINK THE IDEA, YOU KNOW, A FEW DOLLARS PUT INTO A NETWORK MENTORING PROGRAM COULD BE VERY SUCCESSFUL IN KEEPING THOSE INDIVIDUALS IN THE PIPELINE BECAUSE NOT INFREQUENTLY THEY GET TOLD, YOU KNOW, AS I WAS EARLY ON, YOU KNOW, DON'T DO DIVERSITY WORK. DO SOMETHING ELSE. AND MOREOVER, NOT INFREQUENTLY, THEY MAY BE THE ONLY ONE IN THEIR SCHOOL AND DEPARTMENT OF COLOR. SO I THINK, YOU KNOW, THE OPPORTUNITY TO NETWORK IS WAY BEYOND THE IDEA OF JUST GETTING TO KNOW SOMEBODY, BUT CREATING A NETWORK OF PEERS AND A NETWORK LINKED TO SENIOR FACULTY, AND THAT'S I THINK WHAT MAKES SUCCESSFUL INDIVIDUALS IN ACADEMIA. >> Dr. Eliseo Perez-Stable: THAT 'S A GREAT SUGGESTION AND I HOPE THE PROGRAM SCIENTISTS, I LOOK OVER AT LEE, I DIDN'T SEE JOAN, JOYCE, TO TAKE THESE IDEAS FOR NEXT YEAR BECAUSE I THINK WHAT I'M HEARING IS SAYING IF WE BRING THEM HERE, HAVE THEM NETWORK WITH EACH OTHER AND THEN CONTINUE TO NETWORK WITH THEM, THEY CAN BE LINKED TO OUR NIMHD STUFF, BUT ALSO I THINK I HEARD YOU SAY BASICALLY LINK THEM UP WITH A MENTOR. >> RIGHT. >> Dr. Eliseo Perez-Stable: WITH ONE OF US OR PREFERABLY ONE OF YOU WHO TAUGHT OR ANYBODY, ANY MENTOR VOLUNTEERS THAT WE MAY ORGANIZE TO SAY CAN YOU HELP THIS PERSON FROM UCSC, SO I THINK THAT'S SOMETHING, THAT'S A TASK THAT WE COULD LOOK TO SEE WHAT WE CAN DO. >> THE OTHER PART IS TO HELP MENTOR THEMSELVES, BECAUSE THEY CAN SUPPORT EACH OTHER WITH THE IDEA THAT SOMEBODY WENT THROUGH THE SAME THING, AND THAT IN ITSELF, I MEAN, WE CAN SAY AS A SENIOR MENTOR TO SOMEBODY, JUST KEEP AT T BUT IT'S SOMETIMES MUCH MORE EMPATHETIC TO HAVE SOMEBODY AT YOUR OWN LEVEL SAY, YOU KNOW, I WENT THROUGH THAT AND I WAS SUCCESSFUL, THIS IS WHAT YOU HAVE TO DO. >> LET'S NOT FORGET ALSO WE HAVE THE NATIONAL RESEARCH MENTORING, NRMN, NATIONAL RESEARCH MENTORING NETWORK THAT CONVENES AT DIFFERENT TIMES. I THINK WE'RE GETTING READY ON CONVENE AT WHATEVER THE MEETING IS IN OCTOBER, ONE OF THOSE BIG SCIENCE MEETINGS, BUT THAT WOULD BE ANOTHER GROUP WHERE WE ARE CREATING THOSE NETWORK MENTOR COHORTS AROUND THE NATION, SO WE COULD CONNECT WITH THEM. I ALSO HOPE, I KNOW THAT REV RFP FOR THE CRECD PROGRAM. ONE OF THE THINGS THAT -- AND I KNOW WE BROUGHT THIS UP AT PREVIOUS MEETINGS, THAT WHAT HAPPENS WITH THOSE PERSONS WHO AT THE INSTITUTION OF COURSE WE GIVE THEM PROTECTED TIME TO PARTICIPATE IN THAT PROGRAM FOR TWO YEARS, AND IT WAS REALLY FOCUSED ON TRYING TO GET MORE PHYSICIAN SCIENTISTS, IS THAT WHAT WE DON'T HAVE IS A PIPELINE BRIDGE FOR THEM TO CONTINUE THEIR RESEARCH AFTER THAT TWO-YEAR PROTECTED TIME, AND MANY OF THEM GO BACK INTO THE CLINICAL ARENA AND THEN OF COURSE BURDENED WITH THE CLINICAL ROLES THAT THEY REALLY HAD BEFORE THEY HAD THAT PROTECTED TIME, AND WE DON'T SEE THE RETURN ON INVESTMENT. SO I THINK AS WE REVIEW THOSE GRANTS, HOPEFULLY WE'RE GOING TO BE LOOKING FOR HOW ARE THEY GOING TO BRIDGE OR WHAT IS THAT CAREER DEVELOPMENT PLAN FOR THOSE INDIVIDUALS, AND LIKE YOU SAID, THE CONCERN IS THAT THERE ARE NOT THAT MANY OPPORTUNITIES TO APPLY FOR A K AWARD NEXT, BUT THERE OUGHT TO BE A STRUCTURED PLAN FOR THEIR CAREER DEVELOPMENT, AND I THINK THAT WE AS A COUNCIL AND THE NIH IN GENERAL ARE GOING TO HAVE TO DEVELOP MORE MECHANISMS TO SUPPORT PEOPLE DOING THOSE PERIODS WHERE WE'VE ALREADY MADE THIS INVESTMENT BECAUSE WE ARE LOSING THOSE CLINICIAN SCIENTISTS BECAUSE THEY GO BACK TO HAVING, YOU KNOW, TO DEVELOP AND PRODUCE THEIR RVU'S ONCE THAT PROTECTED TIME IS OVER. SO I WISH, I HOPE WE CAN THINK ABOUT A WAY TO BRIDGE. I DON'T KNOW IF WE DO IT IN ADMINISTRATIVE SUPPLEMENTS OR WE DO IT IN WHATEVER WAY TO SUPPORT PEOPLE AS THEY WERE APPLYING FOR THE K AWARD OR THE RO3 OR THE R21. >> Dr. Eliseo Perez-Stable: THE MECHANISM THAT IS THERE ALREADY AND UNDERUSED IS DIVERSITY SUPPLEMENTS, AND I THINK THAT WOULD BE USUALLY A TWO-YEAR BRIDGE TO A K AWARD. >> BUT YOU'VE GOT TO HAVE ENOUGH RO1'S AND U54'S AT YOUR INSTITUTIONS AND MOST LESS RESEARCH INTENSIVE INSTITUTIONS WE USE THOSE MINORITY SUPPLEMENTS TO SUPPORT OTHER PERSONS WHO ARE NOT IN THE CREATIVE PROGRAM OF THE MECHANISMS TO GROAM TO GROW OUR Ph.D. PROGRAMS AND OTHER THINGS SO I THINK WE HAVE TO HAVE A STRUCTURE, BECAUSE WE REALLY DO KNOW THAT WE SEE A HIGH DROPOFF FROM THE AWARDEES, THE INVESTIGATORS WHO GO BACK AND DO NOT EVER LAUNCH THEIR PHYSICIAN SCIENTIST, MAYBE WE CAN DO SOME FURTHER ANALYSIS OF THAT TO LOOK AND SEE WHAT THE DROPOFF RATE IS, AND I KNOW A COUPLE YEARS AGO WE DEFINITELY HAD A ROUNDTABLE DISCUSSION ABOUT WHAT MECHANISM SHOULD WE PUT IN PLACE TO SORT OF BRIDGE SO THEY'RE READY FOR A K OR AN R GRANT SO THAT THEY STILL HAVE THE PROTECT THE -- THE PREKED TIME TO DO THE -- THE PROTECTED TIME TO DO THE RESEARCH. OKAY. PRIS LARKS THEN WE'LL TAKE A BREAK -- PRISCILLA, THEN WE'LL TAKE A BREAK. >> Ms. Priscilla Grant: I'M GOING TO BRIEFLY OUTLINE THE STATEMENT OF UNDERSTANDING BETWEEN THE NIMHD AND COUNCIL AND HIGHLIGHT PARTS OF IT. THE STATEMENT IS IN YOUR FOLDER. IT SUMMARIZES OUR UNDERSTANDING WITH YOU ABOUT HOW OUR INTERACTIONS WILL PROCEED OVER THE NEXT YEAR. I WILL GO THROUGH IT IN THE ORDER THAT THE SECTIONS APPEAR IN THE DOCUMENT, WHICH IS WHY I WILL BE MENTIONING SOME SECTIONS THAT DON'T APPLY TO THE PARTICULAR GRANTS REVIEWED THIS ROUND. AFTER THE COUNCIL MEETING, IF YOU HAVE QUESTIONS, FEEL FREE TO CONTACT ME ABOUT THEM. MY CONTACT INFORMATION IS ON THE LAST SLIDE. TO HELP ACHIEVE THE GOALS OF THE INSTITUTE, THE 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. COUNCILMEMBERS SERVE AS A NATIONAL RESOURCE IN DEVELOPING, RECOMMENDING AND SETTING THE INSTITUTE'S POLICY AND RESEARCH PRIORITIES. ON OCCASION, SPECIAL WORKING GROUPS MAY BE FORMED BY OR 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, AND 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 MORE DETAIL IN THE STATEMENT. IN THE CLOSED SESSION, THERE IS SECONDARY REVIEW OF GRANT APPLICATIONS, THE STATEMENT PROVIDES MORE DETAILS ON THAT TOO. CERTAIN ACTIONS MUST BE CONSIDERED INDIVIDUALLY BY COUNCIL, AND WE BRING THEM TO YOUR ATTENTION AND NEEDED APPLY. TWO MOST IMPORTANT ARE CLEARANCE INITIATIVES IN THE OPEN SESSION AND SECONDARY REVIEW OF GRANT APPLICATIONS IN THE CLOSED SESSION. ACTIONS CONSIDERED INDIVIDUALLY INCLUDE PLANDZ FOR FUNDING UNDER RFA'S, APPLICATIONS OF HIGH OR LOW PROGRAM PRIORITY, APPLICATIONS FROM FOREIGN INSTITUTIONS WITHIN A FUNDABLE RANGE, SUMMARY STATEMENTS OF SPECIAL INTEREST OR NEEDING DISCUSSION OR ACTION, FOR EXAMPLE, IF SOME ASPECT OF THE SRG'S RECOMMENDATION HAS BEEN QUESTIONED, CO-FUNDING APPLICATIONS FOR WHICH OTHER IC'S HAVE PRIMARY RESPONSIBILITY, AND INVESTIGATOR-INITIATED APPLICATIONS OF PI'S RECEIVING OVER $1 MILLION DIRECT COST PER YEAR FROM ACTIVE NIH RPG AWARDS. THERE IS A SECTION ON REVIEW AND RESOLUTION OF APPEALS. RFA'S DON'T GENERALLY ALLOW APPEALS OF INITIAL PEER REVIEW. IF WE HAVE ANY IN THE FUTURE, ANY APPEALS OF THE REVIEW OF UNSOLICITED APPLICATIONS, WE WILL INFORM YOU. THE STATEMENT HAS A SECTION THAT LISTS ADMINISTRATIVE DECISIONS AND ACTIONS THAT DON'T REQUIRE COUNCIL RECOMMENDATION. THE ITEMS LISTED ON THIS SLIDE ARE EXAMPLES OF ACTIONS THAT WOULDN'T BE BROUGHT BEFORE COUNCIL SUCH AS CHANGE OF PI, CHANGE OF DOMESTIC INSTITUTION OR ADMINISTRATIVE SUPPLEMENTS FOR INCREASED COSTS WITHIN THE PREVIOUSLY PEER REVIEWED AND APPROVED SCOPE OF A FUNDED GRANT. A SECTION DESCRIBES THE OPTIONS AVAILABLE TO COUNCIL WHEN REVIEWING NOT GRA APPLICATIONS DURING -- GRANT APPLICATIONS DURING THE CLOSED SESSION. THE COUNCIL MAY NOT CHANGE THE SCORES ASSIGNED BY THE SRG. HERE ARE THE OPTIONS AVAILABLE, CONCURRENCE WITH THE SRG'S RECOMMENDATION, NONCONCURRENCE WITH THE SRG'S RECOMMENDATION 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 RECOMMENDATIONS IS PRESENTED. SUMMARY STATEMENTS NOT REQUIRING INDIVIDUAL DISCUSSION ARE TREATED A BLAQ. ANY COUNCILMEMBER MAY REQUEST THAT AN INDIVIDUAL SUMMARY STATEMENT BE DISCUSSED INDIVIDUALLY BY THE COUNCIL. THE EXPEDITED REVIEW PROCESS IS NOT MENTIONED ON THESE SLIDES BECAUSE IT DESCRIBES AN OPTIONAL PROCESS THAT DOESN'T APPLY TO THIS ROUNDS' APPLICATIONS. IF WE WERE TO FOLLOW THIS PROCESS IN THE FUTURE FOR CERTAIN APPLICATIONS, YOU WOULD BE PROVIDED WITH DETAILS IN ADVANCE. A SECTION DESCRIBES 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 ARE APPLICABLE TO THE PARTICULAR GRANTS AND ITEMS DISCUSSED AT THIS COUNCIL MEETING. HOWEVER, WE WILL 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 LISTED. ARE THERE ANY QUESTIONS? >> Dr. Eliseo Perez-Stable: SO THANK YOU, PRISCILLA. WE WILL NOW TAKE A BREAK AND RECONVENE FOR DR. COLLINS. ACTUALLY WE HAVE UNTIL 10:15 WHEN HE'S SCHEDULED TO COME, SO IF YOU -- SO YES, BE BACK BY MAYBE 5 MINUTES BEFORE IF YOU'RE GOING TO GO DOWNSTAIRS. THANK YOU. WE'RE REALLY HONORED AND PRIVILEGED TODAY TO HAVE DR. FRANCIS COLLINS PRESENT. HE NEEDS NO FORMAL INTRODUCTION, THE DIRECTOR OF THE NATIONAL INSTITUTES OF HEALTH WHO HAS DONE AN ENORMOUS AMOUNT OF SCIENTIFIC WORK IN HUMAN GENETICS. I DON'T KNOW IF EVERYONE KNOWS HIS INITIAL CLAIM TO FAME WAS THE DISCOVERY OF THE CYSTIC FIBROSIS GENE BACK IN THE DAYS WHEN THE TECHNIQUES WERE MUCH MORE LABORIOUS AND TEDIOUS, BEFORE HE CAME TO NIH TO LEAD THE HUMAN GENOME PROJECT, AND FRANCIS, I THINK, IS ONE OF THE REASONS I'M HERE, HAVING MET HIM A YEAR AND A HALF AGO, WHEN HE OFFERED ME THE JOB, RIGHT? BUT HE REALLY WAS CAPTIVATING AS AN INDIVIDUAL AND A LEADER. I THINK HE'S DONE A TREMENDOUS AMOUNT OF BUILD OF THE NIH AND ITS PUBLIC RELATIONS WITH THE GENERAL US PUBLIC AS WELL AS THE CONGRESSIONAL LEADERS AND DESERVES ALL THE CREDIT FOR OUR CURRENT POSITION IN GOVERNMENT. SO FRANCIS, WE WOULD LOVE TO HEAR YOU. [APPLAUSE] >> Dr. Francis Collins: SO APPARENTLY IT'S BEHIND HERE SOMEWHERE. MAYBE NOT. OKAY. THANK YOU, ELISEO, AND YES, I WILL TAKE CREDIT FOR THE FACT THAT YOU ARE HERE IN PART, ALTHOUGH A LOT OF OTHER PEOPLE HELPED WITH THAT ARM TWISTING, AND MAY I SAY I'M AWFULLY GLAD IT HAD THE OUTCOME THAT IT D I'LL SAY A LITTLE BIT MORE ABOUT THAT IN A MOMENT. IT'S REALLY WONDERFUL TO BE HERE WITH ALL OF YOU, WITH THIS DISTINGUISHED GROUP WHO TAKES YOUR TIME TO ADVISE US ABOUT A VERY CRITICAL AREA OF NIH RESEARCH, NAMELY, MINORITY HEALTH AND HEALTH DISPARITIES, AS MEMBERS OF THE ADVISORY COUNCIL, YOU CARRY A FAIR AMOUNT OF WEIGHT ON YOUR SHOULDERS ABOUT TRYING TO STEER US IN THE RIGHT DIRECTION AT A TIME WHERE RESOURCES ARE TIGHT BUT OPPORTUNITIES ARE GREATER THAN THE RESOURCES, AND THAT MEANS WE HAVE TO FIGURE OUT HOW TO SET PRIORITIES AND HOW TO MAKE THE BEST OF THE OPPORTUNITIES WE SEE IN FRONT OF US RIGHT NOW, WHICH ARE TRULY EXCITING AND UNPRECEDENTED. I THOUGHT WHAT I WOULD TRY TO DO IS COMING BEFORE YOU HERE THIS MORNING, IS TO SAY A LITTLE BIT FROM MY PERSPECTIVE AS NIH DIRECTOR ABOUT THIS WHOLE AREA OF PRIORITY SETTING AND A FEW EXAMPLES OF THINGS THAT WE HAVE HIGHLIGHTED AS BEING PARTICULARLY COMPELLING, AND I'LL PICK A FEW FROM YOUR OWN PORTFOLIO, BUT HOPEFULLY ALSO HAVE A CHANCE TO ANSWER SOME OF YOUR QUESTIONS. SO YOU KNOW THE HISTORY OF THIS ORGANIZATION, WITH THE OFFICE BEING ESTABLISHED IN 1990 WITH JOHN RUFFIN AS THE DIRECTOR, THAT THEN BEING CONVERTED TO A CENTER IN 2000 AND AN INSTITUTE IN 2010 AS PART OF THE AFFORDABLE CARE ACT, ALL OF THESE WITH JOHN RUFFIN OVERSEEING THE EFFORT, BUT THEN HIS RETIREMENT HAPPENING TWO YEARS AGO, LEAVING ALL OF US TO REALIZE OH, MY GOSH, WE HAVE TO FIND A LEADER FOR THIS NEXT PHASE AND THIS INTENSE NATIONAL SEARCH GOT UNDERWAY AND I AM, AS I SAID A MINUTE AGO, DELIGHTED THAT WE WERE SUCCESSFULLY ABLE TO BRING SUCH A DISTINGUISHED LEADER AND SCIENTIST AS DR. PEREZ-STABLE TO COME AND JOIN US, AND HE HAS CERTAINLY IN JUST A YEAR OF BEING HERE VERY MUCH BROUGHT MANY OF HIS COLLEAGUES INTO AN EXCITING SPACE HERE IN TERMS OF COLLABORATIVE OPPORTUNITIES. WHEN WE GATHER AROUND THE TABLE ON THURSDAY, ALL THE 27 INSTITUTE AND CENTER DIRECTORS, ELIS HE IS O HAS BECOME A -- ELISEO HAS BECOME A REALLY IMPORTANT VOICE AT THAT TABLE AND ALL THOSE OTHER 26 CENTER DIRECTORS ARE WORKING HARD IN WAYS TO COLLABORATE WITH NIMHD WHICH IS CRITICAL BECAUSE AS YOU KNOW NIH FUNDING FOR HEALTH DISPARITIES RESEARCH GOES WELL BEYOND NIMHD BUT NIMHD IS A HUB FOR THAT KIND OF ACTIVITY AND IT'S REALLY IMPORTANT TO HAVE A DIRECTOR SERVING TO MAKE THAT HUB THE BEST IT CAN BE. I DON'T KNOW IF YOU SAW THE PROFILE IN THE WASHINGTON POST ABOUT ELISEO THAT REVEALED SOME THINGS I DIDN'T KNOW ABOUT HIM IN TERMS OF EARLY EXPERIENCES WITH CHICKENPOX AND NOT EXACTLY HAVING A GREAT TIME IN PUBLIC SCHOOLS WHEN HE CAME TO THE U.S. NOT SPEAKING ENGLISH AND CERTAINLY GAVE HIM A SENSE OF WHAT LOTS OF OTHER PEOPLE CONTINUE TO GO THROUGH IN SIMILAR STATES. SO HE HAS A PERSONAL STORY THAT IS INCREDIBLY COMPELLING, AS WELL AS BEING A HIGHLY DISTINGUISHED AND RECOGNIZED RESEARCHER FROM ALL THE WORK HE DID AT UC SAN FRANCISCO AND AS A DIVISION CHIEF OF GENERAL MEDICINE. AND I THINK HIS QUOTE HERE CERTAINLY IS APT HERE IN TERMS OF SHAPING THE FIELD AND PROMOTE EGG THE DEVELOPMENT OF THE NEXT GENERATION IN MINORITY HEALTH AND HEALTH DISPARITIES AND THAT'S VERY MUCH WHAT A DIRECTOR NEEDS TO DO, CERTAINLY SURVEY WHAT WE HAVE DONE AND WHAT WE'RE DOING BUT THINK A LOT ABOUT WHERE WE'RE GOING AND I KNOW YOU'RE HAVING THIS VISIONING PROCESS AMONG THE COUNCIL, AND THIS IS A GREAT TIME FOR THAT, AND YOU HAVE A GREATER LEADER TO LEAD YOU THROUGH IT. I WANT TO GIVE CREDIT TO THE NIMHD STAFF, REMARKABLY DEDICATED GROUP OF PEOPLE WHO HAVE A VERY CHALLENGING SET OF AGENDA ITEMS IN FRONT OF THEM EVERY DAY AND WHO COLLECTIVELY ARE I THINK SEEN AS FOLKS THAT REALLY HAVE THE VISION, HAVE THE PERCEPTION, HAVE THE PASSION TO MAKE THIS PARTICULAR PART OF NIH'S FUTURE EVEN BETTER THAN IT COULD BE WITHOUT THE TALENT ENGAGED IN LEADING THAT EFFORT. ALSO POINT OUT YOU HAVE SOME OTHER ALLIES, SOME OF THEM PROBABLY QUITE FAMILIAR, I THOUGHT I WOULD MENTION A COUPLE NEW ONES. WE JUST ESTABLISH THE NIH TRIBAL HEALTH RESEARCH OFFICE JUST A YEAR AGO TO COORDINATE TRIBAL HEALTH RESEARCH ACROSS NIH'S 27 RESEARCH INSTITUTES AND CENTERS, OBVIOUSLY WITH MUCH OF A STRONG CONNECTION HERE WITH NIMHD, WE HAVE NOW AN NIH TRIBAL CONSULTATION ADVISORY COMMITTEE, IN FACT, THEY'RE MEETING THIS WEEK AND I'LL BE SPEAKING TO THEM LATER IN THE WEEK, ELICITING AS TRIBES OFTEN INSIST WE'RE NOT THAT GOOD AT, TRYING TO SEE IF WE CAN GET BETTER AT IT, IN TERMS OF LIFNG TO THEIR CONCERNS -- LISTENING TO THEIR CONCERNS, WHICH ARE SUBSTANTIVE ABOUT THE WAYS IN WHICH MEDICAL RESEARCH AFFECTS THEIR COMMUNITIES, AND ALSO JUST THIS PAST YEAR, ESTABLISHED IN BUILDING 19 DIRECTOR'S OFFICE, THIS NEW OFFICE CALLED SEXUAL AND GENDER MINORITY RESEARCH OFFICE, SGMRO, TO COORDINATE SEXUAL AND JESHED MINORITY RELATED RESEARCH ACROSS NIH RECOGNIZING BASED ON THE OIM REPORT AND A NUMBER OF OTHER AREAS THAT THIS IS SOMETHING WE NEED TO PAY PARTICULAR ATTENTION TO THIS, DIRECTOR HAS BEEN PIENLTED, KAREN PARKER, Ph.D. AND SOCIAL WORKER TO BE THE INAWG ARTICLE DIRECTOR OF SGMRO. THEN THERE'S A PASSION OF PEOPLE AT NIH INCLUDING ME TO WORK HARD TO SEE WHAT WE CAN DO TO ENHANCE THE DIVERSITY OF THE BIOMEDICAL RESEARCH WORKFORCE. I JUST CAME FROM A MEETING WITH FUTURE RESEARCH LEADERS GATHERING HERE FOR THREE DAYS THIS WEEK FROM ALL OVER THE COUNTRY, THESE ARE INDIVIDUALS FROM UNDERREPRESENTED GROUPS WHO ARE ON A PATH TOWARDS BECOMING LEADERS IN BIOMEDICAL RESEARCH BUT WHO AS WE KNOW ARE SUBJECTED TO LOTS OF STRESSES, MAYBE ARE NOT IN THE PART OF THE COMMUNITY THAT OFFERS IDEAL MENTORING AND NETWORKING, AND WE'RE TRYING TO FIGURE OUT NEW WAYS TO PROVIDE THAT KIND OF SUPPORT AND ENCOURAGEMENT. HANNA VALENTINE, WHO I RECRUITED FROM STANFORD TO BE THE FIRST CHIEF OFFICER FOR SCIENTIFIC WORKFORCE DIVERSITY HAS INITIATED A WHOLE HOST OF EFFORTS HERE THAT WE ARE DETERMINED TO IMPLEMENT AND TO DO SO IN A WAY THAT IS SCIENTIFIC, BASICALLY COLLECTING DATA ABOUT WHETHER THESE KINDS OF PROGRAMS ARE HAVING THE EFFECT THAT WE WANT THEM TO. NIH OBVIOUSLY HAS FOR MANY YEARS, DECADES, TRIED TO DO THINGS THAT WOULD ENCOURAGE UNDERREPRESENTED GROUPS TO COME AND JOIN OUR WORKFORCE, BUT WE HAVEN'T ALWAYS BEEN AS STRINGENT AS WE SHOULD BE IN TERMS OF LOOKING UNFLINCHINGLY AT WHETHER THOSE PROGRAMS WERE WORKING AND TRYING TO EXPAND THE ONES THAT WERE AND BASICALLY LEARNING FROM THE ONES THAT DIDN'T AND NOT CONTINUING TO DO THINGS THAT WERE NOT SUCCESSFUL. THIS TIME WE'RE GOING TO BE VERY MUCH FOCUSED ON TRYING TO COLLECT THAT DATA AND ACTING ACCORDINGLY. THOSE ARE ALL PARTNERS THAT I JUST THOUGHT I WOULD MENTION THAT FIT INTO THIS VERY BROAD ARRAY OF ISSUES AFFECTING MINORITY HEALTH AND HEALTH DISPARITIES WITH NIMHD IN A CENTRAL ROLE ENCOURAGING ALL THE REST OF NIH TO BE EVEN BETTER THAN WE OTHERWISE COULD BE. BY THE WAY, HANNAH AND I WROTE THIS ESSAY IN PROCEEDINGS OF NATIONAL ACADEMY OF SCIENCES TRYING TO CAPTURE A LOT OF THE THOUGHTS ABOUT WHERE WE NEED TO GO AS WELL AS EMPHASIZING THE DIVERSITY AND SCIENTIFIC WORKFORCE IS NOT JUST A NICE IDEA, THE EVIDENCE IS VERY COMPELLING THAT THAT IS ALSO HOW MORE PRODUCTIVITY HAPPENS, THE TEAMS THAT ARE DIVERSE ARE SIMPLY BETTER THAN THOSE THAT RNLT -- ARE NOT AND WE THOUGHT IT WOULD BE GOOD TO HIGHLIGHT THAT DATA. TURNING TO HOW DO WE SET PRIORITIES, THAT'S CONSTANTLY AN AREA OF INTEREST TO ANYBODY WHO IS INVOLVED AT NIH AND CERTAINLY AN AREA OF INTEREST TO THE U.S. CONGRESS, THEY'RE CONSTANTLY INQUIRING OF US HOW IS IT THAT WE DECIDE HOW TO SPEND THOSE MONIES, CURRENTLY $32 BILLION A YEAR, HOW CAN WE ASSURE THEM THAT THIS IS GOING IN THE THAT IT'S GOING TO HAVE THE GREATEST IMPACT FOR THE AMERICAN PUBLIC ULTIMATELY, WHICH IS OUR GOAL. SO WE PUT TOGETHER LAST YEAR AN EFFORT TO ACTUALLY LAY OUT A STRATEGIC PLAN THAT WOULD DOCUMENT IN A WRITTEN FORM HOW WE ON AN ALMOST DAILY BASIS STRUGGLE TO TRY TO SET THOSE PRIORITIES, AND THIS WAS COMPLETED LAST DECEMBER. IF YOU HAVEN'T HAD A CHANCE TO LOOK AT THIS DOCUMENT, IT'S UP ON THE WEBSITE. IT'S ONLY ABOUT 50 PAGES LONG AND ABOUT HALF OF THAT IS ACTUALLY EXAMPLES OF EXCITING SCIENCE, SO THE DOCUMENT ITSELF IS QUITE DIGESTIBLE. I WANT TO GIVE A SHOUT OUT BECAUSE NIMHD WAS ONE OF THE MOST INVOLVED PLAYERS AS WE TRIED TO PULL ALL OF THE NIH LEADERSHIP TOGETHER TO TRY TO FIGURE OUT HOW TO PUT THE STRATEGIC PLAN TOGETHER. NIMHD WAS A KEY CONTRIBUTOR. YOU CAN SEE THE DIAGRAM HERE IS SORT OF THE OVERALL FORMAT IN WHICH THE STRATEGIC PLAN IS WRITTEN, BUT I PARTICULARLY WANT TO FOCUS ON THIS TRIO OF INTERSECTING AND INTERLOCKING AREAS OF BIOMEDICAL RESEARCH THAT WE TRIED TO EMPHASIZE NIH'S ROLE ALL THE WAY FROM FUNDAMENTAL SCIENCE TO TREATMENTS AND CURES, HEALTH PROMOTION, DISEASE PREVENTION, ALL OF WHICH WE'RE DEEPLY INVOLVED IN. SO LET'S MAYBE START WITH THE FUNDAMENTAL SCIENCE PART, AND AGAIN, I'LL TRY TO PICK VERY BRIEFLY BECAUSE I WANT TO HAVE TIME FOR CONVERSATION, AN EXAMPLE IN EACH OF THESE THAT PERHAPS SEEMS PARTICULARLY RELEVANT TO MINORITY HEALTH AND HEALTH DISPARITIES. FUNDAMENTAL SCIENCE IS AT A REMARKABLE PHASE RIGHT NOW, SO MANY THINGS BECOMING POSSIBLE. A LOT OF IT TECHNOLOGY DRIVEN, CERTAINLY GENOMICS BEING ONE OF THOSE THINGS BUT ALSO WHAT'S HAPPENING IN NEUROSCIENCE AND IMAGING, WHAT WE CAN DO WITH METABOLOMICS, A WHOLE HOST OF ADVANCES THAT I DIDN'T IMAGINE HAPPENING IN MY LIFETIME AND WHICH ARE NOW FINDING THEIR WAYS INTO LOTS OF LABS, THINGS LIKE CHRIS CASS, ALLOWING YOU TO EDIT THE GENOMES OF LOTS OF SPECIES. GENOMIC PROJECT WHICH I HAD THE PRIVILEGE OF LEADING AND PRODUCED THAT FIRST REFERENCE SEQUENCE IN 2003 HAS HAD ALL KINDS OF SPINOFFS IN TERMS OF OUR ABILITY TO UNDERSTAND WHAT ARE THE FACTORS THAT ARE INVOLVED IN HEALTH AND DISEASE AND PARTICULARLY TO IDENTIFY THOSE THAT ARE HERITABLE. A PARTICULAR PROJECT THAT I GOT INVOLVED IN AND JUST WANT TO MENTION HERE BECAUSE IT WOULD NOT HAVE HAPPENED WITHOUT NCMHD, WHICH IS WHAT IT WAS AT THE TIME. BACK IN 1996, RECOGNIZING THAT IF WE ARE REALLY GOING TO UNDERSTAND HEREDITARY FACTORS IN COMMON DISEASES LIKE DIABETES, THAT IT WOULD NOT BE A GOOD IDEA TO FOCUS SOLELY ON THE MAJORITY POPULATION IN THE U.S., MOST OF WHOM ARE EUROPEAN IN BACKGROUND, BUT WE REALLY NEEDED TO UNDERSTAND GENETIC DIVERSITY, WE NEEDED TO GO TO THE CRADLE OF HUMANITY, WHICH IS AFRICA. WE ARE ALL AFRICANS. WE ALL STARTED THERE. AND THAT'S WHERE THE GREATEST GENETIC DIVERSITY REMAINS. SO WORKING WITH CHARLES ROTIMI WHO WAS AT THAT TIME AT HOWARD AND DIABETOLOGIST IN NIGERIA AND GHANA WE PUT TOGETHER THIS PROGRAM AADM TO STUDY GENETICS OF TYPE 2 DIABETES AND THAT PROGRAM WAS THE FIRST TO ATTEMPT TO UTILIZE SOME OF THESE NEW DEVELOPMENTS IN GENETICS WHICH IN 1996 WERE STILL VERY LESS THAN MATURE IN ORDER TO TRY TO TACKLE A COMPLICATED SITUATION LIKE TYPE 2 DIABETES, AND THAT HAS GONE ON TO PRODUCE ALL KINDS OF INTERESTING RESULTS IN TERMS OF HOW THINGS ARE SIMILAR AND HOW THEY'RE DIFFERENT DEPENDING ON IF YOU LOOK IN AFRICA VERSUS, SAY, IN THE U.S. MIDWEST. THE HAPMAP PROJECT MOTHER THING THAT GOT INVOLVED, WE NEEDED TO UNDERSTAND THE CATALOG OF HUMAN GENETIC DIVERSITY, IT WAS VERY IMPORTANT THAT HAPMAP HAD SAMPLES AVAILABLE FROM OTHER PARTS OF THE WORLD, THIS LED THEM TO COLLECT SAMPLES FROM SUBSAHARAN RAFER CA, THIS IS A LOVELY PHOTOOL' OF A CHIEF IN NIGERIA CARRYING HIS MATERIALS TO A MEETING ABOUT HAPMAP TO UNDERSTAND THE REASONS TO PARTICIPATE OR NOT IN THIS PROJECT, THIS WAS VERY MUCH CONNECTED WITH AN ETHICAL AND LEGAL AND SOCIAL DISCUSSION, AND THOSE HAPMAP SAMPLES PRUSMSED THE FIRST REALLY RICH MAP OF GENETIC VARIATION WHICH HAS GONE ON TO BECOME EVEN DEEPER WITH THE 1,000 GENOMES PROJECT. AGAIN, RECOGNIZING THAT IF YOU WANT TO UNDERSTAND HEREDITY AND ITS GREATEST BREADTH AND DEPTH, YOU REALLY SHOULD GO TO AFRICA, BUILDING ON THOSE EXPERIENCES WITH AADM AND HAPMAP PUT TOGETHER WITH THE JOINT SUPPORT OF THE WELCOME TRUST, THE BRITISH CHARITY, A PROJECT CALLED HUMAN HEREDITY AND HEALTH IN AFRICA, H3AFRICA, WHICH AIMS TO LOOK AT HEREDITARY FACTORS IN BOTH COMMUNICABLE AND NONCOMMUNICABLE DISEASES AND HAS FUNDED NOW INSTITUTIONS, DIRECT GRANTEES, NOT AS SUB CONTRACTS, IN 13 COUNTRIES IN SUB SA HARN AFRICA LINKING THEM TOGETHER AS A NETWORK OF UNPRECEDENTED SORT WITH NOW MORE THAN 20,000 CLINICAL SPECIMENS HAVING BEEN OBTAINED. I JUST CAME BACK FROM TEN DAYS IN TANZANIA, KENYA AND UGANDA SEEING SOME OF THE CONSEQUENCES OF THIS PROJECT AS WELL AS OTHERS THAT NIH SUPPORTS, PARTICULARLY AMAZED TO SEE THE BIOBANK THAT IS NOW BUILT WITH H3AFRICA SUPPORT IN EWE UGANDA AND THE VERY IMPRESSIVE NUMBER OF YOUNG SCIENTISTS WHO WITH THIS KIND OF SUPPORT HAVE GATHERED IN THAT INSTITUTION WITH MANY GREAT IDEAS OF THE KIND OF SCIENCE THAT THEY WOULD LIKE TO DO AND THIS IDEA OF USING MODEST RESOURCES FROM NIH TO TRY TO BUILD RESEARCH CAPACITY IN SUBSAHARAN AFRICA HAS REACHED A POINT WHERE IT'S PRETTY EXCITING TO CONTEMPLATE WHAT MIGHT BE POSSIBLE AND WE IN THE WELCOME TRUST AND THE GATES FOUNDATION ARE NOW WORKING WITH THE WORLD ECONOMIC FORUM TO SEE WHAT WE COULD DO TO TRY TO FURTHER ACCELERATE THAT CAPACITY-BUILDING OPPORTUNITY. HERE ARE THE SUM OF THOSE CENTERS THAT ARE NOW SUPPORTED BY THE H3AFRICA NETWORK, AS YOU CAN SEE BY THE VARIOUS BLUE AND RED COLORS. SO THAT WAS JUST A SNAPSHOT OF FUNDAMENTAL SCIENCE. I COULD GO ON FOR AT LEAST A DAY ABOUT ALL THE THINGS THAT ARE HAPPENING IN THAT SPACE. HEALTH PROMOTION, DISEASE PREVENTION, OBVIOUSLY A CRITICAL AREA TO ATTEND TO WHEN IT COMES TO HEALTH DISPARITIES. M NIMED HAS MANY INVESTMENTS IN THAT SPACE, ONE INVESTIGATOR LOOK BE AT TRIPLE NEGATIVE BREAST CANCER WHICH WE DO UNDERSTAND SEEMS TO BE UNEVENLY DISTRIBUTED IN TERMS OF GROUPS, BEING PARTICULARLY COMMON IN AFRICAN AMERICAN WOMEN, AND A CLEAR NEED THEREFORE TO UNDERSTAND WHAT ARE THE INTERVENTIONS THAT WILL WORK IN THIS SUBSET, AND JILL BARGONETTI CARRYING OUT THIS WORK AND YOU CAN SEE THE PUBLICATION THAT CAME OUT AS A RESULT. HEALTH DISPARITIES AS IT RELATES TO ASTHMA, PICKING ANOTHER PAPER HERE FROM ESTEBAN BUSHBUSHARD AND HIS COLLEAGUES, SUSCEPTIBILITY AMONGST LATINOS. TREATMENTS IN CURES, OBVIOUSLY AN AREA THAT WE ALL WANT TO SEE FLOURISH AND AGAIN JUST PICKING AN EXAMPLE BECAUSE IT'S VERY MUCH IN THE PRESS RIGHT NOW IS THE CANCER MOONSHOT, PRESIDENT ANNOUNCING THIS LAST JANUARY IN THE STATE OF THE UNION ASKING VICE PRESIDENT BIDEN TO LEAD THE EFFORT. VICE PRESIDENT BIDEN WHO I HAVE NOW SPENT A LOT OF TIME WITH EVER SINCE THEN, AND HE'S A VERY PASSIONATE GUY GIVEN HIS OWN SON'S DEATH FROM A BRAIRN CANCER A LITTLE MORE THAN A YEAR AGO AND HIS DETERMINATION TO TRY TO SEE WHAT COULD BE DONE TO ACCELERATE PROGRESS HERE. THE PRESIDENT PROPOSED A SUBSTANTIAL INCREMENT IN FUNDING FOR CANCER RESEARCH IN FY17. DUG LOWY WHO IS THE ACTING DIRECTOR OF NCI AND I WROTE A BRIEF PIECE BACK IN APRIL IN TERMS OF WHAT THAT MIGHT LOOK LIKE IN TERMS OF THE SCIENTIFIC COMMUNITIES. THE CONGRESS HAS YET TO DECLARE THEMSELVES ABOUT WHAT THEY THINK MIGHT BE POSSIBLE IN FY17 FOR THIS OR ANYTHING ELSE, WE SORT OF WAIT WITH SOME ANXIETY TO SEE WHETHER THEY PASS A CONTINUING RESOLUTION THIS WEEK PERHAPS THAT WILL CARRY US THROUGH DECEMBER AND THEN REALLY DO SOMETHING IN DECEMBER AS FAR AS DEFINING WHAT OUR BUDGET WILL BE, BUT I AM GUARDEDLY OPTIMISTIC AT THIS PRESENT TIME THAT WE MAY SEE YET ANOTHER BUMPUP IN OUR BUDGET AS WE HAVE THIS YEAR GIVEN THE STRONG LEADERSHIP WE HAVE IN BOTH THE HOUSE AND THE SENATE. THE MOONSHOT HAD ITS SCIENTIFIC MOMENT, A PARTICULARLY IMPORTANT ONE JUST LAST WEEK WITH THE RELEASE OF A REPORT FROM THIS BLUE RIBBON PANEL OF SOME 28 EXPERTS THAT WE CONVENED TO TRY TO ASK THE QUESTION, WHAT WOULD YOU DO IF YOU REALLY PULLED OUT ALL THE STOPS TO ACCELERATE CANCER RESEARCH? THERE WAS A LOT OF COVERAGE OF THAT WHEN THAT REPORT CAME OUT, THEY MADE TEN RECOMMENDATIONS, I DON'T HAVE TIME TO GO THROUGH ALL OF THEM, BUT JUST TO MENTION A COUPLE, CANCER IMMUNOTHERAPY WHICH SEEMS TO BE SUCH AN AREA OF OPPORTUNITY THAT'S JUST EXPLODED WITH A IMRAD WAL RECOGNITION THAT YOU REALLY CAN GET THE IMMUNE SYSTEM ACTIVATED TO HELP ATTACK CANCERS THAT OTHERWISE ARE RESISTANT TO TREATMENT. BETTER IDEAS ABOUT HOW TO OVERCOME DRUG RESISTANCE, NEW CANCER TECHNOLOGIES LIKE SINGLE CELL ANALYSIS TO LOOK AT HETEROGENEITY AND VERY IMPORTANT WURCHES AGAIN, THIS IS NOT -- ONCE AGAIN, THIS IS NOT JUST ABOUT CURE, THIS IS ALSO ABOUT EARLY DETECTION, IF YOU READ THE LANGUAGE OF THIS, I WOULD ENCOURAGE YOU TO READ THIS REPORT, ALSO UP ON THE WEB, PARTICULAR FOCUS, IN FACT, THE FOCUS IS THROUGHOUT THESE TEN RECOMMENDATIONS ON HEALTH DISPARITIES, THE PANEL WAS VERY CLEAR THAT THEY WANTED THAT TO BE FRONT AND CENTER ARE IN EVERYTHING THAT THEY RECOMMENDED ABOUT THIS, RECOGNIZING THAT THIS IS A SERIOUS ISSUE THAT HAS BEEN UNDERATTENDED. SO ALL THOSE THINGS KIND OF CONNECTING TOGETHER, AND WE WANT THIS VIRTUOUS CIRCLE TO HAPPEN, I'LL GIVE YOU ONE OTHER EXAMPLE OF SOMETHING THAT'S GETTING UNDERWAY THAT'S OCCUPYING A LOT OF TIME FOR QUITE A FEW OF US, INCLUDING MYSELF AND BILL RILEY AND CERTAINLY A NEW DIRECTOR THAT WE HAVE BROUGHT TO LEAD IT, AND THAT'S IN THE AREA OF PRECISION MEDICINE. PRECISION MEDICINE IS A BROAD TERM, AND BASICALLY IT MEANS THIS EMERGING APPROACH FOR DISEASE TREATMENT AND PREVENTION THAT LOOKS AT INDIVIDUAL VARIABILITY, AND THAT'S NOT JUST ABOUT GENOMICS, ALTHOUGH GENOMICS IS IN THERE, IT'S AT LEAST AS IMPORTANT TO BE LOOKING AT ENVIRONMENT, AT LIFESTYLE, AT SOCIAL CIRCUMSTANCES, SOCIOECONOMIC FACTORS, STRESS AND SO ON, BUT TRYING TO MOVE AWAY FROM ONE-SIZE-FITS-ALL APPROACHES, WHICH IN MANY INSTANCES WAS THE BEST WE COULD DO, TO SOMETHING THAT WE MIGHT NOW BE ABLE TO DO THAT TAKES INTO ACCOUNT THOSE INDIVIDUAL DIFFERENCES IN ORDER TO FIGURE OUT ULTIMATELY HOW TO OFFER TO EACH PERSON THE BEST CHANCE OF A LONG HEALTH SPAN AS WELL AS A LONG LIFE SPAN. SO MANY ASPECTS OF PRECISION MEDICINE COULD BE COMMENTED ON. THE PRESIDENT OF THE UNITED STATES HAS BECOME INCREDIBLY INTERESTED IN THIS AND IS VERY MUCH DRIVING ALL THE REST OF US TO MOVE AS QUICKLY AS POSSIBLE TO TAKE ADVANTAGE OF THIS SCIENTIFIC MOMENT OF OPPORTUNITY, AND THE CONGRESS LIKEWISE HAS BECOME QUITE CONVINCED THAT WE ARE AT AN EXCEPTIONAL MOMENT HERE FOR TRYING TO MOVE FROM A ONE-SIZE-FITS-ALL TO THIS MORE INDIVIDUALIZED APPROACH. A PARTICULAR STRONG FLAGSHIP EFFORT IN THAT REGARD IS THIS PMI COHORT PROGRAM, AND THIS IS THE CORNERSTONE IN MANY WAYS OF ALL THE OTHER THINGS WE'RE DOING IN PRECISION MEDICINE. THIS IS AN INCREDIBLY AMBITIOUS RESEARCH PROJECT. IT IS A COHORT THAT INTENDS TO ENROLL 1 MILLION OR MORE VOLUNTEERS ACROSS THE UNITED STATES AND TO REFLECT THE BROAD DIVERSITY OF THE U.S. THIS IS NOT GOING TO BE A STATISTICAL SAMPLING BECAUSE THAT TURNS OUT TO BE INCREDIBLY SLOW AND EXPENSIVE, BUT IT IS INTENDED TO BE DIVERSE AND THEREFORE GENERALIZEABLE, I MEAN DIVERSE IN TERMS OF ETHNICITY, GEOGRAPHY, IN TERMS OF SOCIOECONOMIC STATUS, GENDER AND SO ON. IT DOES ALSO SET A TONE WHERE THE PARTICIPANTS ARE NOT PATIENTS, THEY'RE NOT SUBJECTS, THEY'RE PARTICIPANTS. THEY'RE PARTNERS. THEY'RE FULLY AT THE TABLE IN EVERYTHING THAT WE AIM TO DO IN MAKING DECISIONS ABOUT WHAT THIS STUDY INCLUDES. WE THEN ASK THEM AS PARTNERS TO MAKE AVAILABLE ELECTRONIC HEALTH RECORDS, TO MAKE A BLOOD SAMPLE AVAILABLE AND TO ANSWER A LOT OF QUESTIONNAIRES, AND FOR MANY OF THEM TO WEAR VARIOUS SENSORS THAT CAN TRACK WHAT'S HAPPENING TO THEIR HEALTH ON A MINUTE-BY-MINUTE BASIS. THE FULL DESIGN OF THIS IS STILL IN THE WORKS. ERIC DISHMAN WHO IS RECRUITED TO LEAD THIS FROM INTEL HAS BEEN WORKING INTENSELY WITH A WIDE VARIETY OF INSTITUTE STAFF TO TRY TO PUT THIS TOGETHER AND LAUNCH THE EFFORT BY SOMETIME LATER THIS CALENDAR YEAR, AND THAT'S NOT VERY FAR OFF. SO SOMETHING TO KEEP AN EYE ON, AND IF YOU'RE INTERESTED IN BEING PART OF THIS, YOU CAN GO TO THIS WEBSITE THAT YOU SEE AT THE BOTTOM OF THE SLIDE HERE AND KEEP TRACK OF WHERE WE ARE, AND THERE WILL BE AN OPPORTUNITY FOR ANYBODY IN THE U.S. WHO WANTS TO TAKE PART IN THIS TO RAISE THEIR HAND LATER ON THIS YEAR. VERY COMPLEX PLAN HERE IN TERMS OF HOW ENROLLMENT IS GOING TO HAPPEN, HOW THE DATA WILL BE COLLECTED, HOW THE DATABASE WILL BE HANDLED, THIS IS A BIG DATA ISSUE IF THERE EVER WAS ONE, A MILLION PEOPLE. WE THOUGHT FRAMINGHAM WAS BIG, THIS IS 40 TIMES THAT, AND IT WAS NOT DIVERSE, THIS IS GOING TO BE DIVERSE, AND I THINK THIS WILL BE THE MOST POWERFUL ENGINE FOR UNDERSTANDING A LOT OF ISSUES THAT WE STILL ONLY DIMLY CAN SEE IN TERMS OF HEALTH DISPARITIES, SO I HOPE THIS WILL BE SOMETHING THAT ALL OF YOU HERE ON THIS COUNCIL WILL TRACK CLOSELY AND FIGURE OUT WAYS TO MAKE THE BEST OF IT. THIS IS A PLATFORM UPON WHICH A WHOLE LOT OF RESEARCH QUESTIONS CAN BE POSED. SO THOSE ARE THINGS I WANTED TO TELL YOU ABOUT IN A FAIRLY QUICK AND SOMEWHAT CAPRICIOUS ROMP THROUGH WHAT IS AN ENORMOUS PORTFOLIO OF ACTIVITY IN AREAS OF MINORITY HEALTH AND HEALTH DISPARITIES. AGAIN, I'M GLAD TO BE HERE WITH YOU, AND I THINK I SHOULD STOP NOW AND SEE WHAT QUESTIONS YOU MIGHT HAVE FOR THE NIH DIRECTOR. SO THANK YOU. [APPLAUSE] ZEES INTRODUCE YOURSELF. >> HI, DR. COLLINS, THANK YOU VERY MUCH FOR THAT PRESENTATION. GREG TELEVERA, I'M AT THE SAN DIEGO STATE UNIVERSITY AND ALSO WITH SANEFRANDO HEALTH CEMETARY, ONE OF THE SIX CHOSEN TO BE PART OF THIS. ONE OF MY ROLES FOR THE COMMUNITY HEALTH CENTER IS COMMUNICATING THIS INITIATIVE TO OUR COMMUNITY AND I KNOW ONE OF THE BIG QUESTIONS THAT'S GOING TO COME UP IS WHAT ARE THE HEALTH CONDITIONS OR DISEASES OR TREATMENTS THAT YOU COULD PREDICT MIGHT BE FIRST UP ON THE LIST FOR THIS PROGRAM. >> Dr. Francis Collins: WELL, IT CERTAINLY WILL HAVE ITS GREATEST POWER FOR COMMON ILLNESSES BECAUSE WITH A MILLION PEOPLE, IF YOU HAVE A CONDITION LIKE DIABETES OR HYPERTENSION, HARLT DISEASE, COMMON CANCERS, YOU'RE GOING TO HAVE A VERY LARGE NUMBER OF PREVALENT AND THEN INCIDENT CASES, SO THE POWER OF THIS STUDY, OBVIOUSLY THE POWER IS ALWAYS IN SORT OF NUMBERS, WILL BE GREATEST IN THOSE CIRCUMSTANCES. FOR VERY RARE DISEASES, THIS MAY OR MAY NOT MAKE MUCH OF A CONTRIBUTION, EVEN IF A MILLION PEOPLE IF THE INCIDENCE OF THE DISEASE IS 1 IN 100,000, WELL, YOU'LL GET TEN CASES, SO RARE DISEASE RESEARCH I THINK WILL CONTINUE TO NEED FOCUS ON CASE CONTROL STUDIES THAT ARE SPECIFICALLY DESIGNED FOR THOSE DISEASES. MUCH OF THE ANSWER TO YOUR QUESTION I THINK REMAINS TO BE DEFINED. WE ARE OVER THE COURSE OF THE NEXT COUPLE THREE MONTHS GOING TO BE HAVING INDIVIDUAL GATHERINGS WITH INSTITUTE DIRECTORS TO SAY HOW DO YOU WANT TO USE THIS AMAZING RESOURCE AND ELISEO WILL BE A CRITICAL PART OF THOSE CONVERSATIONS. WHAT WOULD BE, JUST IMAGINE IT, THAT YOU HAVE A MILLION PEOPLE ALREADY SIGNED UP, YOU HAVE THEIR ELECTRONIC HEALTH RECORDS IN INTRAOPERABLE FORM, THAT'S A BIT OF A CHALLENGE OF COURSE BUT WE DREESM ON, AND WE'LL HAVE A BLOOD SPECIMEN WHICH IS GOING TO MAKE IT POSSIBLE TO LOOK AT VARIOUS BLOOD CHEMISTRIES, METABOLOMICS AND OF COURSE AS THE PRICE COMES DOWN, THE COMPLETE GENOME SEQUENCE OF ALL THESE PEOPLE AND THEIR PARTICIPATION AS PARTNERS, SO THEY EXPECT TO BE RECONTACTED, THEY'RE EXCITED ABOUT PARTICIPATION, THEY'RE GOING TO ANSWER QUESTIONS, WHAT WOULD YOU WANT TO SORT OF MAKE THE FIRST TEN STUDIES OF THIS PROGRAM LOOK LIKE? I'M NOT SURE I EXACTLY KNOW THE ANSWER, BUT I HOPE BY THREE OR FOUR MONTHS FROM NOW WE'LL HAVE A PRETTY GOOD LIST. >> JUST A COMMENT, REPRESENTING THIS INSTITUTE, I WOULD HOPE IT WOULD FOCUS ON DISPARITIES. >> Dr. Francis Collins: AND I TOTALLY AGREE. IF WE MISS THE BOAT ON DISPARITIES WITH THIS RESOURCE, WE HAVE REALLY BLOWN IT. SO IT'S GOING TO BE RIGHT UPFRONT. YES. >> DR. COLLINS, THANK YOU FOR YOUR EFFORTS ON DIVERSITY. I'M FERNANDO MENDOZA FROM STANFORD AND I'VE WORKED WITH HANNAH IN THE PAST. >> Dr. Francis Collins: SORRY WE STOLE HER FROM YOU, BUT WE DID. >> FINAL ANALYSIS, I'VE BEEN A DEAN AT STANFORD FOR 33 YEARS, WITH STUDENT AFFAIRS WITH MINORITY, AND YOU LOOK AT THE LAST THREE DECADES AND, YOU KNOW, GOING INTO MEDICAL SCHOOL, MINORITIES, THE PERCENTAGE HAS BEEN FLAT, IT'S BEEN FLAT IN FACULTY, IN EVERY AREA. THE QUESTION IS, AT THIS POINT IN TIME WITH THE DEMOGRAPHICS OF OUR SOCIETY THAT HAVE CHANGED TREMENDOUSLY, AND MINORITIES ARE NOW GOING TO BE THE MAJORITY, THAT'S GOING TO BE THE HUMAN CAPITAL THAT WE HAVE TO WORK TO PRODUCE THE NEXT CADRE OF SCIENTISTS. WHAT, IN YOUR THINKING, CAN WE DO DIFFERENTLY? ARE THERE WAYS TO PARTNER WITH OTHER GROUPS? ARE THERE WAYS TO REACH OUT FURTHER DOWN THE PIPELINE? BECAUSE I THINK IN THE FINAL ANALYSIS, TO ME, THIS IS GREAT SCIENCE, VERY EXCITING, A LOT OF OUR MINORITY COMMUNITIES HAVE YOUNG PEOPLE THAT WOULD BE VERY EXCITED ABOUT THIS, COULD DO A LOT TO CONTRIBUTE TO IT. THE QUESTION IS HOW DO WE GET THAT PROCESS DONE? >> Dr. Francis Collins: WELL, BELIEVE ME, THAT IS THE QUESTION, BECAUSE THE WAY THINGS CURRENTLY ARE IN TERMS OF THE RESEARCH WORKFORCE, WHICH IS NIH'S PRIMARY CONCERN, WE DO NOT SEE THAT ENTHUSIASM THAT MANY YOUNG PEOPLE HAVE BEING SUSTAINED FOR THOSE WHO COME FROM TYPICALLY UNDERREPRESENTED GROUPS. THEY FALL OFF ALONG THE WAY, LACK OF OPPORTUNITIES TO SEE WHY THIS WOULD BE A CAREER PATH, DISCOURAGING SORT OF FACTORS, LACK OF MENTORING AND NETWORKING, MAYBE AN UNFRIENDLY ENVIRONMENT THAT DOESN'T SEEM VERY WELCOMING TO PEOPLE OF DIFFERENT BACKGROUNDS. THIS IS ONE OF THE REASONS THAT WE PUT A LOT OF MONEY NOW INTO THIS PROGRAM CALLED BUILD, AND BUILD AIMS TO MAKE IT POSSIBLE FOR UNDERGRADUATES WHO HAVE SOME INTEREST IN SCIENCE, AND THERE'S A LOT OF INTEREST AT SORT OF THE FRESHMAN ENTRANCE LEVEL, TO HAVE A REAL EXPERIENCE IN A SCIENTIFIC PROJECT BECAUSE I THINK ANY OF US WHO TALK TO OUR COLLEAGUES ABOUT, WELL, WHAT WAS IT THAT GOT YOU EXCITED ABOUT SCIENCE AND MADE YOU THINK MAYBE THIS WAS THE CAREER YOU WANTED TO PURSUE? IT WAS HAVING THAT REAL EXPERIENCE, NOT IN A LECTURE HALL LISTENING TO SOMEBODY DRONE ON FROM A TEXTBOOK, BUT ACTUALLY BEING ABLE TO DO RESEARCH AND HAVE THAT MOMENT OF DISCOVERY HAPPEN. AND MANY OF THE PEOPLE THAT WE WOULD LOVE TO BRING INTO OUR WORKFORCE ARE NOT HAVING THOSE EXPERIENCES. MANY OF THEM ARE TRAINED IN UNIVERSITIES THAT ARE NOT THEMSELVES INTENSELY ENGAGED IN RESEARCH, SO THE OPPORTUNITIES ARE SOMEWHAT LIMITED. BUILD MAKES THE POSSIBILITY HAPPEN FOR MANY OF THOSE INDIVIDUALS TO HAVE SUCH AN EXPERIENCE BY PARTNERING THE UNIVERSITIES WHERE MANY OF THOSE STUDENTS ARE WITH OTHER PLACES THAT HAVE LOTS OF RESEARCH CAPABILITIES AND MAKING SURE THAT THIS CONNECTION HAPPENS AND ALSO PROVIDING AN EXTENSIVE MENTORING OPPORTUNITY THAT SOMETIMES WASN'T THERE EITHER. IT IS AN EXPERIMENT. WE'RE ONLY SORT OF TWO YEARS INTO THIS. IT'S NOT BEEN WITHOUT ITS CHALLENGES. VALERIE COULD ASSESS TO THOSE, HAVING HELPED US WITH MANY OF THE VARIOUS CHALLENGES AND ADVISING THAT WE'VE NEEDED. BUT I BELIEVE THIS IS AN UNTAPPED AREA OF TALENT THAT WE TRADITIONALLY LOSE AND MAYBE WE CAN ACTUALLY PULL A LOT OF THOSE FOLKS INTO A SPACE WHERE THIS REALLY SEEMS LIKE SOMETHING THAT THEMENT TO DO AND ARE PASSIONATE ABOUT DOING -- THAT THEY WANT TO DO AND ARE PASSIONATE ABOUT DOING AND WE'VE GIVEN THEM A CHANCE TO SEE WHAT THAT'S ALL ABOUT. >> THANK YOU, DR. COLLINS, FOR YOUR PRESENTATION. YOU KNOW, ONE OF THE THINGS I'VE ALWAYS ADD HIRED ABOUT YOU IS WHEN YOU WERE DOING THE EARLY GENOMIC WORK AND YOU RECOGNIZED YOU NEEDED TO GO WHERE THE MONEY WAS, SO YOU WENT TO AFRICA BECAUSE YOU UNDERSTOOD ANCESTRY AND YOU UNDERSTOOD REALLY WHAT THE DATA WAS SHOWING YOU, AND YOU WENT WHERE THE DATA WAS. AND WHAT I WOULD SAY FOR US IN ADDRESSING THE CONCERNS THAT WE HAVE ABOUT EDUCATING AND TRAINING THIS NEXT GENERATION, THAT WE REALLY WANT TO BE REFLECTIVE OF THE CHANGE IN DEMOGRAPHICS IN THE NATION. YOU KNOW, EARLY ON WHEN I WAS AT MAJORITY INSTITUTIONS, THERE WERE THESE U54 MECHANISMS THAT WERE BUILT AROUND THE MAJORITY INSTITUTION, GOT THE GRANT, AND THEY WORKED WITH THE MINORITY SERVING INSTITUTION TO HELP BUILD THEIR RESEARCH CAPACITY, THE NICHDH, NIMC, ET CETERA. BUT YOU HAVE A CADRE OF INSTITUTIONS THAT DO UNDERSTAND HOW TO EDUCATE AND TRAIN UNDERREPRESENTED MINORITIES AND TO CREATE THAT ENVIRONMENT THAT NOT JUST ALLOWS FOR SCIENTIFIC COMPETENCY BUT THE CONFIDENCE AND ENCOURAGEMENT THAT IS REQUIRED IN ORDER FOR PEOPLE TO APPLY FOR A GRANT 15 TIMES AND GET KNOCKED DOWN AND MAYBE GET IT THE 16TH TIME, BUT, YOU KNOW, THAT REZIL EXPWRENS GRIT THAT COMES ALONG -- RESILIENCE AND GRIT THAT COMES ALONG. SO PERHAPS WE MAY WANT TO CONSIDER MECHANISMS WE HAVE LIKE HARVARD AND EMERY TO PARTNER WITH THE SUBSTITUTIONS THAT HAVE A TRACK RECORD FOR TRACKING AND TRAINING UNDERREPRESENTED MINORITIES LIKE MOREHOUSE SCHOOL OF MEDICINE OR CHARLES HOWARD AND WE WOULD BE THE LEAD INSTITUTION AND THEY COME IN UNDERSTANDING THAT WE'RE GOING ON SHARE SOME IDEAS WITH THEM ABOUT HOW TO CREATE THAT ENVIRONMENT THAT LEADS TO SUCCESS. >> Dr. Francis Collins: I APPRECIATE THAT VERY MUCH AND I BELIEVE THE RMI PROGRAM HAS BEEN A WONDERFUL SUCCESS IN TERMS OF PROVIDING AN ENVIRONMENT FOR TRAINING AND DOING EXPRERCH BRINGING SOME OF THESE REALLY TAL ENLED FOLKS INTO OUR WORKFORCE IN A SUSTAINABLE AND SUCCESSFUL WAY, AND ELISEO AND I HAVE SPENT MANY MEETINGS OVER THE COURSE OF THE LAST TWO OR THREE MONTHS TALKING ABOUT RCMI AND WAYS TO MAKE IT EVEN BETTER AND I'M VERY SUPPORTIVE OF THE IDEAS THAT HE'S PUT FORWARD IN TERMS OF STRENGTHENING SOME OF THE SCIENTIFIC ASPECTS WHILE PRESERVING THE OPPORTUNITY FOR FUNDS TO GO INTO SUCH THINGS AS INFRASTRUCTURE AND TO MAKE SURE THAT TRAINING IS WELL SUPPORTED, SO THIS IS A VERY IMPORTANT PROGRAM TO US AND I'M GLAD IT NOW RESIDES AT NIMHD WHICH I THINK IS THE APPROPRIATE HOME FOR THE ENTERPRISE. I KNOW THERE HAVE BEEN CONCERNS, THERE ARE ALWAYS CONCERNS WHEN A PROJECT IS BROUGHT UP FOR SOME POTENTIAL CHANGES, BUT I BELIEVE THAT WHAT'S BEING PUT FORWARD WILL MAKE THIS PROGRAM EVEN BETTER AND I PERSONALLY WILL BE WATCHING CLOSE TOLL SEE HOW THIS GOES. BUT I APPRECIATE YOUR IDEA ABOUT PARTNERSHIPS. I DO THINK WE DON'T DO ENOUGH OF THAT. NIH IS NOW I THINK VERY CONVINCED THAT THAT IS A MODEL WESH BE DOING MORE OF. CTSA, OF COURSE ANOTHER BIG INVESTMENT WE HAVE NOW, FUNDED THROUGH NCAT, HALF A BILLION DOLLARS GOING INTO THE CLINICAL AND TRANSLATIONAL SCIENCE AWARDS IN THESE 62 CENTERS ACROSS THE COUNTRY. FRANKLY I THINK IN THE PAST HAVE KIND OF BEEN A LITTLE ISOLATED ENTITIES, THEY'VE BEEN GREAT FOR THE SCHOOLS THAT HAD ONE BUT THEY P HAVEN'T WHAT I HAD THE WHOLE INTO SOMETHING IMREART THAN THE SUM OF THE PARTS AND WE'RE NOW DETERMINED TO DO THAT AND NOT EVERYBODY IS HAPPY ABOUT THAT EITHER BECAUSE THAT MEANS MAYBE GIVING UP A LITTLE LOCAL AUTONOMY IN ORDER TO HAVE A NATIONAL NETWORK THAT CAN DO REALLY AMAZING THINGS LIKE CLINICAL TRIALS WHERE YOU CAN ENROLL A LOT OF PATIENTS IN A SHORT TIME FOR AN UNCOMMON DISORDER THAT NO SINGLE INSTITUTION CAN DO. OTHER QUESTIONS? I PROBABLY HAVE TO SCOOT ACTUALLY. IT'S QUITE A FULL DAY. BUT I REALLY APPRECIATE THE CHANCE TO BE HERE WITH ALL OF YOU. LET ME THANK YOU AGAIN FOR YOUR DEDICATION TO NIMHD AND TO NIH. WE REALLY APPRECIATE IT. >> THANK YOU. [APPLAUSE] >> Dr. Eliseo Perez-Stable: HE STAYED A LITTLE BIT LONGER THAN HE WAS SUPPOSED TO, SO I WANTED TO MAKE SURE HE HAD AN OPPORTUNITY TO SCOOT OUT. ANY QUICK AFTERTHOUGHTS AFTER HIS PRESENTATION? >> I'M INTERESTED TO HEAR HIS COMMENT. I HADN'T HEARD HIM SAY THAT WE'RE ALL AFRICANS. IT WILL BE REALLY INTERESTING TO HEAR THAT BROADCAST ON U.S. NEWS TODAY. [LAUGHTER] SO I HOPE EVERYBODY RECOGNIZES THAT. >> I DIDN'T HAVE A CHANCE TO ASK THE QUESTION, BUT IT MIGHT BE A GOOD SEGWAY INTO THE NEXT SPEAKER, AND THAT IS, COULD THERE BE CONSIDERATION, JUST CONSIDERATION OF SMALL POPULATIONS, NATIVE POPULATIONS AS WELL, AND ALSO THE ISSUE OF THE DEFINITION OF UNDERSERVED AND UNDERREPRESENTED INVESTIGATORS, THERE'S A LOT OF HETEROGENEITY IN THATION AMERICAN POPULATIONS -- IN THE ASIAN AMERICAN POPULATIONS WHERE THERE ARE FEW LAY -- LAOTIANS, CAMBODIANS, WITH CR DEGREES AND SMALLER FOR GRADUATE DEGREES, NOT ELIGIBLE FOR APPLYING FOR DIVERSITY SUPPLEMENTS. >> Dr. Eliseo Perez-Stable: I DON'T THINK FRANCIS IS ON TOP OF THAT PARTICULAR ISSUE, BUT WE ARE AND HANNAH AND I HAVE BEEN DISCUSSING IT. THERE ARE A NUMBER OF REASONS WHY THAT, YOU KNOW, THAT IS USED OPERATIONALLY, IT HAS TO DO WITH NATIONAL REPRESENTATION AND SOME RESISTANCE ON THE PART OF LOOKING AT, YOU KNOW, DIFFERENT NATIONAL ORIGINS WITHIN THESE LARGE RACIAL ETHNIC GROUPS, BUT I COULDN'T AGREE MORE THAT THAT IS A CONCERN. AND I THINK YOU'RE RIGHT THAT FRANCIS DID FOLLOW THE DATA AND THE FACT THAT IT WAS IN THE '90S THAT THE CONSENSUS CAME FORTH THAT THE ORIGIN OF HUMANS AS WE KNOW IT TODAY CAME FROM ACTUALLY EAST AFRICA, NOT WEST AFRICA AS HE SHOWED ON HIS MAP, BUT THAT'S A DETAIL, AND IT WAS A CONFLUENCE OF DATA FROM THE ANTHROPOLOGISTS AND THE GENETICISTS AND ALL THE DIFFERENT LINES OF EVIDENCE OF THE MIGRATION OF HUMAN SPECIES OUT OF THAT AREA OF THE WORLD. SO LYNN DARKS YOU WANTED -- SO LINDA, YOU WANTED TO SAY SOMETHING? >> YES. I WAS JUST GOING TO ASK DR. COLLINS ABOUT WHETHER IT MIGHT MAKE SENSE TO HAVE A FUND, A CENTRAL FUND, TO INCENTIVIZE CROSS-INSTITUTE COLLABORATION, AND THE DETAILS, OF COURSE, WOULD BE IMPORTANT, BUT IN A SINGLE DISCIPLINE THERE ARE USUALLY VERY LITTLE INCENTIVE TO ACTUALLY WORK OUTSIDE THE CORE OF THE FIELD, SO HAVING SOME INCENTIVE, WE ALSO KNOW THAT THE GREAT DISCOVERIES ARE OFTEN AT THE INTERSECTION OF DISCIPLINES AND SYSTEMS, AND SO THAT WAS JUST A POSSIBILITY, AND THAT BUILDS ON MY OWN EXPERIENCE WITH THE UNIVERSITY OF WISCONSIN MADISON CLUSTER HIRE INITIATIVE WHERE WE DID INVEST ALMOST $80 MILLION IN CREATING THOSE CROSS-DEPARTMENT, CROSS-DISCIPLINARY FACULTY COHORTS THAT HAVE, YOU KNOW, REALLY PLAYED A ROLE IN OUR CONTINUED PREEMINENCE AND ACHIEVEMENT. SO THAT'S ALL. >> Dr. Eliseo Perez-Stable: IN CASE YOU DIDN'T NOTICE, I DECIDED TO FOREGO THE SHORT BREAK THAT WAS SCHEDULED AFTER HIS PRESENTATION SO WE COULD HAVE MORE CONVERSATION AND THEN LEAD RIGHT TO CHAU'S PRESENTATION, THEN WE'LL HAVE A BREAK FOR LUNCH. CAN I AGREE, SOMETIME THE FUNDS SOMETIMES CHANNEL THOSE KINDS OF ACTIVITIES, ALSO BY DEFINITION WE ARE KIND OF AN ENTITY THAT EXISTS KIND OF ALONG THOSE LINES, AND I THINK A LOT OF WHAT PROGRAM SCIENTISTS DO IN TERMS OF FINDING SUPPORT FOR PROGRAM ANNOUNCEMENTS OR CONCEPTS AND FINDING COLLABORATION ACROSS INSTITUTES, FINDING COMMON WAYS TO COLLABORATE IS REALLY WHERE A LOT OF THIS ACTION HAPPENS AT NIH, AND THEN THERE ARE THE OFFICES LIKE THE ONE THAT BILL LEADS, BEHAVIORAL SCIENCE RESEARCH, NOW THE PREVENTION, THE OFFICE OF PREVENTION THAT DAVID MURRAY LEADS, AND THEN THERE'S ALSO NOW THE SEXUAL GENDER AND MINORITY RESEARCH. SO I THINK WE'LL SEE COLLABORATIONS COMING THAT WAY, SO I THINK THAT'S A GREAT POINT, THAT WAS A GOOD SUGGESTION. >> WHERE THE MONEY IS, I THINK WHAT I'VE BEEN LEARNING ABOUT NIH IS THAT, YOU KNOW, YOU DO HAVE INSTITUTES WITH DIFFERENTIAL FUNDING PATTERNS, AND, YOU KNOW, OBVIOUSLY YOU DEAL WITH STRUCTURE SO THAT AN INSTITUTE IS NOT SIMPLY APPLYING FOR MONEY, NEW MONEY, BUT MAYBE IT BECOMES THE POSSIBILITY OF SOME MONEY THEY SET ASIDE AND THEN SOME MONEY THAT'S PROVIDED CENTRALLY, AND REALLY WE WERE TALKING IN OUR SMALL GROUP ABOUT HOW DO WE ENSURE THAT OUR INSTITUTE IS AT THE CENTER OF OR INVOLVED IN AN INTRI GALLOWAY IN -- INTEGR AL WAY IN CONVERSATIONS IN THE FUTURE ABOUT HEALTH DISPARITIES RESEARCH AND WE COULDN'T DO IT ALONE BUT WE COULD LEVERAGE OUR EXPERTISE WITH THE EXPERTISE AROUND NIH TO REALLY HAVE THE POSSIBILITY TO SET PRIORITIES AND HAVE BREAKTHROUGHS, SO WE HAD A PRETTY INTERESTING CONVERSATION ABOUT THAT, AND THAT'S WHY I WANTED TO MENTION IT. >> I GUESS I WAS A LITTLE DISAPPOINTED THAT WE SENT QUESTIONS AND NONE OF THEM WERE ASKED, SO I DON'T KNOW IF IT WAS HE DECIDED TO FOREGO, BECAUSE THEY WERE TOO PROVOCATIVE, OR WERE THEY NEVER PRESENTED TO HIM? SO IT'S A QUESTION. >> Dr. Eliseo Perez-Stable: I THINK KNOWING FRANCIS, HE PREPARED HIS TALK INDEPENDENT OF THOSE QUESTIONS AND I ANTICIPATED, I SAID HERE ARE SOME QUESTIONS FOLKS SAID THEY MIGHT ASK, INCLUDING THE LAST ONE THAT LINDA SENT, IN CASE YOU ASK DID THEM, DEAD BEEN HE CAN POSED TO THEM, BUT YOU DIDN'T ASK THEM. SO YOU THOUGHT HE WAS GOING TO ADDRESS THEM IN HIS TALK. >> I THOUGHT HE WOULD HAVE THEM, AND I THOUGHT THE WHOLE PURPOSE OF SENDING THEM AHEAD OF TIME WOULD BE FOR HIM TO ADDRESS >> Dr. Eliseo Perez-Stable: WELL , I APOLOGIZE. THAT MAY HAVE NOT HAVE BEEN APPROPRIATELY COMMUNICATED, BUT CERTAINLY HE GAVE US A FEW MINUTES TO FIELD QUESTIONS, AND SOME OF YOU TOOK ADVANTAGE OF IT. OKAY. WE'RE READY TO GO? GREAT. OUR NEXT PRESENTER IS CHAU TRINH-SHEVRIN, WHO IS ASSOCIATE PROFESSOR AT THE DEPARTMENT OF POPULATION HEALTH AND MEDICINE AT NYU. CHAU IS A DIRECTOR A LARGE RESEARCH INITIATIVE FOCUSED ON HEALTH EQUITY AND FOR 15 YEARS HAS BEEN INVOLVED IN RESEARCH ON ASIAN AMERICAN, NATIVE HAWAIIAN AND PACIFIC ISLANDERS AND OTHER UNDERSERVED COMMUNITIES, CURRENTLY PI OF A NIMHD CENTER OF EXCELLENCE AS WELL AS A CDC SPONSORED PREVENTION RESEARCH CENTER AND HAS PARTNERED WITH OTHERS AS CO-DIRECTOR OF THE COMMUNITY ENGAGEMENT AND POPULATION HEALTH RESEARCH CORE FOR NYU HEALTH AND HOSPITALIZATIONS CORPORATION CLINICAL AND TRANSLATIONAL SCIENCE INSTITUTE, SO PTSA THAT FRANCIS REFERRED TO, AND SHE'S BEEN AT THE FOREFRONT OF FOSTERING COMMUNITY ENGAGEMENT RESEARCH BETWEEN NYU AND ITS COMMUNITY PARTNERS. I ASKED HER TO PRESENT ABOUT HER >> Dr. Chau Trinh-Shevrin: GREAT THANK YOU. GOOD AFTERNOON, EVERYONE, I'M REALLY EXCITED AND GRATEFUL TO BE HERE TODAY AND HONORED TO SHARE THE WORK OF THE NYU CENTER FOR THE STUDY OF ASIAN AMERICAN HEALTH, SOME OF THE LESSONS LEARNED AND SCIENTIFIC DIRECTION. MY TALK TODAY WILL BE FRAMED ON ADVANCING HEALTH EQUITY THROUGH THE LENS OF CONTEXT AND OPPORTUNITY. IN A RECENT EDITORIAL BY STEVE WOLF AND JASON PURNELL, THEY DISCUSS THE NOTION OF THE GOOD LIFE AND OPPORTUNITY AND THEY DEFINE OPPORTUNITY AS THE CHANCE TO THRIVE IN HEALTH AND OTHER ASPIRATIONS AND ALSO NOTE THAT IT'S UNEVENLY DISTRIBUTED ACROSS SOCIETY, WHICH HAS PROFOUND IMPLICATIONS WITH RESPECT TO SOCIAL AND HEALTH INEQUALITIES. IN MANY RESPECTS THIS HAS COROLLARY TO OUR OWN WORK WITH ADVANCING HEALTH EQUITY. SO IN THE COURSE OF MY OWN WORK AT THE NYU CENTER FOR THE STUDY OF ASIAN AMERICAN HEALTH, CSA, I'VE BEEN INCREASINGLY AWARE OF HOW CONTEXT AND OPPORTUNITY INFLUENCES HEALTH STATUS, RISK AND HEALTH DISPARITY ACROSS COMMUNITIES IN PART BY THE WAY THEY SHAPE IDENTITY FORMATION AND AGENCY, SO MY PRESENTATION WILL BE FOCUSED ON THOSE THEMES OF CONTEXT, IDENTITY, AS WELL AS AGENCY AND OPPORTUNITY. SO FIRST SOME DEFINITIONS. CONTEXT, AS MANY OF YOU KNOW, IS REALLY ABOUT THE SOCIAL DETERMINANTS OF HEALTH. IT INFLUENCES OUR IDENTITY OF HOW WE PERCEIVE WHO WE ARE ACCIDENT OF HOW OTHERS -- OF WHO WE ARE AND HOW OTHERS PERCEIVE OURSELVES AND COMMUNITY. ALSO INFLUENCES OUR SELF-OF AGENCY, OF WHAT WE CAN AND CAN'T DO AS WELL AS HOW WELL WE CAN SUCCESSFULLY NAVIGATE ACROSS DIFFERENT SYSTEMS, DIFFERENT INSTITUTIONAL STRUCTURES, ACROSS NEIGHBORHOODS AND COMMUNITIES. WHEN THE CONTEXT IS POOR OR CONSTRAINED, IT CERTAINLY LIMITS BOTH OUR AGENCY, OUR AGENCY, AS WELL AS OUR OPPORTUNITIES, AND EVEN WHEN OPPORTUNITIES DO EXIST, FOR INDIVIDUALS WHO ARE COMING FROM THESE CONSTRAINED ENVIRONMENTS, THOSE OPPORTUNITIES MAY BE PERCEIVED AS INTANGIBLE. WHAT I THINK IS REALLY POWERFUL AND PROMISING ABOUT THIS NOTION OF OPPORTUNITY IS THAT WHEN OPPORTUNITIES DO AVAIL, THEY CAN IN SMALL MEASURED WAYS REALLY CHANGE THE CONTEXT, CHANGE THE SENSE OF AGENCY, AND POTENTIALLY LEAD TO A CASCADING EFFECT WHERE THERE ARE MORE OPPORTUNITIES, GREATER AGENCY, A NEW SENSE OF IDENTITY, AS WELL AS A NEW CONTEXT. SO LET ME BEGIN WITH SOME CONTEXT WITH RESPECT TO ASIAN AMERICAN POPULATIONS. THE DEMOGRAPHIC PROFILE OF THE UNITED STATES IS CHANGE RAPIDLY, AND NOWHERE IS THIS MORE PROFOUND THAN IN THE PROFILE OF THE IMMIGRANT POPULATION. SO AS YOU CAN SEE, SINCE 1965, THERE'S BEEN SUBSTANTIAL INCREASES IN THE FOREIGN-BORN AMONG ALL RACIAL AND ETHNIC COMMUNITIES, WHETHER IT'S ASIAN, HISPANIC OR BLACK, WHILE DECREASING AMONG WHITE NON-HISPANICS. THE SURGE IS PARTICULARLY PROFOUND AMONG ASIAN AMERICAN COMMUNITIES. SO AS YOU CAN UNDERSTAND, WHEN YOU'RE WORKING WITH MINORITY POPULATIONS, THAT INTERSECTION OF BEING A RACIAL AND ETHNIC MINORITY AS WELL AS IMMIGRANT STATUS WILL HAVE PROFOUND SALIENCE IN OUR UNDERSTANDING OF THE NATURE AND THE MAGNITUDE OF SOCIAL AND HEALTH INEQUALITIES. ASIAN AMERICANS IN THE UNITED STATES ARE THE FASTEST GROWING MINORITY POPULATION, WE'RE EXPECTED TO GROW TO ABOUT 43.2 MILLION ASIAN AMERICANS OR 10% OF THE U.S. POPULATION, MORE THAN DOUBLING IN SIZE FROM WHERE WE ARE TODAY. FROM 2000 TO 2010, THERE HAVE BEEN ABOUT 3.6 MILLION INDIVIDUALS ARRIVING FROM ASIA, SO MIGRATION IS REALLY FUELING THOSE INCREASES AMONG THE ASIAN AMERICAN POPULATION. WE KNOW RELATED TO THESE TRENDS ARE THAT THE GENERATIONAL STATUS IS ALSO INFLUENCED, SO TODAY ABOUT MORE THAN 80% OF ASIAN AMERICANS ARE EITHER FIRST OR SECOND-GENERATION IMMIGRANT. SO THE ASIAN AMERICAN EXPERIENCE IS INHERENTLY THE IMMIGRANT EXPERIENCE. RELATED TO BOTH IMMIGRANT AND GENERATIONAL STATUS ARE ISSUES OF LANGUAGE ACCESS, LINGUISTIC ISOLATION AND HIGH RATES OF LIMITED ENGLISH PROFICIENCY, AND THOSE RATES MAY VARY ACROSS DIFFERENT ASIAN AMERICAN ETHNIC GROUPS FROM ANYWHERE BETWEEN 30% TO AS HIGH AS 65, 70% IN CERTAIN COMMUNITIES. NO NEW YORK CITY, FOR EXAMPLE, THE OVERALL RATE OF LIMITED ENGLISH PROFICIENCY AMONG OUR EXUNTS IS ABOUT 60 -- COMUNLTSES IS ABOUT 60%, THREE OUT OF FIVE INDIVIDUALS, AND THOSE RATES VARY AMONG SUBGROUPS. AMONG THE BAG LA DASH COMMUNITY IT COULD BE AS HIGH AS 75%. WE ARE ALSO TREMENDOUSLY DIVERSE POPULATION, THE LARGEST SOURCE CRURPTS OF ASIAN AMERICANS ARE FROM CHINA, PHILIPPINES, INDIA, VIETNAM, KOREA, AND JAPAN, BUT A ALSO HAVE SMALLER EMERGING COMMUNITIES FROM COUNTRIES LIKE PAKISTAN, CAMBODIA, THAILAND, BANGLADESH AND BURMA. YET DETION SPITE THE TREMENDOUS POPULATION GROWTH ANTICIPATED AS WELL AS THE DIVERSITY AMONG ASIAN AMERICAN POPULATIONS, THE DATA ON ASIAN AMERICAN COMMUNITIES IS SPARSE. MUCH OF WHAT WE HAVE IN TERMS OF THE ASIAN AMERICAN COMMUNITIES IS AGGREGATED. THERE'S A LACK OF DATA THAT'S DISAGGREGATED ACROSS ETHNIC GROUPS. WE ARE HAMMERED BY A NUMBER OF REASONS WITH RESPECT TO LIMITED DATA, AND AS A RESULT OF THAT, THOSE BARRIERS IN TERMS OF HAVING SUFFICIENT DATA AVAILABLE ABOUT OUR OWN COMMUNITIES, THERE'S A TENDENCY TO REPORT ASIAN AMERICANS IN THE AGGREGATE, AS ONE LARGE GROUP. BUT WHAT HAPPENS WHEN WE'RE AGGREGATED IN ONE LARGE GROUP, IT MASKS DISPARITIES OR HEALTH CHALLENGES EXPERIENCED BY THE SMALLER SUBGROUPS, THE SMALLER POPULATION SIZES. AND AS A RESULT IT'S LED TO THE EMERGENCE AND PERSISTENCE OF THE MODEL MINORITY STEREOTYPE AND THAT'S PERMEATED OUR IDENTITY IN MANY WAYS. SO WHAT IS THE MODEL MINORITY STEREOTYPE? IT'S ESSENTIALLY A STEREOTYPE THAT WAS FIRST COINED IN 1966 BY WILLIAM PETERSON AND CONNOTELESS THE IDEA OF ASIAN AMERICANS AS HEALTHIER, WEALTHIER AND WISER. AT THE OUTSET THIS APPEARS TO BE A VERY POSITIVE STEREOTYPE BUT IT OBJECT SCURPZ THE EXPERIENCES OF MANY INDIVIDUALS ACROSS DIFFERENT ETHNIC GROUPS AND WITHIN COMMUNITIES. IT IS A VERY PERSISTENT AND HARDY STEREOTYPE AS YOU CAN SEE ON THE COVER OF TIME IN 1987, THE ASIAN AMERICAN WHIZ KIDS AND LAST YEAR IN THE NEW YORK TIME THE ASIAN ADVANTAGE. IN ADDITION TO THE MODEL MINORITY STEREOTYPE, WE ARE ALSO CONFRONTED WITH STEREOTYPES OR PERCEPTIONS OF ASIAN AMERICANS AS OTHERS, CONSTANT FOREIGNERS, NONAMERICAN, SO HERE IS AN EXAMPLE LAST YEAR OF TWO ASIAN AMERICANS WHO WON THE NATIONAL SPELLING BEE, TWO ASIAN AMERICAN CHILDREN WHO WERE BORN IN THE UNITED STATES, MIND YOU, AND THE REACTION TO THEIR AWARD WAS VERY TELLING OF MAINSTREAM SENTIMENT TOWARDS ASIAN AMERICAN COMMUNITIES IN GENERAL. DO AMERICANS EVER WIN THE SPELLING BEE ANYMORE? WHEN WAS THE LAST TIME A TRUE AMERICAN WON THE SPELLING BEE? 1815? NOT MEANT TO BE A RACIST, BUT COME ON. TWO LEFT IN THE SPELLING BEE? THEY AIN'T EVEN AMERICAN. [LAUGHTER] SO THERE ARE A NUMBER OF CHALLENGES ASSOCIATED WITH THE MODEL MINORITY STEREOTYPE. SUCCESS ISN'T EVENLY DISTRIBUTED ACROSS AND WITHIN OUR SUBGROUPS. THERE ARE A NUMBER OF INEQUALITIES WHICH ARE OBSCURED AND MASKED. THOSE WHO SUFFER ARE REALLY RENDERED INVISIBLE. AND AMONG THOSE WHO UNDERPERFORM OR WHO EXPERIENCE POOR MENTAL AND PHYSICAL HEALTH, THERE'S TREMENDOUS STIGMA AND SELF-HATRED FOR NOT BEING PART OF THAT MODEL MINORITY. IT ALSO, THIS WHOLE MODEL MINORITY STEREOTYPE IMPACTS FUNDING, THE ALLOCATION OF RESOURCES FOR RESEARCH. IN A STUDY THAT CHANDA GOSH FROM HRSA DID, HE REVIEWED IN MEDLINE AND PUBMED ARTICLES FROM 1966 TO 2000 AND FOUND THAT .01% OF THOSE ARTICLES INCLUDED ASIAN AMERICANS IN THE STUDY SAMPLE. AND HE ALSO FOUND THAT ASIAN AMERICANS IN GENERAL ARE THE MOST UNDERSTUDIED RACIAL AND ETHNIC MINORITY GROUP IN THE UNITED STATES. FOR A TEXTBOOK THAT WE SPONSORED, OUR CENTER SPONSOREDDED, HE UPDATED HIS LITERATURE REVIEW UP TO 2007 AND FOUND THAT REALLY THERE HAD BEEN VERY LITTLE INCREASES IN THAT IN TERMS OF THE NUMBER OF ARTICLES THAT HAVE BEEN GENERATED FOCUSED ON ASIAN AMERICAN HEALTH. AND AS A RESULT OF THE LACK OF DATA, THERE'S A SEVERE LACK OF INFORMATION THAT CAN INFORM ACCURATE AND APPROPRIATE HEALTH PLANNING FOR SOCIAL SERVICES AND OTHER PROGRAMS FOR ASIAN AMERICAN POPULATIONS. SO ARE ASIAN AMERICANS HEALTHIER AND ARE WE ALL ALIKE? THE NEXT COUPLE SLIDES, BECAUSE OF CONSTRAINTS, I COULD SPEND HOURS TALKING ABOUT ASIAN AMERICAN HEALTH, BUT WHAT I WANT TO DO IN THE NEXT SERIES SLIDES IS REALLY ILLUSTRATE A FEW POINTS, THE DIVERSITY AND HER TOE GENERAL A TI OF OUR COMMUNITY, THE NEED OR AGGREGATED DATA AS WELL AS NEED FOR ACCURATE REPRESENTATION OF OUR COMMUNITIES. NEXT COUPLE SLIDES REGARDING HEALTH OF ASIAN AMERICAN COMMUNITIES IS REALLY GOING TO BE FOLK UMTIONED ON THE VALUE OF DISAGGREGATED DATA AND I'LL ALSO PRESENT AN EXAMPLE OF WHEN DISOF DISPARITIES ARE ROYALSED OR SOMETIMES OVERLOOKED AND AN EXAMPLE WHEN DATA IS AVAILABLE BUT SOMETIMES NOT INCLUDED OR PRESENTED. HERE IN A STUDY BY BARNES AND COLLEAGUES WHERE THEY REVIEW DATA FROM THE NATIONAL HEALTH INTERVIEW SURVEY AND PULLED IT OVER SEVERAL YEARS, THEY FOUND THAT WHEN YOU LOOK AT THE DATA DISAGGREGATED, THAT THE PREVALENCE OF DIFFERENT CONDITIONS VARIED ACROSS DIFFERENT SUBGROUPS WITHIN THE ASIAN AMERICAN POPULATION, REALLY UNDERSCORING THE VALUE OF DISAGGREGATED DATA, WHETHER IT BE FOR HEART DISEASE, HYPERTENSION, STROKE, CANCER, DIABETES AND HEPATITIS, NOT ALL THE ASIAN AMERICAN SUBGROUPS EXPERIENCED HEALTH CHALLENGES IN THE SAME WAY. SIMILARLY IN NEW YORK CITY WE KNOW THERE ARE CHALLENGES WHEN YOU'RE LOOKING AT THE DATA IN AGGREGATE. CITY HEALTH DEPARTMENT COLLECTED DATA ON SMOKING PREVALENCE IN NEW YORK CITY AND FOUND ASIAN AMERICANS HAD LOWER SMOKING PREVALENCE. WE WERE ABLE TO PARTNER WITH CDC TO OVERSAMPLE ASIAN AMERICAN CITIES IN NEW YORK CITY AND WE WERE ABLE TO PULL DATA AND DISAGGREGATE IT ACROSS DIFFERENT GROUPS AND FOUND THAT WHEN YOU LOOK AT THE DATA AND COMPARE THE SAME DATA TO THE CITY HEALTH DEPARTMENT THAT THERE ARE TREMENDOUS DIFFERENCES ACROSS ETHNIC GROUPS AND THAT KOREAN AMERICANS, FOR EXAMPLE, HAD THE HIGHEST SMOKING RATES COMPARED TO OTHER ASIAN SUBGROUPS AND EVEN COMPARED TO OTHER RACIAL AND ETHNIC MINORITY COMUNGTS IN NEW YORK CITY. SO REALLY UNDERSCORING THE VALUE OF DISAGGREGATED DATA. IN THIS EXAMPLE HERE I JUST WANT TO HIGHLIGHT, IT'S CLEARLY RECOGNIZED THAT THERE ARE RACIAL AND ETHNIC DISPARITIES IN DIABETES IN NEW YORK CITY AND ELSEWHERE. BUT EVEN WHEN THAT DATA IS AVAILABLE, OFTENTIMES VERY LITTLE IS DONE. WE KNOW THAT IN NEW YORK CITY ASIAN AMERICANS HAVE TWICE THE RATE OF DIABETES COMPARED TO WHITE NON-HISPANICS, BUT MUCH OF THE MONEY THAT GOES TOWARDS DIABETES INTERVENTIONS ARE FOCUSED ON BLACK AND HISPANIC COMMUNITIES. VERY LITTLE IS ALLOCATED FOR ASIAN AMERICAN POPULATIONS. WE ALSO KNOW THAT WHEN DATA IS AVAILABLE FOR OUR COMMUNITIES, SOMETIMES WE'RE EXCLUDED, SO IN THIS EXAMPLE OF A STUDY, EXAMINING THE IMPACT OF THE AFFORDABLE CARE ACT ON INCREASING INSURANCE ACCESS, THE AUTHORS CHOSE TO PRESENT THE DATA ON WHITE, BLACK AND HISPANIC, BUT WE KNOW FROM OUR PARTNERSHIP WITH NATIONAL, LOCAL POLICY AND GRASSROOTS ORGANIZATIONS REGARDING ACA AND EXPANSION OF HEALTH INSURANCE COVERAGE THAT THE DATA EXIST. THE AUTHORS DID NOTE THAT WE FOCUSED ON NON-HISPANIC WHITES, NON-HISPANIC BLACKS AND HISPANICS IN LINE WITH MUCH OF THE LITERATURE ON HEALTH DISPARITIES, SO ESSENTIALLY EVEN WHEN THE DATA IS NOT -- WHEN THE DATA IS AVAILABLE AND NOT PRESENTED, IT GENERATES OR LEADS TO THIS CONCLUSION THAT WE'RE AN INVISIBLE POPULATION. SO ARE ASIAN AMERICANS WEALTHIER AND WISER? THE SOCIODEMOGRAPHIC PROFILE OF ASIAN AMERICANS IS VERY NUANCED. WHEN YOU LOOK AT THE DATA IN THE AGGREGATE, YOU SEE THAT ASIAN AMERICANS DO BETTER IN GENERAL, FOR EXAMPLE, WITH RESPECT TO COLLEGE DEGREE ATTAINMENT, THE U.S. AVERAGE IS ABOUT 28.2%, AND FOR ASIAN AMERICANS OVERALL IN THE AGGREGATE IT'S ABOUT 49%, BUT WHEN YOU LOOK AT THE DATA DISAGGREGATE BY SUBGROUPS, YOU SEE THAT MANY COMMUNITIES, MANY ASIAN AMERICAN SUBGROUPS, PARTICULARLY THE SOUTHEAST ASIAN COMMUNITY, THANK YOU FOR MENTIONING THAT, HAVE MUCH LOWER RATES WITH COLLEGE DEGREE ATTAINMENT. SIMILARLY, WHEN YOU LOOK AT POVERTY RATES, THE NATIONAL AVERAGE FOR THE U.S. POPULATION IS ABOUT 13 TO 14%, AND FOR ASIAN AMERICANS IN THE AGGREGATE IT'S ABOUT 12%. BUT WHEN YOU BREAK IT OUT DISAGGREGATED, BREAK IT OUT BY ETHNIC GROUP, YOU SEE THAT THERE'S TREMENDOUS DIFFERENCES IN THE PERCENT OF INDIVIDUALS LIVING IN POVERTY, WITH SOUTHEAST ASIANS AGAIN EXPERIENCING MUCH HIGHER RATES OF POVERTY COMPARED TO OTHER GROUPS AND COMPARED TO THE NATIONAL AVERAGE. IN NEW YORK CITY WE KNOW THAT'S THE CASE FOR MANY ASIAN AMERICANS. IN FACT, ASIAN AMERICAN COMMUNITIES HAVE THE HIGHEST POVERTY RATE IN NEW YORK CITY COMPARED TO ALL THE OTHER GROUPS. WE KNOW THAT MORE THAN ONE OUT OF FOUR ASIAN AMERICAN COMMUNITIES ARE LIVING IN POVERTY. WE ALSO KNOW THAT ONE OUT OF TWO INDIVIDUALS WHO ARE LIVING IN A POOR NEIGHBORHOOD ARE ASIAN AMERICAN. WE KNOW THAT ONE OUT OF THREE ASIAN AMERICAN OLDER ADULTS, SENIOR CITIZENS, ARE ALSO LIVING IN POVERTY AND THEY HAVE THE HIGHEST POVERTY RATE AMONG SENIOR CITIZENS IN NEW YORK CITY. AND CERTAINLY IT JUST GENERATES THIS PROFILE THAT NOT ALL ASIAN AMERICANS ARE EXPERIENCING THE SAME LEVEL OF EDUCATIONAL AND WEALTH STANDARDS THAT THE MODEL MINORITY STEREOTYPE TENDS TO PROJECT. SO AGENCY AND OPPORTUNITY. BOTH ARE VERY MUCH INFLUENCED BY STRUCTURAL FACTORS THAT ARE EITHER POLICY RELATED OR SYSTEMS RELATED, SO FOR ASIAN AMERICAN COMMUNITIES THOSE FACTORS COULD INCLUDE HEALTH INSURANCE ACCESS, IT COULD INCLUDE IMMIGRATION POLICIES, IT CAN INCLUDE LANGUAGE ACCESS AS WELL AS RESTRICTIONS TO EDUCATIONAL AND TRAINING OPPORTUNITIES. IT'S ALSO INFLUENCED BY THE MODEL MINORITY STEREOTYPE AND OTHER STEREOTYPES OF ASIAN AMERICANS AS THE OTHER OUTSIDERS I'M GOING ON SWITCH GEARS EVEN FURTHER AND TALK ABOUT CISA AND HOW ABOUT REALLY THAT OPPORTUNITY TO ESTABLISH CISA AS A HEALTH DISPARITIES RESEARCH CENTER REALLY SHIFTED THE CONTEXT IN NEW YORK CITY AND SHIFTED AGENCY FOR BOTH NYU AND OUR PARTNERS TO WORK TOGETHER AND MOBILIZE AROUND HEALTH DISPARITIES. SO WITH CISA, THERE ARE MANY PARALLELS WITH THE THEMES OF CONTEXT, IDENTITY, AGENCY AND OPPORTUNITY. BEFORE 2002, THERE WERE I WOULD SAY ABOUT A HANDFUL OF RESEARCHERS IN NEW YORK CITY SPREAD OUT ACROSS DIFFERENT UNIVERSITIES REALLY FOCUSED ON ASIAN AMERICAN HEALTH RESEARCH, EVEN THOUGH WE KNEW THAT WE HAD MORE THAN A MILLION ASIAN AMERICAN INDIVIDUALS LIVING IN NEW YORK CITY, AND WE ALSO KNEW THAT THERE WAS SUBSTANTIAL POCKETS, SEGMENTS OF COMMUNITIES EXPERIENCING SOCIAL AND HEALTH INEQUALITIES. IN 2003 WHEN NCMD ISSUED THEIR POLICY FOR EXPORT CENTERS WHICH WERE ESSENTIALLY INFRASTRUCTURE GRANTS TO ESTABLISH COMMUNITY PART PARTNERSHIPS AROUND HEALTH DISPARITY RESEARCH, IT WAS LIMITED TO THOSE WORKING WITH SPECIFIC POPULATIONS, AFRICAN AMERICAN, LATINO COMMUNITY, MEDICALLY UNDERSERVED COMMUNITIES, OSTENSIBLY ASIAN AMERICANS WERE LEFT OUT OF THAT CATEGORY. TO MAKE THE CASE FOR THE NYU CENTER FOR THE STUDY OF ASIAN AMERICAN HEALTH, WE REALLY HAD TO JUSTIFY AND DEFINE ASIAN AMERICANS IN NEW YORK CITY AS A MEDICALLY UNDERSERVED POPULATION WHO EXPERIENCED HEALTH DISPARITIES BECAUSE OF THAT FACT. WE WERE FORTUNATE TO RECEIVE THE FUNDING AND RECEIVE THE EXPORT CENTER GRANT AWARD THAT SAME YEAR, AND IT REALLY HAD A TRANSFORMATIONAL IMPACT FOR NYU AND FOR OUR PARTNERS AS WELL AS FOR OTHERS WHO WERE DOING RESEARCH ON ASIAN AMERICAN COMMUNITIES IN NEW YORK CITY. IT WAS POWERFUL IN THE WAY THAT NIH WAS ABLE TO REALLY LEGITIMIZE THE NEED, THE VALUE TO REALLY THINK ABOUT AND STUDY THE HEALTH CHALLENGES, HEALTH DISPARITIES AMONG ASIAN AMERICAN POPULATIONS, SO IT CREATED A NEW SENSE OF AGENCY AMONG OUR COMMUNITY PARTNERS, AMONG NYU INVESTIGATORS AND OTHER RESEARCHERS WHO WERE NOT PART OF NYU WHO JUST WANTED TO WORK WITH US BECAUSE THEY DIDN'T HAVE A PLACE TO GO IN TERMS OF DOING THIS KIND OF RESEARCH. SO IT WAS A REALLY TRANSFORMATIONAL EFFECT AND UNDERSCORE THE POWER OF NIH, NIHMD TO SET POLICY AND ALSO TRANSFORM BOTH OPPORTUNITY AND AGENCY. OUR MISSION SINCE 2003 HAS REMAINED THE SAME, FOCUS ON IDENTIFYING HEALTH PRIORITIES AND REDUCING HEALTH DISPARITIES IN THE ASIAN AMERICAN COMMUNITY, THROUGH RESEARCH TRAINING AND COMMUNITY ENGAGED PARTNERSHIPS. WE HAVE FOUR SCIENTIFIC TRACKS, CANCER, CARDIOVASCULAR DISEASE AND DIABETES, SOCIAL DETERMINANTS AND MENTAL HEALTH. THE P60 INFRASTRUCTURE REALLY PROVIDED AN AMAZING INFRASTRUCTURE TO MOBILIZE BOTH HEALTH AND NONHEALTH PARTNERS TOGETHER AROUND DIFFERENT DISPARITIES, AND IT REALLY ALSO PROVIDED AN OPPORTUNITY TO EXPAND OUR WORK IN DIFFERENT WAYS. SO IN ORDER TO FURTHER INFLUENCE AGENCY, WE WERE ABLE TO EMPLOY A MULTILEVEL APPROACH, LOOKING AT HOW DO WE TACKLE SOCIAL DETERMINE ANLTS OF HEALTH, HOW DO WE EMPLOY ALE LIFE COURSE PERSPECTIVE, THINKING ABOUT VULNERABLE POPULATIONS, FAMILY BASED APPROACH, WORKING WITH HEALTH AND NONHEALTH PARTNERS TO PROMOTE A HEALTH IN ALL POLICIES, WE EMPLOYED PRINCIPLES OF SOCIAL MARKETING BECAUSE WE KNEW THAT THE MODEL MINORITY STEREOTYPE WAS A MAJOR CHALLENGE AND WE WANTED TO WORK WITH DISPELLING IT, WE ALSO WANTED TO WORK TOWARDS RAISING AWARENESS OF THE EXPERIENCE OF HEALTH CHALLENGES AND HEALTH DISPARITIES IN ASIAN AMERICAN COMMUNITIES FOR THOSE WHO WERE OF ASIAN AMERICAN DESCENT AS WELL AS THOSE WHO WERE JUST NOT AWARE OF THESE DISPARITIES, WE ALSO EMPLOYED COMMUNITY BASED PARTICIPATORY RESEARCH APPROACHES TO DEVELOP AND MAINTAIN OUR PARTNERSHIP AND WE ALSO DEVELOPED INTERVENTION STRATEGIES THAT NOT ONLY FOCUSED IN COMMUNITY SETTING BUT WE'RE ALSO THINKING ABOUT ACCESS TO CARE AS A MAJOR DETERMINANT OF HEALTH, MAJOR DETERMINANT OF HEALTH DISPARITIES SO WE WANTED TO DO MORE WORK IN TERMS MUCH BRIDGING THE GAP BETWEEN CLINICAL SYSTEMS, CLINICAL PROVIDERS AND UNDERSERVED, MEDICALLY UNDERSERVED COMMUNITIES. SO IN TERMS OF THE FRUITS OF OUR LABOR, WE'VE BEEN ABLE SINCE 2003, CISA STAFF, FACULTY AND OUR PARTNERS ALIKE HAVE BEEN ABLE TO TRAIN 371 STUDENTS, WE'VE PUBLISHED WITH THE EXPANSION OF ALL THE WORK UNDER THE FOUR SCIENTIFIC TRACKS ABOUT 395 PUBLICATIONS, OF WHICH 96 WERE DIRECTLY SUPPORTED BY THE P60 GRANT. WE HAVE A CORE NETWORK OF 55 RESEARCH AND COMMUNITY PARTNERS THAT WORK WITH US, AND WE'VE BEEN ABLE TO LEVERAGE MORE THAN 101 ML YON DOLLARS -- MORE THAN $101 MILLION, FIVE TIME THE INVESTMENT PROVIDED, TO SYNERGIZE OUR EFFORTS AND ADD SUBSTANTIVE DEPTH TO EACH OF THE FOUR SCIENTIFIC TRACKS AND TO BE ABLE TO DO NOT ONLY RESEARCH, BUT TO DISSEMINATE, TO DO EDUCATION AND TO DO TRAINING. IN ADDITION TO INCREASING OUR OWN IMPACT AND OUR CAPACITY, WE'VE ALSO SEEN THIS TRANSLATE WITH RESPECT TO OUR COMMUNITY PARTNERS. SO FOR EXAMPLE, WORKING WITH THE UNITED STATES, SOCIAL SERVICE AGENCY THAT SERVES A SUBSTANTIAL SOUTH ASIAN POPULATION IN NEW YORK CITY, WE PROVIDED THEM RESOURCES TO SUPPORT COMMUNITY HEALTH WORKERS AT THEIR SITE, TO DO DIABETES PREVENTION, AND WE ALSO PROVIDED TRAINING TO THEM TO BE ABLE TO ENGAGE IN RESEARCH IN AN EQUITABLE MANNER. WE ALSO PROVIDE TRAINING FOR THEM SO THAT THEY COULD CONDUCT THEIR OWN NEEDS ASSESSMENTS, CONDUCT EVALUATIONS, AND IN THEIR PARTICIPATION IN WORKING WITH US WITH RESPECT TO THAT FIRST RESEARCH PROJECT, THEY'VE BEEN ABLE TO SUSTAIN AND EXPAND THEIR HEALTH PROGRAMS AND THEIR HEALTH RESEARCH ABOVE AND BEYOND WHAT WE PROVIDED AS A CENTER TO DO THEIR WORK. WE'VE BEEN VERY ACTIVE AS A CENTER IN TERMS OF ADVANCING SCIENTIFIC AND POLICY DIALOGUES, WE HAVE A NUMBER OF PROJECTS THAT ARE FOCUSED ON COMMUNITY HEALTH WORKER APPROACHES, AND NOW WE'RE WORKING TOWARDS TRYING TO FIGURE OUT HOW DO WE INTEGRATE CHW'S AND NOW WITH THE OPPORTUNITIES THAT ABOUND WITH HEALTHCARE REFORM AS WELL AS WHAT WE'RE SEEING WITH MEDICAID REDESIGN AND INTEGRATING COMMUNITY HEALTH WORKERS IN COMMUNITY CLINICAL LINKAGE PROGRAMS. WE'RE STILL VERY MUCH VERY ACTIVE IN TERMS OF THINKING ABOUT LIVER CANCER DISPARITIES AMONG ASIAN AMERICAN POPULATIONS AND BETTER UNDERSTANDING THE NATURAL HISTORY OF HELP -- OF HEPATITIS B DISPARITIES AND HOW IT LEADS TO LIVER CANCER OF OUR POPULATIONS AND WE'RE ALSO WORKING WITH NATIONAL GROUPS LIKE THE ASIAN AMERICAN PACIFIC ISLANDERS HEALTH FORUM AND OTHER GRASSROOTS AND POLICY ORGANIZATIONS TO DEVELOP EVIDENCE-BASED POLICY SYSTEMS AND ENVIRONMENTAL STAT JIZ AROUND CHRONIC DISEASE PREVENTION, AROUND ADVANCING HEALTH EQUITY FOR ALL. SO I'M GOING TO TRY TO HELP FRAME OUR WORK EVEN FURTHER AND REALLY ILLUSTRATE ONE EXAMPLE OF ONE PROJECT IN OUR CARDIOVASCULAR/DIABETES TRACK SO YOU CAN GET A SENSE OF OUR APPROACH TO THE WORK AND ALSO WHAT WE THINK IS OUR IMPACT IN TERMS OF NOT ONLY TO THE SCIENCE BUT TO OUR COMMUNITIES. SO PROJECT ASPIRE, THE PROJECT IS FOCUSED ON IMPROVING HEALTHCARE ACCESS AND REDUCING HYPERTENSION DISPARITIES AMONG FILIPINO AMERICANS IN NEW YORK CITY USING COMMUNITY HEALTH WORKER APPROACHES. WE WERE FUNDED FOR THREE YEARS AS A PLANNING GRANT AND FIVE YEARS AN AN INTERVENTION GRANT AND FOR THE LAST FEW YEARS THROUGH OTHER RESOURCES HAVE BEEN SUPPORTING THE DISSEMINATION PHASE. THE PROJECT ASPIRE, THE SEEDS FOR PROJECT ASPIRE FIRST BEGAN IN 2004 WORKING WITH COMMUNITY STAKEHOLDERS TO BETTER UNDERSTAND THE HEALTH NEEDS OF FILIPINO AMERICAN COMMUNITIES, WE WORKED WITH THOSE STAKEHOLDERS TO DEVELOP AND CO-SPONSOR A COMMUNITY FORUM WHERE WE INVITED 100 INDIVIDUALS FROM THE COMMUNITY IN THE NEW YORK CITY, NEW JERSEY, CONNECTICUT AREA TO REALLY THINK ABOUT WHAT ARE THOSE CHALLENGES AND WHAT ARE STRATEGIES THAT ARE MEANINGFUL AND RELEVANT TO THOSE COMMUNITIES. FROM THAT COMMUNITY FORUM THE GROUP TOGETHER DECIDED WE NEEDED TO JOINTLY SPONSOR A COMMUNITY HEALTH NEEDS ASSESSMENT TO QUANTITY PHI THOSE HEALTH NEEDS. IN ADDITION, THE COMMUNITY PROVIDED I AM IMPETUS FOR THE COMMUNITY TO DEVELOP A COMMUNITY COALITION THAT WAS DRIVEN BY THE COMMUNITY FOCUSED ONT ONLY PHYSICAL BUT ALSO SOCIAL WELL-BEING OF FILIPINO AMERICAN COMMUNITY IN THE NEW YORK CITY AREA. WITH THIS ESTABLISHED PARTNERSHIP WITH THE COALITION, WE JOINTLY APPLIED FOR FUNDING FROM NIMHD TO SUPPORT PROJECT ASPIRE. AND THE ACCOMPLISH MGHTS OF PROJECT ASPIRE IS JUST REALLY INDICATIVE OF THE ACCOMPLISHMENTS THAT WE HAVE SEEN IN OUR OTHER RESEARCH PROJECTS, FIRST AND FOREMOST, WE THINK WHAT IS REALLY POWERFUL IS THE FORMATION, DEVELOPMENT AND SUSTAINABILITY OF THAT COMMUNITY COALITION BECAUSE WE KNOW THAT WE WANT SOMETHING TO EXIST WITHIN THE COMMUNITY EVEN, YOU KNOW, BEYOND THE LIFE OF THE P60 GRANT OR OTHER GRANTS TO NYU SO IT'S BEEN POWERFUL TO SEE THE COMMUNITY ORGANIZE AROUND THEIR HEALTH AND SOCIAL NEEDS, AROUND HEALTH PROMOTION AND DISEASE PREVENTION, THEY'VE BEEN ABLE TO GARNER ADDITIONAL FUNDING ABOVE AND BEYOND WHAT WE PROVIDED THROUGH OTHER GRANTS, THROUGH CDC GRANTS, THROUGH STATE GRANTS, TO REALLY SUPPORT THEIR HEALTH PROGRAMS, HEALTH RESEARCH ACTIVITIES. WE'VE ALSO SEEN EXPANSION OF OUR CARDIOVASCULAR DISEASE AND DIABETES TRACK, PROJECT ASPIRE, AS WELL AS THE DREAM PROJECT, ANOTHER P60 SUPPORTED PROJECT PROVIDED AMAZING FOUNDATION FOR US TO DEVELOP A SUCCESSFUL APPLICATION TO CDC FOR OUR PREVENTION RESEARCH CENTER TWHAS -- THAT I S FOCUSED ON CARDIOVASCULAR DISEASE AND DIABETES PREVENTION AND IS CURRENTLY NOW TESTING DIFFERENT COMBINATIONS OF COMMUNITY HEALTH WORKER AND ELECTRONIC HEALTH WORKER BASED INTERVENTIONS TO REALLY INCREASE ACCESS TO CARE AND TO HELP BETTER CONTROL HYPERTENSION AND DIABETES DISPARITIES. WE HAVE BEEN INVOLVED WITH OUR COMMUNITY STAKEHOLDERS IN NOT ONLY DISSEMINATING IN PEER REVIEWED JOURNALS BUT ALSO THINKING ABOUT WHAT ARE THE NONTRADITIONAL DISSEMINATION VENUES THAT WE NEED TO CONSIDER TO REALLY MAKE OUR WORK OUT IN THE MAINSTREAM AND ALSO OUT WITHIN THE COMMUNITIES THAT WE WANT TO SERVE AND REACH. WE'VE BEEN VERY ACTIVE IN POLICY TRANSLATION, I SIT ON A NUMBER OF ADVISORY PANELS FOR NEW YORK STATE, FOR NEW YORK STATE MEDICAID REDESIGN, THINKING ABOUT HOW TO INTEGRATE COMMUNITY HEALTH WORKERS AND HOW DO WE DEVELOP STRATEGIES THAT INCREASE PATIENT-CENTERED CARE FOR UNDERSERVED VULNERABLE POPULATIONS, AND OUR PROJECT ALSO WAS HIGHLIGHTED ON THE AGENCY FOR HEALTHCARE RESEARCH AND QUALITIES INNOVATION EXCHANGE AS AN EVIDENCE-BASED PROGRAM FOR REACHING OUT TO A VULNERABLE POPULATION AROUND CARDIOVASCULAR DISEASE PREVENTION. SO THERE ARE A NUMBER OF LESSONS LEARNED AND ALSO OPPORTUNITIES FROM OUR WORK. FIRST AND FOREMOST, I THINK CONTEXT MATTERS. SOCIAL POSITION MATTERS. BUT WE ALSO KNOW THAT OPPORTUNITIES CAN SHIFT THAT CONTEXT AT AN OPPORTUNITIES, AT AN INDIVIDUAL, AT AN INSTITUTIONAL AND COMMUNITY LEVEL, CAN REALLY SHIFT THAT CONTEXT AND ALSO SHIFT ONE'S AGENCY AND THE COMMUNITY'S COLLECTIVE AGENCY TO TACKLE HEALTH DISPARITIES. WE ALSO KNOW THAT ASIAN AMERICANS REMAIN UNDERSTUDIED, THERE'S A CLEAR LACK OF EVIDENCE BASE OF WHAT WORKS AND DOESN'T WORK FOR OUR COMMUNITIES, BUT FROM THE LAST 13-PLUS YEARS OF WORKING WITH MANY DIVERSE ASIAN AMERICAN POPULATIONS IN NEW YORK CITY, WE KNOW THAT THEY HAVE THE CAPACITY AND THEY HAVE THE DESIRE TO ENGAGE IN HEALTH RESEARCH, THEY WANT TO ENGAGE IN RESEARCH, THEY'RE NOT THE REASON FOR WHY WE'RE UNDERSTUDIED. WE KNOW THAT RACISM, DISCRIMINATION AND STIGMA REMAIN POTENT DETERMINANTS OF HEALTH, DETERMINE ANLTS OF HEALTH INEQUALITIES, AND THAT FOR ASIAN AMERICAN POPULATIONS THE MODEL MINORITY STEREOTYPE AS WELL AS THE STEREOTYPES OF ASIAN AMERICANS AS OUTSIDERS AND FOREIGNERS REMAIN PERSISTENT CHALLENGES FOR OUR COMMUNITIES. BUT WE ALSO SEE A TREMENDOUS OPPORTUNITY HERE TO THINK ABOUT HOW DO WE SUPPORT AN INTEGRATE THE IMMIGRANT HEALTH FRAMEWORK THAT'S REPRESENTATIVE OF THE DIVERSITY OF ASIAN AMERICAN POPULATIONS AND REALLY CAPTURES THE NEEDS, THEIR MIGRATION AND IMMIGRATION EXPERIENCES AND THEIR PRIORITIES. WE ALSO KNOW FROM OUR WORK FOR MORE THAN A DECADE THAT COMMUNITY HEALTH WORKER APPROACHES ARE FEASIBLE, ACCESSIBLE AND EFFECTIVE FOR ASIAN AMERICAN COMMUNITIES, FOR LANGUAGE MINORITY COMMUNITIES, FOR LIMITED ENGLISH PROFICIENT COMMUNITIES, FOR IMMIGRANT POPULATIONS. SO THERE'S AN OPPORTUNITY HERE TO THINK ABOUT HOW DO WE LEVERAGE WHAT WE KNOW WITH COMMUNITY HEALTH WORKER APPROACHES AND REALLY LINK TO THOSE OPPORTUNITIES WITH RESPECT TO ELECTRONIC HEALTH RECORD BASED SYSTEMS AND PLATFORMS THAT ARE NOW BEING PUSHED OUT THROUGH HEALTHCARE REFORM THROUGH NEW OPPORTUNITIES TO REALLY REACH OUT TO THOSE MEDICALLY UNDERSERVED COMMUNITIES, TO THOSE LINGUISTICALLY ISOLATED COMMUNITIES THAT WOULD IMPROVE ACCESS TO CAIRKS IMPROVE BETTER ADHERENCE FOR BOTH PREVENTION AND TREATMENT. WE ALSO NEED TO CONTINUE TO PROMOTE DATA DISAGGREGATION FOR NOT ONLY THE LARGER SUBGROUPS BUT ALSO FOR THE SMALLER EMERGING POPULATIONS WITHIN THE ASIAN AMERICAN COMMUNITY. AND THERE ARE TREMENDOUS OPPORTUNITIES NOW WITH THE PRECISION MEDICINE INITIATIVE. IT WILL BE A CHALLENGE IN MANY WAYS TO THINK ABOUT HOW DO WE ENSURE THAT OUR COMMUNITIES ARE REPRESENTED IN THIS PMI COHORT AND THAT WE CAN GENERATE THE DATA THAT'S GENERALIZEABLE TO OUR DIVERSE POPULATIONS. FROM THE WORK THAT WE'VE BEEN DOING THE LAST FEW YEARS ON A NUMBER OF PROJECTS, WE KNOW THAT WE NEED TO BETTER UNDERSTAND THE RELATIONSHIP BETWEEN UNHEALTHY ASSIMILATION, SO WHAT WE WOULD LIKE TO DO IS TO MOVE FORWARD AND TO THINK ABOUT WHAT ARE THOSE BIOLOGICAL AND BEHAVIORAL MECHANISMS THAT LEAD TO UNHEALTHY ASSIMILATION AND OBESITY RISKS AND CANCER RISKS AND CARDIOVASCULAR DISEASE RISKS. WE'VE STARTED NEW COLLABORATIONS RECENTLY WITH EXPERTS IN THE MICROBIOME WHO ARE DEVELOPING A MICROBIOME COHORT IN NEW YORK CITY WE'RE ADDING AN ASIAN AMERICAN COMPONENT TO IT SO WE CAN REALLY UNDERSTAND THOSE BUY EXPLL BEHAVIOR AS WELL AS SOME OF THE ENVIRONMENTAL MECHANISMS THAT LEAD TO OBESITY RISK, WHERE UNHEALTHY ASSIMILATION FALLS IN BETWEEN, AND WE ARE ALSO HOPE THAT BY DOING SO, WE CAN MAYBE ADD ON OR CREATE A POTENTIAL OPPORTUNITY TO ADD A PRECISION MEDICINE COHORT SPECIFIC TO ASIAN AMERICAN POPULATIONS. PIPELINE TRAINING PROGRAMS IS ALSO AN AREA THAT WE KNOW REMAINS A MAJOR CHALLENGE, ALTHOUGH WE'VE TRAINED 371 STUDENTS OVER THE LAST DECADE-PLUS, MANY OF OUR STUDENTS AGE OUT OR NEED A NEW PROGRAM TO REALLY DEVELOP AND CULTIVATE THEIR RESEARCH DEVELOPMENT, AND THOSE OPPORTUNITIES DON'T REALLY EXIST FOR MANY OF THEM, PARTICULARLY FOR SOUTHEAST ASIAN COMMUNITIES AND FOR THOSE WHO ARE STRUGGLING AND COMING FROM POOR ENVIRONMENTS BECAUSE OF THE ASIAN AMERICAN -- OR THE PERCEPTION OF ASIAN AMERICANS AS THE MODEL MINORITY. SO, YOU KNOW, JUST TO DID HAPPE'S POINT, HOW DO WE REVIEW AND REDEFINE SORT OF THE ELIGIBILITY, THE DEFINITION OF WHAT IT MEANS TO BE UNDERREPRESENTED, SO FOR ASIAN AMERICAN COMMUNITIES, WE KNOW THAT IN MEDICINE AND IN SOME HEALTH RESEARCH AREAS, THAT WE MIGHT BE WELL REPRESENTED AMONG CHINESE OR SOUTH ASIAN DOCTORS, BUT WE'RE NOT WELL REPRESENTED AMONG SOUTHEAST ASIANS, AND CERTAINLY NOT IN NURSING OR IN SOCIAL WORK OR OTHER PROFESSIONS THAT REALLY HAVE MEANINGFUL IMPACT IN TERMS OF REDUCING BOTH THE SOCIAL AND HEALTH INEQUALITIES IN OUR COMMUNITIES, AND AS A FIRST GENERATION IMMIGRANT AND A PRODUCT OF PIPELINE PROGRAMS, AS WELL AS A FACULTY MENTOR FOR THE NYU PRIDE PROGRAM, WHICH IS SPONSORED THROUGH NHLBI, THERE'S TREMENDOUS POWER TO HAVING THESE PIPELINES AND CAREER DEVELOPMENT PROGRAMS TO REALLY BUILD THAT HUMAN CAPITAL AROUND HEALTH DISPARITIES REASON THAT IS NEEDED FOR ASIAN AMERICAN COMMUNITIES, FOR IMMIGRANT POPULATIONS, AND FOR THOSE WHO ARE WORKING WITH SMALL POPULATIONS. BEFORE I END, I JUST WANTED TO NOTE THAT MUCH OF OUR WORK IS GROUNDED WITHIN THE DEPARTMENT OF POPULATION HEALTH. TREMENDOUS SUPPORT IS PROVIDED THROUGH THIS DEPARTMENT AND I JUST WANT TO ACKNOWLEDGE A FEW CORE FACULTY, PART OF CISA, THAT'S QUAN, CAN AND WHO HAS HELPED ME TO THINK ABOUT MOVING THE SCIENTIFIC AGENDA, NUMEROUS SCIENTIFIC COMMUNITY PARTNERS I WILL NOT NAME TODAY, BUT SPECIAL KUDOS TO THE PACIFIC ISLANDER ASIAN AMERICAN HEALTH FORUM TO HELPING US THINK ABOUT HOW DO WE SHAPE OUR AGENDA, HEALTH DISPARITIES RESEARCH AROUND ADVANCING HEALTH EQUITY FOR ASIAN AMERICAN POPULATIONS AND EXPANDING AND WORKING COLLECTIVELY WITH NATIVE HAWAIIAN AND PACIFIC ISLANDER COMMUNITIES AND ONE LAST PLUG, WE ARE CO-SPONSORING A CONFERENCE TO HEALTHY AGING IN TWO WEEKS WITH AARP, IT'S ON HEALTHY AGING AMONG ASIAN AMERICAN, NATIVE HAWAIIAN AND PACIFIC ISLANDER COMMUNITIES, SO IF YOU'RE IN NEW YORK CITY, INTERESTED AND AVAILABLE, LET ME KNOW, WE WOULD LOVE TO HAVE YOU THERE. AND THAT'S IT. THANK YOU. [APPLAUSE] >> Dr. Eliseo Perez-Stable: THAN K YOU, CHAU, THAT WAS GREAT. WE'RE OPEN FOR CONVERSATION. WE HAVE TIME. LINDA AND THEN -- YOUR MIC. >> MAY WE PLEASE VIEW YOUR PRESENTATION? >> Dr. Chau Trinh-Shevrin: SURE, I WOULD BE HAPPY TO SHARE THAT. >> THAT WOULD BE GREAT. >> YOU'RE DOING ABSOLUTELY FANTASTIC WORK AND LOVE THE EFFORTS THAT YOU'RE DOING TO DISAGGREGATE THE DATA. THERE'S BEEN SO MANY EFFORTS TO TRY TO DO THIS OVER THE YEARS, AND YOU'RE REALLY BEING SUCCESSFUL IN IT. I DO ENCOURAGE YOU, THOUGH, WHEN YOU'RE COMPARING WITH RACIAL GROUPS TO REMEMBER THAT AMERICAN INDIANS ARE A RACIAL GROUP AND THAT NEW YORK CITY IS THE LARGEST, HAS THE LARGEST NUMBER OF AMERICAN INDIANS ANYWHERE IN THE COUNTRY, SO WE HAVE SOME OTHER PATTERNS THAT WOULD BE NICE TO PLUG IN THERE. SO PLEASE INCLUDE US IN THE FUTURE. >> Dr. Chau Trinh-Shevrin: ABSOL UTELY. I WOULD LOVE TO COLLABORATE WITH YOU ON THAT. >> VERY EXCEPTIONAL WORK THAT YOU ALL ARE DOING AND IT'S VERY ENLIGHTENING, AND I WAS SITTING HERE THINKING THAT THE PRESIDENT AND DEAN OF THE MEDICAL SCHOOL AND WHEN WE LOOK AT THE NUMBER OF APPLICATIONS THAT WE GET AND THEY ARE ALL CATEGORIZED UNDER ASIAN, AND THE BIGGEST CHALLENGE WE HAVE IS REALLY WITH THE INDIVIDUAL SELF-IDENTIFYING AND REALLY BREAKING DOWN THE DIFFERENT ETHNICITIES FOR US SUCH THAT WE COULD THEN DISAGGREGATE THE DATA TO UNDERSTAND WHO IS REALLY UNDERREPRESENTED BECAUSE THAT'S WHAT WE ARE TRYING ON LOOK AT, UNDER REPRESENTED STUDENTS, BUT WE DON'T HAVE THAT MANY BOXES FOR THEM TO CHECK OFF. SO IT ALL GETS LUMPED UNDER OTHER, AND THEY DON'T NECESSARILY SELF-IDENTIFY IN A WAY THAT WE CAN THEN BEGIN TO UNDERSTAND WHO IS UNDERREPRESENTED, AND I KNOW THAT PART OF THAT IS CULTURAL AND PEOPLE NOT WANTING NECESSARILY TO BE SINGLED OUT, BUT THAT IS SOMETHING THAT I THINK WE ALL KIND OF SORT OF HAVE TO WORK TOWARDS BECAUSE WE REALLY DON'T END UP SOMETIMES SELECTING THOSE STUDENTS WHO REALLY ARE UNDERREPRESENTED BECAUSE WE DON'T KNOW HOW TO DISTINGUISH THEM. MY SECOND POINT WOULD BE UNDERSTANDING THE TERM OF IMMIGRANT IN HOW YOU ARE USING THAT. IN THE SENSE OF WHEN YOU JUST DESCRIBED YOURSELF, YOU SAID FIRST GENERATION IMMIGRANT, I >> Dr. Chau Trinh-Shevrin: RIGHT >> AND MY UNDERSTANDING OF THE DISTINCTION OF HOW I WOULD USE THAT IN THE CONTEXT OF UNDERSTANDING WHEN I'M THINKING ABOUT ASIAN AMERICANS VERSUS WHEN I'M THINKING ABOUT HISPANIC OR LATINO AMERICANS AND DO WE HAVE ENOUGH DATA TO DEFINE THAT YOU'RE ASIAN AMERICAN IMMIGRANT FIRST GENERATION, THAT THE DISPARITIES OR THE CHALLENGES THAT WE'RE GOING TO SEE ARE GOING TO BE DISTINCTLY DIFFERENT FROM ANOTHER ETHNIC GROUP, I THINK I'M GETTING THIS RIGHT, WHO IS FIRST-GENERATION >> Dr. Chau Trinh-Shevrin: RIGHT SO, YOU KNOW, I THINK WITH THE FIRST PIECE, I THINK IT WOULD BE WONDERFUL IF NIMHD COULD HELP TAKE THE LEAD IN TERMS OF THINKING ABOUT HOW DO WE REALLY REVIEW AND WHAT IS THAT DEFINITION OF WHAT IT MEANS TO BE UNDERREPRESENTED BECAUSE THERE IS TREMENDOUS DIVERSITY AND THERE'S TREMENDOUS NEED AND IT'S NOT WITHIN JUST THE ASIAN AMERICAN POPULATION. THERE ARE OTHER COMMUNITIES TOO THAT ARE NOT CAPTURED, THAT HAVE SUBSTANTIAL SUBGROUPS OR ETHNIC GROUPS WITHIN THE LARGER UMBRELLA, FOR EXAMPLE, THE LATINO COMMUNITY, SO THINKING ABOUT WHAT DOES THAT MEAN IN TERMS OF BEING REPRESENTED, UNDERREPRESENTED, AND THAT DOESN'T EVEN GO TOWARDS THINKING ABOUT SEXUAL MINORITIES AND OTHER, YOU KNOW, WHAT IS THE LANGUAGE THAT WE WOULD WANT TO THINK ABOUT SOFTLY IN TERMS OF THAT ELIGIBILITY AND WHAT IS THE IMPLICATION IN TERMS OF OPPORTUNITIES. THE SECOND PIECE, THE FIRST GENERATION, I WAS NOT BORN IN THE UNITED STATES, I WAS BORN IN VIETNAM, BUT SECOND GENERATION WOULD BE A QUHIELD OF AN IMMIGRANT BORN IN THE UNITED STATES -- WOULD BE A CHILD OF AN IMMIGRANT BORN IN THE UNITED STATES. >> I KNOW THAT. >> Dr. Chau Trinh-Shevrin: OKAY. I WANTED TO MAKE SURE. >> OKAY. THAT'S NOT THE DISTINCTION I'M TRYING TO GET, BUT -- CHAU CHAWCH THE DISTINCTION IN TERMS OF -- >> ARE WE SEEING WHEN WE WILL COMPARE FIRST GENERATION HISPANIC OR LATINO AS COMPARED TO, SAY, FIRST GENERATION ASIAN AMERICAN OR FIRST GENERATION AFRICAN, DO WE BEGIN TO SEE DISTINCT DIFFERENCES IN COMPARING THEM, YOU KNOW, BECAUSE WE TALK A LOT ABOUT ACCULTURATION AND WE SEE WHAT HAPPENS AFTER ONE GENERATION OR AFTER A TIME PERIOD. DO WE SEE THOSE DISTINCTIONS BASED ON THE FACT SO MUCH THAT THEY'RE FIRST GENERATION AS COMPARED TO THE SECOND GENERATIONS AND THE ASIAN AMERICAN? >> Dr. Chau Trinh-Shevrin: SOMET IMES. I FEEL LIKE SOMETIMES IT ALSO IS IMPACTED BY MIGRATION EXPERIENCES, SO FOR EXAMPLE, IN THE VIETNAMESE COMMUNITY, MY FAMILY CAME IN DURING THE FIRST WAVE OF REFUGEES IN 1975, AND SO WE CERTAINLY EXPERIENCED A LOT OF SOCIAL CHALLENGES THAT IMPACTED MANY DIFFERENT LAYERS IN TERMS OF ACCESS TO CARE, IN TERMS OF POTENTIAL RESOURCES, BUT OUR EXPERIENCE WAS MUCH BETTER THAN THE SECOND OR THIRD WAVE OF VIETNAMESE REFUGEES THAT CAME IN LATER OVER TIME BECAUSE THEY HAD DIFFERENT TYPES OF MIGRATION EXPERIENCES. SO EVEN THE CATEGORY OF FIRST GENERATION IMMIGRANT SOMETIMES DOESN'T CAPTURE ALL THE EXPERIENCES THAT REALLY INFLUENCE HEALTH STATUS OR RISKS FOR DISEASE OR HEALTH DISPARITIES IN A SENSE. SO I GUESS I DON'T KNOW THE BEST ANSWER TO THAT. MAYBE, MAYBE HAPPE OR MAGGIE, IF YOU HAVE ANY THOUGHTS RELATED TO THAT PIECE. >> I THINK IT DEPENDS ON THE HISTORY OF MIGRATION, SO THERE ARE OPPORTUNITIES TO LOOK AT SECOND AND THIRD GENERATION CHINESE AMERICANS IN SAN FRANCISCO WHO MIGRATED HERE 100 YEARS AGO AND FOR OUR COMPARISON WE USED FILIPINOS IN HAWAII WHO HAVE BEEN HERE FOR OVER 100 YEARS. DO U.S. BORN CHILDREN AND SECOND-GENERATION HAVE WORSE OUTCOMES THAN IMMIGRANTS? WE'RE FINDING YES. SO IT'S ALE SIMILAR TREND AS LATINOS. >> MY THOUGHT WAS THAT IT WAS THE MIGRATION PATTERN, BUT WHAT I AM NOT NECESSARILY SEEING THAT WE ARE CAPTURING THAT WHEN WE THINK ABOUT OUR SOCIAL DETERMINANTS. AND THAT'S ONE OF THE THINGS THAT I THINK THAT WE SHOULD WHEN WE THINK ABOUT ALL OF THESE SOCIAL DETERMINANTS, AND THEN ONCE SOMEONE IS BORN TO A SECOND IMMIGRANT OR FIRST IMMIGRANT, THERE I BELIEVE EVEN LIES MORE INTO SOME OF THE SOCIAL DETERMINANTS BECAUSE THEN THEY HAVE THE INHERENT BIASES THAT COME WITH EVEN THOUGH THEY ARE U.S. CITIZENS, U.S. CITIZEN, THE DISTINCTION AND THE VALUE PLACED UPON THAT THEY DON'T NECESSARILY RECEIVE THAT BENEFIT. SO THAT'S SOME OF THE SUBTLE SOCIAL DETERMINANTS THAT I DON'T NECESSARILY THINK THAT WE ARE CAPTURING, AND I DON'T KNOW HOW TO CAPTURE, I MEAN, BUT I THINK THAT'S SOMETHING THAT WE HAVE TO THINK ABOUT. >> I THINK FOR THE LATINOS IT'S THE SAME THING THAT HAPPE WAS SAYING, WE'RE SEEING MORE PROBLEMS IN THE SECOND GENERATION, BUT I THINK ALSO YOU HAVE TO BE VERY CAREFUL BECAUSE I THINK THE PROBLEM OF AGGREGATION IS HORRENDOUS WHEN WE ARE LOOKING NOW AT FIRST GENERATION REFUGEES THAT ARE COMING FROM HONDURAS, EL SALVADOR ACCIDENT WE'RE FINDING VERY SERIOUS PROBLEMS, SO THE OTHER THING I WANTED TO MENTION, AND I MEAN YOU MADE A FABULOUS PRESENTATION, I THINK CONTEXT MATTERS A LOT, SO WHERE YOU ACTUALLY MIGRATE TO, THE RECEPTION, THE HOST ENVIRONMENT IS SO IMPORTANT BECAUSE PEOPLE MIGHT HAVE EXCELLENT EXPERIENCES IN SOME PARTS OF THE U.S. BUT REALLY TERRIBLE ONES. >> I HAVE A COMMENT. I'M NOT SURE WHERE THE OTHER COMES FROM, YOU KNOW, WHEN YOU SPELL OUT THESE, WHO IS IN CHARGE OF THAT, DO YOU KNOW? SERIOUSLY, JUDGE DOES IT HAVE TO BE AN OTHER, WHY CAN'T WE GET INTO THE NITTY-GRITTY AND DEFINE IT. 15 YEARS FROM NOW, WHAT WOULD BE THE THREE THINGS YOU WOULD WANT THIS COUNCIL TO ADDRESS ON YOUR BEHALF AND IN YOUR RESEARCH? >> THE FIRST THING, FIRST ON MY WISH LIST IS THAT -- >> YOU CAN BE DIRECT. >> IS THAT IT WOULD BE GREAT TO HAVE MORE THAN ONE CENTER FOCUS ON ASIAN AMERICAN HEALTH. WE DON'T HAVE A CRITICAL MASS NATIONALLY. OF THE 76 CENTERS THAT HAVE BEEN FUNNED, WITHIN THE NIMHD HISTORY ONLY ONE HAS BEEN FOCUSED ON ASIAN AMERICAN HEALTH AND ONE THAT'S FOCUSED ON THE HEALTH NEEDS OF NATIVE HAWAIIAN PACIFIC ISLANDERS AND IN ORDER TO CREATE A CRITICAL MASS TO REALLY ADVANCE OUR UNDERSTANDING TO REDUCE HEALTH DISPARITIES IN OUR POPULATION, THERE CERTAINLY NEEDS TO BE MORE THAN ONE CENTER TO BE ABLE TO DO THAT. SO THAT WOULD BE ONE OF THE FIRST PIECES, ALTHOUGH WE'VE BEEN VERY FORTUNATE TO HAVE AMAZING NATIONAL AND LOCAL COMMUNITY PARTNERS REALLY GALVANIZE AND WORK WITH US BECAUSE THEY KNOW THAT OUR FUNDING LIMITS AND WHAT WE CAN AND CAN'T DO WITH FUNDING THAT COMES THROUGH NIH, THEY'VE BEEN VERY CREATIVE WITH US IN TERMS OF THINKING ABOUT HOW DO WE LEVERAGE OTHER RESOURCES TO DO THE WORK THAT WE NEED TO DO IN THE NEW YORK CITY AREA, IN NEW JERSEY, AND WE CERTAINLY NEED MORAL OF A CRITICAL MASS FOCUSED ON THIS TO CREATE OUR COLLECTIVE AGENCY. MORE RESEARCH I THINK THAT ADDRESSES THOSE TRANSLATIONAL GAPS. I THINK THAT, YOU KNOW, WE CERTAINLY NEED A LOT MORE IN TERMS OF CONTRIBUTING TO THE KNOWLEDGE BASE OF WHAT WORKS AND DOESN'T WORK. THERE'S NOT AN EVIDENCE BASE FOR DIFFERENT TYPES OF HEALTH INTERVENTIONS, FOR CANCER DISPARITIES, FOR DIABETES. WE NEED THAT EVIDENCE BASE, BUT WE ALSO NEED TO KNOW WHAT'S GOING ON WITH RESPECT TO THE BIOLOGICAL, ENVIRONMENTAL FACTORS THAT LEAD TO IT. SO SOME OF THE RESEARCH THAT REALLY SUPPORTS OUR UNDERSTANDING OF DEVELOPING TAILOR-TARGETED INTERVENTIONS AND ALSO I THINK BUILDING THAT HUMAN CAPITAL AND REALLY CREATING THAT PIPELINE IS CRITICAL FOR US TO HAVE THE NEXT GENERATION OF LEADERS IN THIS AREA THAT CAN MOVE AND ACCELERATE THE WORK THAT WE DO. >> THE TERMS UNDERREPRESENTED, UNDERREPRESENTED WITH RESPECT TO WHAT? WITH RESPECT TO A PROFESSION, WITH RESPECT TO DEGREES IN THE HEALTH SCIENCES, JUST MENTIONING THAT, AND THEN THE QUESTION OF DISADVANTAGED, REALLY ALMOST YOUR PRESENTATION AND THE QUESTIONS YOU RAISED ARE REALLY SORT OF POSTER ADVERTISEMENTS FOR TRUE INTERDISCIPLINARY RESEARCH. YOU'VE GOT THE PIECE THAT HAS TO DO WITH THE BACKGROUND OF PEOPLE COMING FROM DIFFERENT AND SOCIOLOGICAL OF PEOPLE WITHIN THEIR OWN COUNTRIES, THEN YOU HAVE THE CULTURAL AND ANTHROPOLOGICAL AND SOCIOLOGICAL AND DEMOGRAPHIC EXPERTISE COULD BE VERY IMPORTANT IN THE IDENTIFICATION OF BOTH THE DIFFERENCES IN THE EXPERIENCE AS WELL AS THE QUESTION OF DISADVANTAGE, WHAT DOES IT MEAN TO BE DISADVANTAGED WITH RESPECT TO HEALTH ISSUES. SO IT'S REALLY PROBABLY IMPORTANT, I'M SURELY YOU HAVE ON YOUR TEAM, TO HAVE THE RIGHT KIND OF INTERDISCIPLINARY TEAM TO REALLY PROBE THESE QUESTIONS BECAUSE THE QUESTION OF OTHER, SO MAYBE THERE ARE A NUMBER OF OTHERS, AS WE KNOW, BUT WHETHER THEY ARE OTHERS THAT DESERVE TO BENEFIT FROM A DIFFERENT LENS, USING A DIFFERENT LENS TO VIEW NOT ONLY THEIR QUALIFICATIONS TO DO SPECIFIC THINGS OR THEIR NEEDS REALLY REQUIRES THAT INTERDISCIPLINARY KIND OF FOCUS BECAUSE WE CAN'T DO IT AS SCIENTIST OR MEDICAL PEOPLE ALONE, BUT THE MEDICAL SOCIOLOGISTS AND OTHER PEOPLE IT WOULD SEEM NEED TO BE -- AND MEDICAL DEMOGRAPHERS AND ANTHROPOLOGISTS PROBABLY NEED TO BE A PART. TEAM TO HELP US UNPACK WHAT IT MEANS TO BE DISADVANTAGED, AND THAT KIND OF CUTS ACROSS, YOU KNOW, YOU'VE SAID WE'VE GOT THE ASIAN AGGREGATION AND YOU'RE PULLING IT APART TO TEASE OUT THE QUESTION OF WHAT TRUE DISADVANTAGE OR DISPARITIES ACTUALLY EXIST. SO THAT'S ENOUGH. BUT I JUST THINK IT'S AN INTERDISCIPLINARY EFFORT THAT WOULD BE ADEQUATE TO DECIDE HOW WE MIGHT DECIDE TO GO FORWARD IN THE FUTURE IN OUR OWN ADVOCACY >> Dr. Chau Trinh-Shevrin: RIGHT >> ONE COMMENT AND A QUESTION. THE COMMENT IS, I THINK THE MAINSTREAM SOCIETY PAYS ATTENTION WHEN YOU SHIFT THE REFER ENLT GROUP FROM WHITES TO OTHER MINORITIES, IT'S ALMOST EXPECTED THAT OTHER MINORITIES WILL HAVE A HIGHER PREVALENCE OF CONDITIONS, AND THAT WAS RECOGNIZED WITH DIABETES, FOR EXAMPLE, WHEN KAISER PUBLISHED DATA THAT SHOWED THAT PACIFIC ISLANDERS, FILIPINOS AND ASIAN INDIANS HAVE HIGHER DIABETES PREVALENCE THAN GROUPS TRADITIONALLY PERCEIVED TO BE AT HIGHER RISK COMPARED TO BLACKS, LATINOS AND NATIVE AMERICAN TION, AND THAT'S WHEN PEOPLE WOKE UP AND SAID WE DIDN'T REALIZE THAT OR THAT IN CALIFORNIA EVEN AS EARLY AS 30 YEARS AGO, FILIPINOS HAVE HIGHER PREVALENCE OF HYPERTENSION THAN AFRICAN AMERICANS, SO I THINK THAT JUST PROVIDES MORE PUNCH. MY QUESTION HAS TO DO WITH THE REFUGEE POPULATION, AND WE HAVE A LOT OF INTEREST IN IMMIGRANTS AND THERE'S A DISTINCTION BETWEEN IMMIGRANTS AND REFUGEES WHO ARE HERE AGAINST THEIR CHOICE OR AGAINST THEIR WILL, AND AS WE'RE SEEING MORE REFUGEE POPULATIONS FROM SYRIA, HAVE YOU HAD A CHANCE TO EXPLORE AND DISTINGUISH DIFFERENCES BETWEEN REFUGEE AND IMMIGRANT HEALTH PARTICULARLY WITH REGARDS TO MENTAL HEALTH OUTCOMES? >> CHAU AM AS MUCH. MOST OF OUR FOCUS HAS BEEN ON IMMIGRANT POPULATIONS, FOCUS ON LARGER GROUPS, CHINESE, KOREAN, JAPANESE, VIETNAMESE COMMUNITY, SOUTH ASIAN COMMUNITY, BUT WE'RE NOW STARTING TO WORK IN THE SMALL EMERGING COMMUNITIES THAT WE'RE SEEING IN NEW YORK CITY THAT WEREN'T THERE TEN YEARS AGO, LIKE NEPALESE COMMUNITY, HIMALAYAN COMMUNITY, SOME OF THEM HAVE COME IN UNDOCUMENTED BUT WE HAVEN'T HAD A CHANCE TO FULLY WORK WITH REFUGEE COMMUNITIES IN NEW YORK CITY. WITHIN THE REASM OF THE ASIAN AMERICAN POPULATION. WE HAVE WORKED WITH REFUGEE POPULATIONS WITH COLLEAGUES AT THE CENTER FOR HEALTH AND HUMAN RIGHTS, REFUGEES COMING IN OR ACTUALLY ASYLUM SEEKERS IN A SENSE WHO HAVE BEEN FORCED OUT, BUT WE HAVEN'T HAD A CHANCE TO REALLY MARRY THE TWO. >> OKAY. WE'LL TAKE A BREAK AND RECONVENE FOR TOM LAVEIST'S PRESENTATION, SO 10, 15 MINUTES TO GET LUNCH OUR SECOND SCIENTIFIC PRESENTATION TODAY FOR COUNCIL IS BY DR. TOM LAVEIST, AND HE'S A VERY DISTINGUISHED RESEARCHER IN MINORITY HEALTH AND HEALTH DISPARITIES. I ACTUALLY HAVE KNOWN OF HIS WORK FOR YEARS AND YEARS AND READING PAPERS THAT HE HAD PUBLISHED IN VARIOUS JOURNALS WAY BACK EVEN 15 YEARS APPEARING AT UCSF, YET I HAD NEVER MET TOM UNTIL WAS IT LAST MONTH, RIGHT? >> Dr. Thomas LaVeist: YEAH, ABOUT A MONTH AGO. >> Dr. Eliseo Perez-Stable: WE WERE BOTH AT AAMC FOR A RECEPTION FOR MARK DUVAY AND AS WE SHOOK HANDS HE SAID WE MUST KNOWN 1,000 PEOPLE IN COMMON. SO AFTER SPENDING 25 YEARS AS A DISTINGUISHED MEMBER OF THE FACULTY AT JOHNS HOPKINS UNIVERSITIES, TOM MADE THE BOLD MOVE OF MIGRATING 40 MILES SOUTH AND WEST TO THE DISTRICT OF COLUMBIA AND TO BE NOW A CHAIR AT GEORGE WASHINGTON UNIVERSITY WHERE HE IS -- WHERE YOU WERE THE WILLIAM AND C CAN PROFESSOR IN HEALTH POLICY AND NOW YOU'RE BASED AT G-W. AND YOU HAVE BEEN RECOGNIZED WIDELY IN THE FIELD AS AN OUTSTANDING RESEARCHER AND A LEADER, A THOUGHT LEADER, SO WE'RE REALLY PRIVILEGED TO HAVE YOU PRESENT TO US TODAY. THANK YOU, TOM. [APPLAUSE] >> Dr. Thomas LaVeist: THANK YOU. THE PRIVILEGE IS MINE. I'M VERY PRIVILEGED TO HAVE THE OPPORTUNITY TO ADDRESS YOU, AND WHEN ELISEO ASKED ME TO SPEAK -- IS THIS MICROPHONE WORKING? CAN YOU HEAR ME? >> YEAH. >> Dr. Thomas LaVeist: I LIKE TO BE A MOVING TARGET. YOU KNOW, WHEN YOU TALK BENEFICIARY USE OF RACE AND HEALTH, YOU'VE GOT TO BOB AND W HE IS AVE SOMETIMES, SO I LIKE TO MOVE AROUND. >> UNLESS YOU'RE FROM CHICAGO. >> Dr. Thomas LaVeist: YEAH, I'VE BEEN DOING THIS STUFF FOR A WHILE. AS USUAL, I BROUGHT TOO MUCH INFORMATION AND NOT ENOUGH TIME TO DO IT ALL, BUT ON TOP OF THAT, I WANT TO SAY A FEW THINGS ABOUT, YOU KNOW, THIS PRESENTATION WAS SUPPOSED TO BE ABOUT MY JOURNEY ABOUT TRYING TONLD WHY DISPARITIES EXIST AND WHAT WE CAN DO ABOUT IT AND I WILL TALK ABOUT THAT AND HOPEFULLY I'LL GET THROUGH ALL THAT BEFORE YOU CUT ME OFF, BUT I DO WANT TO SPEND A LITTLE BIT OF TIME TALKING ABOUT THE WORK THAT WE DID AT NIMHD AND THE ROLE THAT NIMHD PLAYS IN MY CAREER AS WELL AS THE CAREERS OF MANY, MANY PEOPLE AT JOHNS HOPKINS AND AT OTHER INSTITUTIONS THAT WE WORKED WITH. EVERY YEAR WE HAD A SUMMER PROGRAM WHERE WE WOULD BRING IN STUDENTS FROM ALL OVER THE COUNTRY AND MANY OF THOSE STUDENTS PUBLISHED ARTICLES, CO-AUTHORED ARTICLES WITH US, WENT ON TO GRADUATE SCHOOL, DOING IMPORTANT THINGS ALL OVER THIS COUNTRY RIGHT NOW, AND THIS WORK WOULD NOT HAVE BEEN POSSIBLE WITHOUT THE SUPPORT THAT WE HAD, THAT WE RECEIVED FROM NIMHD. WHEN I WENT TO HOPKINS, I WENT THERE FROM THE UNIVERSITY OF MICHIGAN AND WHEN I WAS AT UNIVERSITY OF MICHIGAN I WAS PART OF A TEAM THERE CALLED THE PROGRAM FOR RESEARCH ON BLACK AMERICANS, AND THIS WAS A PROGRAM HEADED BY JAMES JACKSON FOCUSED ON A WIDE VARIETY OF TOPIC AREAS BUT NOT REALLY HEALTH. I WAS LIKE THE HEALTH PERSON WHO REALLY WANTED TO DO THAT KIND OF WORK. WHEN I DISCOVERED THAT HEALTH DISPARITIES EXISTED WHILE I WAS A GRADUATE STUDENT IS WHEN I DISCOVERED IT. I DIDN'T DISCOVER HEALTH DISPARITIES, I LEARNED THAT HEALTH DISPARITIES WAS A PROBLEM, LET'S PUT IT THAT WAY. I WENT TO HOPKINS WITH THE IDEA THAT WE SHOULD HAVE A CENTER LIKE THE PROGRAM FOR RESEARCH ON BLACK AMERICANS THAT FOCUSED ON HEALTH ISSUES, THAT THAT WAS AN IMPORTANT THING AND A VITAL THING FOR THE COUNTRY, AND I THOUGHT THAT A CENTER LIKE THAT NEEDED TO BE AT AN INSTITUTION WITH THE CACHE AND THE PRESTIGE OF JOHNS HOPKINS BECAUSE ONE OF THE THINGS THAT I LEARNED BEING AT JOHNS HOPKINS IS THAT WHEN YOU SAY YOU'RE FROM JOHNS HOPKINS, PEOPLE BELIEVE T YOU MIGHT BE A BLACK AND BLUERING ID YOT, I WON'T NAME NAMES, BUT THERE ARE SOME, BUT WHEN YOU SALE YOU'RE FROM JOHNS HOPKINS, IT HAS A DIFFERENT LEVEL OF CREDIBILITY. I FIGURED I WOULD RATHER HAVE THAT ON MY SIDE THAN HAVE TO WORK AGAINST THAT. SO WE WENT THERE WITH THE HOPE OF ESTABLISHING THIS CENTER, I GOT THERE IN 1990, IT WASN'T UNTIL 200 THAT WE WERE ABLE TO GET FUNDING BECAUSE AT THE TIME NIMHD WAS DEVELOPED AND CAME OUT WITH THIS PROGRAM TO ESTABLISH RESEARCH CENTERS ON HEALTH DISPARITIES, THIS WAS A DREAM COME TRUE. WE WERE FORTUNATE TO BE AMONG THE FIRST CENTERS THAT WERE ESTABLISHED AND WE WERE ALSO FORTUNATE TO HAVE BEEN CONTINUOUSLY FUNDED FROM THE VERY FIRST YEAR OF THAT PROGRAM AND WE ARE STILL FUNDED NOW. I'M NOT EVEN THERE ANYMORE, I'M STILL SAYING WE, BECAUSE IT HAS THIS MUCH IMPORTANCE TO ME. WE PUBLISHED OVER 350 PEER-REVIEWED PARTICLES, THAT'S WRONG, ABOUT 2/3 OF THE ARTICLES ARE CO-AUTHORED WITH STUDENTS AND FELLOWS, THE IMPACT HAS BEEN HUGE, NOT ONLY FOR THE FACULTY MEMBERS, THESE ARE SOME EXAMPLES OF SOME OF THE IMPACTS THAT THIS CENTER HAD ON SOME OF THE FACULTY MEMBERS. OF COURSE, FOR ME, YOU KNOW, LISA COOPER, WHO WITHIN THE MACARTHUR GENIUS AWARD FOR THE WORK SHE DID, SHE'S NOW A VICE PRESIDENT AT JOHNS HOPKINS, SAIR ARE BBLE CIRCUMSTANCES H ACCEPTED A POSITION FOREIGN DOWED PROFESSOR AT HARVARD, FURR HOLDEN, ENDOWED PROFESSOR AT MSU, GAS SKIN, JOHNS HOPKINS, THORPE, 75 PEER REVIEWED FROM ARTICLES, I WAS THE FIRST FULL PROFESSOR AT JOHNS HOPKINS, FIRST FULL PROFESSOR AND ENDOWED PROFESSOR AND SEVERAL OF US HAVE BEEN ELECTED TO THE INSTITUTE OF MEDICINE AND ALL OF THAT IS BECAUSE OF THE WORK WE DID AT THAT CENTER AND THAT CENTER WAS ONLY POSSIBLE BECAUSE OF NIMHD. SOME OF THE IMPACTS THAT WE HAD BEYOND JUST RESEARCH, POLICY WORK WE DID, REPORT ON THE ECONOMIC BURDEN OF HEALTH DISPARITIES, HEALTH INEQUALITIES WHICH WAS A REPORT THAT CALCULATED THE ECONOMIC IMPACT OF HEALTH INEQUALITIES, THAT I'M TOLD THAT WORK PLAYED AN IMPORTANT ROLE DURING THE NEGOTIATIONS FOR THE AFFORDABLE CARE ACT IN KEEPING SOME OF THE HEALTH EQUITY PROVISIONS IN THE BILL. WE CALCULATED THAT COST AT $1.24 TRILLION ACCIDENT THAT'S A HUGE DRAPG ON THE U.S. ECONOMY. WE SPONSORED AN INTERNATIONAL CONFERENCE, INTERNATIONAL CONFERENCE ON HEALTH AND AFRICAN DIASPARA WHERE WE BROUGHT PEOPLE FROM ALL OVER THE WESTERN HEMISPHERE TO BALTIMORE TO TALK ABOUT THE HEALTH OF AFRICAN DESCENT POPULATION WHO HAD GONE THROUGH THE MIDDLE PASSAGE, SOMETHING THAT HAD NOT PREVIOUSLY BEEN LOOKED AT IN HEADLIGHT. WE'RE WORKING ON A DOCUMENTARY FILM CALLED THE SKIN YOU'RE IN, THE GOAL OF WHICH IS TO TAKE THE INFORMATION THAT WE'VE ALL PUBLISHED, NOT JUST ME, BUT THAT HAS BEEN PUBLISHED OVER THE LAST 30 YEARS THAT'S NOW LOCKED AWAY IN MEDICAL LIBRARIES, INACCESSIBLE TO MOST PEOPLE, AND TRYING TO PUT THAT INFORMATION INTO A FORMAT THAT CAN BE TAKEN INTO COMMUNITIES WHERE PEOPLE CAN LEARN WHAT HEALTH DISPARITIES ARE ALL ABOUT, AND ON THURSDAY AT THE CONGRESSIONAL BLACK CAULK CUSS MEETINGS ON THURSDAY, WE'RE GOING TO HAVE A PRESS CONFERENCE WHERE WE'LL BE ANNOUNCING THE BLACK MEN'S HEALTH INITIATIVE, WHICH IS A NATIONAL STUDY THAT WE'RE DOING, WE'RE ATTEMPTING TO ENROLL 10,000 BLACK MEN NATIONALLY INTO A NATIONAL COHORT THAT WE WOULD BE ABLE TO GO FORWARD AND FOLLOW TO LEARN HOW DO WE CREATE TAILORED MESSAGES OF INTERVENTIONS TO THIS POPULATION THAT HAS NOT RECEIVED SUFFICIENT RESEARCH. BUT IN SPITE OF ALL THOSE IMPACTS ON INDIVIDUALS AND ON COMMUNITIES AND ON THE RESEARCH COMMUNITY AT LARGE, THE IMPACT OF THE CENTER ON JOHNS HOPKINS WAS THE GREATEST IMPACT OF ALL. WHEN WE GOT FUNDED, I LEARNED THAT THERE WERE SYSTEMS OF LEADERSHIP AT THE INSTITUTION THAT I DIDN'T KNOW EXISTED BECAUSE NOW AS A CENTER DREK TORQUES AS A P60 COMPREHENSIVE CENTER DIRECTOR, YOU GO TO THE DEAN'S MEETING, YOU GO TO THE DEAN'S RETREAT, YOU'RE ON THIS COMMITTEE, YOU'RE AT THE TABLE WHEN DECISIONS ARE BEING MADE. THIS WAS THE HUGEST IMPACT, I'M GETTING PHONE CALLED NOW FROM DEPARTMENT CHAIRS ALL OVER THE CAMPUS ASKING ME TO COLLABORATE WITH THEM ON FACULTY HIRES AND FACULTY RECRUITMENTS. CAN YOU PUT SOME RESOURCES INTO IT? CAN YOU HELP US TO BRING THIS PERSON TO CAMPUS? AND IN 2011 WHEN WE WROTE OUR LAST RENEWAL APPLICATION, AT THAT TIME WE DID AN ANALYSIS LOOKING AT ASSOCIATION OF SCHOOLS PUBLIC HEALTH DATA AND DETERMINED THAT AT THE TIME WE HAD THE LARGEST NUMBER OF AFRICAN AMERICAN FACULTY OF ANY SCHOOL OF PUBLIC HEALTH, AND WHEN I SAY ANY, I'M INCLUDING MOREHOUSE, MORGAN FLORIDA A & M, MAHARIY, HISTORICALLY BLACK COLLEGES, WE WOULD MORE BLACK FACULTY THAN ANY HBCU AT JOHNS HOPKINS. WHEN I GOT THERE IN 19 THE 0, I WAS THE ONLY BLACK FACULTY MEMBER. I'M NOT SAYING THAT I'M THE REASON FOR THAT CHANGE ARE BUT I'M SAYING THAT THE FACT THAT WE WERE ABLE TO CREATE THIS INFRASTRUCTURE IS THE REASON FOR THAT CHANGE. THERE ARE TWO THINGS I'VE BEEN NOTICING COMING OUT OF THIS SNULT THAT I THINK -- THIS INSTITUTE THAT I THINK ARE REALLY IMPORTANT CHANGED IN DIRECTION. ONE IS THE MOVE INTO THE RO1 AND THE OTHER IS THE MOVE INTO THE U GRANLTS AS OPPOSED TO THE P'S. IN COMPETITIVE ACADEMICS, MONEY IS GOOD BUT NOT ALL MONEY IS TREATED EQUALLY AND AN R GRANLTD IS NOT AN R GRANT IS NOT AN R GRANT. THE RO1 IS THE HOLY GRAIL, THE MOST PRESTIGIOUS FORM OF GRANT GETTING, THE MOST PRESTIGIOUS GRANT YOU CAN GET, AND NIMHD PREVIOUSLY DIDN'T PARTICIPATE IN THAT. SO THE FACT THAT YOU ARE NOW DOING THAT IS HUGELY IMPORTANT AND IT'S GOING TO HELP TO EVOLVE A WHOLE NEW GENERATION OF RESEARCHERS WHO ARE GOING TO BENEFIT FROM THIS. IT'S GOING TO HAVE A MASSIVE IMPACT. BUT THE MOVE TO THE U'S IS A MOVE, IN MY ASSESSMENT, IN THE WRONG DIRECTION BECAUSE THE U GRANT DIRECTORS ARE NOT INVITED TO THE DEAN'S RETREAT, THEY ARE NOT PART OF THE LEADERSHIP OF THE INSTITUTION, THEY DO NOT HAVE THE SAME PRESTIGE AS THE COMPREHENSIVE CENTER GRANTS. AS A P60 CENTER DIRECTOR OR PI, I SAT NEXT TO THE CANCER CENTER'S PI BECAUSE THEY ARE A P60 ALSO, A MUCH BIGGER P60, BUT THEY RECALL A P60 COMPREHENSIVE GRANT AND THEY WERE ON THAT COUNCIL RIGHT ALONG WITH ME AND THAT GAVE ME THE OPPORTUNITY TO BE A PART OF THAT. SO IF I WOULD MAKE ONE PITCH TO YOU GUYS, I DON'T KNOW WHERE YOU ARE ON THE CONTINUATION OF THAT PROGRAM, I'M NO LONGER A PI OF THE GRANT, SO I'M NOT SPEAKING FROM THE STANDPOINT OF BEING SELF-SERVING, AND IF YOU DID CONTINUE THEM, I MOST LIKELY, I WON'T PROMISE THIS, BUT I MOST LIKELY WOULD NOT APPLY FOR GW GIVEN THE OTHER WORK I'M DOING, BUT THE INFRASTRUCTURE CRATED, THE CREDIBILITY YOU BROUGHT TO THE TOPIC OF HEALTH DISPARITIES WHICH WAS NOT EVEN SEEN AS A CREDIBLE TOPIC MUCH RESEARCH BACK IN THE 1990S, BUT WHEN YOU NOW HAVE ATTACHED THE IMPRONADA OF A NIH PROGRAM GRANT OR CENTER GRANT OR CENTER OF EXCELLENCE GRANT AND WHEN YOU GIVE THE IMPRAMADA OF RO1 IT TAKES ON LEVEL OF PRESTIGE AND IMPORTANCE WITHIN THESE RESEARCH INSTITUTIONS THAT WOULD NOT BE POSSIBLE WITH ANY OTHER SOURCE OF FUNDING. THAT'S THE END OF MY RANLT, NOW I'LL GO ON TO MY PRESENTATION, BUT I NEED TO DO SAY THIS TO YOU BECAUSE I THINK THIS IS SO IMPORTANT IF WE'RE GOING TO HAVE THIS NEXT GENERATION OF RESEARCHERS, WE NEED TO HAVE THE INFRASTRUCTURE FOR THEM TO BE ABLE TO LAUNCH AND ENFUEL THEIR CAREERS, AND IT'S THE RO1'S AND IT'S THE P'S, NOT THE U'S, THAT'S GOING TO DO THAT. SO I IMPLORE YOU TO CONSIDER THAT. AS I SAID EARLIER, I LEARNED HEALTH DISPARITIES EXISTED WHEN I WAS IN GRADUATE SCHOOL AND THE REPORT CAME OUT, SECRETARY'S CAN REPORT CAME OUT, IF YOU REMEMBER THAT REPORT, HECLARE REPORT, IT WAS PAGE AFTER PAGE AFTER PAGE OF THIS, AND SUMMARY OF THE WHOLE THICK, MORTALITY, HOW LONG DO YOU LIVE, AND THIS TO ME IS THE SUMMARY OF THIS ISSUE OF HEALTH DISPARITIES, I STOPPED UPDATING THIS CHART IN 2011 BECAUSE IT BECAME FUTILE. IT'S THE SAME CHART. YOU CAN JUST PRETEND IT SAYS 2014, 2015, IT'S THE SAME CHART. BUT THE QUESTION IS WHY. WHY DO THESE DISPARITIES EXIST? WHEN I TALK TO PEOPLE, ESPECIALLY PEOPLE THAT ARE NOT IN THE SCIENCES, BUT ALSO PEOPLE THAT ARE RESEARCHERS, I OFTEN GET THREE MYTHS ABOUT WHY DISPARITIES EXIST. ONE MYTH IS OH, IT'S NOT REALLY RACE, IT'S SOCIOECONOMIC STATUS, WHICH TO ME IS THE MOST INTERESTING ONE, BECAUSE EVEN IF THAT WERE TRUE, WHICH IT IS NOT, WHY WOULD THAT MAKE ANY DIFFERENCE, IT WOULD BE AS UNACCEPTABLE TO ME AS RACIAL DISPARITIES WOULD BE. BUT OF COURSE IT IS NOT JUST THAT AND THIS IS A NARRATIVE THAT WE HAVE TO COMBAT BECAUSE YOU FIND AMONG MANY RACIAL AND ETHNIC MINORITIES THEMSELVES BELIEVING THAT THIS IS REALLY ABOUT SOCIOECONOMIC STATUS AND REALLY NOT ABOUT RACE OR ETHNICITY AND IT'S JUST OH THOSE POOR PEOPLE THAT HAVE THESE BAD HEALTH OUTCOMES THINKING THEY CAN EDUCATE OR NICK THEIR WAY OUT OF THIS PROBLEM BUT YOU CANNOT EDUCATE AND INCOME YOUR WAY OUT OF THE PROBLEM, THE DISPARITIES STILL EXIST BY RACE. THE OTHER ONE IS THAT THERE ARE SOME BIOLOGICAL AND GENETIC DIFFERENCES. DON'T HEAR THAT ONE AS OFTEN ANYMORE, ALTHOUGH YOU DO STILL HEAR PEOPLE MAKE ALEUTIANS TO THE FACT THAT -- ALLUDING TO THE FACT THAT BLACK PEOPLE RESPOND BETTER TO THIS DRUG OR ASIANS HAVE A BETTER RESPONSE TO THIS BECAUSE THERE'S SOME BIOLOGICAL DIFFERENCE THAT PRODUCES THAT, WE HEAR THAT SORT OF THING AND THE OTHER THAT THIS IS REALLY ABOUT ACCESS TO HEALTHCARE, SO IF WE JUST GET THEM BETTER ACCESS TO HEALTHCARE, THAT WOULD INVOLVE SOLVE THE PROBLEM. I'LL ILLUSTRATE WHY THESE ARE ALL TRUE, I HOPE NOT TO SPEND TOO MUCH TIME ON THIS. THIS IS FROM ONE OF THE STUDIES THAT WE DID BACK IN EARLY 2000S, WE DID A STUDY THREE HOSPITALS IN BALTIMORE ARE AREA, LOOKED AT CORONARY ANGIOGRAPHY, LOOKED AT PATIENTS ADMITTED TO THESE THREE HOSPITALS, 10,000 PATIENTS TOTAL, ALL PATIENTS THAT HAD A DIAGNOSIS THAT WOULD SUGGEST THAT THEY COULD BE A CANDIDATE FOR CORONARY ANGIOGRAPHY, WE DID A MEDICAL RECORD ABSTRACTION, WE EVALUATED THOSE MEDICAL RECORDS AND TRIED TO DETERMINE BASED ON AMERICAN COLLEGE OF CARDIOLOGY GUIDELINES SHOULD THEY HAVE BEEN REFERRED FOR THE PROCEDURE, WE ELIMINATED PATIENTS THAT DID NOT HAVE INSURANCE OR PATIENTS WHO WE DIDN'T THINK HAD THE ABILITY TO PAY, SO WE'RE ONLY LOOKING HERE, THERE'S NO ONE REFLECTED IN THIS CHART THAT HAS AN ACCESS PROBLEM BECAUSE EVERY ONE OF THESE PATIENTS FOUND THEIR WAY INTO THE HOSPITAL AND GOT SEEN AND GOT A DIAGNOSIS AND GOT A MEDICAL RECORD. EVERY PATIENT IN THIS STUDY WAS INSURED AND HAD INSURANCE THAT WOULD HAVE COVERED THE PROCEDURE. SO THIS IS NOT AN ACCESS ISSUE. AND EVERY PATIENT IN THIS STUDY, IN THIS CHART, SHOULD HAVE BEEN REFERRED FOR THE PROCEDURE. BOTH BARS SHOULD BE AT 100%. BUT WE SEE TWO THINGS. WE SEE AN OVERALL QUALITY PROBLEM BECAUSE THE WHITE BAR IS NOT 100%, BUT THERE'S A DISPARITY IN QUALITY BECAUSE THE AFRICAN AMERICAN BAR IS SIGNIFICANTLY SMALLER THAN THAT BAR. A SIMILAR STUDY WAS DONE IN PITTSBURGH BUT THIS TIME THEY WERE LOOKING AT REVASCULARIZATION, DONE AT THE PITTSBURGH VA, AND THIS IS ONE OF MY FAVORITE STUDIES BECAUSE THEY AS BEST AS POSSIBLE HAVE ACCOUNTED FOR ALL OF THE NOISE AND SO LET'S GET DOWN TO PATIENTS BEING SEEN AT THESE SAME HOSPITALS AT THE SAME TIME WITH THE SAME VA INSURANCE. WE FIND AGAIN 100% OF THESE PATIENTS SHOULD HAVE BEEN REFERRED FOR AVASCULARIZATION, ONLY HALF OF THE WHITE PATIENTS GOT REFERRED, WHICH IS REFLECTIVE OF A PROBLEM THAT I THINK MANY OF US ARE AWARE THAT VA HAS SOME ISSUES THAT WAIR WORKING THROUGH, BUT ONLY HALF AGAIN OF THAT NUMBER OF THE AFRICAN AMERICANS WERE REFERRED, SO EVEN WHEN THERE IS NO ECONOMIC INCENTIVE, VA POSITIONS ARE ON SALARY, IF ANYTHING, THE ECONOMIC INCENTIVE WOULD BE TO PROVIDE THE SERVICE BECAUSE IF YOU GET PAID FOR THE SERVICE, WHY NOT PROVIDE THE SERVICE WHEN PATIENTS ARE APPROPRIATE CANDIDATES AND HAVE THE ABILITY TO PAY. SO WE HAVE A DISPARITIES PROBLEM IN, AND IN SIMPLY IMPROVING ACCESS TO CARE IS NOT GOING TO SOLVE THAT PROBLEM. I'LL QUICKLY TALK ABOUT THIS BIOLOGICAL DIFFERENCE ONE BECAUSE THIS COMES UP IN VERY SUBTLE WAYS. VERY SUBTLE WAYS. PROBABLY THERE'S NO ONE IN THE ROOM THAT BELIEVES THAT THERE'S SOME GENE THAT BELONGS TO ONLY ONE RACIAL GROUP AND THAT GENE IS CAUSING HEART DISEASE AND CANCER AND STROKE AND AUTOMOBILE INJURIES AND HOMICIDE AND HIV AND ALL THE OTHER CAUSES OF DEATH IN ALL THE PLACES WHERE WE HAVE THESE DISPARITIES, RIGHT? I'M SURE NONE OF YOU BELIEVE THAT. BUT THIS BIOLOGY THING DOES CREEP INTO OUR THINKING IN VERY SUBTLE WAYS. SO I'M SURE EVERYONE HERE IS FAMILIAR WITH THE BIDIL STORY. ANYONE HERE NOT FAMILIAR? YOU WOULD BE ASHAMED TO SAY THAT. ANYONE HERE NOT KNOW ABOUT BIDIL? OKAY. I'M GOING TO TALK REALLY FAST ABOUT BIDIL. THOSE OF YOU WHO KNOW ALL ABOUT IT, FORGIVE MEL FOR ALL THE DETAILS -- ME FOR ALL THE DETAILS I'M GOING TO LEAVE OUT, BUT TOIF BREEZE THROUGH THIS. BIDIL IS A DRUG TO TREAT CONGESTIVE HEART FAILURE, 1970S, NEW CLASSES OF DRUGS WERE COMING OUT, CALCIUM CHANNEL BLOCKERS, BETA BLOCKERS, DRUGS THAT ARE NOW COMMON, AND THESE DRUGS WERE AT THE TIME BELIEVED TO BE SIGNIFICANT IMPROVEMENTS OVER DIURETICS, SO THEY WERE COMING ONTO THE MARKET, SOME PHYSICIANS DISCOVERED THAT IF IF YOU COMBINE THESE NEW DRUGS WITH TWO VERY INEXPENSIVE GENERIC DRUGS, THAT PATIENTS WERE HAVING A VERY POSITIVE OUTCOME WITH THIS, THIS NEW COMBINATION INEXPENSIVE THERAPY WAS VERY EFFECTIVE SO THEY SAID LET'S DO A CLINICAL TRIAL, MAKE SURE THIS THERAPY IS REALLY WORKING, DO A CLINICAL TRIAL, PUBLISH IT IN THE JOURNAL OF MEDICINE, HAVE WILDLY POSITIVE RUL, THEY'RE HAVING AN IMPACT, AND THIS IS AN IMPORTANT DISCOVERY BECAUSE NOW WE HAVE THIS NEW THERAPY FOR THIS DEBILITATING DISEASE AND IF IT STOPPED THERE IT WOULD HAVE BEEN A GREAT STORY BUT THEN THEY SAID, WELL, WHAT IF WE TAKE THESE TWO GENERICS AND WE PUT THEM IN ONE PILL AND WE GET A PATENT FOR THAT PILL, THEN THERE WOULD BE AN ECONOMIC WINDFALL WE GET FOR THAT, THEY DO THAT, AND THEY WANT TO COME TO MARKET WITH THIS, THE FDA SAYS I'M SORRY, YOU CAN'T COME TO MARKET WITH THIS NEW DRUG, YOU HAVE TO DO A NEW CLINICAL TRIAL BECAUSE THE TRIAL YOU DID WAS NOT TO OUR STANDARDS. SO IF YOU KNOW HOW LONG IT TAKES TO DO A CLINICAL TRIAL, IF THEY WERE TO TRY TO DO THAT AT THAT POINT, OF COURSE, BY THE TIME THEY FINISH THE TRIAL, IT WOULD BE OFF PAT ENLT AND THEY WOULD LOSE THE ECONOMIC WINDFALL. SO WHAT DO THEY DO? THEY GO BACK INTO THE DATA, THEY DO A LITTLE DATA MINING, AND THIS IS BASICALLY WHAT THEY FOUND. LET'S IMAGINE THAT WE HAD A CONDITION AND WE HAD A PILL THAT WE THOUGHT MIGHT HELP THE CONDITION AND I'M GOING ON KEEP IT SIMPLE, TWO GROUPS -- TO KEEP IT SIMPLE, TWO GROUPS, BLACK PATIENTS, ASIAN PATIENTS, WE GIVE 100 BLACK PATIENTS, 100 ASIAN PATIENTS WITH THE SAME CONDITION, WE GIVE THE PILL AND WE FIND 75% OF THE BLACK PATIENTS BENEFITED FROM THE DRUG AND 65% OF THE WHITE PATIENTS BENEFITED FROM THE DRUG. I KNOW I'M TALKING FAST. ARE YOU WITH ME? I DIDN'T LOSE YOU? THAT 10 PERCENTAGE POINT, IN THE REAL WORLD THOSE PROPORTIONS WOULD BE UNBELIEVABLE, BUT THAT 10 PERCENTAGE POINT DIFFERENCE WHICH MOST ASSUREDLY BE STATISTICALLY SIGNIFICANT, RIGHT? AND WE WOULD INTERPRET THAT DIFFERENCE APPEARS THE DRUG IS MORE EFFECTIVE IN BLACK PATIENTS. AM I RIGHT? WHO SAYS I'M RIGHT? WHO SAYS I'M NOT RIGHT? BHO IS AFRAID TO ANSWER THE QUESTION? [LAUGHTER] SO THAT'S THE WAY WE TALK ABOUT IT, THE DRUG IS MORE EFFECTIVE IN BLACK PATIENTS BECAUSE A LARGER PERCENTAGE OF THEM BENEFITED. BUT OF COURSE THE DRUG IS NOT MORE EFFECTIVE IN BLACK PATIENTS. IT WAS EFFECTIVE FOR A LARGER PERCENTAGE OF BLACK PATIENTS, BUT IF YOU WERE PART OF THE 65% OF ASIAN PATIENTS THAT BENEFITED, YOU BENEFITED. IF YOU WERE PART OF THE 75% OF BLACK PATIENTS THAT BENEFITED, YOU BENEFITED. THAT STATISTICALLY PIECE OF BETA COEFFICIENT FOR RACE DOES NOT MEAN THAT THIS IS A BLACK DRUG. IT MEANS THAT YOU FOUND A DRUG WITH A LARGER EFFECT SIZE IN ONE GROUP, WHICH DOES NOT MEAN A LARGER IMPACT ON A PAISH, IT MEANS A -- ON A PATIENT, IT MEANS A STRONGER RELATIONSHIP. SO IF YOU BENEFITED, YOU BENEFITED. IT DIDN'T MATTER WHETHER YOU WERE PART OF THE 65% ASIAN OR 75% WHITE. THEY GO BACK AND PUBLISH THE JOURNAL, PUBLISH THIS ARTICLE IN THE JOURNAL THAT I CAN'T REMEMBER THE NAME OF AND PROBABLY NO ONE HERE HAS HEARD OF AND THEN THEY GO BACK AND SAY OKAY, WE NEED A NEW PATENT, THIS TIME WE WANT A PATENT FOR USE IN ONLY BLACK PATIENTS BECAUSE, LOOK, THE DRUG IS MORE EFFECTIVE IN BLACK PATIENTS. THIS WAS TWO YEARS AFTER THE HUMAN GENOME PROJECT DEMONSTRATED THERE WERE NO RACE DIFFERENCES, NO SIGNIFICANT RACE DIFFERENCES AT THE GENOMIC LEVEL. SO IN 2005 WE GET THE FIRST DRUG FOR ONE RACIAL GROUP, AFRICAN AMERICANS. RIGHT? NOT 1905. 2005. SO TO WHOM DO WE PRESCRIBE BIDIL? DO WE PRESCRIBE BIDIL TO THIS AFRICAN AMERICAN GENTLEMAN WHO HAS ONE GRANDPARENT FROM SCOTLAND, ONE GRANDPARENT FROM IRELAND AND TWO GRANDPARENTS FROM JAMAICA AND IS BORN IN THE BRONX? DO WE PRESCRIBE IT FOR THIS GENTLEMAN WHO HAS GOT TWO GRANDPARENTS FROM KENYA AND TWO WHITE AMERICAN GRANDPARENTS AND IS BORN IN THE UNITED STATES? [LAUGHTER] DO WE PRESCRIBE IT TO THIS AFRICAN AMERICAN GENTLEMAN? HE'S GOT ONE GRANDPARENT FROM CHINA, ONE GRANDPARENT FROM THAILAND WHO ALSO HAS CHINESE ANCESTRY, HE'S GOT ONE WHITE AMERICAN GRANDPARENT WITH NATIVE AMERICAN ANCESTRY THEN HE'S GOT A BLACK AMERICAN GRANDPARENT, FROM WHOM DID HE INHERIT HIS BIDOBICEPTOR AND HOW DO YOU KNOW BY ASKING HIM HIS RACE ON THE INTAKE FORM, WHICH IS THE ONLY PLACE YOU'RE GOING TO GET RACE, RIGHT? THE BELIEF THAT RACE HAS ANYTHING TO DO WITH BIOLOGY. THESE THREE MEN COME FROM DIFFERENT REGIONS OF THE WORLD, THEY COULD NOT BE MORE DISSIMILAR IN TERMS OF THEIR GEOGRAPHIC ORIGIN ON THEIR ANCESTRY, BUT WE ALL THEM ALL AFRICAN AMERICAN BECAUSE SOCIALLY IN THIS COUNTRY, THAT'S WHAT THEY ARE. BY THE WAY, DO WE GIVE IT TO THIS GUY? HE LOOKS LIKE A BLACK GUY TO ME. [LAUGHTER] HE DOES. I THINK HE LOOKS LIKE A BLACK GUY. BUT OF COURSE THIS IS VIJAY SINGH WHO IS FROM FIJI. HOPEFULLY HE DOESN'T EVER NEED BIDIL BUT IF HE DID, I WOULD HOPE IT WOULD BE AVAILABLE TO HIM, BECAUSE IT IS SUPPOSED TO BE PRESCRIBED ONLY TO AFRICAN AMERICANS. WHAT HAPPENED TO BIDIL IS NO ONE PUT IT ON THEIR FORMULARY BECAUSE THEY SAID WHY WOULDN'T WE JUST PRESCRIBE TO GENERIC DRUGS, WHICH IS WHAT EVERYONE DID, BIDIL GOT B LISTED ON THE NEW YORK STOCK EXCHANGE, PRIVATE EQUITY COMPANY HAS NOW PURCHASED THE RIGHTS TO BIDIL AND THEY'RE NOW AGGRESSIVELY MARKETING BIDIL AMONG BLACK PHYSICIANS BY THE WAY BUT WE KNOW IT'S AN EFFECTIVE DRUG SO THAT'S NOT NECESSARILY A BAD THING BUT IT SHOULD BE AVAILABLE TOFER ONE. THESE ARE THE WAYS THAT RACE AND BIOLOGY CREEPS INTO OUR THINKING IN SUBTLE WAYS THAT CAN SEND US DOWN THE WRONG PATH. NOW FINALLY, IT'S NOT REALLY RACE, IT'S NOT REALLY A RACE OR ETHNICITY, IT'S REALLY ABOUT INCOME. SO I'M GOING TO JUST SHOW YOU A COUPLE QUICK SLIDES HERE THAT I PULLED OUT OF THE NATIONAL HEALTH INTERVIEW SURVEY, LOOKING AT EDUCATION LEVELS AND SOME DIFFERENT OUTCOMES AND I COULD GO ON LIKE THIS FOR HOURS. I PROMISE I WON'T. AND CHART AFTER CHART AFTER CHART WILL SHOW YOU A RACE DIFFERENCE AT ALL LEVELS OF EDUCATION, HERE IS SOME FOR INCOME, THIS IS FROM MEPS, THE DISPARITIES ARE BOTH SOCIOECONOMIC STATUS AND RACE, AND THIS IS THE MORE INTERESTING ONE, THIS IS A PAPER THAT WE'RE WORKING ON NOW. WE WERE ABLE TO FAR FOR THE FIRST TIME GET DATA ON PEOPLE VERY HIGH INCOME PEOPLE, PEOPLE WITH INCOMES OVER $175,000 WHICH WE TYPICALLY CAN'T GET ON FEDERAL DATA BECAUSE MOST DATASETS END AT 175,000 AND BOVMENT I'LL BRING THAT MESSAGE TO NCHS. MEPS ACTUALLY COLLECTS ACTUAL DOLLAR AMOUNTS SO WE WERE ABLE TO COMBINE EIGHT YEARS OF MEPS DATA TO GET ENOUGH PEOPLE AT THE HIGHEST INCOME LEVELS TO SHOW THAT ACTUALLY UNLIKE OTHER CONDITIONS FOR AFRICAN AMERICANS AT LEAST, AS INCOME INCREASES INTO THE HIGHER LEVELS, HIGHEST INCOME LEVELS, THE RISK OF HYPERTENSION ACTUALLY INCREASES SO I'M SURE WE CAN HAVE SOME INTERESTING CONVERSATIONS ABOUT WHAT THAT'S ABOUT. BOTTOM LINE IS THAT SOCIOECONOMIC STATUS IS NOT THE REASON FOR THE DISPARITIES THAT WE SEE. SO I'M SURE THERE WERE SOME OH FISH GNAW DOUGHS IN THIS -- OFFICIANADOS, IN THIS ROOM OF RESEARCH SCIENTISTS WHO SAID WE DEAL WITH THAT PROBLEM THROUGH MULTIVARIATE MODELS, SO I THOUGHT I WOULD DO THIS DEMONSTRATION HERE FOR YOU SO WE CAN ASSUAGE YOU OF THIS BELIEF. I'LL DO A DEMONSTRATION OF HOW CAN MODELS WORK IN RESEARCH, DO YOU USING THE NATIONAL HEALTH INTERVIEW SURVEY, USING A VERY BIG RESPECTED DATASET, THIS IS THE MOST OFFICIAL OF OFFICIAL DATASETS THERE IS, ALL ADULTS OVER AGE 40 OF WHICH THERE ARE 33,000, SO IT'S A NICE BIG DATASET, 4400 AFRICAN AMERICANS, WE'LL COMPARE THEM BLACK AND WHITE, COMPARE THEM IN CATEGORIES, LESS THAN 20,000, 20 TO 75,000, ABOVE 75,000. WE'LL USE ADL, ABILITY OF PHYSICAL FUNCTIONING AND TRY TO SET THE BAR AS LOW AS POSSIBLE SO YOU CAN'T SAY THAT WE GAMED THIS, RIGHT? WE'LL JUST HAVE ONE ADL LIMITATION, WHICH HOPEFULLY YOU ALL WILL AGREE IS A VERY LOW STANDARD FOR A PERSON WITH PHYSICAL FUNCTIONING DISABILITY. SO THIS IS BIO STAT 101. FIRST WE'LL LOOK AT THE BIVARIATE RELATIONSHIP BETWEEN RACE AND ADL LIMITATION. WE'VE DONE THAT, WE HAVE ODDS RATIO OF 1.46 AND A CONFIDENCE INTERVAL THAT TELLS US THAT THIS IS A STATISTICALLY SIGNIFICANT EFFECT. AM I RIGHT? GIVE ME SOME FEEDBACK. IRN WE'RE NOT IN CHURCH, BUT YOU CAN GIVE ME SOME. [LAUGHTER] ALL RIGHT. WE'RE GOOD, RIGHT? SO FAR I'M PASSING 10 1-RBGS RIGHT? NEXT WE'LL LOOK AT INCOME AND ITS EFFECT AND SO WE SEE AS THE ODDS RATIO -- APPEARS THE INCOME LEVELS INCREASE, THE ODDS RATIO DECREASE, WHICH IS WHAT WE WOULD EXPECT. CONFIDENCE INTERVAL SAID THIS IS STATISTICALLY SIGNIFICANT. SO FAR EVERYTHING IS AS YOU WOULD EXPECT. SO BIO STATS 102, YOU PUT RACE AND INCOME TOGETHER AND SEE WHAT HAPPENS. OKAY. SO WE'VE DONE THAT. NOW FIRST LET'S LOOK AT INCOME. SO THE INCOME EFFECT IS REALLY UNCHANGED. AS INCOME LEVELS INCREASE, THE ODDS OF HAVING LIMITATION REDUCES AND IT'S SIPPING BUT LOOK AT WHAT HAPPENS TO THE RACE VARIABLE, IT'S NOT STATISTICALLY SIGNIFICANT. SO WHAT DO WE DO NOW? WELL, I'M A DEPARTMENT CHAIR, SO WHAT WOULD YOU TELL YOUR DEPARTMENT CHAIR? YOU PUBLISH THE ARTICLE. RIGHT? AND YOU GET A MERIT RAISE, YOUR PROMOTION, AND ALL IS RIGHT WITH THE WORLD EXCEPT YOU'VE NOW ADDED FALSE INFORMATION TO THE RESEARCH LITERATURE BECAUSE IF YOU COULD SIMPLY HAVE DONE THIS, WHICH, I DON'T KNOW, THIS MAY BE B I O STAT 201, I GUESS, AN ARRAY OF THE DATA BY INCOME AND RACE GROUPS AND LOOK WITHIN EACH CELL AT WHAT IS THE PROPORTION OF PATIENTS OR PERSONS WITH AN ADL LIMITATION, YOU WOULD SEE TWO THINGS THAT WERE IMPORTANT. FIRST, IN THE LOWEST INCOME CATEGORY, 20,000 AND BELOW, YOU DO HAVE A SIGNIFICANT RACE DIFFERENCE AND ADL LIMITATIONS, AND THE OTHER THING IS THAT YOU WOULD SEE IN THIS INCOME CATEGORY OF $75,000 OR MORE, THERE ARE ONLY 8 EVENTS, MEANING THAT IN THE NATIONAL HEALTH ENTER VIEW SURVEY, THE MOST OFFICIAL DATASET THAT WE HAVE, THERE ARE ONLY 8 AFRICAN AMERICANS WITH INCOMES OVER $75,000 WHO HAVE AT LEAST ONE ADL LIMITATION. SO THIS EXTREMELY SIMPLISTIC ANALYSIS IS NOT POSSIBLE IN THE NATIONAL HEALTH ENTER VIEW SURVEY. -- INTERVIEW SURVEY. NOW, THIS IS WHERE IT GETS REAL DEPRESSING. HOW MANY STUDIES HAVE YOU READ OR WRITTEN WITH MUCH SMALLER SAMPLES AND MUCH MORE COMPLEX ANALYSIS? IT'S OKAY. I'VE DONE IT TOO. IF YOU GO TO PUBMED AND YOU PUNCH UP MY NAME, YOU'LL FIND THAT I'VE COMMITTED SOME OF THE VERY SAME SINS THAT I'M TALKING ABOUT HERE TODAY, SO IT'S NOT ABOUT HE WHO HAS NOT SINNED CAST THE FIRST STONE, IT'S REALLY MORE ABOUT REPENALTY, GO -- IT'S REALLY MORE ABOUT REPENT, GO FORWARD AND SIN NO MORE. [LAUGHTER] YOU'LL FIND THAT I'VE DONE THAT. AMEN. SO, HERE IS ANOTHER ISSUE. THIS IS A HIGH SCHOOL IN THE BALTIMORE AREA, THIS IS AT THE ENTRANCE, TREES, LAWN, I DRIVE ONTO THE DISTANCE, THERE ARE BUILDINGS IN THE DISTANCE WHERE, HERE IS THE GYMNASIUM WHERE THE BASKETBALL AND VOLLEYBALL TEAM PLAY IN BOUGHT MOR. HERE IS ANOTHER IF HIGH SCHOOL, UPPER MIDDLE CLASS, LAWN AND TREES, BUILDING CLEARLY VISIBLE TO, DID GOING OUT TO THE FIELD, NO BLEACHERS FOR THE SPECTATORS TO WATCH THE BASEBALL GAME. OF COURSE IN THIS UPPER MIDDLE CLASS SUBURBAN HIGH SCHOOL IN BALTIMORE THE BUILDING IS NOT SUFFICIENT TO ACCOMMODATE ALL THE STUDENTS. HERE ARE SOME OF THE PORTABLE CLASSROOMS WHERE THE CLASSES ARE HELD. FINALLY, ANOTHER HIGH SCHOOL IN THE BALTIMORE AREA, THERE'S NO LAWN, BUT THERE ARE SOME WEEDS HERE. [LAUGHTER] AND THERE'S A TREE. SO WHAT'S MY POINT? THE POINT IS THAT THE GRADUATES OF EACH OF THESE INSTITUTIONS ARE IN YOUR DATASETS CODED AS HIGH SCHOOL GRADUATES. DO YOU THINK THAT PERHAPS THERE ARE QUALITATIVE DIFFERENCES IN THE LIFE CHANCES AND OPPORTUNITIES OF THE GRADUATES OF THESE INSTITUTIONS? I'LL GIVE YOU ONE GUESS. DO YOU THINK THAT PERHAPS THERE ARE DIFFERENCES BY RACE AND ETHNICITY IN WHO GOES TO WHICH OF THESE SCHOOLS? SO AGAIN, DON'T FEEL BAD. I'VE DONE IT TOO. IT'S ALL OF US. IT'S WE. WE ALL HAVE SINNED. SO WHEN WE BUILD OUR FANCY MULTIVARIATE MODEL ASK WE THINK THAT WE HAVE CONTROLLED FOR SOMETHING BY PUTTING OUR EDUCATION VARIABLE IN THAT MULTIVARIATE MODEL, I WANT YOU TO THINK ABOUT THIS SLIDE. WHAT AM I DOING HERE? AM I REALLY ACCOUNTING FOR DIFFERENCES, LIFE CHANCES AND OPPORTUNITIES? AM I REALLY ADJUSTING IN A WAY THAT'S MEANINGFUL AND IS GOING ON REALLY ALLOW ME TO UNDERSTAND WHAT ARE THE TRUE RACIAL OR ETHNIC DIFFERENCES THAT I'M INTERESTED IN? SO IF IT'S NOT GENETICS, NOT HEALTHCARE, NOT SES, THEN WHAT IS IT? I BELIEVE THAT IT'S REALLY ABOUT THE FACT THAT WE LIVE IN THE COUNTRY TOGETHER BUT WE EXPERIENCE THE COUNTRY DIFFERENTLY BECAUSE THE COUNTRY IS DRAMATICALLY RACIALLY SEGREGATED, AND BECAUSE OF THAT RACIAL SEGREGATION, WE LIVE IN VERY DIFFERENT HEALTH RISK ENVIRONMENTS AND WE HAVE VERY DIFFERENT LEVELS OF ACCESS TO PROTECTIVE FACTORS. YOU CAN CALL THAT SOCIAL DETERMINANTS, YOU CAN CALL IT ENVIRONMENTAL EXPOSURES, YOU CAN CALL IT WHAT YOU WANT, BUT THAT'S THE BOTTOM LINE OF WHAT'S GOING ON. THIS IS A MAP THAT WAS PRODUCED AT THE YEUFERLT OF VIRGINIA FROM THE 2010 CENSUS, THEY PLACED A DOT ON THE MAP REPRESENTING THE LOCATION OF EVERY AMERICAN AND IT'S COLOR-CODED BY RACE, AND I WISH WE COULD GET IT TO LOOK A LITTLE BETTER THAN THAT. SO BLUE DOTS ARE WHITE PEOPLE, GREEN DOTS ARE AFRICAN AMERICANS OR BLACK PEOPLE, RED DOTS ARE ASIAN, HISPANICS ARE ORANGE, AND THEN OTHER IS I GUESS BLACK. SO LET'S ZERO IN ON A CITY. THIS IS MY HOMETOWN, NEW YORK CITY. SO IF YOU NOTICE HERE, THIS IS MANHATTAN ISLAND, YOU SEE THE BIG WHITE RECTANGLE, THAT'S CENTRAL PARK BECAUSE NOBODY LIVES IN CENTRAL PORK, SO -- CENTRAL PARK, SO BEFORE I STARTED DOING HAD I WORKED AS A SOCIAL WORKER IN MANHATTAN AND WORKED WITH HOMELESS POPULATIONS IN MANHATTAN AND I CAN ASSURE YOU THAT THERE ARE PEOPLE LIVING IN CENTRAL PARK. [LAUGHTER] BECAUSE WHEN I WAS DOING THE WORK, I PERSONALLY KNEW SOME OF THESE PEOPLE, THEY WERE PERSONAL FRIENDS OF MINE AT THE TIME. ANYWAY, THAT'S NEW YORK. NOTICE THE RAIN BOWL -- NOTICE THE RAINBOW OF COLORS, NOTICE THE CLARITY AND DISTINCTION FROM ONE COMMUNITY TO THE NEXT, RACIAL SEGREGATION IS EVIDENT IN NEW YORK. I CIRCLED BROOKLYN, THAT'S WHERE I'M FROM, PEOPLE FROM BROOKLYN BELIEVE IT'S THE CENTER OF THE UNIVERSE AND OF COURSE IT IS THE CENTER OF THE UNIVERSE SO THIS IS BROOKLYN AND THIS MASS OF GREEN HERE CENTRAL BROOKLYN IS WHERE I GREW UP IN A NEIGHBORHOOD CALLED BROWNSVILLE, 6 TO 8,000 PEOPLE LIVING IN -- 68,000 PEOPLE LIVING IN TWO SQUARE MILES. HOW FAR DUF GET THAT MANY PEOPLE LIVING IN TWO SQUARE MILES? THIS IS HOW DO YOU IT, THIS WAS THE BUILDING I GREW UP IN, THIS IS THE ELEMENTARY SCHOOL THAISHED HAVE GONE TO BUT DIDN'T BECAUSE IT WAS CONDEMNED ABOUT A MONTH BEFORE I WAS SUPPOSED TO START THERE. WHEN I SAY CONDEMNED, THEY LITERALLY JUST LOCKED THE DOOR AND SAID OKAY, WE'RE OUT OF HERE, AND JUST LEFT IT TO ROT. THESE PICTURES ARE TAKEN NOW. YOU SEE THAT THERE ARE LEAVES GROWING OUT OF THE TOP OF THE BUILDING HERE, IT'S BEEN SO ABANDONED SO LONG, THERE ARE PEOPLE LIVING IN THE BUILDING NOW, THIS IS THE SIDE OF IT HERE. THIS IS A LITTLE BIT ABOUT THE FOOD ENVIRONMENT, I'LL LEAVE IT TO YOU TO DRYWALL YOUR OWN CONCLUSIONS ABOUT THE QUALITY OF THE FOOD. THESE ARE JUST SOME KIDS I TOOK A PICTURE OF BECAUSE I WOULD HAVE BEEN ONE OF THOSE KIDS ABOUT 40 YEARS AGO, SO I TOOK A PICTURE OF THEM. BUT THEY'RE STANDING IN FRONT OF CROWN FRIED CHICKEN AND CROWN FRIED I CAN EN IS UBIQUITOUS IN NEW YORK CITY AND CAMDEN AND NEWARD AND PHILADELPHIA. HERE ARE PICTURES OF MY ADOPTED HOME OF PHILADELPHIA, THESE ARE THE CORNER STORES, LOTTERY TICKETS, CIGARETTES, MALT LIQUOR, SOME FOODSTUFFS, AN IMPORTANT PART OF THE INFRASTRUCTURE FOR THE DRUG TRADE. THIS IS MY FAVORITE ONE, THIS IS ON NORTH AVENUE, I DID NOT PHOTOSHOP THIS SIGN. I LOVE THE SIGN. L & L LIQUORS, THEY SELL BEER, WINE AND MEDICINE. [LAUGHTER] TRUTH IN ADVERTISING. OF COURSE THE MEDICINE THEY SELL IS THE ELIXIRS FOR THE ILLS OF POVERTY. MALT LIQUOR. IF YOU DON'T KNOW, I'M SURE I'M THE ONLY ONE HERE WITH EXPERIENCE WITH MALT LIQUOR, I'M THE ONLY ONE WHO WENT TO COLLEGE, RIGHT? [LAUGHTER] >> SURE THE ONLY ONE WHO KNOWS WITH AUTHORITY. >> Dr. Thomas LaVeist: ABOUT DOUBLE THE ALCOHOL CONTENT OF BEER AND THAT IS, YES, A 64-OUNCE BOTTLES OF GLASS. CAN YOU IMAGINE HOW HEAVY THAT THING IS? BUT IT IS AN ENGINEERING MARVEL, THIS THING IS ERGONOMICALLY DISIEMED FOR EASY ONE-HAND CONSUMPTION. -- DESIGNED FOR EASY ONE-HAND CONSUMPTION. [LAUGHTER] IT'S GENIUS. IT'S EVIL GENIUS, BUT IT'S GENIUS. WE DID A STUDY ON LOOK AT THE LOCATION OF THESE STORES IN BALTIMORE, PLOTTED THEM ACCORDING TO THE CENSUS TRACKS AND WE FOUND THESE STORES ARE ALMOST EXCLUSIVELY LOCATED IN LOW-INCOME PREDOMINANTLY BLACK COMMUNITIES IN BALTIMORE CITY, EVEN THE HIGHER INCOME PREDOMINANTLY BLACK COMMUNITIES DON'T HAVE AS MANY OF THESE STORES AND EVEN THE POORER WHITE NEIGHBORHOODS DON'T HAVE THEM, THEY'RE VERY CLEARLY TARGETING CERTAIN NEIGHBORHOODS. SO THIS IS PART, THIS IS THE ECOSYSTEM THAT PRODUCES THE DISPARITIES. WHEN YOU GROW UP IN THAT ENVIRONMENT, IT'S NORMATIVE TO OVERCONSUME ALCOHOL. IT'S NORMAL, IT'S WHAT YOU'RE SUPPOSED TO DO. IT'S WHAT'S AVAILABLE TO YOU. IT'S ALL THAT'S AVAILABLE TO YOU REALLY. A 40-OUNCE BOTTLE OF MALT LIQUOR IS LESS EXPENSIVE THAN A 2 LITTER BOTTLE OF SODA, WHICH IS ALSO UNHEALTHY, AND THEY'RE BOTH LESS EXPENSIVE THAN WATER. NOW, WHAT IS THAT ABOUT? SO WE GOT THE IDEA, WHAT IF WE COULD IDENTIFY RACIALLY INTEGRATED COMMUNITIES WHERE PEOPLE LIVING TOGETHER IN THE SAME COMMUNITIES, NOT SIMILAR COMMUNITIES, THE SAME COMMUNITY, AND WHERE THERE WERE NO SIGNIFICANT DIFFERENCES IN SOCIOECONOMIC STATUS BETWEEN DIFFERENT RACE GROUPS? SO WE SEARCHED ALL OVER, THERE ARE ABOUT 168,000 CENSUS TRACKS IN THE UNITED STATES, WE IDENTIFIED 425 CENSUS TRACKS AROUND THE COUNTRY THAT MET THE CRITERIA THAT WE ESTABLISHED AND THAT CRITERIA IS AT LEAST 35% AFRICAN AMERICAN AND 35% WHITE LIVING IN THE SAME CENSUS TRACK AND THE INCOME -- THE DIFFERENCE IN INCOME AND HIGH SCHOOL GRADUATION RATES WERE VERY SMALL, IN OTHER WORDS, ESSENTIALLY EQUAL LEVELS OF EDUCATION AND INCOME AND LIVING IN THE SAME NEIGHBORHOOD. THIS IS A STUDY OF SOCIAL DETERMINANTS, IN THE PAST MOSTLY WE TRIED TO FIGURE OUT WHAT ARE THE SOCIAL DETERMINANTS, HOW DO WE WILL MEASURE ALL OF THEM, THEN WE DID SOME KIND OF MULTILEVEL MODELING WHICH HAS THE ADDITIONAL PROBLEM OF NEEDING AN EVEN LARGER SAMPLE SIZE, I DON'T WANT TO GET TOO TECHNICAL, BUT EVERY WAY OF DEALING WITH THESE PROBLEMS REQUIRES A BIGGER SAMPLE SO WE SAID OKAY, LET'S NOT TRY THAT, WHY DON'T WE SEE IF WE CAN MAKE THE SOCIAL DETERMINANTS A CONSTANT, LET'S FIND PEOPLE LIVING YOUR HONOR THE SAME CONDITIONS WITH THE SAME EXPOSURES AND SEE, DO WE STILL FIND THE SAME DISPARITIES THAT YOU FIND IN NATIONAL DATASETS LIKE NATIONAL HEALTH INTERVIEW SURVEY. SO THE IDEA WAS TO IDENTIFY A COMMUNITY THAT WE CAN GO INTO AND REPLICATE PORTIONS OF THE PROTOCOL FROM NHANES AND HEALTH INTERVIEW SURVEY AND FIND DO WE FIND THE SAME RESULTS THAT THEY FOUND IN NHANES, HAIS AND MEPS, THOSE ARE THE THREE DATA DATASETS THAT WE RECOMMEND INDICATED. WE FOUND TWO CENSUS TRACTS IN BALTIMORE CITY, SOUTHWEST PORTION OF THE CITY THAT WERE CONTIGUOUS, WE PUT THOSE TWO TRACTS TOGETHER AND MADE THAT OUR STUDY AREA, AND HERE IS A LITTLE BACKGROUND FROM THE CENSUS, 44% WHITE, 51% BLACK, WHICH IS PRETTY MUCH NOT THE PROPORTIONS FOR BALTIMORE BUT THIS IS PRETTY MUCH BAWMENT MORE, BLACK/WHITE TOWN, VERY SMALL PERCENTAGE OF NONBLACK AND NONWHITE IN THAT CITY. MEDIAN INCOME AS YOU CAN SEE IS VERY LOW, ABOUT $24,000 IN THESE TWO CENSUS TRACTS. POVERTY RATES FOR THE TIME IS VERY HIGH, BUT NOT SUBSTANTIALLY DIFFERENT BETWEEN THE GROUPS. THIS IS EDUCATIONAL LEVELS. AGAIN, PRETTY EQUAL. THIS IS ABOUT AS CLOSE AS YOU CAN COME TO LABORATORY CONDITIONS IN A NATURALLY OCCURRING COMMUNITY. SO TWO CENSUS TRARKTS 40 MINUTE INTERVIEW, DONE AT THEIR HOMES, WE ALSO USED WHAT I CALL A MODIFIED CVP PROCESS, I'LL EXPLAIN THAT LATER MORE WHAT THAT MEANT, IF YOU WANT TO KNOW MORE, MOST OF INTERVIEWS IN THEIR HOMES, BLOOD PRESSURE PRIMARY OUTCOME AND WE WERE SUCCESSFUL AT INTERVIEWING 42% OF THE PEOPLE OF THE ADULTS LIVING IN THAT CENSUS TRACTS. WE DID NOT SAMPLE, WE WENT FOR EVERYONE. SO THIS IS 42% OF ALL ADULT RESIDENTS LIVING IN THAT CENSUS TRACTS, IN THOSE TWO CENSUS TRACTS PARTICIPATED IN THE STUDY. I'LL TELL YOU HOW WE WERE ABLE TO ACCOMPLISH THAT, TOO, IF YOU WANT TO HEAR ABOUT IT. SO THIS IS FIRST JUST HOW WELL DID WE REPRESENT THE COMMUNITY. BLUE IS THE CENSUS AND RED IS WHAT WE GOT. AS YOU CAN SEE, I THINK WE DID A FAIRLY GOOD JOB OF GETTING A SAMPLE THAT IS REPRESENTATIVE OF THAT NEIGHBORHOOD. A COUPLE OF EXCEPTIONS BEING HERE WITH EDUCATION LEVELS FOR BLACKS IN OUR SAMPLE. SO I THINK WE DID A FAIRLY GOOD JOB. IN TERMS OF THE ANALYSIS, FIRST WE WENT INTO THE RESEARCH LITERATURE, AND I'LL SHOW YOU THE EXAMPLE FROM HYPERTENSION, WENT INTO THE HYPERTENSION LITERATURE AND FOUND STUDIES PUBLISHED IN PEER REVIEWED JOURNALS USING NHANES LOOKING AT RACE DIFFERENCES IN HYPERTENSION BETWEEN BLACKS AND WHITES AND REPLICATED ANALYSIS IN THOSE PAPERS, FOUR DIFFERENT PAPERS WE REPLICATED. THAT'S THIS CHART. THESE ARE ALL MODELS FROM DIFFERENT PAPERS, BUT PRETTY MUCH YOU SEE IF YOU LOOK AT FIRST THIS COLUMN, YOU SEE A CONSISTENT SET OF FINDINGS PRETTY MUCH, AFRICAN AMERICANS ABOUT DOUBLE THE ODDS OF BEING HYPERTENSIVE COMPARED TO WHITES, REGARDLESS OF THE SET OF CONTROLS, THE DISPARITY IS PRETTY MUCH THE SAME. WHAT WE FIND, HOWEVER, WHEN WE REPLICATE THOSE ANALYSES ON OUR SAMPLE IS THAT WE FIND SUBSTANTIALLY SMALLER DISPARITIES BUT THEY'RE STILL SIGNIFICANT AND THOSE DIFFERENCES RANGE UP TO ABOUT A THIRD. SO WE'RE ABLE TO EXPLAIN ABOUT ONE-THIRD OF THE RACE DISPARITY BY CONTROLLING FOR SOCIAL DETERMINANTS. NOW, THAT'S HYPERTENSION. NOW LOOK AT WHAT HAPPENS WHEN WE LOOK AT OTHER CONDITIONS. WE LOOK AT DIABETES AND THE NATIONAL SAMPLE, SHOW OF 1.61, AFRICAN AMERICANS ABOUT 60% ODDS OF BEING DIE DIABETIC, IN OUR SAMPLE, NO SIGNIFICANT RACE DIFFERENCE IN DIABETES. OBESITY AMONG WOMEN, NATIONAL SAMPLE, 87% GREATER ODDS FOR AFRICAN AMERICAN WOMEN TO BE OBESE COMPARED TO WHITE WOMEN, IN OUR SAMPLE, NO SIGNIFICANT RACE DIFFERENCE IN OBESITY. THE HYPERTENSION RESULTS WE'VE ALREADY TALKED ABOUT AND THEN USE OF PREVENTIVE HEALTH SERVICES, INTERESTING, WE FOUND NO SIGNIFICANT DIFFERENCE IN EITHER THE NATIONAL OR IN OUR DATASET BUT IT WAS INTERESTING TO NOTICE THAT THE RELATIONSHIP, THE DIRECTION OF THE RELATIONSHIP CHANGES FROM ONE SAMPLE TO THE NEXT, SO YOU CAN MAKE OF THAT WHAT YOU WILL. JUST HERE IS THE SUMMARY OF THE RESULTS. SO TO WHAT EXTENT, WE TEACH IN OUR CLASSES THAT AFRICAN AMERICANS HAVE DOUBLE THE ODDS OF BEING HYPERTENSIVE. WE TEACH THAT BEING BLACK IS A RISK FACTOR FOR BEING A DIABETIC. IS BEING BLACK A RISK FACTOR OF BEING DIABETIC? IS BEING NATIVE AMERICAN REALLY A RISK FACTOR FOR BEING A DIABETIC, OR IS IT LIVING IN CERTAIN CONDITIONS THAT ARE MORE LIKELY TO BE THE CONDITIONS THAT BLACKS AND NATIVE AMERICANS LIVE IN? IS THAT REALLY WHAT THE RISK FACTOR IS? IS THERE A SPURIOUS RELATIONSHIP? SO WHERE I LIVE OVER IN CENTRAL -- I LIVE IN A WOODED AREA, AND EVERY FALL I NOTICE TWO THINGS HAPPEN, A LOT OF COLORFUL BIRDS AND FURRY WOODLAND CREATURES AROUND THE HOUSE, BUT EVERY FALL THE BIRDS TEND TO DISAPPEAR AND THE LEAVES FALL OFF THE TREES. NOW, IS THE CORRELATION THAT THE BIRDS MAKE THE LEAVES FALL? OR DO THE LEAVES LEAVE -- I MEAN DO THE BIRDS LEAVE BECAUSE THE LEAVES HAVE FALLEN? OR PERHAPS THERE'S SOME OTHER FACTOR THAT'S INFLUENCING BOTH OF THESE OBSERVATIONS. I'LL LEAVE THAT AS A QUESTION FOR YOU TO PONDER. THANK YOU. [APPLAUSE] >> Dr. Eliseo Perez-Stable: THAN K YOU, TOM. I THINK WE CAN TAKE A COUPLE OF QUESTIONS. I THINK YOU STAYED WITHIN THE HOUR, SO THAT WAS GOOD. >> Dr. Thomas LaVeist: SPEED TALKING. >> Dr. Eliseo Perez-Stable: IS THAT BRIAN? >> GREAT TALK. EARLIER ON YOU MENTIONED BLACK MEN'S HEALTH INITIATIVE. MIGHT YOU SAY A LITTLE MORE ABOUT THAT, WHO IS FUNDING IT, HAVE YOU KICKED OFF THE STUDY, INSTITUTIONS INVOLVED? >> Dr. Thomas LaVeist: SO THIS IS A STUDY -- THANK YOU FOR THE QUESTION. THIS IS A STUDY THAT I'VE BEEN WANTING TO DO SIN THE 1980S, I WAS A GRADUATE STUDENT AND I WAS SAYING, YOU KNOW, YOU GOT THE NURSES HEALTH STUDY, DOCTORS HEALTH STUDY, ALL THOSE COHORTS GOING ON, WOMEN'S BLACK HEALTH STUDY, NOBODY IS STUDYING BLACK MEN, THEY HAVE THE LOWESTLY LIFE EXPECTANCY, FITS AND STARTS TRYING TO GET THAT TO HAPPEN FOR YEARS AND FINALLY A GROUP OF US, THIS IS A STUDY LED BY A GROUP OF AFRICAN AMERICAN MALE HEALTH RESEARCHERS FROM UNIVERSITIES ALL OVER THE COUNTRY, GW, JOHNS HOPKINS, MICHIGAN, VANDERBILT, MAHARY, HOPEFULLY MOREHOUSE, TEXAS A & M, WE'RE TRYING TO -- SAME UNIVERSITIES, I DON'T WANT TO FORGET ANYBODY, AND WE ARE TRYING TO DEVELOP A COHORT OF 10,000 BLACK MEN NATIONALLY, WHAT WE WANT TO DO IS WE'RE DOING THIS AS AN ONLINE SURVEY, WE'RE ENROLLING PEOPLE AND USING QUOTA SAMPLING WE'RE GOING TO CREATE A NATIONALLY REPRESENTATIVE SAMPLE OF BLACK MEN, EDUCATIONAL LEVELS, NRK LEVELS, GEOGRAPHIC LOCATION. FOR EXAMPLELY, I SAID WE'VE BEEN IN FITS AND STARTS TRYING TO GET FUNDING FOR IT, WE HAVE NOT BEEN FUNDED FOR IT, SO WE ARE JUST DOING IT, AND SO I'M PAYING FOR SOME OF THAT OUT OF MY POCKET, WE HAVE OTHERS ON THE TEAM WHO IS PAYING OUT OF THEIR POCKET FOR IT, WE'RE COBBLING TOGETHER RESOURCES FROM THE INSTITUTIONS WE WORK AT. WE THINK IT'S TOO IMPORTANT NOT TO DO IT AND WE'RE GOING TO JUST DO IT AND DO AS MUCH AS WE CAN WITH THE RESOURCES WE HAVE. SO WE'LL BE ANNOUNCING THAT AT THE CONGRESSIONAL BLACK CAUCUS MEETING ON THURSDAY, THERE WILL BE A PRESS CONFERENCE WHERE WE'LL BE ANNOUNCING THE START OF THIS STUDY AND HOPE THAT WE CAN ATTRACT 10,000 MEN. THANK YOU FOR GIVING ME A CHANCE TO TALK ABOUT IT. >> YOU'VE BEEN SAYING THIS FOR A LONG, LONG TIME, TOM, SO IF YOU WERE GOING TO SELECT THREE VARIABLES THAT YOU WERE GOING TO STUDY TO TRY TO EXPLAIN THE DISPARITIES, WHAT WOULD THOSE BE? ARE. >> Dr. Thomas LaVeist: I'M TRYING TO WRITE A BOOK WHERE I'M TRYING TO PUT ALL MY THINKING ON THIS AND THIS IS WHERE I'M COMING NOW. SEGREGATION I THINK IS THE VARIABLE BECAUSE WHAT IT DOES IS IT PLACES PEOPLE AT DIFFERENT LEVELS OF RISK. IT PUTS PEOPLE IN SOME RISK CATEGORIES AND CREATES THIS SPURIOUS RELATIONSHIP WHICH I'M ARGUING IS WHAT HEALTH DISPARITIES IS ALL ABOUT. IT'S NOT ANYTHING ABOUT THE PEOPLE, IT'S ABOUT THE PLACES THAT THEY LIVE AND THAT'S WHAT'S GOING ON. SEGREGATION WOULD BE A BIG ONE. I DO THINK THAT THERE'S A CULTURAL DIMENSION TO IT. I THINK AT THE BOTTOM LINE IS RACISM AND THERE ARE THREE FORMS OF RACISM. YOU HAVE STRUCTURAL RACESSISM WHICH IS WHAT SEGREGATION IS ALL ABOUT, INTERPERSONAL RACISM WHICH I THINK IS PROBABLY THE LEAST IMPORTANT, INTERPERSONAL INSULTS, MICROAGGRESSIONS, THAT SORT OF THING, BUT THEN THERE'S INTERNALIZED RACESSISM BECAUSE, YOU KNOW, THE DEVALUING OF AFRICAN AMERICANS IS AN AMERICAN VALUE AND I THINK THAT AFRICAN AMERICANS ARE AMERICANS ALSO AND I DO THINK THAT THERE ARE SOME INTERNAL DYNAMICS WITHIN BLACK CULTURE THAT WE ALSO NEED TO ADDRESS. SO THAING WE NEED TO BE OPERATING ON ALL LEVELS, AT THE INDIVIDUAL LEVEL, AT THE CULTURAL LEVEL, AT THE COMMUNITY LEVEL. I KNOW THAT'S GOING TO DEFINITELY JERCH RATE SOME COMMENTS NOW. >> SO MY QUESTION WAS GOING TO BE ABOUT, THIS IS FASCINATING WITH THE NEIGHBORHOOD STUDY, WE HAVE EQUAL INCOMES AND THE WAY PEOPLE LIVE AND THAT SORT OF THING. DOES THIS FOLLOW YOU THROUGHOUT YOUR ENTIRE LIFE COURSE? I KNOW THERE ARE SOME STUDIES SUGGESTING THAT, YOU KNOW, IF YOU'RE BORN SOMEWHERE, YOU CARRY THAT FROM MISSES MISS TO NEW YORK CITY AND WHAT HAVE YOU, AND I WAS GOING TO ASK, DOES IT CARRY THAT WAY GEOGRAPHICALLY AND DOES IT CARRY IF YOUR INCOME AND STUFF DOES IMPROVE, YOU KNOW, THE CHALLENGES THAT YOU HAD WHEN YOU YOUNGER? >> Dr. Thomas LaVeist: VERY COMPLICATED STUDY. WHEN I FIRST CAME TO HOPKINS, THERE WAS A STUDY THAT HAD BEEN DONE IN THE 1950S CALLED THE PERINATAL COLLABORATIVE STUDY, IT WAS THE STUDY THAT DEMONSTRATED THAT PRENATAL CARE MATTERED, THEY ENROLLED ALL WOMEN WHO GAVE BIRTH AT THE HOSPITAL IN 1958 THROUGH 1966 INTO THIS STUDY AND FOLLOWED THE KIDS FOR SIX YEARS LOOKING AT THEIR DEVELOPMENT AND WE WENT BACK IN THE '90S TO RE-INTERVIEW THOSE KIDS AND ONE OF THE QUESTIONS WE WANTED TO KNOW IS THIS LIFE TRAJECTORY AND WHAT HAPPENS. IT'S REALLY HARD TO TEASE IT OUT BECAUSE ON THE ONE HAND, THE KID WHO WAS BORN POOR AND ABLE TO SUCCEED IS PROBABLY A KID WHO HAS A HEALTH ENDOWMENT THAT IS MORE ADVANTAGEOUS, SO THEY'RE MORE HEALTHY, THEY WEREN'T AS SICK AS CHILDREN, SO THEY MAY CARRY CERTAIN BEHAVIORAL PROVISIONS OF A CHILD BORN IN POVERTY, IN ADULTHOOD, THE ONES BORN POOR IN ADULTHOOD WERE THE ONES WHO HAD THE BEST HEALTH IN CHILDHOOD, BUT IF YOU WERE SICK IN CHILDHOOD, YOU WERE MORE LIKELY TO BE LOWER INCOME IN ADULTHOOD BUT YOU WERE ALSO MORE LIKELY TO BE -- HAVE POOR HEALTH OUTCOMES IN ADULTHOOD. SO IT JUST MIGHT HAVE BEEN THE FACTOR OF YOU WERE SICKLY, YOU WERE POOR AND YOU WERE SICK, YOU WEREN'T ABLE TO BREAK OUT OF POVERTY IN PART BECAUSE YOU DIDN'T HAVE THE PHYSICAL ABILITY TO DO IT, SO IT'S REALLY DIFFICULT TO TEASE OUT IS IT AN INDIVIDUAL THING, IS IT A STRUCTURAL THING. IT WOULD TAKE I THINK A REALLY BIG STUDY TO DO SOMETHING LIKE THAT. >> I WAS JUST WONDERING IF THE IMPACT OF RACISM COULD BE TRANSLATED INTO IMMIGRANT POPULATIONS IF YOU'VE HAD A CHANCE TO LOOK AT IMMIGRANTS FROM THE CARIBBEAN, FOR EXAMPLE, WHO HAVE NOT EXPERIENCED RACISM THERE BUT MIGRATE TO BROOKLYN, AND DOES THE IMPACT OF RACISM DIFFER AMONG IMMIGRANTS VERSUS U.S.-BORN PEOPLE OF AFRICAN DESCENT. >> Dr. Thomas LaVeist: MY FAMILY IS FROM THE CARIBBEAN, I WOULD ARGUE THAT PEOPLE IN THE CARIBBEAN EXPERIENCE RACISM ON A MASS SCALE, WHICH YOU MAY HAVE AS DIFFERENT WAYS OF INTERPRETING WHAT THAT RACISM S MAYBE DIFFERENT ATTRIBUTIONS, AND THERE ARE CROSS-CULTURAL DIMENSIONS TO IT BUT I THINK THAT ONE OF THE THINGS THAT CAME OUT OF THAT CONFERENCE WE HAD ON OFFER CAN D I ASPERA IS ALL AFRICAN POPULATIONS, REALLY ALL NONWHITE POPULATIONS EXPERIENCE A FORM OF RACISM, WHETHER IT'S BECAUSE OF ETHNICITY OR RACE OR RELIGION, THERE'S A LOT OF THAT HATRED AND THAT KIND OF HATRED ON THE INTERPERSONAL LEVEL I THINK AFFECTS EVERYONE WHO IS EXPOSED TO IT. >> JUST REAL QUICK. I KNOW YOU'VE DONE QUITE A BIT OF WORK ON POLICY AND HEALTH DISPARITIES. SUMMATION, WOULD YOU SAY IT'S STATE POLICY OR FEDERAL POLICY, THAT PROPAGATES DISPARITIES. >> Dr. Thomas LaVeist: YOU MEAN THE POLICIES THAT PROPAGATE IT OR POLICIES PROMISING TO ADDRESS IT? I'LL ANSWER IT THIS WAY. >> HOWEVER YOU WANT TO ADDRESS IT. >> Dr. Thomas LaVeist: THE POLICY PRESCRIPTION I'M PROMOTING THESE DAYS REALLY COMES OUT OF THE AARA, THE COMMUNITY REINVESTMENT ACT AND THE AFFORDABLE CARE ACT. TWO THINGS HAPPEN. I'M GOING TO TALK REALLY FAST, I KNOW. THE AARA CREATES THE ELECTRONIC MEDICAL RECORDS AND IN THERE THERE'S A PROVISION THAT REQUIRES THE COLLECTION OF DATA ON RACE AND ETHNICITY IN HEALTHCARE. AFFORDABLE CARE ACT CREATES VALUE BASED PURCHASING WHICH NOW TIES PATIENT OUTCOMES TO -- TIES REIMBURSEMENTS TO PATIENT OUTCOMES, THE OPPORTUNITY NOW, THE FORT WAYNE STRUCTURE IS NOW CREATED TO -- THE INFRASTRUCTURE IS NOW CREATED TO CREATE SYSTEMS WHERE YOU CAN TIE REIMBURSEMENTS TO DISPARITIES IN OUTCOMES AND THAT LAST LINK THIS CHAIN HASN'T BEEN BRIDGED YET AND I THINK THAT'S THE NEXT STEP, AND MAYBE THE PLACE TO DO THAT IS WITH THE ACCREDITING AGENCIES, THE ACCREDITING BODIES, CMS CLEARLY WOULD BE ONE, BUT LIKE JOINT COMMISSION, NCQA AND THE OTHER ACCREDIT TORS WOULD BE A PLACE WHERE SOMETHING LIKE THAT COULD BE IMPLEMENTED. >> Dr. Eliseo Perez-Stable: THAN K YOU AGAIN, TOM, FOR A GREAT PRESENTATION. [APPLAUSE] I'M GOING TO TURN IT OVER TO JOYCE TO GO FOR THE CONCEPT DISCUSSION. >> Dr. Joyce Hunter: GOOD AFTERNOON, EVERYONE. AT THIS POINT WE'RE GOING TO MOVE INTO THE CONCEPT CLEARANCES. WE HAVE THREE CONCEPTS WE'RE GOING TO BRING TO YOU TODAY. PRIOR TO THIS MEETING, COUNCILMEMBERS HAVE BEEN ASSIGNED TO THOSE CONCEPTS. DR. STINSON IS GOING TO INTRODUCE THE CONCEPT, AND THEN ONE OF OUR PROGRAM OFFICERS WILL GIVE YOU AN OVERVIEW OF THE CONCEPT, AND THEN I WILL ASK THE COUNCILMEMBERS WHO HAVE BEEN ASSIGNED TO MAKE THEIR COMMENTS. WE'LL HAVE A LITTLE DISCUSSION, AND THEN I WILL ASK FOR A MOTION TO MOVE THE CONCEPT FORWARD. WE'RE ONLY MOVING FORWARD. THIS IS A DISCUSSION, INFORMATION, MOVING FORWARD. >> ARE WE GOING TO MOVE FORWARD? >> Dr. Joyce Hunter: DR. STINSON , MOVE US FORWARD. GNAT GNAT THANK. >> NATURE. >> THANK YOU, DR. HUNTER. FIRST IS MECHANISMS AND CONSEQUENCES OF SLEEP DISPARITIES AND DR. RINA DAS WILL GIVE THE PRESENTATION. >> Dr. Rina Das: GOOD ASP, IT'S A AFTERNOON, EVERYBODY, IT'S A HARD ACT TO FOLLOW AFTER SUCH AN INTERESTING AND ENTERTAINING TALK, BUT I'M HERE TO PRESENT THE INITIATIVE ON MECHANISMS AND CONSEQUENCES OF SLEEP DISPARITIES AND MY COLLEAGUE DR. ALDAREZ AND DR. JONES HAVE BEEN WORKING WITH ME ON THIS EFFORT AND I WANT TO MENTION THAT WE'VE BEEN ALSO CLOSELY COLLABORATING WITH NHL BION THIS TOPIC. SO THE OBJECTIVE OF THIS INITIATIVE IS TO UNDERSTAND THE UNDERLYING MECHANISMS OF SLEEP DEFICIENCIES AMONG DIFFERENT HEALTH DISPARITY POPULATIONS AND THEN HOW THESE SLEEP DEFICIENCIES LEAD TO VARIOUS DISPARITIES IN HEALTH OUTCOME, AND WHAT I MEAN BY SLEEP DEFICIENCY IS THE INSUFFICIENT SLEEP DURATION, IRREGULAR TIMING OF SLEEP, POOR SLEEP QUALITY, AND SLEEP AND CIRCADIAN DISORDERS. SO JUST TO GIVE YOU BACKGROUND ON WHY WE THINK SLEEP IS SUCH AN IMPORTANT AREA TO FOCUS ON, SLEEP IS IMPORTANT FOR OUR OVERALL HEALTH, BOTH MENTAL AND PHYSICAL, AND INADEQUATE SLEEP CAN LEAD TO POOR HEALTH. SO GOOD SLEEP HABITS ARE JUST AS IMPORTANT AS WE THINK ABOUT HAVING A GOOD DIET OR DOING PHYSICAL EXERCISE. SO HOW MUCH SLEEP DO WE NEED? ACCORDING TO THE NATIONAL SLEEP FOUNDATION, ADULTS NEED BETWEEN 7 TO 9 HOURS OF SLEEP PER NIGHT, BUT WE ARE NOT REALLY MEETING THAT GOAL. ACCORDING TO CDC REPORTS, MORE THAN ONE-THIRD OF U.S. POPULATION TYPICALLY SLEEP LESS THAN 6 HOURS IN A 24-HOUR PERIOD, AND SLEEP DEFICIENCIES ARE ASSOCIATED WITH A VARIETY OF DIFFERENT HEALTH CONDITIONS, CHRONIC DISEASES, AND ALSO INCREASES MORTALITY. RACIAL ETHNIC MINORITIES AND LOW SOCIOECONOMIC POPULATIONS HAVE THE HIGHEST PREVALENCE OF SLEEP DEFICIENCIES COMPARED TO WHITES. THE FIGURE THAT YOU SEE ON THE RIGHT SHOWS SOME OF THESE DIFFERENCES THAT HAVE BEEN REPORTED BY CDC. NATIVE HAWAIIAN AND PACIFIC ISLANDER HAVE THE LOWEST HEALTHY SLEEP, THEN FOLLOWED BY BLACKS, AND THEN AMERICAN INDIAN, COMPARED TO WHITES. IN ADDITION, SLEEP DISORDERS ARE USUALLY UNDERDIAGNOSED, UNDERTREATED IN VARIOUS RACIAL AND ETHNIC GROUPS. SO WHAT ARE SOME OF THE CONSEQUENCES OF POOR SLEEP? SLEEP DWICIALT STIZ HAVE BEEN ASSOCIATED -- DEFICIENCIES HAVE BEEN ASSOCIATED WITH A VARIETY OF HEALTH OUTCOMES, SUCH AS OBESITY, DIABETES, HYPERTENSION. AS YOU CAN SEE ON THE FIGURE, THE BLACK BAR SHOWS THAT LESS THAN FIVE HOURS OF SLEEP, WHAT HAPPENS TO YOUR RISK OF CERTAIN DISEASES. WE KNOW MENTAL HEALTH ARE ALSO EQUALLY AFFECTED, SUCH AS DEPRESSION, SUICIDE RATES ARE ASSOCIATED WITH POOR SLEEP. SLEEP APNEA HAS BEEN ASSOCIATED WITH A VARIETY OF DISEASES SUCH AS DIABETES, STROKE, AND BLACKS ARE LESS LIKELY TO HAVE GOOD SLEEP COMPARED TO THE OTHER POPULATION. TREATMENT FOR SLEEP APNEA BY USING CPAP, SOME OF YOU KNOW ABOUT THIS CONTINUOUS POSITIVE AIR PRESSURE, WAS ABLE TO IMPROVE A VARIETY OF HEALTH OUTCOMES SUCH AS INSULIN SENSITIVITY, BLOOD PRESSURE, CARDIOVASCULAR DISEASE AND HYPERTENSION. ANOTHER STUDY REPORTED THAT SHORTER SLEEPERS WERE 55% MORE LIKELY TO BE OBESE. ANALYSIS OF THE NATIONAL HEALTH ENTER VIEW SURVEY SHOWED THAT THE RISK OF OBESITY ASSOCIATED WITH SHORT SLEEP DURATION WAS HIGHER IN BLACKS COMPARED TO WHITES. SO SOME OF THE POSSIBLE MECHANISMS THAT COULD BE PLAYING A ROLE IS THE SOCIAL AND CULTURAL FACTORS MAY PLAY A ROLE IN SLEEP DISPARITIES. THERE'S AN EXAMPLE WHERE MEXICAN AMERICAN WOMEN WERE INTERVIEWED AND THEY ARE LESS LIKELY TO REPORT TROUBLE SLEEPING COMPARED TO WHITE WOMEN, SO THE LEVEL OF SLEEP DISAIRT MIGHT BE UNDERREPORTED, THEN THE TIME TO GO TO BED COULD BE ANOTHER AREA WHICH WOULD BE DIFFERENT AMONG HEALTH DISPARITY POPULATION. ONE REPORT SUGGESTED THAT LALT NOTICE CHILDREN GO TO BED LATER COMPARED TO WHITES AND HAVE SHORTER SLEEP DURATION. DISRUPTIONS OF CIRCADIAN RHYTHM AND SLEEP-WAKE CYCLE IS ALSO KNOWN TO PLOY A VARIETY OF PHYSICIAN -- PROVIDE A VARIETY OF PHYSIOLOGICAL DISRUPTIONS AND CIRCADIAN DISRUPTIONS ARE LIKELY TO BE LINKED TO SOCIOCULTURAL AND ENVIRONMENTAL FACTORS, SUCH AS OCCUPYING AL SHIFT WORK, ECONOMIC ADD VERSUS TI, FINANCIAL INSECURITY, NEIGHBORHOOD DEPRIVATION, SUB OPTIMAL HOUSING, I CAN GO ON AND ON, RESIDENTIAL SEGREGATION, EXPOSURE TO STRESS, DISCRIMINATION, SO SLEEP EMERGES AS A VERY IMPORTANT FACTOR THAT IS AFFECTED BY THESE FACTORS AND IT HAPPEN S EARLY IN THE LIFE COURSE AND MAY PERSIST THROUGHOUT ADULTHOOD. THIS FIGURE IS A REPORT FROM CDC FROM THE BEHAVIORAL RISK FACTORS SURVEILLANCE SYSTEM SURVEY RECENTLY PUBLISHED THAT INDICATES GEOGRAPHIC CLUSTERING WHERE AT THE NATIONAL LEVEL HOW WE ARE DOING WITH SLEEP. THE DARK BLUE IS SUPPOSED TO BE HEALTHY SLEEP, AND THE LIGHTER ONES WHERE YOU GET LESS SLEEP. SO IN THIS FIGURE IT SHOWS THAT THERE IS A LOWER PREVALENCE OF HEALTHY SLEEP IN SOUTHEAST UNITED STATES AND IN THE APPALACHIAN MOUNTAINS, WHICH ARE ALSO REGIONS WITH HIGHEST BURDENS OF CHRONIC CONDITIONS SUCH AS OBESITY. SO BASED ON THIS SURGICAL VAI, ANOTHER INTERESTING -- BASED ON THIS SURVEY, ANOTHER INTERESTING FACT EMERGED, THAT IF YOU ARE UNEMPLOYED OR IF UFL ALE LOWER EDUCATION -- IF YOU HAVE ALE LOWER EDUCATION, YOU GET POOR SLEEP, COMPARED TO IF YOU ARE HIGHLY EDUCATED AND HAVE A COLLEGE DEGREE. IN ADDITION TO THAT NATIONAL LEVEL PICTURE, WHEN YOU LOOK AT IT AT A REGIONAL LEVEL, THIS WAS A STUDY DONE IN THE BOSTON AREA IN A POPULATION-BASED SURVEY THAT REPORTED THAT BLACK AND LATINO MEN WERE MORE LIKELY TO REPORT SLEEPING LESS THAN 5 HOURS OF SLEEP PER NIGHT COMPARED TO WHITE MEN, AND LOWER AND MIDDLE INCOME SES LEVELS ALSO REPORTED SHORTER SLEEP DURATION. SO THESE STUDIES INDICATE THAT THERE ARE SLEEP DISPARITIES THAT ARE BASED ON RACE, SOCIOECONOMIC STATUS, EDUCATIONAL LEVEL AND OTHER GEOGRAPHIC AREAS. SO WHEN WE LOOKED AT THE LITERATURE AND WHAT HAS BEEN DONE SO FAR, IN 2011, NATIONAL HEART, EXPLUNG BLOOD INSTITUTE CONVENED A WORKSHOP WHERE THEY HAD BROUGHT ALL THE SLEEP EXPERTS AND DISPARITIES RESEARCH TOGETHER AND THEY CREATED A RESEARCH PLAN WHERE THEY IDENTIFIED THIS AS AN AREA THAT'S A GAP, THAT WE NEED TO DO MORE RESEARCH ON, AND LOOKING AT THE NIH PORTFOLIO, ALSO WE LOOKED AT GRANTS THAT VERY FEW WERE FOCUSING ON SLEEP DISPARITIES. THE FEW THAT WE FOUND, MAJORITY OF THE RESEARCH WAS FOCUSING ON DESCRIBING DEFICIENCY IN SLEEP BETWEEN DIFFERENT RACIAL GROUPS AND A FEW FOCUSED ON SLEEP DISORDERS, ESPECIALLY SLEEP APNEA IN AFRICAN AMERICANS. SO THERE'S CLEARLY A GAP IN TRYING TO UNDERSTAND WHAT ARE THE CAUSES AND MECHANISMS OF THESE DISPARITIES IN HEALTHY SLEEP AMONG VARIOUS HEALTH DISPARITY POPULATION. THERE ARE VERY FEW STUDIES THAT HAVE EXPLORED THE LINK BETWEEN SOCIAL DETERMINANTS AND THE CAUSES OF SLEEP DISPARITIES, AND MORE RESEARCH IS NEEDED TO UNDERSTAND HOW CIRCADIAN RHYTHM IS ALTERED, HOW OUR BODY RESPONDS TO CIRCADIAN DISRUPTIONS IN THESE VARIOUS RACIAL AND ETHNIC GROUPS. PARTICULARLY THERE IS A NEED TO UNDERSTAND THE IMPACT OF RACISM, DISCRIMINATION AND CHRONIC STRESS ON SLEEP. IN ADDITION, THERE'S LACK OF OBJECTIVE MEASURES OF SLEEP IN MINORITIES, SO MAYBE WITH THE MOBILE TECHNOLOGY THAT IS NOW AVAILABLE, THERE MIGHT BE OPPORTUNITIES TO COLLECT BETTER DATA FROM OUR HEALTH DISPARITY POPULATION. SO TO ADDRESS IT GAP, WE ARE PROPOSING AN INITIATIVE THAT WOULD PROMOTE RESEARCH TO UNDERSTAND THE UNDERLYING FACTORS THAT CONTRIBUTE TO SLEEP DISPARITIES AND WHAT ARE SOME OF THE HEALTH CONSEQUENCES OF THESE DISPARITIES AMONG VARIOUS RACIAL ETHNIC MINORITIES AND LOW SOCIOECONOMIC STATUS POPULATIONS. SO THIS INITIATIVE WILL PROMOTE RESEARCH TO UNDERSTAND HOW SLEEP, WHICH IS A CRITICAL HEALTH BEHAVIOR, MAY BE ASSOCIATED WITH SOME OF THE SOCIAL DETERMINANTS OF HEALTH AND MAYBE THEN HELP US LINK AND EXPLAIN SOME OF THE HEALTH OUTCOMES THAT WE SEE. AS WE KNOW, HEALTH DISPARITY IS CAUSED BY MULTIPLE FACTORS. THIS INITIATIVE WILL PROMOTE A MULTIDETERMINE ABILITY RESEARCH TO EXAMINE HOW THESE DIFFERENT FACTORS INTERACT AND INFLUENCE SLEEP IN HEALTH DISPARITY POPULATION, SUCH AS BOTH ENVIRONMENT, SOCIAL, BIOLOGICAL, HEALTHCARE FACTORS. WE WILL ALSO -- THIS INITIATIVE WILL ALSO HELP US UNDERSTAND HOW SLEEP AFFECTS DIFFERENT DEVELOPMENTAL TRAJECTORIES ACROSS THE LIFE COURSE AND TO UNDERSTAND SLEEP ATTITUDES, BEHAVIORS AND PRACTICES AMONG HEALTH DISPARITY POPULATIONS INCLUDING SELF-MANAGEMENT STRATEGIES THAT ADDRESS THESE SLEEP DISPARITIES. WE ALSO WANT TO UNDERSTAND THE ROLE OF SLEEP IN THE MEDIATING VARIOUS HEALTH OUTCOMES, DISEASE PREVALENCE, MORBIDITY AND MORTALITY. A FEW OTHER TOPICS THAT WE THINK MIGHT BE IMPORTANT TO STUDY IS TO UNDERSTAND THE CIRCADIAN RHYTHMS THAT ARE DISRUPTED BY VARIOUS SOCIAL, CULTURAL AND ENVIRONMENTAL FACTORS IN DIFFERENT MINORITY POPULATIONS AND WHAT ARE THESE DIFFERENCES AND HOW THEY AFFECT THE HEALTH OUTCOMES. WHAT ARE SOME OF THE PROTECTIVE FACTORS IN HEALTH DISPARITY POPULATION THAT HAVE HEALTHY SLEEP? WE ALSO WOULD LIKE TO EXAMINE WHAT ARE SOME OF THE BARRIERS IN IDENTIFICATION, DIAGNOSIS AND TREATMENT OF SLEEP DEFICIENCY AMONG HEALTH DISPARITY POPULATIONS. SO ONCE WE HAVE A BETTER UNDERSTANDING OF THESE UNDERLYING CAUSES, WE MIGHT BE ABLE TO THEN DESIGN EFFECTIVE STRATEGIES FOR PRIMARY PREVENTION OF CHRONIC DISEASES AND ULTIMATELY REDUCE HEALTH DISPARITIES. I JUST WANTED TO POINT OUT THAT WE PLAN TO PARTNER WITH NHLBI AND AM DELIGHTED THAT A COLLEAGUE FROM NHLBI IS HERE TO SUPPORT THIS INITIATIVE. THANK YOU, AND I WOULD BE HAPPY TO ADDRESS ANY QUESTIONS. >> NOT YET. YEAH. SO THE COUNCIL REVIEWERS FOR THIS ARE DOCTORS ARANETA AND DR. GALALAA. ARE YOU ON THE PHONE IN. >> I AM INDEED. >> THIS IS A IMPORTANT INITIATIVE AND AS IMPORTANT AS EXERCISE AND DIET OR THE INTERACTION WITH BOTH. I THINK I WOULD SUGGEST THAT WE CONSIDER EXCESS SLEEP AS WELL AND THAT'S USUALLY DEFINED AS 9 HOURS OR LESS, RECENT PAPERS HAVE SUGGESTED THAT IT IS ASSOCIATED WITH IMPAIRED GLUCOSE TOLERANCE, BUT I THINK WHAT'S REALLY IMPORTANT IS THE REFINEMENT OF SLEEP MEASURES BECAUSE THESE ARE MOSTLY CROSS-SECTIONAL STUDIES AND THE ISSUE OF REVERSE CAUSALITY. MY SUGGESTION WOULD RECOMMEND APPLICATIONS THAT NOT ONLY QUANTITY PHI SLEEP DURATION WITH PRECISE MEASURES, CAN FIT BITS THAT ARE MORE PRECISE, BUT ALSO LOOKING AT THE QUALITY OF SLEEP, REM SLEEP, SHORT WAVE SLEEP, AS WELL AS MEASURING INDICATORS OF SLEEP DEFICIENCY, HOW OFTEN ARE PEOPLE NAPPING, HOW DO THEY REPORT THE QUALITY OF SLEEP. ANOTHER CONCERN IS JUST AS WE'VE NRN THERE ARE DIFFERENT VITAMIN D THRESHOLDS ON BONE HEALTH AND DIFFERENT CUT POINTS FOR BMI AND RISK FOR DIEBILITIES, ARE THERE ALSO DIFFERENT THRESHOLDS FOR OPTIMUM SLEEP BY AGE AND BY DIFFERENT ETHNIC GROUPS? I THINK NAPPING IS ALSO SOMETHING THAT REQUIRES CONSIDERATION, AND THEN AS FAR AS STUDY DESIGN, IF WE COULD FOCUS ON CAUSALITY, TEMPORALITY, SUGGEST PROSPECTIVE STUDIES WHERE SLEEP MEASUREMENTS PRECEDE INCIDENT DISEASE, AND MAYBE WE RECOGNIZE THE COST OF ENROLLING NEW COHORTS BUT PERHAPS THIS MEASUREMENT COULD BE INCLUDED IN EXISTING COHORTS, AN EXAMPLE IS THE NEWLY FUNDED U54 IN GUAM AND PONAPY THAT WILL BE LOOKING AT PARENT AND CHILDREN DIADS, ABOUT 500 FAMILIES AND CARDIO METABOLIC RISK, AS THEY'RE JUST BEGINNING THEIR ENROLLMENT, THIS MIGHT BE AN OPPORTUNE TIME TO INCLUDE SLEEP AS AN EXPOSURE SWMS THE ADOLESCENT BRAIN STUDY COHORT IF WE'RE INTERESTED IN LIFE COURSE MEASURES OF SLEEP. THE TAXING NETWORK, BANGLADESH TAXI DRIVERS IN NEW YORK AND DIFFERENT OCCUPATIONAL GROUPS INCLUDING SHIFT WORKERS. FINALLY, IT WOULD BE IMPORTANT TO CONSIDER CONFOUNDERS, SLEEP APNEA CERTAINLY AN INTERESTING AND IMPORTANT CONFOUNDER, ANXIETY AND DEPRESSION, MEDICATION, CAFFEINE INTAKE THROUGHOUT THE DAY TO COMPENSATE FOR THE SLEEP DEFICIENCY, AND AGE AND MENOPAUSAL SYMPTOMS THAT DISRUPT SLEEP, ACCESS TO AIR CONDITIONING IN THE ENVIRONMENT, AND THEN FINALLY THE MECHANISMS INCLUDING THE CONSEQUENCE OF DEFICIENT AND EXCESS SLEEP ON CYTOKINES, OTHER METABOLIC PARAMETERS, CORTISOL, INSULIN, AND LEPTIN AND GRELLIN THAT MIGHT ALSO ENHANCE APPETITE AND BE ASSOCIATED WITH DIABETES, AND FINALLY TO RECOMMEND INTERVENTIONS FOR OPTIMAL SLEEP HYGIENE TO PREVENT INCIDENT CON CHRONIC DISEASES AND ALSO IN THE MANAGEMENT OF PEOPLE WITH CHRONIC DISEASES. >> THANK YOU. I REALLY APPRECIATE ALL THE COMMENTS THAT YOU HAVE GIVEN. >> EXCUSE ME, WE HAVE ONE MORE REVIEWER. COULD YOU JUST HOLD THAT THOUGHT? >> OKAY. >> DR. GALILEA. >> THANK YOU VERY MUCH. SORRY FOR THE INCONVENIENCE OF BEING ON THE PHONE. I AGREE WITH DR. ARANETA, IT'S AN INTERESTING PROPOSAL, I COMMEND DR. DAS AND I'LL BE ADDRESSING DR. JONES FOR THEIR WORK ON THIS. I ALSO HAVE SIMILAR COMMENTS TO DR. ARANETA, THINKING ABOUT OVERSLEEP IS ALSO IMPORTANT. THE OTHER THOUGHT I HAD FOR THE CONSIDERATION IS WHETHER EFFORT CAN BE MADE TO LINK THIS A LITTLE BIT MORE EXPLICITLY TO DIFFERENCES IN POPULATION HEALTH. SO WHEN YOU READ THIS, THIS IS ACTUALLY PART OF THE OBJECTIVES, AND IN THE BACKGROUND I ACTUALLY FEEL LIKE THIS GETS LOST A LITTLE BIT. WE HAVE A SECTION ABOUT DOES SLEEP LEAD TO DIFFERENCES IN DISEASE RISK, BUT AT THE EN OF THE DAY, THE GOAL FOR THE INSTITUTE GIVEN THE VALUES OF THESE AND THE DOCUMENT THAT WAS REVIEWED YESTERDAY, ULTIMATELY THE INSTITUTE IS INTERESTED IN SLEEP AS A MEANS RATHER THAN AS AN END. SO I WOULD -- I MIGHT ACTUALLY MAKE THAT VERY CLEAR. I WAS STRUCK BY THE CONVERSATION YESTERDAY ABOUT MAKING SURE THE INSTITUTE RESOURCES DON'T END UP BEING ESSENTIALLY USED TO ADVANCE SCIENCE THAT IS ONLY FRANKLY TAKING ADVANTAGE OF THE INSTITUTE'S INTERESTS FOR ITS OWN END, I THINK THIS CAME UP AILT BIT FROM DR. DR. MONTGOMERY-RICE YESTERDAY, SO I WOULD MAKE IT CLEAR THAT THE INSTITUTE ONLY IN EXPLAINING RACIAL ETHNIC DIFFERENCES, OTHERWISE I WOULD BE WORRIED THAT THE INSTITUTE WOULD BE BRANCHING OUT INTO A FAIRLY EXPLICIT DIRECTION, I DON'T KNOW MUCH ABOUT SLEEP RESEARCHERS, BUT I IMAGINE THERE IS A COMMUNITY OF SLEEP RESEARCHERS LIKE THERE IS IN EVERYTHING ELSE WHICH WOULD RED AND WILL QUICKLY FLOOD ANY RESOURCES YOU WOULD HAVE TO JUST SIMPLY SEE IT AS ANOTHER OPPORTUNITY TO EXTEND THEIR PORTFOLIO. THAT'S MY OVERALL COMMENT WHICH I THINK IS RELEVANT TO THIS OBVIOUSLY BUT I WOULD SUGGEST THAT COMMENT IS RELEVANT TO ANY NEW DIRECTION THE INSTITUTE TAKES TO. I WOULD RESTS THERE. >> THANK YOU VERY MUCH. AT THIS TIME I WOULD LIKE TO OPEN THE DISCUSSION TO THE REST OF THE COUNCILMEMBERS, ANY COMMENTS, ANY QUESTIONS YOU MIGHT HAVE, WILL YOU PLEASE STATE THEM. I HAVE ONE. >> DOWN HERE. I WOULD JUST LIKE TO RECOMMEND AN RFA THAT YOU MAKE, CREATE STRONG LANGUAGE THAT INDICATES THAT, YOU KNOW, ANY ASSESSMENT FOR SLEEP DISORDERS WOULD BE ACCOMPANIED BY AN ABILITY TO DEAL WITH IT ON A CLINICAL LEVEL. FROM PERSONAL EXPERIENCE IN A COHORT STUDY I'M INVOLVED IN, I WAS SURPRISED TO FIND THAT NOT ALL HEALTH INSURANCE COVERS THE ASSESSMENT AND TREATMENT OF SLEEP DISORDERS AND MECHANISTICALLY IT'S NOT SOMETHING THAT YOU CAN REFER DIRECTLY TO A SLEEP DISORDER CENTER, IT HAS TO GO THROUGH A FAMILY CENTER, SO I THINK THE ABILITY TO REFER FOR PROPER ASSESSMENT AND PROPER TREATMENT THROUGH SPECIALTY CARE SERVICES IS MADE AVAILABLE, IF THEY'RE GOING TO GO LOOK FOR IT. >> MINIMUM IS A QUESTION OF IGNORANCE. A LOT OF THE SOURCES FOR THIS ARE COMING FROM CDC AND I'M JUST WONDERING, NIH ADDED ALL THESE DIFFERENT PROMISE ITEMS AND THERE'S A MAJOR, MAJOR SECTION ON SLEEP AND SLEEP DISORDERS. ARE ANY OF THE STUDIES THAT HAVE BEEN DONE USING THE NIH PROMISE MEASURES OUT THERE THAT CAN HELP DIRECT WHERE THIS GOES? INSTEAD OF JUST BE LIMIT IT GO TO CDC. >> Dr. Rina Das: ARE YOU ASKING IF THE DATA THAT I PRINTED WAS AVAILABLE FROM OTHER SOURCES BESIDES CDC? >> I'M JUST CURIOUS BECAUSE NIH DID SUCH A PUSH ON THE PROMISE MEASURES AND I KNOW FOR MANY PEOPLE ARE USING NIH PROMISE MEASURES IN THAT WHOLE SLEEP AREA, THEY'VE GOT TWO DIFFERENT MAJOR CATEGORIES, ARE THERE ANY STUDIES THAT HAVE BEEN PUBLISHED ABOUT IT THAT COULD HELP INDICATE WHERE THIS RESEARCH MIGHT GO? >> Dr. Rina Das: SO I DON'T KNOW ABOUT THE PROMISE MEASURES, I DON'T KNOW IF MY COLLEAGUE HAS ANY INFORMATION TO ADD TO THAT, BUT IN TERMS OF THE INFORMATION THAT'S OUT THERE THAT NIH FUNDS, WE HAVE DONE A THOROUGH EVALUATION OF THE PORTFOLIO AND LOOKING AT WHAT TYPES OF RESEARCH THAT ARE BEING FUNDED FROM OTHER INSTITUTES AND TRYING TO SEE IF THERE ARE GAPS, AND THESE ARE THE GAPS THAT WE IDENTIFIED THAT STILL EXIST. SO IN TERMS OF SOME OF THE MEASURES FOR SLEEP, I KNOW THERE ARE VARIOUS COHORT STUDIES THAT HAVE INCLUDED SLEEP QUESTIONNAIRES IN SOME OF THOSE STUDIES, AND AARON, DID YOU WANT TO ADD ANYTHING TO THAT? >> HI. SO MY NAME IS AARON LAPASKY, I'M FROM THE AMERICAN HEART, LUNG AND BLOOD INSTITUTE, ONE OF OUR FUNCTIONS IS TO TRY TO COORDINATE, SWEEP ACROSS INSTITUTES AND CENTERS AT THE NIH. SO THAT'S A CATALYST FOR WHY WE'VE BEEN WORKING WITH RINA ON THIS PROJECT. IN TERMS OF MEASURES, THERE'S A LOT OF MEASURES THAT CAN BE USED, THERE'S A LOT OF MEASURES THAT HAVE BEEN USED IN SURVEILLANCE TOOLS, LIKE NHANES, FOR EXAMPLE, THERE'S MEASURES THAT HAVE BEEN DEVELOPED LIKE PROMISE AVAILABLE TO INVESTIGATORS TO USE AND TUD DIZ THEY MAY BE DEVELOPING OR DESIGNING SO THERE'S A WHOLE RANGE OF, YOU KNOW, QUESTIONS, MOST OF THE RESEARCH, AS RINA SAID, THAT'S BEEN PUBLISHED SO FAR ON SLEEP HAS BEEN MAINLY DESCRIPTIVE, SHOWING THAT THERE MIGHT BE DIFFERENCES IN SLEEP DURATION BETWEEN CERTAIN RACE OR ETHNIC GROUPS OR SOCIOECONOMIC STATUS. SO REGARDLESS OF THE TYPES OF QUESTIONNAIRES THAT ARE AVAILABLE, NONE OF THEM HAVE REALLY, YOU KNOW -- THERE'S NOT BEEN MUCH PUBLISHED TO ADDRESS THE KINDS OF QUESTIONS THAT WE'RE LOOKING AT HERE, YOU KNOW, THE QUESTIONS I DON'T THINK -- THE TOOLS -- THERE ARE TOOLS AVAILABLE TO ASSESS SLEEP, THERE'S TOOLS AVAILABLE TO MEASURE SLEEP OBJECTIVELY, THERE'S TOOLS AVAILABLE TO MEASURE CIRCADIAN RHYTHMS OBJECTIVELY AND WHAT WE NEED TO DO IS APPLY THOSE TO THESE SCIENTIFIC QUESTIONS AND THAT'S THE REAL CATALYST I THINK BEHIND THIS INITIATIVE. >> A COUPLE THINGS. ONE IS JUST THE CATEGORIZATION OF HISPANICS SHOULD BE BROKEN UP AND PARTICULARLY WHETHER IMMIGRANT OR NONIMMIGRANTS, BESIDES THE SOCIAL CLASS. CLEARLY IN MY CLINICAL EXPERIENCE, A LOT OF FAMILIES LIVE TOGETHER SO THEY MAIL LIVE IN ONE ROOM, SLEEP APPROXIMATE ONE ROOM, THAT'S PROBLEMATIC FOR SLEEP. BUT THE OTHER THING I WOULD SAY, AT LEAST IN PEDIATRICS THE BIG THING WE DEAL WITH IS CERTAINLY SLEEP APNEA BUT CERTAINLY THE PROBLEM OF THE IMPACT OF SLEEP ON EDUCATION AND PERFORMANCE. IF YOU WANT TO LOOK AT ONE THING, I LOVE KIDS, AND THE IDEA THERE IS THE OUTCOME FOR ME IN KIDS IS SUGGESTION AS AN ADULT AND I THINK EDUCATION IS KEY TO THAT. IF WE LOOK AT SLEEPING AS A HEALTH PARAMETER, BESIDES FALLING ASLEEP, THE ISSUE IS WHEN DO THEY FALL ASLEEP, IF THEY FALL ASLEEP IN SCHOOL AND DON'T DO WELL THAT HAS LONG-TERM IMPACT BECAUSE THEY'LL BE NOT DOING WELL IN SCHOOL, END UP IN POVERTY AND THAT CREATES ANOTHER CYCLE. SO I HIGHLY ENCOURAGE THAT AND I THINK IF THERE CAN BE A LINK WITH EDUCATION, THAT WILL BE GREAT. >> THANK YOU. I JUST WANTED TO RESPOND TO SOME OF THE COMMENTS THAT DR. ARANETA MADE IN TERMS OF THINKING ABOUT INTERVENTIONS FOR SLEEP HYGIENE. I KNOW THAT IS A VERY IMPORTANT AREA, BUT WE WERE GOING TO FOCUS ONLY ON SOME OF THE UNDERLYING CAUSES, AND ONCE WE HAVE A GOOD HANDLE OF WHAT THESE CAUSES ARE, THEN WE CAN HAVE THE NEXT CONCEPT ON DEVELOPING EFFECTIVE INTERVENTIONS. >> THANK YOU VERY MUCH, DR. DAS. >> Dr. Rina Das: THANK YOU. >>. >> Dr. Joyce Hunter: AT THIS TIME, ARE THERE ANY OTHER COMMENTS? IF NOT, MAY I PLEASE HAVE A MOTION FOR THIS CONCEPT TO MOVE FORWARD TO FOA DEVELOPMENT? >> SO MOVED. >> Dr. Joyce Hunter: SECOND? >> SECOND. >> Dr. Joyce Hunter: ALL IN FAVOR? >> AYE. >> ANY OPPOSE? >> AYE JOYCE JOIPS THE MOTION CARRIES. THANK YOU VERY MUCH, DR. DAS. >> Dr. Rina Das: THANK YOU. >> THE NEXT CONCEPT IS YOUTH VIOLENCE PREVENTION INTERVENTIONS, INCORPORATING RACISM OR DISCRIMINATION PREVENTION AND DR. JENNIFER ALVIDREZ WILL GIVE THE PRESENTATION. >> Dr. Jennifer Alvidrez: GOOD AFTERNOON. SO AS THE TITLE SUGGESTS, THE PURPOSE OF THIS INITIATIVE IS TO SUPPORT RESEARCH, DEVELOP AND TEST YOUTH VIOLENCE PREVENTION INTERVENTIONS FOR HEALTH DISPARITY POPULATIONS THAT INCORPORATE RACISM OR DISCRIMINATION PREVENTION STRATEGIES. SO SOME BACKGROUND. EVEN THOUGH VIOLENT BEHAVIOR IN GENERAL HAS DECREASED OVER THE PAST FEW DECADES, YOUTH VIOLENCE IS STILL A SIGNIFICANT PUBLIC HEALTH PROBLEM IN THE U.S. OVER HALF A MILLION YOUTH AGED 10-24 PER YEAR ARE TREATED FOR PHYSICAL ASSAULTS IN EMERGENCY DEPARTMENTS AND COUNTLESS OTHERS ARE NOT PRESENTING TO EMERGENCY DEPARTMENTS, NEARLY 5,000 ARE VICTIMS OF HOMICIDE ANNUALLY. RACIAL/ETHNIC MINORITY YOUTH, IN PARTICULAR AFRICAN AMERICAN, LATINO AND AMERICAN INDIAN AND ALASKA NATIVE YOUTH EXPERIENCE HIGHER RATES OF HOMICIDE, PHYSICAL ASSAULT AND SCHOOL FIGHTS THAN NON-HISPANIC WHITE YOUTH. BECAUSE MOST VIOLENCE IS INTRARACIAL OR INTRAETHNIC, IF YOU WANT TO PREVENT VIOLENT VICTIMIZATION AMONG MINORITY YOUTH, YOU NEED TO PREVENT VIOLENCE PERPETRATION BY THESE SAME POPULATIONS. SO THERE'S A LARGE LITERATURE THAT HAS IDENTIFIED RISK FACTORS AND ABILITY SEE DENTS OF -- ANTECEDENTS OF YOUTH VIOLENCE PERPETRATION AT THE INDIVIDUAL LEVEL, FAMILY RELATIONSHIP LEVEL AND COMMUNITY LEVEL, THIS IS A SCHEMATIC FROM THE CDC REPORT ON PREVENTING YOUTH VIOLENCE AND YOU CAN SEE A RANGE OF FACTORS THAT THEY -- EXAMPLES OF FACTORS THAT THEY IDENTIFY, FOR EXAMPLE, AT THE INDIVIDUAL LEVEL, POOR SCHOOL ACHIEVEMENT, AT THE RELATIONSHIP LEVEL, HAVING PEERS WHO ARE ENGAGED IN VIOLENCE, AT THE COMMUNITY LEVEL, COMMUNITY COHESION AND AT THE SOCIETAL LEVEL, SOCIETAL NORMS AND THINGS LIKE THAT. WHAT WE'VE SEEN IN THE FIELD OF YOUTH VIOLENCE PREVENTION IS THAT AS NEW EVIDENCE ABOUT MULTILEVEL RISK AND PROTECTIVE FACTORS FOR VIOLENCE HAVE EMERGED, AS NEW EVIDENCE HAS EMERGED, THESE YOUTH VIOLENCE PREVENTION PROGRAMS HAVE ELM BRAIMSED A MORE SOCIOECOLOGICAL FRAMEWORK, SO THESE INTERVENTIONS INITIALLY STARTED OUT BEING VERY INDIVIDUALLY FOCUSED, SO WORKING ON IMPULSE CONTROL, COPING SKILLS, DOING BETTER IN SCHOOL, AND AS THESE OTHER HIGHER LEVEL RISK FACTORS HAVE EMERGED, YOUTH VIOLENCE INTERVENTIONS HAVE INCORPORATED PEER COMPONENTS, FAMILY COMPONENTS, SCHOOL COMPONENTS, COMMUNITY COMPONENTS TO ADDRESS THE MULTILEVEL NATURE OF THIS PHENOMENON. AS FAR AS THE EVIDENCE BASE FOR WHETHER VIOLENCE PREVENTION INTERVENTIONS WORK, MANY SCHOOL AND FAMILY BASED INTERVENTIONS HAVE BEEN SHOWN TO REDUCE VIOLENT BEHAVIOR IN THE SHORT TERM, AND THESE EFFECTS TENT TO DISSIPATE OVER TIME. OTHER TYPES OF INTERVENTIONS HAVE EITHER NOT BEEN AS RIGOROUSLY EVALUATED, LIKE SOME OF THE LARGER COMMUNITY-BASED VIOLENCE PREVENTION, CURE VIOLENCE, CEASE-FIRE, THESE THRINGZ PRETTY HARD TO RIGOROUSLY EVALUATE. OTHER INTERVENTIONS HAVE NOT SHOWN TO BE EFFECTIVE SO FAR, LIKE DATING VIELSZ INTERVENTION, AND SOME HAVE ACTUALLY BEEN SHOWN TO INCREASE DLIN QUENLT BEHAVIOR, LIKE THE SQUARED STRAIGHT PROGRAM. ONE RISK FACTOR FOR YOUTH VIOLENCE THAT HAS NOT BEEN INCORPORATED INTO YOUTH VIOLENCE PREVENTION PROGRAMS IS RACISM AND DISCRIMINATION. SO A WEALTH OF RESEARCH EVIDENCE INDICATES THAT THE EXPERIENCE OF RACISM AND DISCRIMINATION IS A PREDICTOR OF AGGRESSION AND VIOLENT BEHAVIOR. FRANCHES A SYSTEMATIC REVIEW BY PRIEST, ET AL., IDENTIFIED 121 STUDIES PUBLISHED UP TO 2011 THAT LOOKED AT ASSOCIATIONS BETWEEN REPORTED OR EXPERIENCED RACISM AND CHILD AND YOUTH HEALTH AND WELL-BEING. AND AROUND 70% OF THE ASSOCIATIONS TESTED BETWEEN RACISM AND AGGRESSIVE OR DLIN QUENLT BEHAVIOR OR OTHER EXTERNALIZING BEHAVIORS FOUND A POSITIVE RELATIONSHIP AND NONE OF THE ASSOCIATIONS WERE FOUND TO BE NEGATIVE. THIS PATTERN LINKING RACISM AND AGGRESSION SIEVE BEHAVIOR WAS CONSISTENT ACROSS U.S. ETHNIC RACIAL MINORITY GROUPS AND THE PATTERN OF ASSOCIATION FOUND BETWEEN RACISM AND VIOLENT BEHAVIOR WAS EQUIVALENT TO THAT FOUND FOR RACISM AND MENTAL HEALTH PROBLEMS AND STRONGER THAN THAT FOUND FOR RACISM AND PHYSICAL HEALTH PROBLEMS. JUST AN EXAMPLE OF ONE OF THESE KINDS OF STUDIES. THIS IS A STUDY BY MARTIN, ET AL., THEY DID A LONGITUDINAL STUDY OF AROUND 650 BLACK FAMILIES IN IOWA AND GEORGIA, THEY WERE 10-12 YEARS OLD WHEN THE KIDS WERE ENROLLED AND THEY LOOK AT A VARIETY OF DIFFERENT HYPOTHESIZED FACTORS THAT MAY BE RELATED TO DELINQUENCY, THEY LOOKED AT RACIAL SEGREGATION OF THE COMMUNITY, COMMUNITY DISADVANTAGE, SOCIAL COHESION OF THE COMMUNITY, SOCIAL NORMS, SUPPORT FOR THE STREET CODE AND THEN PERCEIVED DISCRIMINATION AND ALL THOSE EITHER HAVING HYPOTHESIZED DIRECT LINKS OR INDIRECT LINKS. THEY RAN THE DATA AND FOUND A LOT OF THESE FACTORS IN PREDICTING VIOLENT DELINQUENCY ACTUALLY DROPPED OUT AND IN FACT PERSONAL DISCRIMINATION WAS THE ONLY FACTOR THAT HAD A DIRECT LINK WITH VIOLENT DELINQUENCY TWO TO FIVE YEARS LATER. OTHER FACTORS DROPPED OUT ENTIRELY, LIKE THE SOCIAL NORM FACTOR, THEN OTHER THINGS LIKE COMMUNITY DISADVANTAGE WERE ONLY RELATED TO VIOLENT DELINQUENCY AS MEDIATED THROUGH PERSONAL DISCRIMINATION. SO IT SEEMS TO BE A THING, THE CONNECTION BETWEEN RACISM AND DISCRIMINATION AND VIOLENCE, BUT IT HAS NOT YET BEEN INCORPORATED AS A THING INTO VIOLENCE PREVENTION PROGRAMS. YOU CAN SEE THE SCHEMATIC THAT I SHOWED EARLIER DOESN'T MENTION RACISM OR DISCRIMINATION. BECAUSE THE PSYCHOLOGICAL AND PHYSICAL CONSEQUENCES OF RACISM AND DISCRIMINATIONS MIRROR THOSE SEEN FOR VIOLENT VICTIMIZATION, THE IMPACT ON THE MIND AND THE BODY, RACISM AND DISCRIMINATION HAS BEEN ITSELF CONCEPTUALIZED AS A FORM OF VIOLENCE EVEN IF PHYSICAL VIOLENCE DOES NOT OCCUR. SO ALTHOUGH SOME INTERVENTIONS, SOME VIOLENCE PREVENTION INTERVENTIONS HAVE INCLUDED STRATEGIES TO HELP YOUTH COPE WITH RACISM OR DISCRIMINATION, THEY DON'T ADDRESS IT DIRECTLY. SO IF YOU DO SEE RACISM AND DISCRIMINATION AS A FORM OF VIOLENCE, IF CHILDREN ARE BEING VICTIMIZED, IT'S NOT REALLY SUFFICIENT TO HELP THEM COPE WITH VICTIMIZATION. YOU NEED TO STOP THE VICTIMIZATION. SO THAT IS THE THINKING BEHIND THIS CONCEPT. IT WILL SUPPORT RESEARCH TO DEVELOP AND TEST RESEARCH INTERVENTION AT THE MIDDLE SCHOOL AND HIGH SCHOOL AGE YOUTH, SO 11 TO 18-ISH THAT INCORPORATE RACISM AND CAN DISCRIMINATION PREVENTION STRATEGIES. THERE ARE EXISTING DISCRIMINATION PREVENTION PROGRAMS, THEY COULD BE COMBINED TOGETHER, IT COULD BE ADDING NEW DISCRIMINATION PREVENTION COMPONENTS TO EXISTING VIOLENCE PREVENTION PROGRAMS OR THE DEVELOPMENT OF COMPLETELY NEW FULLY INTEGRATED PREVENTION INTERVENTIONSES. SO INTERVENTIONS CAN ADDRESS INTERPERSONAL AND/OR STRUCTURAL DISCRIMINATION RELATED TO RACE, ETHNICITY OR OTHER STATUSES, SO IT DOESN'T HAVE TO JUST BE RACISM. IT COULD ALSO BE OTHER STIGMATIZED STATUSES SUCH AS SES, RELIGION, IMMIGRATION STATUS, WITHIN HEALTH DISPARITY POPULATIONS IF THAT POPULATION HAS A PROBLEM WITH VIOLENT BEHAVIOR. SOME EXAMPLES OF INTERPERSONAL DISCRIMINATION PREVENTION STRATEGIES THAT HAVE SHOWN SOME EFFECTIVENESS, INCREASING AWARENESS OF UNCONSCIOUS BIAS, THAT'S MOSTLY AMONG ADULTS AND TEACHERS AND HEALTHCARE PROVIDERS, SHIFTING SOCIAL NORMS AND REINFORCEMENT OF INCLUSIVE BEHAVIOR, AND PROBABLY THE MOST COMMON WITH YOUTH IS THE FOASERRING OF GREATER CONTACT AND THE INTERACTION BETWEEN GROUPS OF YOUTH OR YOUTH AND ADULTS. EXAMPLES OF STRUCTURAL DISCRIMINATION REDUCTION STRATEGIES, LOOKING AT POLICIES AND PRACTICES THAT MAY DIFFERENTIALLY IMPACT CERTAIN POPULATIONS OF YOUTH OR MONITORING TO ENSURE THAT POLICIES ARE ENFORCED EQUITABLY AS WELL AS CULTURAL COMPETENCY OR DIVERSITY TRAINING FOR ORGANIZATIONAL PERSONNEL, THAT BEING FOCUSED MORE ON THE ADULTS TOO. SO POSSIBLE RACISM/DISCRIMINATION PREVENTION TARGETS INCLUDE, SO THIS IS MORE KIND OF AT THE LOCAL LEVEL, HATE CRIMES, THINGS AHAPPEN IN THE SCHOOL -- THINGS THAT HAPPEN IN THE SCHOOL BY THE TEACHER OR THE CLASSROOM, SCHOOL DISCIPLINARY PRACTICES, CRIMINAL JUSTICE OR LAW ENFORCEMENT PRACTICES, BEHAVIOR OF NEIGHBORHOOD BUSINESSES, STORES, SERVICES, LOCAL MEDIA MESSAGES AND THE VIOLENCE PREVENTION TARGETS ARE MOSTLY KIND OF LOWER LEVEL VIOLENCE SO NOT GANG VIOLENCE AND THINGS THAT WILL PUT YOU IN PRISON FOR THE REST OF YOUR LIFE, BUT THIFNGZ, KINDS OF VILS THAT MAY START YOU ON A NEGATIVE TRAJECTORY WHERE THERE'S STILL ROOM TO CHANGE THAT TRAJECTORY. SO FIGHTING, BULLYING AND OTHER SCHOOL-BASED VIOLENCE, ELECTRONIC AGGRESSION, OF WHICH CYBERBULLYING IS A PART OF, DATING VIOLENCE, WHICH COULD INCLUDE BOTH PHYSICAL AND SEXUAL VIOLENCE, FAMILY VIOLENCE, VIOLENT BEHAVIOR IN JUVENILE JUSTICE SETTINGS. AND JUST TO CLARIFY, THE THINKING BEHIND THIS, IT'S NOT LIMITED TO VIOLENCE IN DIRECT RETALIATION TO DISCRIMINATION. SO IF SOMEONE USES A RACIAL SLUR TOWARDS ME AND I HIT THAT PERSON, THAT'S NOT REALLY WHAT WE'RE TALKING ABOUT. WE'RE TALKING ABOUT A DISCRIMINATION REALLY AS A MORE DISTAL KIND OF FACTOR THAT LEADS TO VIOLENT BEHAVIOR NOT NECESSARILY AT THE TARGET, THE PERMANENT TRAITOR OF THE DISCRIMINATION. SO WE'RE INTERESTED IN REALLY LOOKING AT THE INCREMENTAL VALUE OF ADDING THESE DISCRIMINATION PREVENTION ELEMENTS TO VIOLENCE PREVENTION INTERVENTION, SO REALLY STUDY DESIGNS THAT ALLOW FOR THE TESTING OF THAT AND THEN OF COURSE WE WOULD BE LOOKING FOR PROJECTS WHERE THEY CAN DEMONSTRATE BOTH THE PREVALENCE OF VIOLENCE IS A PROBLEM AND THAT THERE IS DISCRIMINATION GOING ON TOWARDS THAT POPULATION. >> Dr. Joyce Hunter: THANK YOU VERY MUCH, DR.. COUNCIL REVIEWERS FOR THIS ARE DR. ADAMS AND DR. DR. ALEGRIA. >> THANK YOU FOR THIS WONDERFUL PRESENTATION THAT YOU JUST GAVE, AND I THINK JUST WHAT'S HAPPENING IN THIS COUNTRY TODAY, I MEAN, THERE'S INDICATIONS JUST WITH THE BLACK LIVES MATTER AND ALL OF THE CONVERSATIONS I KNOW HAPPENING ON OUR CAMPUS, THE NEED FOR THIS TYPE OF WORK IS SO, SO IMPORTANT AND SO CRITICAL AND I JUST HATE TO EVEN ADMIT THAT GIVEN I THOUGHT AT THIS STAGE OF OUR COUNTRY'S DEVELOPMENT WE WOULD NOT NEED TO HAVE THIS. BUT I THINK IT'S IMPORTANT, AND YOU PROVIDED CLEAR INFORMATION IN WAYS THAT WE CAN BEGIN TO LOOK AT THIS ISSUE FROM A COMMUNITY OR A SOCIAL, ECOLOGICAL KIND OF MODEL I THINK WOULD BE IMPORTANT CONTRIBUTIONS TO THIS WHOLE LINE OF RESEARCH. THIS HAS BEEN DONE FOR QUITE A WHILE LOOKING AT YOUTH VIOLENCE AND YOUTH VIOLENCE INTERVENTION AND MOST OF THE WORK HAS BEEN DONE AT THE INTERPERSONAL OR THE INDIVIDUAL LEVEL, SO EXPANDING THAT OUT AND THEN ADDING THIS WHOLE FOCUS ON RACISM AND DISCRIMINATION SYNC A GOOD WAY FOR US TO MOVE FORWARD. SO I SUPPORT THIS CONCEPT AND I WELCOME BEING INVOLVED IN IT, AND WE'VE ALREADY TALKED ABOUT OUR APPRECIATION OF THIS. >> I WANT TO COMMEND FOR PUTTING THIS TOGETHER, IT'S VERY CURE RAGE YUS, I KNOW SOME FOUNDATIONS ARE CRINGING BACK FROM GETTING INVOLVED IN THIS SORT OF STUDY, SO I THINK THIS IS REALLY, TO ME, QUITE SHOULD BE A PRIORITY OF THE INSTITUTE, SO I GUESS I ONLY HAVE ONE COMMENT TO DO, TWO COMMENTS. ONE IS IN MAKING THE INVESTIGATIONS THAT YOU ACTUALLY DID IN YOUR PRESENTATION ABOUT HOW TO DISTINGUISH WHAT'S GOING TO BE CALLED DISCRIMINATION AND I THINK THIS IS REALLY IMPORTANT BECAUSE IF NOT, I THINK IT'S GOING TO BE CONFUSING. THE OTHER THING THAT WASN'T CLEAR TO ME WAS WHETHER WE'RE TALKING ABOUT PREVENTION ELEMENTS OF DISCRIMINATION OR ARE WE TALKING -- WHEN IS IT AN ELEMENT THAT YOU HAVE TO INCORPORATE VERSUS A PROGRAM? BECAUSE I THINK THOSE TWO WILL BE CONFUSING TO PEOPLE. SO IF YOU COULD CLARIFY THE DIFFERENCE BETWEEN ELEMENTS OF A PROGRAM OR PREVENTION STRATEGY VERSUS YOU HAVE TO INCLUDE AN EVIDENCE-BASED PREVENTION STRATEGY. GENERAL. >> OKAY. AT THIS TIME I WOULD LIKE TO OPEN THE FLOOR -- GO AHEAD. >> THANKS VERY MUCH. I WANTED TO ASK, ARE YOU GOING TO INCLUDE IN HERE ANYTHING ABOUT RESILIENCY STUDIES FOR PEOPLE WHO ARE ABLE TO AVOID THIS VIELSZ? COULD THAT BE ONE OF THE HYPOTHESES THAT PEOPLE USE TO PUT TOGETHER A PROPOSAL, FOR EXAMPLE? AND THEN WHAT HAS HAPPENED TO YOU ALONG THE LIFE CYCLE SPECIFICALLY AS A YOUNGSTER? WERE YOU IN SCHOOL, OUT OF SCHOOL, YOU KNOW, THIS KIND OF THING, AS WELL, AS A VARIABLE? AND THEN FINALLY, EXPOSURE AT WHAT STAGE OF YOUR LIFE CYCLE TO THE CRIMINAL JUSTICE SYSTEM AS AN AUGMENTER OF THE RISK FOR BEING INVOLVED IN VIOLENT ALTERCATIONS. I THINK THOSE ARE SOME THINGS THAT YOU KIND OF HAVE TO THROW IN THERE AS POTENTIAL VARIABLES FOR PEOPLE TO THINK ABOUT AS WELL. JUST MY THOUGHT. >> IT WOULD BE CRITICALLY IMPORTANT THAT AS WE DEVELOP A REVIEW PANEL FOR THESE TYPE OF GRANTS, THAT YOU HAVE THE RIGHT SOCIAL SCIENTISTS AND PSYCHOLOGISTS ON THE EVALUATION PANEL. I THINK THIS IS VERY BOLD. I THINK IT IS VERY TIMELY. I THINK WE HAVE TO BE VERY SENSITIVE TO SOME OF THE PUSHBACK THAT WE MAY GET FOR STEPPING OUT WITH THESE DISCUSSIONS AND NOT CLEARLY UNDERSTANDING THAT RACISM AND DISCRIMINATION SOMETIMES IS IN THE EYE OF THE BEHOLDER BUT STILL VALID, AND SO SOMEHOW WE HAVE TO INCORPORATE THAT UNDERSTANDING IN THE DEVELOPMENT OF THE PROJECT AND THE EXPECTATIONS OF THE DELIVERABLES. BUT I THINK THAT IT IS VERY TIMELY, AND HOPEFULLY, I DON'T KNOW, FIVE, TEN YEARS FROM NOW, AS WE START TO SHARE IN A SCIENTIFIC WAY SOME OF THE DISCOVERY, WE WILL BE ABLE TO INFLUENCE POLICY AND THE UNDERSTANDING FOR PEOPLE THAT YOUR MIND IS ALREADY MADE UP IF YOU START BUILDING PRISONS BASED ON THE BIRTHRATE OF AFRICAN AMERICAN MALE SAYS, THE NUMBER THAT'S GOING TO MAKE IT TO THE THIRD GRADE. SO YOUR MIND IS ALREADY MADE UP. AND TO KIND OF UNDO THAT IS WELL BEYOND NIMHD, BUT WE CAN TRY. SO I JUST THINK WE HAVE TO REMEMBER ALL OF THAT AS BACKGROUND, YOU KNOW, TO WHAT WE'RE TRYING TO DO. IT DOESN'T MEAN THAT WE SHOULDN'T STEP OUT HERE AND TAKE THIS BOLD MOVE, BUT WE HAVE TO HAVE THE RIGHT TYPE OF PEOPLE ON THE REVIEW PANEL TO HELP US THINK THROUGH TO MAKE SURE THAT WE'RE BEING SENSITIVE AND APPROPRIATE, IF THAT MAKES SENSE. >> THANK YOU. ARE THERE ANY OTHER COMMENTS OR QUESTIONS? >> YEAH. YOU KNOW, ONE ASPECT THAT I THINK REALLY STRENGTHENS THIS APPROACH IS THE FOCUS ON MULTILEVEL APPROACHES TOWARD THIS ISSUE, BUT MY QUESTION IS, HAVE YOU GUYS PERHAPS CONSIDERED GIVEN THESE RECOMMENDATIONS THAT SORT OF EMANATED FROM THE VISIONING PROCESS, ESPECIALLY INTERVENTION PILLAR, MULTISENSORY APPROACHES, BRING IN THE DEPARTMENT OF EDUCATION, DEPARTMENT OF JUSTICE, TO REALLY LAUNCH, YOU KNOW, A SOLID COMPREHENSIVE APPROACH TO REALLY ADDRESSING THIS ISSUE BECAUSE IT IS MULTIFACETED, AND I THINK IT REALLY WOULD BODE WELL AND STRENGTHEN THIS ANNOUNCEMENT. >> DR. RIVERS TOOK THE WORDS OUT OF MY MOUTH. >> SORRY. >> BUT MILL DAUGHTER IS STUDYING SCHOOL TO PRISON PIPELINES AND WHAT I'VE LISTENED TO HER TALK ABOUT IS ISSUES LIKE SCHOOL IN CENTRAL CALIFORNIA GETS $100,000 FOR THE SCHOOL, THEY PUT IT IN POLICE, TO HIRE POLICE. ANOTHER SCHOOL IN SANTA CLARA COUNTY EXPELLED ABOUT 70% OF THE STUDENTS UNTIL THE TEACHERS GOT TOGETHER AND DECIDED MAYBE THAT'S NOT THE RIGHT THING TO DO. THEY NOW EXPEL 1% OF THE STUDENTS. SO AS YOU LOOK AT THIS, THIS IS REALLY INSTITUTIONAL. YOU KNOW, KIDS GO TO WORK BECAUSE THEY GO TO SCHOOL, AND WITHIN THAT CONTEXT, WE HAVE TO CHANGE THEM, ANDIC WE'RE NOT GOING TO CHANGE THEM -- AND I THINK WE'RE NOT GOING TO CHANGE THEM UNLESS WE GET THEM TO PARTICIPATE. THEASSMENTS THE DEPARTMENT OF EDUCATION. ANOTHER GROUP THAT I WORK WITH HAS A LOT OF PEOPLE FROM THE JUSTICE SYSTEM, POLICE AND JUDGES. THEY WANT HELP. SO I THINK THIS IS AN OPPORTUNITY TO LOOK AT THE WHOLE PERSON, THE WHOLE COMMUNITY, AND REALLY STEP FORWARD AS KIND OF LEANING THIS AS THE HEALTH THAT HOPEFULLY EVERYBODY WOULD BE CONCERNED ABOUT, BUT BRING IN PEOPLE THAT MAY OR MAY NOT THINK ABOUT IT AND SAY HOW CAN WE WORK TOGETHER. SO I AGREE WITH DR. RIVERS THAT AT THE END OF THE DAY, IF YOU'RE GOING TO PUT THE EFFORT IN THIS, MAKE IT HIGH PROBABILITY THAT IT WILL SUCCEED, AND THAT MEANS ALL THESE OTHER GROUPS HAVE TO BE TOGETHER. >> I HAVE A QUESTION. WILL THE STUDY ACTUALLY LOOK AT BLACK ON BLACK? >> I THINK IT CAN LOOK AT WHATEVER THE VIOLENCE ISSUE IS. SO I THINK NOT THAT WE HAVE A SOLICITATION, I IMAGINE WE'LL GET A VARIETY OF DIFFERENT KINDS OF APPLIC ATIONS THAT HAVE DIFFERENT INTERVENTION TARGETS, SO I THINK AT LEAST THE WAY WE'RE THINKING ABOUT IT NOW IS RACISM AND DISCRIMINATION CAN COME FROM ANYWHERE. >> I JUST WANTED TO MAKE SURE THAT IT WAS ON THE TABLE. >> AND THAT THE VIOLENCE, I MEAN, MOST OF THE VIOLENCE IS INTRARACIAL OR INTRAETHNIC, SO WHEN YOU'RE TALKING ABOUT YOUTH VIOLENCE, YOU'RE MOSTLY TALKING ABOUT BLACK ON BLACK VIOLENCE, THE DISCRIMINATION DOESN'T HAVE TO BE BLACK ON BLACK DISCRIMINATION, IT CAN COME FROM ANY SOURCE. >> THE KEY, DR. HUDSON, IS THAT THESE WILL BE INVESTIGATED, INITIATED APPLICATIONS IF THERE'S AN FOA THAT GOES OUT, SO WHAT IS BEING PROPOSED WILL BE PROPOSED BY THE INVESTIGATORS THAT SUBMIT THE APPLICATION, WHICH COULD BE A VARIETY OF THINGS. >> JUST METHODOLOGICALLY I READ THIS AND THINK ABOUT POWER. WE HAVE RELATIVELY LOW INCIDENCE RATES OF THINGS, YOU'RE DOING PROBABLY CLUSTER ANALYSIS AT THE COMMUNITY MULTILEVEL SORT OF PERSPECTIVE AND THEN I WONDER AND WORRY BECAUSE IT'S REALLY AN ADDITIVE MODEL THAT YOU'RE TALKING ABOUT, RIGHT, TRADITIONAL VIOLENCE TREEMENTSZ AND THEN THE ADDITIVE COMPONENT OF RACISM, DISCRIMINATION SORT OF COMPONENTS OF THAT AND IN THAT SITUATION WHERE THEY'RE WORRIED ABOUT POWER, THEY'LL PROBABLY TRY TO MAXIMIZE BY MAKING THE CONTROL GROUP SOMETHING OTHER THAN THE TRADITIONAL VIOLENCE PREVENTION PROGRAM SO THEY CAN MAXIMIZE THE DELTA, SO I WOULD WORRY ABOUT THOSE KIND OF THINGS. >> Dr. Jennifer Alvidrez: RIGHT. I THINK WE ARE FOCUSING ON THE VIOLENCE THAT DOESN'T NECESSARILY RESULT IN CRIMINAL JUSTICE INVOLVEMENT THAT HAVE HIGHER -- I MEAN, SCHOOL FIGHTING AND THINGS LIKE THIS THAT HAVE A HIGHER PREVALENCE, AND THEN THIS WOULD BE A GREAT OPPORTUNITY TO USE FACTORIAL INTERVENTION, SINCE WE WERE JUST AT THE SAME CONFERENCE ABOUT THAT, OR OTHER KINDS OF OPTIMIZATION DESIGNS TO LOOK AT DIFFERENT INTERVENTION COMPONENTS. >> ONE LAST POINT. CAN WE MAKE SURE THAT WE ALSO DON'T BUY INTO SOME OF THE COMMENTARY? YOU KNOW, MOST CRIME IS INTRARACIAL, SO BLACK ON BLACK, HISPANIC ON HISPANIC, WHITE ON WHITE, PURPLE ON PURPLE. I MEAN, MOST OF THE CRIME IS INTRARACIAL. SO WE WANT TO MAKE SURE THAT WE DON'T BUY INTO THAT, YOU KNOW, AND OF COURSE WE WOULDN'T NECESSARILY PUT THAT IN THE RFA, BUT EVEN AS WE'RE DISCUSSING IT. >> ARE WE TALKING ABOUT VIOLENCE THAT AFFECTS MINORITIES? >> Dr. Jennifer Alvidrez: HEALTH DISPARITY POPULATIONS. >> HEALTH DISPARITY POPULATIONS. >> Dr. Jennifer Alvidrez: SO I'M ASSUMING IT WILL BE MOSTLY RACIAL ETHNIC MINORITIES AND THEN THE DISCRIMINATION MAY BE RACIALLY OR ETHNICALLY BASED OR SOME BASED ON SOME OTHER FACTOR LIKE IMMIGRATION STATUS OR RELIGION. >> OKAY. BUT IT IS VIOLENCE THAT -- IT IS VIOLENCE THAT DISPROPORTIONATELY AFFECTS HEALTH DISPARITY POPULATIONS. >> Dr. Jennifer Alvidrez: CORREC T. YEAH. >> ARE YOU GOING TO HAVE A REQUIREMENT FOR PARTNERSHIPS WITH SCHOOLS? IS THAT -- OR IS IT GOING TO BE JUST THE PROGRAM ITSELF? >> Dr. Jennifer Alvidrez: RIGHT. I THINK WE WOULD EXPECT PARTNERSHIPS, BUT WE'RE NOT LIMITING THIS TO JUST SCHOOL-BASED INTERVENTIONS, THEY COULD BE COMMUNITY BASED, THEY COULD BE HOSPITAL BASED, SO WE WOULD EXPECT THE APPROPRIATE COLLABORATIONS RATHER THAN A COMPLETELY RESEARCHER-DESIGNED LET ME GO PLUNK THIS INTERVENTION IN THE COMMUNITY. >> THANK YOU VERY MUCH. ARE THERE ANY ADDITIONAL COMEJTS? IF NOT -- COMMENT IN IF NOT, MAY I PLEASE HAVE A MOTION FOR THIS CONCEPT TO MOVE FORWARD TO FUNDING OPPORTUNITY ANNOUNCEMENT DEVELOPMENT? >> SO MOVED. >> SECOND? >> SECOND. >> ALL IN FAVOR? >> AYE. >> ANY OPPOSED? THEN THE MOTION CARRIES THAT THIS CONCEPT MOVES FORWARD TO FOA DEVELOPMENT. >> THE LAST CONCEPT IS UNDERSTANDING THE MECHANISMS OF LIVER CANCER DISPARITIES AND DR. RINA DAS WILL COME BACK FORWARD FOR THE PRESENTATION. >> Dr. Rina Das: THANK YOU. SO THIS CONCEPT IS ON UNDERSTANDING THE MECHANISMS OF LIVER CANCER DISPARITIES IN THE U.S., AND THIS IS A JOINT INITIATIVE WITH NCI AND NIMHD AND I WOULD LIKE TO ACKNOWLEDGE MY COLLEAGUES DR. ALVIDREZ AND DR. TAYLOR FROM NCI WHO IS PART OF THIS INITIATIVE. THE OBJECTIVE OF THIS INITIATIVE IS TO UNDERSTAND THE CAUSES AND MECHANISMS OF LIVER DISPARITIES, LIVER CANCER DISPARITIES AMONG VARIOUS RACIAL ETHNIC MINORITIES AND LOW SES POPULATIONS IN THE U.S. SO WHY DID WE THINK ABOUT LIVER CANCER? PRIFL LIVER CANCER IS ONE OF THE MOST FATAL CANCERS THAT HAS BEEN REPORTED AND IS ONE OF THE FASTEST RISING CANCERS IN THE U.S. THE INCIDENCE OF LIVER CANCER HAS QUADRUPLED IN THE RECENT YEARS. THE RECENT ANNUAL REPORT FROM THE AMERICAN CANCER SOCIETY THAT DEPICTURES THE STATUS OF CANCER WAS RELEASED IN MARCH 2016, ARTICULATES THE HIGH INCREASE IN RATES OF NEW LIVER CANCER WHICH WAS 38% BETWEEN 2003-2012 AND THERE WAS ALE 36% INCREASE IN DEATH RATES SINCE 2003, SO THE OTHER FACT IS LIVER CANCER IS SHOWN TO DISPROPORTIONATELY AFFECT ALL RACIAL AND ETHNIC MINORITIES, POPULATIONS WITH HIGHER RATES AND WORSE SURVIVAL, AND INCREASE IN LIVER CANCER INCIDENCE HAS BEEN OBSERVED IN CERTAIN POPULATIONS, ESPECIALLY IN HISPANICS AND AMERICAN INDIAN POPULATIONS COMPARED TOWERS. MEN HAVE A HIGHER PREVALENCE OF THIS CANCER COMPARED TO WOMEN, SURVIVAL OF PATIENTS WITH LIVER CANCER IS REALLY POOR, WITH 5-YEAR SURVIVAL BUT ONLY 10 TO 15%. SO BASED ON THIS RECENT INFORMATION, THERE'S REALLY CLEAR EVIDENCE THAT THERE IS DAIRGTS DISPARITIES IN LIVER CANCER. THIS SLIDE GIFDZ YOU SOME OF THE DATA THAT I HAD MENTIONED, ACCORDING TO SEER DATA, THERE'S BEEN A STEADY INCREASE IN LIVER CANCER. SO THIS SLIDE SHOWS THE INCIDENCE RATE AND MORTALITY RATE, AS THESE COLORFUL LINES ARE DIFFERENT RACIAL GROUPS AND WHITE IS AT THE BOTTOM AND YOU CAN SEE THAT THERE IS A STEADY INCREASE IN LIVER CANCER INCIDENCE FROM '90 AND '91 TO 2011. ANOTHER THING TO NOTE IS THAT THE INCIDENT RATE AND MORTALITY RATE ARE VERY CLOSE. APPEARS YOU GET LIVER CANCER, MOST LIKELY YOU'RE GOING ON DIE WITH IT. THE RAITSZ ARE HIGH IN ASIAN AND PACIFIC ISLANDERS, AMERICAN INDIAN. IN 2013 THE RATES WERE REPORTED IN AMERICAN INDIAN TO BE HIGHER THAN ASIANS. SO AS I MENTIONED, THAT LIVER CANCER IS HIGH IN MEN. IF YOU LOOK AT THIS FIGURE, YOU CAN SEE THAT MEN -- THE RATES OF MEN DYING WITH LIVER CANCER IS TWICE AS HIGH AS WOMEN, ESPECIALLY IN AMERICAN INDIAN AND ASIAN MEN, SO THESE RECENT DATA SUGGESTS THAT THERE'S REALLY AN INCREASE IN LIVER CANCER INCIDENCE AND MORTALITY RAITSZ AND THE CAUSES OF THESE IS NOT VERY WELL KNOWN. WHEN YOU LOOK AT THE NATIONAL LEVEL DATA ON LIVER CANCER INCIDENCE, THEY VARY WHERE YOU LIVE BETWEEN DIFFERENT STATES, AND THEY VARY BY ABOUT THREE TIMES, SO THE RED MEANS IT'S BAD, SO THERE ARE A FEW STATES THAT HAVE RED WHICH ARE ALMOST LIKE 8 TO 13 COMPARED TO THE 3 OVER 100,000, SO THE RATES VARY BETWEEN DIFFERENT STATES, AND IN THE UNITED STATES SOME OF THE HIGHEST RATES HAVE BEEN REPORTED IN TEXAS AND HAWAII AND WE DON'T UNDERSTAND WHY THESE VARIATIONS ARE, BUT IT COULD BE THE PEOPLE LIVING THERE ARE VARIOUS RISK FACTORS THAT ARE ASSOCIATED WITH IT. WHEN YOU LOOK AT IT AT A REGIONAL LEVEL, AS I MENTIONED, THAT TEXAS HAD HIGH RATES OF LIVER CANCER, THIS STUDY INDICATED LATINOS IN TEXAS HAVE HIGH RATES OF LIVER CANCER AND THAT HAS BEEN INCREASING FROM 1995 TO 2010 AND THE BOTTOM LINE IS FOR WHITE COMPARED TO THE HISPANIC OVERALL NATIONAL HISPANIC, THE MIDDLE ONE IS IN TEXAS, AND IF YOU LOOK AT RAITSZ IN SOUTH TEXAS, THAT IS THE HIGHEST THAT YOU CAN SEE. SO SOUTH TEXAS HAVE ABOUT 3 TO 4 TIMES THE RATES OF LIVER CANCER COMPARED TO THE NATIONAL AVERAGE. MEXICAN AMERICAN POPULATION HAVE BEEN SHOWN IN THIS U.S./MEXICO BORDER TO HAVE MUCH HIGHER RATES OF LIVER CANCER COMPARED TO OTHER POPULATIONS AND THERE ARE SUBPOPULATION DIFFERENCES WITHIN THE LATINO GROUPS THAT HAVE BEEN REPORTED IF YOU COMPARE CUBANS VERSUS PUERTO RICANS VERSUS MEXICANS, SO WHAT DO WE KNOW ABOUT SOME OF THE RISK FACTORS IN LIVER CANCER? IT HAS BEEN VERY WELL STUDIED AND THE MAIN RISK FACTORS THAT HAVE BEEN REPORTED IS CHRONIC INFECTIONS FROM HEPATITIS B VIRUS OR HEPATITIS C VIRUS, HEAVY ALCOHOL CONSUMPTION, CIRRHOSIS AND DIEBLGHTS, METABOLIC SYNDROME, AND THE PREVALENCE OF THESE RISK FACTORS ALSO DIFFER BETWEEN DIFFERENT RACIAL GROUPS. ABOUT 50% OF CHRONIC HEPATITIS B INFECTION HAS BEEN REPORTED AMONG ASIAN AND PACIFIC ISLANDERS AND 71.3% OF CHRONIC HEP B INFECTIONS WERE AMONG PEOPLE BORN OUTSIDE THE U.S. ACCORDING TO CDC, ACUTE HEPATITIS C INFECTIONS HAVE BEEN INCREASING QUITE RAPIDLY WITH 2.5 TIMES BETWEEN 2010 AND 2014. LIVER CIRRHOSIS IS ANOTHER COMMON CAUSE OF LIVER CANCER. PREVALENCE OF CIRRHOSIS IS FOUR FOLD HIGHER IN HISPANICS, ESPECIALLY IN SOUTH TEXAS, AND CHRONIC LIVER DISEASE MORTALITY WAS FOUR TIMES HIGHER IN AMERICAN INDIAN COMPARED TO WHITES. OBESITY, DIABETES, ALCOHOL USE HAS BEEN ALSO REPORTED TO BE CAUSING LIVER SEROSIS, SCARRING OF THE LIVER, AND ULTIMATELY LIVER CANCER. NONALCOHOLIC FATTY LIVER DISEASE IS ANOTHER RISK FACTOR THAT HAS BEEN REPORTED IN THE LITERATURE, AND FATTY LIVER AND NASH, WHICH IS NONALCOHOLIC HEPATITIS HAS BEEN REPORTED TO BE HIGHER IN MEXICAN AMERICANS, IN A POPULATION BASED STUDY IN A COHORT OF SOUTH TEXANS, THE BURDEN OF NASH AND ADVANCED DR. FIBROSIS WAS 50% IN THE POPULATION AND THE ADVANCED FIBROSIS AND CIRRHOSIS WAS MUCH HIGHER IN ADULTS, YOUNG MEN FOR AGE 30 WHICH WAS REALLY A VERY YOUNG AGE. IN ADDITION, FOOD CONTAMINATION WITH AFLATOXIN, FOUND IN CORN MAY PLAY A ROLE IN LIVER CANCER AND WE KNOW CERTAIN POPULATIONS CONSUME CORN AT A HIGHER RATE. LIVER CANCER RATES HAVE BEEN REPORTED TO BE ALMOST TWICE AS HIGH IN U.S. BORN LATINOS WHEN COMPARED TO FOREIGN BORN LATINOS, WHICH IS DIFFERENT FOR ASIANS, WHERE FOREIGN BORN ASIANS HAVE HIGHER RATES THAN U.S. BORN. THERE COULD BE OTHER RISK FACTORS ASSOCIATED WITH THIS INCREASE OF LIVER CANCER THAT WE DON'T UNDERSTAND VERY WELL. IN TERMS OF LOOKING AT THE GAPS, NCI HAD ORGANIZED A CANCER DISPARITY THINK TANK IN NOVEMBER OF 2015, DR. PARASTABLI ATTENDED THAT AND THERE WAS A STRONG RECOMMENDATION OF LOOKING AT CERTAIN CANCERS AND LIVER CANCER DISPARITY WAS IDENTIFIED AS ONE OF THE AREAS OF INTEREST. IN ADDITION, AS I MENTIONED, AMERICAN CANCER SOCIETY'S RECENT REPORT ALSO INDICATED THAT THERE IS MUCH NEED TO UNDERSTAND THIS HIGH INCREASE IN LIVER CANCER IN THE RECENT YEARS. SO SOME OF THE UNDERSTUDIED AREAS IN TERMS OF WHEN YOU LOOK AT THE NIH PORTFOLIO, WE HAVE A LOT OF RESEARCH THAT HAS BEEN DONE IN LIVER CANCER IN GENERAL POPULATION BUT NOT AS MUCH IN UNDERSTANDING HEALTH DISPARITY. SOME OF THE UNDERLYING SOCIAL, ENVIRONMENTAL, BEHAVIORAL FACTORS HAVE NOT BEEN STUDIED. WE DON'T HAVE A CLEAR UNDERSTANDING OF SOME OF THE RESILIENCY FACTORS IN HEALTH DISPARITY POPULATION. SOME OF THE DIAGNOSTIC TOOLS THAT WE COULD HAVE TO REALLY DIAGNOSE LIVER DISEASE AT AN EARLY STAGE SO THAT THEY DON'T REALLY GO TO CANCER IS REALLY URGENTLY NEEDED, AND THESE TESTS THAT ARE DONE WITH THE CUTOFFS THAT ARE AVAILABLE FOR VARIOUS LIVER ENZYMES ARE ALSO BEING DEVELOPED FROM WHITE POPULATIONS, SO THEY HAVE NOT BEEN VALIDATED OR WE DON'T KNOW THAT THEY WILL BE APPROPRIATE FOR SOME OF THE RACIAL AND ETHNIC POPULATIONS. THE ROLE OF STRUCTURAL DRIVERS IS ANOTHER AREA THAT WE THINK NEEDS MUCH ATTENTION. SO TO FILL THIS GAP, WE ARE PROPOSING THIS JOINT INITIATIVE WITH NCI. WE HAVE A JOINT WORKING GROUP THAT WE HAVE BEEN WORKING SEVERAL IDEAS, AND THIS WAS THE FIRST ONE THAT WE BRING TO YOU. SO THE PURPOSE OF THIS INITIATIVE IS TO PROMOTE RESEARCH TO UNDERSTAND THE UNDERLYING FACTORS THAT ARE RESPONSIBLE FOR THIS INCREASE IN LIVER CANCER DISPARITIES AND TO UNDERSTAND THE MECHANISMS OF HOW THESE FACTORS THEN OPERATE IN THESE VARIOUS RACIAL AND ETHNIC SUBPOPULATIONS IN THESE DIFFERENT GEOGRAPHIC AREAS. WE NEED TO REALLY UNDERSTAND THE INTERACTION OF VARIOUS MULTIPLE RISK FACTORS SO IF YOU HAVE A HEPATITIS C INFECTION ALONG WITH ALCOHOL USE, ALONG WITH SMOKING OR LIFESTYLE FACTORS, WHAT HAPPENS TO YOUR RISK, ESPECIALLY IN HEALTH DISPARITY POPULATIONS THAT NEEDS TO BE STUDIED. WE NEED TO IDENTIFY BOTH RISK AND PROTECTIVE FACTORS AMONG HEALTH DISPARITY POPULATION. THIS WOULD HELP TO DEVELOP BETTER STRATEGIES FOR EARLY DETECTION AND DIAGNOSIS OF ADVANCED LIVER DISEASE AND LIVER CANCER IN HEALTH DISPARITY POPULATIONS. RECENT ADVANCES WITH MOLECULAR BIOLOGY HAS REALLY OPENED THIS FIELD AND WE COULD INTEGRATE SOCIAL FACTORS ALONG WITH SOME OF THESE OMICS TO UNDERSTAND ARE THERE RISK FACTORS WE CAN DEVELOP EARLY ON AND IDENTIFY RISK POPULATION AT AN EARLY STAGE BEFORE THEY DEVELOP FULL BLOWN LIVER CANCER. TO EXPLORE SOME OF THE HEALTHCARE ACCESS ISSUES AND QUALITY OF CARE, THAT MIGHT MAY A ROLE IN LATE DIAGNOSIS ABOUT LIMITED ACCESS TO TREATMENT OR POOR SURVIVAL RATES, THERE ARE SYSTEM LEVEL FACTORS THAT WE WOULD LIKE TO LOOK AT AND UNDERSTAND, SO OVERALL, WHAT WE FEEL IS BY HAVING A BETTER UNDERSTANDING OF THESE UNDERLYING CAUSES IN THIS RECENT INCREASE IN LIVER CANCER, WE MIGHT BE ABLE TO THEN DEVELOP BETTER INTERVENTIONS IN THE FUTURE AND REDUCE LIVER CANCER DISPARITIES. THANK YOU, AND I CAN TAKE QUESTIONS NOW. >> THANK YOU VERY MUCH. SO THE COUNCIL REVIEWERS FOR THIS ARE DOCTORS TELEVARA AND DR. EDDY GREENE. >> I'LL GO FIRST. OKAY. I THOUGHT THIS WAS WELL PUT TOGETHER CONCEPT PROPOSAL. I DON'T HAVE A LOT OF SUGGESTIONS FOR YOU, SO IN THE INTEREST OF TIME, I'LL JUST FOCUS ON THE THINGS I MIGHT SUGGEST. ONE OF THEM IS MAYBE SOME VERBIAGE THAT WOULD LINK IT OR SUGGEST LINKAGE TO THE PMI INITIATIVE THAT'S TAKING PLACE. I THINK GENETICS WILL PLAY A BIG ROLE. I THINK, YOU KNOW, BASED ON THE LECTURE THIS AFTERNOON BY DR. LAVEIST, WE MIGHT THINK ABOUT PLACE-BASED, YOU KNOW, MICRO LEVEL, MACRO LEVEL ASSESSMENTS OF WHERE LIVER DISEASE IS OCCURRING MIGHT BE A USEFUL THING. AND THEN REGARDING OUR LEXICON FOR IDENTIFYING PARTICULAR RACIAL/ETHNIC GROUPS, WE MIGHT WANT TO TAKE A LOOK AT HOW WE CHARACTERIZE THOSE THINGS, PARTICULARLY FOR OUR IMMIGRANT POPULATIONS. I MIGHT SUGGEST ADDING SOME INDICATION THAT LENGTH OF STAY IN THE UNITED STATES MIGHT BE A FACTOR AS WELL AS HERITAGE GROUPS, YOU KNOW. IT'S ONE THING IF YOU'VE BEEN LIVING IN THE UNITED STATES FOR ONE YEAR, BUT IF YOU'VE BEEN HERE MOST OF YOUR LIFE, 25, 30 YEARS AS AN IMMIGRANT, IT'S VERY DIFFERENT. BUT YEAH, I JUST WANTED TO COMMEND YOU, IT'S A GREAT PROPOSAL AND I LIKE THE GRAPHICS THAT YOU HAVE AND THE PROGRESSION. IT REALLY SETS ITSELF UP FOR EARLY DETECTION AND PREVENTION AS WELL AS JUST LOOKING AT MORE EPIDEMIOLOGY OF WHERE THE DISEASE IS. SO I'LL STOP THERE. >> THANK YOU. >> I WOULD SECOND EVERYTHING THAT DR. TELEVARY SAID AND THIS IS AN OUTSTANDING OPPORTUNITY FOR NIMHD AND ESPECIALLY THE COLLABORATION WITH NCI TO LOOK AT THIS PROBLEM, WHICH WILL ONLY GROW, UNFORTUNATELY, BECAUSE OF ALL THE THINGS THAT DR. DAS MENTIONED. SO THAT'S THE FIRST THING. ONE THING YOU MENTIONED ABOUT THE IMMIGRANT POPULATION, AGAIN, VERY IMPORTANT, AND ALSO WHAT DR. LAVEIST SAID AND I THINK WAS MENTIONED EARLIER THIS MORNING, YOU MIGHT WANT TO DISAGGREGATE SOME OF THE INFRARACIAL GROUPS, FOR EXAMPLE, BECAUSE THERE ARE IMMIGRANTS WHO COME WHO DON'T NECESSARILY ACCULTURATE RIGHT AWAY WHO MAYBE ARE HAVING SOME OF THE HIGHER RISK FACTORS WHO ARE NOW SITTING IN OUR HOSPITALS WITH SIGNIFICANT LIVER CANCER, FOR EXAMPLE. YOU TAKE MINNESOTA WHERE IT LOOKED LIKE THERE WAS NOT VERY MUCH, BUT THE SOMALIA POPULATION THERE HAS AN EXCEPTIONAL AMOUNT OF HEPATIC CANCER AND RELATED CONDITIONS, SOMETIMES HELP TIETSZ C, SOMETIMES DIABETES, NASH, ALL THOSE KIND OF THINGS THAT ARE GOING ON, SO SOMETHING TO SORT OF THINK ABOUT. >> Dr. Joyce Hunter: THANK YOU VERY MUCH. AT THIS TIME I WOULD LIKE TAUPE THE FLOOR FOR QUESTIONS AND COMMENT FROM THE REST OF THE COUNCIL. DR. ARANETA, I SEE YOU HAVE YOUR MIC ON. >> I THINK THIS IS A VERY TIMELY OPPORTUNITY. I ALSO WANTED TO MENTION THAT SAMOAN HAVE THREE TIMES THE PREVALENCE DPLF MEXICAN AMERICANS AND NATIVE HAWAIIANS TWICE, ALSO MENTION THAT AFLOTOXINS ARE DPL IN AND KIKOMANN SOY SAUCE HAS INVESTED IN THIS INVESTIGATION. EXRL ULTRASOUND TO PREDICT BEFORE FATTY LIVER DISEASE ARE NECESSARY. THERE WAS AN AUTOPSY STUDY IN SAN DIEGO THAT LOOKED AT NONCHOMG FATTY LIVER DISEASE AMONG CHILDREN WHO DIED IN CAR ACCIDENTS AND IT WAS MEXICANS, FILIPINOS AND ASIAN INDIANS WHO HAD THE HIGHEST PREVALENCE. I THINK THERE'S SOMETHING TO BE LEARNED ABOUT WHY AFRICAN AMERICANS HAVE THE LOWEST PREVALENCE OF NAFLD, WHAT IS IT ABOUT AFRICAN AMERICANS THAT PREVENTS THEM FROM ACCUMULATING FATS IN THE LIVER. >> I'M NOT SO SURE THAT'S -- >> YOU DON'T THINK IT'S PROTECTIVE? WELL, I THINK JUST THESE DISPARITIES AND THEN THE ASSOCIATION BETWEEN TYPE 2 DIABETES AND LIVER CANCER. THANK YOU. >> GREAT JOB. THANK YOU VERY MUCH. AT THIS TIME MAY I PLEASE HAVE A MOTION. >> THANK YOU. >> I MEAN, I THINK THESE ARE ALL EX-LENLTD SUGGESTIONS. I THINK WE DEFINITELY, AS WE WERE WRITING THE REVIEW, WE ALSO UNDERSTOOD THE SUBPOPULATION DIFFERENCES AND THE IMMIGRANT STATUS IS VERY CRITICAL, SO THAT WILL BE PART OF THIS INITIATIVE. >> Dr. Joyce Hunter: THANK YOU VERY MUCH, DR. DAS. AT THIS TIME MAY I PLEASES HAVE A MOTION TO MOVE THIS CONCEPT FORWARD TO FOA DEVELOPMENT. >> SO MOVED. >> Dr. Joyce Hunter: SECOND? >> SECOND. >> Dr. Joyce Hunter: ALL IN FAVOR? >> AYE. >> Dr. Joyce Hunter: ANY OPPOSED? IT'S BEEN MOVED AND PROPERLY SECONDED THAT THIS CONCEPT MOVE FORWARD TO FOA DEVELOPMENT OF THE THANK YOU ALL VERY MUCH. I'LL NOW TURN THE MEETING BACK >> Dr. Eliseo Perez-Stable: OKAY WE RAN A LITTLE BIT LATER THAN I EXPECTED, SO WE'RE ALMOST CLOSE TO THE TIME OF CLOSE, BUT WE WANTED TO TAKE THE OPPORTUNITY TO OPEN THE FLOOR TO ANY COMMENTS OR QUESTIONS PREFERABLY FROM THE PUBLIC PRESENT. IF YOU HAVE ANY -- OR ACTUALLY FROM ANYBODY, FROM COUNCIL TOO. IF YOU HAVE A COMMENT TO SAY OR HAVE A QUESTION, PLEASE LIMIT YOURSELF TO A COUPLE OF MINUTES SO WE DON'T HAVE ONE PERSON GIVING A WHOLE OTHER TALK. THANK YOU. INTRODUCE YOURSELF AND YOUR INSTITUTION OR LOCATION. >> HI. I'M VICTORIA MITRANI, I'M THE PRINCIPAL INVESTIGATOR FOR THE CENTER OF EXCELLENCE AT THE UNIVERSITY OF MIAMI, AND I JUST WANTED TO ADD MY VOICE TO THAT OF THE TWO SCIENTIFIC PRESENTERS WHO REALLY DID A FABULOUS JOB MAKING THE CASE FOR THE SIGNIFICANCE OF THE CENTERS OF EXCELLENCE FOR RAISING AND ADVANCING HEALTH DISPARITY SCIENCE AND I THINK THAT THEY DO THIS IN A WAY THAT RO1'S, AS TERRIFIC AS THEY ARE, REALLY AREN'T ABLE TO DO. FIRST OF ALL, THEY REALLY FOSTER A CULTURE IN THE INSTITUTION THAT VALUES HEALTH DISPARITIES RESEARCH, AND AS MUCH AS WE'VE ADVANCED IN THAT DREK, THERE'S STILL A NEED FOR THIS AT RESEARCH INTENSIVE UNIVERSITIES AS WELL AS AT LESS RESEARCH INTENSIVE UNIVERSITIES. THEY GIVE THE OPPORTUNITY TO RAISE COMPETENCIES AT THE INSTITUTIONAL LEVEL FOR CONDUCTING RESEARCH FOR MINORITY POPULATIONS, HELPING RESEARCHERS TO UNDERSTAND STRATEGIES AND CHALLENGES AND HOW TO MANAGE CHALLENGES IN TERMS OF ENROLLING AND RETAINING MINORITY INDIVIDUALS, HOW TO DO MEASUREMENT, HOW TO ADDRESS HEALTH -- HUMAN SUBJECTS ISSUES AND HOW TO DO CULTURALLY ENGAGED RESEARCH IN A COMPETENT MANNER, AND BECAUSE THE NIMHD CENTERS ARE NOT DISEASE FOCUSED, THEY REALLY, I THINK, ARE MORE GEARED TOWARD ADDRESSING THESE THINGS AT AN INSTITUTIONAL LEVEL. ANOTHER WAY IS TO REALLY HAVE THE OPPORTUNITY TO NETWORK HEALTH DISPARITIES RESEARCHERS ACROSS THE INSTITUTION FOR SHARING OF RESOURCES AND FOR ADVANCING COLLABORATIONS, AND FINALLY REALLY AS A HOME BASE FOR MINORITY RESEARCHERS AT ALL LEVELS, FROM STUDENTS ALL THE WAY UP TO MID CAREER AND BEYOND, INVESTIGATORS REALLY ADDRESSING, IF YOU WILL, SORT OF THE SOCIAL DETERMINANTS OF SCIENCE SUCCESS, REALLY AS WAS MENTIONED BEFORE, THAT ENCOURAGEMENT THAT YES YOU CAN AND YES YOU HAVE JUST AS MUCH A RIGHT AS ANYBODY ELSE TO BE APPLYING FOR THESE REALLY COMPETITIVE KINDS OF AWARDS AND THE MODELING AND THE NETWORKING THAT THE SENIOR INVESTIGATORS CAN DO TO REALLY HELP FOSTER THE CAREERS OF JUNIOR INVESTIGATORS. SO AS THE WORKING GROUPS CONSIDER THE FUTURE OF THE CENTERS OF EXCELLENCE, I HOPE YOU REALLY CONSIDER AND UNDERSTAND THAT IT'S A GREAT INVESTMENT FOR THIS INSTITUTE. THANK YOU. >> Dr. Eliseo Perez-Stable: THAN K YOU. I WANT TO MAKE THE POINT THAT WE ARE REVIEWING THE PROGRAM AND THAT WE ARE GOING TO CONTINUE TO HAVE CENTERS. I'LL ALSO EMPHASIZE THAT WE HAVE THE RCMI PROGRAM, WHICH ARE CENTERS AND ARE TARGETED TO THE LESS RESEARCH INTENSIVE INSTITUTIONS, IT'S BEEN A SUCCESSFUL PROGRAM THAT WE WILL CONTINUE TO BUILD ON, AND THESE HAVE ANOTHER ROLE. I WOULD ALSO POINT OUT THAT MOST PROGRAMS AT NIH ACTUALLY DON'T PERSIST FOREVER. THERE ARE REALLY EXCEPTIONS. AND THEY KIND OF EVOLVE. AND I THINK THAT'S WHAT WE'RE EVALUATING AT THIS TIME, THE STRATEGY OF THE CENTERS 15 YEARS AGO WAS CERTAINLY AN EXCELLENT ONE, AND I THINK AT THIS POINT, YOU KNOW, USING THE OPPORTUNITY OF BOTH A CYCLE COMING TO A CLOSE AND MY STARTING A YEAR AGO RE-REVIEWING THAT DIRECTION. I APPRECIATE YOUR COMMENTS. AMY? >> THANK YOU ALL FOR SUCH A WONDERFUL DAY. MY NAME IS AMY ELLIOT, I'M FOR THE COLLABORATIVE CENTER, COLLABORATIVE RESEARCH CENTER FOR AMERICAN INDIAN HEALTH, CIRCA, WE HAVE OTHER TTC'S REPRESENTED HERE AS WELL AND I WOULD LIKE TO ECHO MANY OF THE COMMENTS SAID. ONE THING, SO OUR GROUND, WE ARE FUNDED UNDER THE SOCIAL DETERMINANTS FOR THE TCC'S, WE ARE ENTERING OUR FIFTH YEAR AND IT HAS BEEN A TREMENDOUS SUPPORT TO BUILDING FLERCH OUR REGION. IT HAS ELEVATED THE DISCUSSION OF RESEARCH, IT'S OFFERED OPPORTUNITIES IN THE NATIONAL LEVEL IN PARTICULAR FOR US COLLABORATION WITH NATIONAL CONGRESS OF AMERICAN INDIANS, FOR ADDITIONAL TRAINING OPPORTUNITIES AND RESEARCH PROJECTS. THE MOST IMPORTANT PART OF WHAT WE'VE BEEN ABLE TO ESTABLISH IS HARD TO SHOW IN A BAR CHART, AND THAT HAS BEEN THE RESEARCH, THE TRIBAL RESEARCH VOICE THAT HAS EMERGED WHERE WE NOW HAVE TRIBES THAT ARE DRIVING FORTH THEIR OWN AGENDAS, THAT HAVE CREATED THEIR OWN INFRASTRUCTURES TO DO THAT. THE TCC MECHANISM WAS VERY UNIQUE IN THAT IT ALLOWED FOR THIS COMMUNITY VOICE AND COMMUNITY RESEARCH INFRASTRUCTURE BUILDING. I'VE HEARD GREAT SCIENCE PRESENTED HERE TODAY WHICH GETS THE SCIENTIST IN ME VERY EXCITED BUT WHAT I DIDN'T HEAR WAS HOW THE COMMUNITIES ARE NECESSARILY ENGAGED OR HOW THAT THAT VOICE WOULD BE REPRESENTED WITHIN NEW OPPORTUNITIES, AND THERE IS NOT A CLEAR MECHANISM FOR THE CONTINUATION OF CENTERS LIKE WHAT WE'VE BEEN ABLE TO DEVELOP, JUST IN THE LAST FIVE YEARS. WE WOULD LOVE TO HAVE THE OPPORTUNITY TO SEE IT GROW EVEN TO THE NEXT LEVEL, BUT WOULD JUST LIKE TO ENCOURAGE THIS GROUP TO MAKE SURE THAT THAT COMMUNITY VOICE STAYS STRONG AND THE TRIBAL VOICE AND PRIORITIES COME CLEAR THROUGH HERE AND IT'S NOT JUST SCIENCE FOR SCIENCE' SAKE BUT IT DOES HAVE THAT DIRECT IMPLICATION. THANK YOU. >> Dr. Eliseo Perez-Stable: THAN K YOU. OTHER COMMENTS OR QUESTIONS? >> I WOULD LIKE TO MAKE ONE COMMENT. I WAS VERY PREESED WITH THE TWO -- PLEESMSED WITH THE TWO SCIENTIFIC PRESENTATIONS THAT REALLY DID I THINK SHOWCASE WHAT P60, THE CAPACITY OF THEM, AND ONE OF THE THINGS THAT I THINK THAT I WAS NOT AWARE OF IS I WAS MORE AWARE OF THE RESEARCH THAT WAS GOING ON, BUT I DID NOT NECESSARILY KNOW THAT IT WAS FUNDED THROUGH A P60 MECHANISM. SO CLEARLY I WAS FAMILIAR WITH BOTH OF THEIR WORK, BUT I DID NOT KNOW THAT IT WAS FUNDED THROUGH A P60 MECHANISM, AND IN NIMHD, SO THAT REALLY BRINGS A DIFFERENT LIGHT TO ME THE IMPORTANCE OF IT. BUT IT ALSO SHARES WITH ME ALSO THAT IT TAKES TIME TO DO THIS WORK, SO YOU DO HAVE TO GO THROUGH A COUPLE OF FUNDING CYCLES SOMETIMES WHEN YOU'RE BUILDING A CENTER FOR THE FIRST TIME AND BUILD THAT CAPACITY AND THE COMPETENCY AND THAT COMMUNITY OF PERSONS. I THINK IT'S VERY IMPORTANT THAT IT OCCURS ALTHOUGH THESE MAJORITY AND RESEARCH-INTENSIVE, QUOTE, UNQUOTE, INSTITUTIONS BECAUSE IT BRINGS OTHERS ALONG WHO OTHERWISE WOULD NOT NECESSARILY BE BROUGHT ALONG BECAUSE IT WOULDN'T NECESSARILY BE IN THEIR -- NOT IN THEIR FACE, BUT EVEN IF THEIR REALM OF ENGAGEMENT ON A REGULAR BASIS. BUT WHEN YOU HAVE THOSE PRODUCTIVE CENTERS AND YOU HAVE PEOPLE, YOU TALKED ABOUT SITTING AT THE TABLE WITH THOSE OTHER CENTER DIRECTORS, THEN PEOPLE START TO KNOW DIFFERENTLY AND UNDERSTAND THE VALUE THAT IS PLACED ON DOING THIS VERY IMPORTANT RESEARCH. SO I UNDERSTAND THAT FUNDING MECHANISMS DON'T LAST FOR A LIFETIME, BUT RO1'S HAVE, THEY'VE BEEN HERE FOR A WHILE, AND WE STILL CONTINUE TO FIND VALUE IN THEM. SO I WOULD SAY LET'S JUST MAKE SURE WE LOOK AT ALL OF THIS, AND I KNOW OUR COMMITTEE WILL, AND THE IMPACT THAT THEY'RE HAVING, AND PART OF IT MAY BE THAT WE NEED TO TELL THE STORY DIFFERENTLY. >> Dr. Eliseo Perez-Stable: THAN K YOU. HAVING HEARD THAT FROM DR. LAVEIST, IT WAS INTERESTING BECAUSE I THINK IT IS VERY INSTITUTIONAL VARIABLE. I KNOW FOR SURE THAT BEING A PI OF A P60 OR WHATEVER DOES NOT GIVE A SEAT AT THE DEAN'S MEETINGS AT UCSF, I CAN GUARANTEE YOU THAT. IT DOES GIVE YOU RECOGNITION AND YOU DO GET, YOU KNOW, NOTED, BUT AS THEY USED TO SAY, YOU'RE ONLY AS GOOD AS YOUR LAST GRANT. SO IT MAY BE SOME DIFFERENCE BETWEEN THE PRIVATE INSTITUTIONS AND THE STATE ONES, I DON'T KNOW, I DON'T KNOW IF THAT'S THE WAY IT IS AT SOME PLACES, BUT I RECOGNIZE THE VALUE OF THESE, BRINGING THESE GROUPS TOGETHER. I THINK FREQUENTLY OUR EXPERIENCE WAS THAT IT WAS A WAY TO JUMP START A GROUP TO WORK TOGETHER. IT DOES BRING MULTIPLE DISCIPLINES TOGETHER, AND THE INVESTIGATORS WHO INITIALLY LEAD IT AND BRING ENOUGH ELEMENTS TOGETHER TO HAVE COULDN'T NEW TILL BE PART OF IT, AND I DON'T KNOW WHAT THE RIGHT AMOUNT OF TIME IT IS OR WHAT THE RIGHT KIND OF GRANT IS, YOU KNOW. IT'S ALL A LITTLE BIT DEPENDS ON A LOT OF CIRCUMSTANCES, SO I WOULDN'T MAKE ANY BROAD STATEMENTS ON THAT. AND FINALLY, I THINK THE U54 MECHANISM, ACTUALLY THE MAIN THING IT DOES IS IT GIVES US AN OPPORTUNITY TO HAVE A SEAT AT THE TABLE WITH THE SCIENTISTS SO THAT WE WOULD BE COLLABORATIVE, AND I'M ENCOURAGING OUR PROGRAM SCIENTISTS TO BE MORE ACTIVE AND MORE PROACTIVE BOTH WITH GRANTEES BUT ALSO IN THINKING ABOUT THE SCIENCE AND THE AREAS THAT THEY WANT TO BE MOST EXPERT IN, SO I THINK THIS CREATES SORT OF A STRUCTURAL MECHANISM BY WHICH THEY GET MORE INVOLVED. SO I'M ATTRACTED TO IT BECAUSE OF THAT COMPONENT, SO WITHOUT, YOU KNOW -- WELL, WE'LL SEE HOW THINGS GO WITH THAT. YES, OTHER COMENLTSES? >> GOOD AFTERNOON, EVERYONE. RAY SAMUEL, HAMPTON UNIVERSITY, AND ON BEHALF OF ALL THE LITTLE HBCU'S THAT ARE NOT USUALLY REPRESENTED IN THE RO1 POOLS, IN BEHALF OF ALL OUR STUDENTS THAT WE TRAIN THAT GO ON TO BECOME HIGH BIG-TIME RESEARCHERS, LIKE TOM LAVEIST FRAMED AT HBCU AND MANY OTHERS THAT CAN GO THROUGH THE LIST, I JUST WANT TO GIVE A VOICE TO THAT. NIMHD INVESTED IN US, A SMALL HBCU WITH NOT A BIG TRACK RECORD, RO1 OR THE U'S OR THE P'S LEVELING RESEARCH AND SAW A VISION THAT WE CAST TO BRING THE CAPACITY OF THE TALENT THAT'S BEEN TRAINING THESE UNDERGRADS, THE INSIGHT AND THE CONNECTION TO A COMMUNITY, A GROUP OF 105 INSTITUTIONS WHICH ARE HBCU'S WHICH FOR 150 YEARS HAVE HAD THE BACK OF THE AFRICAN AMERICAN COMMUNITY AND TRY TO BRING US TO THE TABLE TO DEAL WITH HEALTH DISPARITIES WHERE THE NIH, THE CDC AND MANY OTHER INSTITUTIONS HAD SPENT MILLIONS OF DOLLARS AND IN MANY FRONTS HAD MADE VERY LITTLE CHANGE BECAUSE PARTLY BECAUSE THERE ARE SOME COMMUNITY FACTORS HERE, AS AMY HAD MENTIONED, A NUMBER OF YOU HAD MENTIONED WITH RESPECT TO WHETHER THE ASIAN COMMUNITIES OR OTHER COMMUNITIES, THAT THERE'S A COMMUNITY FACTOR TO BRING ABOUT BEHAVIORAL CHANGE THAT WE ALL KNOW. MY GOOD FRIEND WHO IS NOW AT MOREHOUSE K HARMOND TAYLOR SAID THAT WE DID ALL THAT WORK ON THE JACKSON BUT WE DIDN'T ACTUALLY DO AN INTERVENTION TO CHANGE THE HELP OF THE PEOPLE IN JACKSON BECAUSE WE DIDN'T TAKE THE THINGS AWE DID KNOW OF THAT WORKS AND GET THE PEOPLE IN THE COMMUNITIES TO PRACTICE THE THINGS THAT MAKE RICH PEOPLE IN AMERICA HEALTHIER, THAT EXTEND THE LIFE SPAN OF RICH PEOPLE BECAUSE POOR PEOPLE SEEMINGLY DON'T DO THE SIMPLE THINGS HA IMPROVE THEIR LIVES, THEY DON'T CUT DOWN ON SALT, THEY DON'T EXERCISE, THEY DON'T SLEEP WELL, I JUST HEARD, AND THEY DON'T EAT FRUITS AND VEGETABLES. BUT THESE ARE THINGS THAT WE ALREADY KNOW THAT WORK THAT REALLY OUR ABILITY, THE PREDOMINANTLY WHITE SCHOOLS THAT TRAIN ME AND OTHERS AREN'T VERY GOOD AT COMMUNICATING TO THOSE COMMUNITY, THOSE DISENFRANCHISED COMMUNITIES, HOW TO TAKE THE THINGS DID WE KNOW HOW TO DO AND DO IT WELL. SO REALLY WHAT I WANT TO SAY IS A PLUG-IN FOR LITTLE SCHOOLS LIKE MINE, LIKE OUR U54 WHO HAS BEEN GIVEN THREE YEARS AND MAY BE AROUND FOR ANOTHER TWO OR ANOTHER FIVE AFTER THAT, BUT GIVE US THE OPPORTUNITY TO BE AT THE TABLE TO BE A VOICE AT THE TABLE TO CONTRIBUTE WHAT WE HAVE TO CONTRIBUTE TO DEAL WITH THIS BIG NATIONAL PROBLEM, AND THE REALLY INDIVIDUAL RO1 DOESN'T WORK AT AN HBCU WHERE I HAVE AN INVESTIGATOR WHO TEACHES A LOT, BUT WHEN WE POOL OUR RESOURCES ACROSS INSTITUTIONS THAT WE'VE DONE IN OUR U54, WE GET A BETTER CHANCE AT DOING THAT, AND WE GET AN OPPORTUNITY TO CONTRIBUTE TO THE PROBLEM THAT'S FACING US TODAY. AND WHAT I REALLY WANT TO SAY IS THAT REALLY THE CENTER GRANTS, WHETHER THEY'RE U54'S OR TCC'S OR CMI'S OR BUILD GRANTS OR ALL THESE INITIATIVES REALLY THAT BUILD COLLABORATION OR CONSORTIUM IS REALLY THE MECHANISM THAT WE NEED. RO1'S ARE WONDERFUL AND WE WILL GET THERE, BUT YOU'VE GOT TO TEACH US HOW TO WALK BEFORE WE CAN START RUNNING AND GIVE US THE OPPORTUNITY TO DO THAT AND DON'T TAKE THAT FROM US. THAT'S ALL I'M ASKING. >> Dr. Eliseo Perez-Stable: THAN K YOU. OTHER COMMENTS? OKAY. OKAY. WELL, I APPRECIATE EVERYONE HANGING IN THERE AND STAYING UNTIL THE END. I DON'T THINK THAT I HAVE ANY SPECIFIC FINAL COMMENTS. I'LL JUST ADD THAT I THINK BETWEEN NOW AND OUR NEXT COUNCIL MEETING, IT WILL BE ALMOST ABOUT FIVE MONTHS, FIVE-PLUS MONTHS, SO IT'S KIND OF AN ASYMMETRIC SCHEDULE THAT WE HAVE. THERE'S A LOT OF POTENTIAL CHANGE HAPPENING OVER THIS PERIOD OF TIME, BOTH EXTERNALLY TO NIH AND IN NIH. I THINK THAT YOU'VE HIGHLIGHTED WITH THE RECENT COMMENTS ABOUT ONE OF THE NEXT ISSUES THAT WE'RE GOING TO BE DEALING WITH AT NIMHD WHICH AFFECTS THE EXTRAMURAL COMMUNITY, WHICH IS TREATED OUR CENTERS PROGRAM AND HOW WE EMPHASIZE DIFFERENT RESEARCH TOPICS IN PROMOTING THE APPLICATION OF RO1 GRANTS TO OUR INSTITUTE AND FINDING THE RIGHT BALANCE. THE OTHER ISSUE WHICH WE'VE ALLUDED TO AND I'LL JUST REITERATE IS THE WAY THAT WE ARE FRAMING THE CONVERSATION HERE AT NIH ABOUT MINORITY HEALTH AND HEALTH DISPARITIES, ALSO INCLUSION AND DIVERSITY AND HOW THESE FOUR RELATED AREAS, YOU KNOW, WITH THE SCIENTIFIC SIDE BEING THE MINORITY HEALTH AND HEALTH DISPARITIES RESEARCH AND THEN THE INCLUSION AND DIVERSITY WHERE YOU CAN'T ALSO DO SCIENTIFIC RESEARCH REFLECTS OTHER TOPICS THAT ARE VERY CLOSE TO OUR GOALS AND TO OUR HEART, AND MOVING FORWARD, HOW THESE WILL HELP GUIDE OUR STRATEGIC PLAN ALONG WITH THE CONTENT AREA DEFINED BY THE VISIONING PROCESS. SO YOU MIGHT EXPECT SOME OUTREACH FROM US OVER THE NEXT FEW MONTHS, EITHER DIRECT COMMUNICATION FROM ME OR VIA JOYCE OR TO EITHER REQUEST TO REVIEW MATERIALS OR TO REFLECT ON SOME THOUGHTS AND JUST STAY IN TOUCH AND NOTE YOU SHOULD ALWAYS, IF YOU FEEL LIKE YOU NEED TO COMURN INDICATE SOMETHING WITH ME DIRECTLY, JUST EITHER SEND ME AN E-MAIL OR -- WELL, THAT WOULD BE THE EASIEST WAY, SEND ME AN E-MAIL AND ASK FOR A PHONE CALL FULL PREFER A PHONE CALL OR PUT IT IN THE E-MAIL AND I'LL GET BACK TO YOU. SO THANK YOU VERY MUCH FOR YOUR CONTRIBUTIONS AND TIME AND YOUR SERVICE, AND WITH THIS, I WILL BRING THE MEETING TO A CLOSE. [GAVEL] [APPLAUSE] [THE MEETING CONCLUDED AT 2:37 P.M.]