NIMHD DIRECTOR SEMINAR
SERIES.
THIS IS THE LAST OF THE YEAR
ENDING UNEQUAL TREATMENT:
STRATEGIES TO ACHIEVE EQUITABLE
HEALTHCARE AND OPTIMAL HEALTH
FOR ALL, I AM NEISHA DINWIDDIE,
WHAT YOU SEE ON THE KREEN IS AN
E-MAIL ADDRESS WHERE YOU CAN
SUBMIT QUESTIONS FOR THE PANEL.
WE ARE GOING TO GO AHEAD AND GET
STARTED SINCE WE WANT TO BE
RESPECTFUL OF EVERYONE'S TIME
AND NOW I WILL HAND IT OVER TO
DR. ELISEO PEREZ-STABLE.
>> THANK YOU SO MUCH NEISHA, AND
WELCOME ERCH TO THE SPECIAL
DIRECTOR'S SEMINAR MUCH --
SEMINAR.
WE WANT TO HIGHLIGHT A REPORT
PUBLISHED EARLIER THIS YEAR,
ENDING UNEQUAL TREATMENT, AND
THE HISTORY OF THIS REPORT DATES
BACK TO OVER 20 YEARS AGO WHEN
THE FIRST REPORT CAME OUT.
IT WAS REALLY A GAME CHANGER IN
MANY WAYS FOR THE FIELD AND AS
DIRECTOR OF THE NIMHD WE CAN SEE
THE IDEA OF DOING A FOLLOW UP
NOW, 3 YEARS AGO, IT WAS A WHILE
BACK.
I GATHERED THE INTEREST OF A
NUMBER OF INSTITUTES AT NIH AS
WELL AS THE AGENCY FOR
HEALTHCARE RESEARCH AND QUALITY,
3 OF MY COLLEAGUES WILL BE HERE
REPRESENTING THEIR INSTITUTES, 2
DIRECTORS, AND SO WE WILL HAVE A
GOOD CONVERSATION AFTER THE
PRESENTATION.
BUT JUST PUT IT IN CONTEXT,
DISPARITIES, AWARENESS AND
ACKNOWLEDGMENT, THAT WAS PHASE
1.
WE REALLY ARE ALL URGENTLY
WANTING INTERVENTIONS TO REDUCE
DISPARITIES.
THERE HAS BEEN PROGRESS IN MANY
AREAS, BUT WE STILL FACE
DAUNTING TASKS.
WE SEE THE POPULATION HEALTH OF
THE UNITED STATES WHERE IT SITS
45th IN THE WORLD ON LIFE
EXPECTANCY AND VERY RECENT
ANALYSIS WE SEE THAT WITHIN THE
POPULATION OF THE UNITED STATES,
AFRICAN AMERICANS AND AMERICAN
INDIANS, ALASKA NATIVES DO MUCH
WORSE IN ALL MEASURES OF
POPULATION HEALTH THAT WE HAVE
LOOKED AT AND IT GOES FROM
HEALTHCARE ON 1 HAND AND ACCESS
TO CARE AND GETTING THE PROPER
DIAGNOSTIC AND THERAPEUTIC
INTERVEKSS FOR INDIVIDUALS WITH
ACUTE AND CHRONIC CONDITIONS TO
COMMUNITY HEALTH AND POPULATION
HEALTH AND WE CAN'T DO IT ALL,
ALL THE TIME BUT THESE THINGS
ARE INTERRELATED AND I THINK
IT'S REALLY RELEVANT THAT WE NOT
SEPARATE THOSE 2 COMPLETELY
ALTHOUGH IN THE REPORT, WE DO
NEED TO FOCUS ON SOME PARTICULAR
AREAS.
AND FINALLY I WANT TO SAY THAT
NIMHD IS LEADING NIH PROCESS OF
DEVELOPMENT OF A NEXT 5 YEAR
STRATEGIC PLAN FOR NIH-WIDE
MINORITY HEALTH AND HEALTH
DISPARITIES RESEARCH.
WE HAD HAD ALREADY 2 SUCCESSFUL
OPEN TOWN HALLS.
SO DIRECTORS THAT ARE HERE AND
SORT OF WHAT WE'RE DOING TODAY
SUGGESTIONS AND QUESTIONS THAT
MAY COME UP THAT MAY HELP US
SHAPE THAT AS WE DEVELOP THAT IS
FINALIZE THAT OVER THE NEXT
HOPEFULLY 6 MONTHS OR SO.
SO WITHOUT FURTHER ADO LET ME
INTRODUCE BRIEFLY MY COLLEAGUES
WHO WERE ON THE NASEM COMMITTEE.
I WILL START WITH JUST CONSUELO
WILKINS.
CONSUELO IS SENIOR VICE
PRESIDENT FOR EQUITY AND
PROFESSOR OF MEDICINE AT VANTER
BUILT MEDICAL CENTER.
JEN DEVOE IS THE CO-CHAIR OF THE
COMMITTEE, THANK YOU FOR DOING
THAT JEN AND PROFESSOR AND CHAIR
OF DEPARTMENT OF FAMILY MEDICINE
AT OREGON HEALTH AND SCIENCE
UNIVERSITY AND MARGARITA ALEGRII
WHO IS WITH MASSACHUSETTS
GENERAL HOSPITAL WHERE ALSO AND
ALSO WHERE SHE HAD OTHER TITLES
OF PROFESSOR THERE.
DARREL GASKIN IS EXPECTED TO
JOIN US, ALTHOUGH HE IS DELAYED
AND DARREL IS A HEALTH ECONOMIST
AND DIRECTOR OF THE HOPKINS
CENTER FOR HEALTH DISPARITY
SOLUTIONS AT JOHNS HOPKINS
UNIVERSITY.
SO JEN, THE FLOOR IS YOURS.
>> THANKS, SO MUCH AND HUGE
THANKS TO OUR COMMITTEE AND THE
STAFF AT THE NATIONAL ACADEMIES
AND OF COURSE NIH FOR SPONSORING
THIS REPORT.
WE SPENT SEVERAL MONTHS,
ACTUALLY BETTER PART OF A COUPLE
OF YEARS REVIEWING THE EVIDENCE,
UPDATING THE REPORT AND
RESPONDING TO AN INCREDIBLY
BROAD STATEMENT OF TASK WHICH
SPECIFIES THAT THIS COMMITTEE
WILL CONSIDER WAYS TO SCALE AND
SPREAD EFFECTIVE INTERVENTIONS
TO REDUCE RACIAL AND ETHNIC
DISPARITIES IN HEALTHCARE AND
MAKE RECOMMENDATIONS TO ADVANCE
HEALTH EQUITY AND APPLY ITS
EXPERT JUDGMENT IN ORDER TO
DEVELOP RECOMMENDATIONS WITH THE
FOCUS ON ADVANCING HEALTH
EQUITY.
THE REPORT IS NEARLY 400 PAGES
LONG.
I UNDERSTAND WE ONLY HAVE A FEW
MINUTES TODAY, SO WE WERE GOING
TO BE HIGHLIGHTING A FEW
SECTIONS OF THE REPORT WHICH
WILL BE PRESENTED IN SOME DETAIL
BY A COUPLE OF COMMITTEE
MEMBERS.
ONE OF THE AREAS THAT WE WERE
ASKED TO TOUCH UPON WAS INCLUDED
IN AN INTER CHAPTER IN THE
REPORT RELATED TO ACCOUNTABILITY
WHICH IS 1 OF THE CRITICAL
ASPECTS WITHIN THE CONCEPTUAL
FRAMEWORK THAT OUR COMMITTEE PUT
TOGETHER IN UNDERSTANDING THAT
GREATER ACCOUNTABILITY IS
NECESSARY TO INSURE THAT
PROGRESS IS MADE IN ACHIEVING
EQUITABLE OUTCOMES IN HELT CARE,
TO IMPROVE ACCOUNTABILITY,
PROCESSES, CLEAR GOALS AND
OBJECTIVES NEED TO BE
STANDARDIZED, METRICS
STANDARDIZES TOWARD TRACKING
PROGRESS TOWARD GOALS AND
CONSEQUENCES IMPOSED FOR THOSE
THAT WHO NOT ACHIEVE THESE GOALS
AND OBJECTIVES.
AND THE COMMITTEE WENT INTO SOME
DEPTH IN OUR ENTIRE CHAPTER 8
REALLY MAKING -- REVIEWING THE
EVIDENCE FOR THE NEED FOR
ACCOUNTABLE AND IDENTIFYING A
NUMBER OF DIFFERENT GAPS WHERE
RESEARCH IS NECESSARY AND THEN
CERTAINLY POLICIES AND LAWS
STRENGTHEN TO INSURE
ACCOUNTABILITY.
SO JUST WANTED TO TOUCH ON THAT
BEFORE WE CIRCLE BACK TO SOME OF
THE AREAS SPECIFIC TO THE
HEALTHCARE SYSTEM AND TO
RESEARCH.
SO I WILL TURN IT OVER TO I
BELIEVE DR. WILKINS WHO WILL
SPEAK NEXT.
>> YES, THANK YOU SO MUCH.
IT'S MY PLEASURE TO TALK A
LITTLE BIT MORE ABOUT WHAT THE
COMMITTEE, THE WORK THE
COMMITTEE DID AS IT RELATES TO
DISCOVERY.
AND SO WHAT I WILL TALK MOST
ABOUT IS IN CHAPTER 7 OF THE
REPORT.
SINCE WE ONLY HAVE LIMITED TIME
AND AS DR. DEVOE MENTIONED, IT'S
QUITE A LOT -- IT'S QUITE A LONG
READ HERE, I'M JUST REALLY
FOCUSING ON THE CONCLUSIONS THAT
OUR COMMITTEE CAME TO AND
HOPEFULLY THAT WILL SPUR SOME
ADDITIONAL CONVERSATION.
YOU KNOW THE FIRST INCLUSION
THAT WE CAME TO, SO WE SPENT
QUITE A BIT OF TIME LOOKING AT
THE NIH PORTFOLIO, WHAT RESEARCH
HAS BEEN FUNDED FUNDED IN THE F
HEALTH DISPARITIES AND HEALTH
INIQUITIES AND LOOKING AT THAT
AT PRESENT TIME IN THE LAST
COUPLE OF YEARS BUT ALSO LOOKING
OVER THE COURSE OF THE LAST MORE
THAN A DECADE.
AND OF COURSE, AS WE STARTED TO
DO THIS, THIS GETS INTO THE
HISTORY OF NIMHD, AND THE CENTER
THAT PROCEEDED IT AND REALLY
REFLECTS A LOT OF PROGRESS SINCE
THE INITIAL REPORT 2 DECADES
AGO.
BUT WHAT WE DID FIND IS THAT
EVEN THOUGH THERE HAS BEEN SOME
PROGRESS YOU CAN SEE HERE THE
INCREASE IN FUNDING OVER YEARS,
THE AMOUNT OF FUNDING THAT IS
GOING FROM OUR NIH CENTERS AND
INSTITUTES TOWARDS HEALTH EQUITY
IS STILL RELATIVELY LOW.
AND THIS TABLE IN PARTICULAR
POINTS OUT THE PERCENTAGE OF THE
FUNDING THAT'S FROM EACH OF
THESE EN--STRATEGIESITUTES AND
CENTERS THAT WE IDENTIFIED AS
FOCUSED ON HEALTH EQUITY OR
HEALTH DISPARITIES, I'M SURE
DR. PEREZ-STABLE IS THINKING ALL
OF HIS 100% SHOULD BE IN THAT
COLUMN FOR NIMHD, BUT YOU CAN
SEE HERE AGAIN THE WIDE RANGE OF
PERCENTAGES FROM THE DIFFERENT
CENTERS AND INSTITUTES AND SO,
OBVIOUSLY, YOU CAN SEE THAT
NIMHD HERE IS THE HIGHEST AT
MORE THAN 70%, NCATS IS
FOLLOWING THERE, AND WE HAVE
WITH MORE THAN 10% NINR AS WELL
AS NIEHS.
SO 1 OF THE THINGS THAT THE
COMMITTEE SPENT SOMETIME TALKING
ABOUT THOUGH IS WHAT THIS LOOKS
LIKE AND OBVIOUSLY THERE'S
DIFFERENT FUNDING AMOUNTS FOR
THESE INSTITUTES AND CENTERS BUT
RECOGNIZING THERE'S SOME
DISPARITIES WITHIN THOSE
INSTITUTES THAT HAVE SMALLER
BUDGETS ACTUALLY HAVING A HIGHER
PERCENTAGE OF THEIR FUNDING GO
TO HEALTH DISPARITIES AND HEALTH
INIQUITIES.
THE NEXT CONCLUSION THAT WE CAME
TO IS YOU KNOW WE RECOGNIZE THAT
COMMUNITY ENGAGED AND COMMUNITY
DRIVEN RESEARCH IS REALLY
CRITICAL TO ADDRESSING HEALTH
DISPARITIES AND HEALTH
INIQUITIES, YET IT REFLECTS A
VERY SMALL PERCENTAGE OF NIH
FUNDED RESEARCH.
THERE ARE OF COURSE A NUMBER OF
LONG STANDING PROGRAMS ACROSS
NIH AND AS WELL AS SOME NEWER 1S
THAT FOCUS EXPLICITLY ON
COMMUNITY ENGAGEMENT AND
COMMUNITY BASED PARTICIPATORY
RESEARCH BUT THERE WAS AN
OBVIOUS DIRTH OF THAT AND REALLY
LOOKING TO SEE THAT EXPAND.
THERE ARE OF COURSE NEWER
EXAMPLES OF WORK IN THIS SPACE
INCLUDING THE COMPASS INITIATIVE
THAT RECENTLY LAWRCHED BY NIH
AND IS FOCUSED ON COMMUNITY
DRIVEN HEALTH, QUITY RESEARCH
WHICH WE -- EQUITY RESEARCH
WHICH WE BELIEVE IS AN IMPORTANT
STEP IN THE RIGHT DIRECTION BUT
HOW CAN WE EXPAND EFFORTS TO
REALLY ENGAGE THOSE COMMUNITIES
THAT HAVE BEEN MARGINALIZED AND
MINORITIZED IN THE WORK SO THAT
WE CAN IMET TO SOLUTIONS FASTER.
WE HAD A LOT OF DISCUSSION ABOUT
THE WORKFORCE, THE SCIENTIFIC
WORKFORCE, AND THINKING ABOUT
WHAT NEEDS TO BE DONE IN TERMS
OF STRENGTHENING IN THAT TO DO
HEALTH DISPARITIES AND HEALTH
EQUITY RESEARCH, RECOGNIZING
THAT INDIVIDUALS FROM
MINORITIZED RACIAL AND ETHNIC
GROUPS ARE BOTH SIGNIFICANTLY
UNDERREPRESENTED IN THE
SCIENTIFIC WORKFORCE BUT ALSO
MORE LIKELY TO DO RESEARCH IN
HEALTH DISPARITIES AND HEALTH
INIQUITIES IS SOMETHING THAT WE
SPENT QUITE A BIT OF TIME
TALKING ABOUT.
WE ALSO DISCUSSED SOME OF THE
STRUCTURAL BARRIERS TO DOING
HEALTH EQUITY AND HEALTHCARE
EQUITY RESEARCH IN THESE
SETTINGS ESPECIALLY IN ACADEMIC
MEDICAL CENTERS THAT HAVE BEEN
DOING BASIC SCIENCE, RESEARCH
SOLELY AND NOT NECESSARILY SET
UP OR INCENTIVIZED TO DO
RESEARCH FOCUSED ON COMMUNITY
ENGAGEMENT, COMMUNITY ENGAGED
RESEARCH AS WELL AS
IMPLEMENTATION SCIENCE AND SO,
AGAIN, WE HAD A NUMBER OF
DISCUSSIONS ABOUT THAT AND THE
COMPLEX RELATIONSHIP WITH
MINORITY SERVING INSTITUTIONS AS
WELL AS HBCUs IN THIS SETTING.
THE HISTORIC UNDERFUNDING OF
THOSE INSTITUTIONS WHO IMEAN MAY
BE MORE LIKELY TO SUPPORT AND BE
DOING HELT DISPARITIES RESEARCH.
IN THE FACE OF THIS INCREASED
INTEREST OF HEALTH DISPARITIES
RESEARCH, WHICH WE SAW QUITE A
BIT OF IN THE LAST 5 YEARS SO
FOLLOWING THE PANDEMIC AS WELL
AS THE HEIGHTENED AWARENESS OF
RACIAL INJUSTICES WE HAVE SEEN
INFLUX OF RESEARCHERS INTO THE
SPACE AS WELL AS AN INFLUX OF
INVESTIGATORS IN THIS SPACE.
WE HAD A NUMBER OF DISCUSSIONS
AND DATA LOOKING AT THOSE
FUNDING TRENDS AS WELL AS WHOSE
GETTING FUNDED AND RECOGNIZING
THAT THERE ARE MANY RESEARCHERS
WHO HAVE BEEN DOING THIS WORK
FOR DECADES IN SETTING OF VERY
FEW OPPORTUNITIES TO DO -- TO
GET FUNDED FOLLOWED BY THIS
BURST OF -- BURST INTO THE FIELD
OF INTEREST IN THE AREA AND MORE
FUNDING INTO THE FIELD, NOT
HAVING BEEN WELL TRAINED OR
HAVING SPECIFIC KNOWLEDGE OR
TRAINING IN HEALTH EQUITY
RESEARCH OR EXPERIENCE WORKING
WITH THESE COMMUNITIES, WE
BELIEVE HIGHLIGHTED THE NEED FOR
MORE TRAINING AS WELL AS PERHAPS
SOME GUARD RAILS FOR THE KINDS
OF EXPECTATIONS WE SET FOR
INDIVIDUALS DOING THIS RESEARCH
AND WE THINK THAT A REALLY
IMPORTANT ASPECT OF THAT WAS
ALSO ACKNOWLEDGING THE HISTORY
OF PEOPLE DOING THE RESEARCH,
BEING MARGINALIZED AND NOT
HAVING THOSE OPPORTUNITIES AND
WHAT IS THE IMPORTANT PERHAPS
SCIENCE AND WORK THAT WE'RE
LEAVING BEHIND.
ALONG WITH THAT, WE NEED TO
FOCUS ON CRITICALLY EVALUATING
THE WORK, THESE INCONSISTENT
PRACTICES, AROUND TOOLS, HOW THE
DATA IS COLLECTED, WE KNOW THAT
NIMHD HAS BEEN REALLY PUSHING
FOR MORE COMMON DATA ELEMENTS TO
BE COLLECTED ACROSS STUDIES AND
MORE CONSIDERATION FOR AGAIN HOW
CAN WE LEARN FROM THE BODY OF
WORK AS A WHOLE AND WE THINK
THERE'S MORE WORK TO BE DONE IN
THIS SPACE.
AND WE ALSO FOCUSED QUITE A BIT
ON THE NEED TO REALLY UNDERSTAND
SOCIAL DRIVERS OF HEALTH AS WELL
AS UNDERSTANDING THE SOCIAL
CONSTRUCTS OF RACE AND ETHNICITY
IN THE SETTING OF BIOLOGICAL
DATA AND USE OF GENETICS
GENOMICS AND ANCESTRY DATA.
PROBABLY GOES WITHOUT SAYING
THERE -- THERE STILL IS A GREAT
NEED FOR MORE INFRASTRUCTURE TO
DO HEALTH EQUITY RESEARCH.
IT HAS BEEN HISTORICALLY
UNDERFUNDED AND WE THINK THAT
THE KINDS OF RESOURCES THAT ARE
NEEDED BOTH WITHIN INSTITUTIONS
WHO DO RESEARCH BUT ALSO TO
SUPPORT IT IN COMMUNITIES NEEDS
TO BE SCALED UP IF WE'RE GOING
TO HAVE TRUE IMPROVEMENT.
AND THEN OUR FINAL CONCLUSION
FROM THIS CHAPTER WAS AS WE
THINK ABOUT WHAT KIND OF
RESEARCH MIGHT TRULY CHANGE
HEALTH OUTCOMES AND REDUCE AND
ELIMINATE INIQUITIES AND
DISPARITIES, WE THINK THAT WE
NEED MORE INTERVENTIONAL
STUDIES, MORE WORK ACTUALLY
LOOKING AT WHAT WORKS AND WHAT
DOESN'T WORK IN COMMUNITIES AND
YOU KNOW THINKING THROUGH HOW WE
CAN LEVERAGE IMPLEMENTATION
SCIENCE AS WELL AS COMPARATIVE
EFFECTIVENESS STUDIES IN
DIFFERENT WAYS INCLUDING USING
MULTILEVEL AND STRUCTURAL
INTERVENTIONS SO VERY FEW
STUDIES EXISTING USING THESE
STRATEGIES AND REALLY NECESSARY
IF WE'RE GOING TO MOVE AWAY FROM
JUST THESE OBSERVATIONS OF
ONGOING DISPARITIES AND
INIQUITIES AND MOVING TOWARDS
ACTUAL OUTCOMES.
AND THEN I'LL JUST END WITH, YOU
KNOW THE GOAL 3 THAT REFLECTS
WHERE WE THINK THIS WORK NEEDS
TO GO.
WE REALLY AS A COMMITTEE WANTED
TO PUSH FOR WHAT
DR. PEREZ-STABLE JUST MENTIONED
EARLIER THAT WE THINK THAT THERE
NEEDS TO BE MORE COORDINATION
AROUND A HEALTH EQUITY FUNDING,
HEALTH EQUITY RESEARCH FUNDING
WITHIN NIH AND THAT THERE SHOULD
BE MORE DISCUSSIONS AND OF
COURSE MORE FUNDING TO SUPPORT
THE WORK AND THINKING THROUGH
HOW WE CAN ACTUALLY LEVERAGE THE
EXISTING STRUCTURES TO SUPPORT
NOT JUST THE RESEARCH BUT THE
TRAINING, THE WORKFORCE, SOME
STANDARDS, AS WELL AS BUILDING
IN NEW AND DIFFERENT WAYS TO
ACTUALLY EVALUATE THAT WORK.
AND I THINK I'M PROBABLY OUT OF
TIME SO I WILL STOP HERE AND
PASS THE BATON.
THANK YOU.
>> WELL, I THINK I'M NEXT AND I
WILL BE COVERING HEALTHCARE
SERVICE DELIVERY SO LET ME SHARE
JUST FOR A SECOND.
LET ME MAKE SURE.
LET ME GO HERE.
OKAY, I THINK CONSUELO DID A
GREAT PIECE ON WHAT I WILL BE
TALKING ABOUT AND THIS CHAPTER
IS A VERY LONG CHAPTER SO I WILL
TRY TO JUST COVER A FEW NOTES
ABOUT THE CHAPTER BUT IT'S A
VERY IMPORTANT CHAPTER AND I
WANTED TO ALSO EMPHASIZE MORE
THE ISSUES OF WHAT WE FOUND ARE
PROMISING WAYS OF MITIGATING
HEALTH INEQUITIES AND HEALTH
DISPARITIES.
I WANT TO JUST START BY TALKING
ABOUT LIKE WHAT WERE THE MAJOR
ISSUES THAT WE FOUND, THE
OBSTACLES IN PROGRESS AND AS YOU
CAN SEE HERE POLICIES THAT FALL
SHORT OVER EMPHASIZE ON
TREATMENT SICKNESS AND
FRAGMENTED HEALTHCARE SYSTEM,
FAILURE TO PURSUE PROMISING
AVENUES OF RESEARCH, FAILURE TO
INVEST THIS PROMISING SOLUTIONS
AND PERVASIVE RACISM IN
HEALTHCARE AND YOU CAN SEE HERE
MANY OF THE THINGS WE FOUND ARE
REALLY TARGETING THE HEALTHCARE
SYSTEM AS BEING VERY CENTRAL IN
CHANGING WHAT'S HAPPENING.
I ALSO WANTED TO SHOW YOU HERE
WHERE WE FOUND, YOU KNOW WE DID
A LOT OF REVIEWS LIKE CONSWALE O
WAS SAYING AND WE FOUND THAT
ACTUALLY THERE IS A LOT OF
DISPARITIES AND INIQUITIES THAT
ARE COMING FROM SPECIALLY
OUTPATIENT CARE AND INPATIENT
CARE.
I JUST WANT TO SHOW YOU VERY --
3 EXAMPLES SO YOU SEE.
THIS IS THE NUMBER OF BLACK
VERSUS WHITE PATIENTS VISITS AND
IN ALL THE PHYSICIAN SPECIALTIES
AND YOU CAN SEE HERE THIS IS A
REALLY GOOD EXAMPLE THAT FOR
ALMOST ALL OF THEM THERE'S A
HIGHER VISIT RATES FOR WHITE
PATIENTS COMPARED TO BLACK
PATIENTS AS YOU CAN SEE THERE
FOR RADIOLOGY, PLASTIC SURGERY,
BLACK PATIENTS ONLY HAD HIGHER
VISITS FOR NEPHROLOGY IN TERMS
OF DIAGNOSIS AND TREATMENT AND
THAT'S BECAUSE THEY RECEIVED
CARE MUCH LATER AND HEMEATOLOGY.
IF YOU GO BACK TO HISPANIC
LATINO WHITE PATIENTS COMPARED
TO 1 PATIENTS, YOU SEE EXACTLY
THE SAME PATTERN, MANY MORE
HIGHER VISITS RATES FOR WHITE
PATIENTS COMPARED TO HISPANIC
PATIENTS IN ALL TYPES OF
PHYSICIANS SPECIALTIES AND YOU
SEE THE SAME PATTERN AGAIN FOR
ASIAN AND PACIFIC ISLANDERS.
SO AGAIN, THIS WAS VERY
CONVINCING OF THE PROBLEMS THAT
WE'RE HAVING IN TERMS OF MOST
SPECIALTIES.
WE HAVE STILL HIGHER VISIT RATES
FOR WHITE PATIENTS COMPARED TO
OTHER MINORITIZED PATIENTS.
I THINK BASED ON THAT, THERE
WERE SEVERAL THINGS THAT WE
FOUND THAT REALLY COULD BE
CENTRAL IN ENDING UNEQUAL
TREATMENT.
ONE THAT WAS DISCUSSED ENDLESSLY
WAS REFORMING PUBLIC HEALTH AND
PRIVATE INSURANCE TO MAKE SURE
THAT WE HAVE EQUITABLE ACCESS
AND QUALITY OF CARE AND SOME OF
THE THINGS THAT WERE MENTIONED
AS ALTERNATIVES TO REALLY
IMPROVE THIS AREA ARE
ACCOUNTABLE CARE ORGANIZATIONS,
THIS IS A HEALTH MODEL THAT USES
SHARE SAVINGS TO INCENTIVIZE
ACCOUNTABILITY FOR QUALITY AND
COST.
WE ALSO TALKED ABOUT HEALTH
HOMES WHICH IS A PRIMARY BASED
MODEL FOCUSING ON WHOLISTIC
APPROACH TO PATIENT HEALTH AND
PUBLIC HEALTH AND PREVENTION
FUND, 1 OF THE AREAS THAT WAS
DISCUSSED, YOU KNOW AD NAUSEUM
AND HOW LITTLE PREVENTION THAT
IS HOW IT CREATES POPULATIONS
THAT ARE NOT TREATED UNTIL THE
VERY, VERY END.
I WANT TO SHOW YOU AN EXAMPLE OF
DATA ON MEDICAID ACCOUNTABLE
CARE ORGANIZATIONS, WHICH WAS 1
OF THE AREAS WE ARE DISCUSSING
AS AN AREA TO END UNEQUAL
TREATMENT AND THIS IS STUDIES
THAT WERE DONE WITH THE EQUAL
SURVEYS SHOWING THAT USING
ACOs, IN 7 STUDIES QUALITY
IMPROVED, PREVENTIBLE
UTILIZATION DECREASED IN 10.
SAVINGS WERE FOUND IN 6,
DISPARITIES IMPROVE IN 3 OUT OF
THE 4 STUDIES THAT WERE ACTUALLY
MEASURING INIQUITIES AND THIS
LEADS US TO WHAT THE 4 AREAS OF
THE ACTUAL REPORT TALKS ABOUT.
WE TALKED ABOUT THE IMPORTANCE
AS WE TALK BEFORE OF REALLY
IMPROVING AND ACTUALLY MAKING
SURE THAT HEALTHCARE LOSS AND
PAYMENT POLICIES ARE REALLY
REVIEWED TO MAKE SURE THAT --
MAKE SURE THAT THIS LOSS AND
POLICIES MITIGATED THE
DISPARITIES THAT WE ARE FINDING.
THIS INCLUDES ALSO HEALTHCARE
DELIVERY, REALLY -- REDESIGNING
HELT CARE DELIVERY TO MAKE SURE
THAT WE CAN PROVIDE CARE THAT
HAS BOTH CULTURALLY LANGUAGE AND
REPRESENTATION FROM THE
COMMUNITY TO DO THE BRIDGING
THAT'S SO MUCH NEEDED.
COMMUNITY CENTEREDNESS IS AN
ENGAGEMENT AS CONKUELO IS AN
AREA OF ENGAGEMENT BECAUSE WE
TALKED ABOUT IN THE REPORT ABOUT
HOW WE NEED TO MOVE MANY OF THE
ASPECTS OF PREVENTION TO
COMMUNITY CENTEREDNESS AND
ENGAGEMENT AND AS CONSUELO
REPEATED RECENTLY, A LOT OF THE
WORK IN TERMS OF IMPLEMENTING
THIS NEW MODELS OF CARE,
REQUIRES TO HAVE MORE
INFRASTRUCTURE AT BOTH THE
SYSTEMS LEVEL AND AT THE
COMMUNITY LEVEL BUT ALSO
RESEARCH TO SEE WHAT WORKS UNDER
WHICH CONDITIONS AND FOR WHOM.
I WANT TO SAY THAT 1 OF THE
THINGS WE DISCUSS IN THE REPORT
IS THAT A LOT OF THE TYPICAL
MODEL OF CARE OF PROVIDERS BEING
IN A HIERARCHICAL POSITION NEEDS
TO CHANGE TO MORE PERSON
CENTERED CARE WHERE WE
PRIORITIZE BOTH PROVIDER AND
PATIENT SHARED DECISION MAKING
TO MAKE THEM A TEAM WITH THE
PATIENT HAVING THE KNOWLEDGE AND
EXPERTISE WITH THEIR LIVED
EXPERIENCE ALSO BEING PART OF
HOW WE PLAN THE CARE SO
PERSON-CENTERED CARE WAS
DISCUSSED MAKING SURE THAT THE
NEW MODELS OF CARE PRIORITIZE
PERSON THINKING ABOUT THEIR
ASSETS AND ABILITIES, FAMILY
HISTORY AND CONTEXT TO MAKE SURE
WE ARE RESONATING WITH WHAT THEY
NEED.
THE OTHER AREA DISCUSSED WAS HOW
WE SHOULD BE MOVING TO TEAM
BASED CARE BECAUSE REALLY THE
EVIDENCE SHOWS THAT BOTH
INPATIENT AND OUTPATIENT
SETTINGS, IT INCREASES PATIENT
SATISFACTION, IT REDUCES
HOSPITAL READMISSIONS, EMERGENCY
DEPARTMENT USE, CARE
COORDINATION SO THIS IS AN AREA
OF INTEREST IN DOING MORE WORK
AND SEEING WHETHER THESE MODELS
REDUCE COST AND IMPROVE
COORDINATED CARE AND REALLY OUR
MORE IN-LINE WITH WHAT PEOPLE
ARE LOOKING INCLUDING MAKING
SURE WE REACH THE HARDLY REACHED
POPULATIONS AND WHEN WE TALKED
ABOUT THIS INTERPROFESSIONAL
PRIMARY CARE TEAPS WE WERE
TALKING THAT WE SHOULD REALLY BE
WORKING ACROSS THE SYSTEMS TO
PROVIDE SOCIAL SUPPORT SERVICE,
DENTISTS, PHARMACISTS, NURSE,
THE PATIENT AND FAMILIES SHOULD
BE CENTRAL BUT THAT THERE ARE
MANY MORE PEOPLE THAT SHOULD BE
PART OF MITIGATING THE
DISPARITIES.
AND THIS IS OUR THINGS THAT ARE
NEEDED.
WE'RE REALLY GOING TO PROVIDE
SOCIOLOGICAL CULTURALLY TAILORED
INTERVENTIONS.
IF WE'RE REALLY GOING TO BE ABLE
TO GIVE LINGUISTIC APPROPRIATE
CARE WHICH REQUIRES FOR HAVING
BILING Y'ALL CLINICIANS OR
INTERPRETERS OR ACTUALLY HAVING
PEOPLE THAT CAN DO THE WORK IN
THE LANGUAGE, IN THE PRIMARY
LANGUAGE OF THE PATIENT.
ASK WE KNOW FROM PRETTY MUCH THE
DATA THAT WE HAVE AND PRESENTED
IN THE REPORT THAT IN THE STUDY
THAT WAS DONE IN 2010 ONLY 13%
OF THE HOSPITALS THAT WERE
SURVEYED HAD CLASS STANDARDS
THAT THEY WERE USING.
ALSO I WANT TO SHOW YOU THE
IMPORTANCE OF LANGUAGE.
AND YOU CAN SEE HERE THAT FOR
HISPANIC AND ASIAN POPULATIONS,
PARTICULARLY NOT HAVING -- WE
HAVE A VERY BIG PERCENTAGE,
ALMOST A THIRD OF THE PATIENT
POPULATION THAT DO NOT SPEAK
ENGLISH AS THEIR PRIMARY
LANGUAGE OR WHO SPEAK ENGLISH
LESS THAN VERY WELL AND THIS IS
GOING TO AFFECT THE QUALITY OF
THE CARE THAT THEY RECEIVE.
WHEN YOU ACTUALLY ADD TO THIS,
WHAT TYPE OF INSURANCE THEY
HAVE, YOU CAN SEE HERE THAT
PARTICULARLY IN MEDICAID AND
EVEN IN THE UNINSPURRED, THEY'RE
VERY HIGH RATES, 29% IS LIMITED
ENGLISH PROFICIENCY IN UNINSURED
AND 28% IS IN MEDICAID AND OTHER
PUBLIC PROGRAMS AND AS YOU CAN
SEE HERE, THIS REALLY SHOWS HOW
WE WOULD BE GIVING LOW QUALITY
CARE TO THIS POPULATION.
ONE OTHER THING THAT WAS
MENTIONED IN THE REPORT IS
MOVING AWAY FROM THE INDIVIDUAL
TO SEE IF WE COULD DO MORE
FAMILY CENTERED CARE MODELS THAT
REALLY THINK ABOUT THE FAMILY IN
A HOLISTIC WAY TO TRY TO COVER
NOT ONLY 1 PERSON IN THE FAMILY
BUT THE WHOLE FAMILY AS SUCH.
COMMUNITY-BASED CARE WAS ALSO AN
AREA AGAIN FOR PREVENTION AND
FOR MAKING SURE THAT WE REACH
PEOPLE EARLIER IN TERMS OF
ASSESSMENT AND IN TERMS OF
COORDINATING PEOPLE COMING IN
AND OUT OF HEALTH SERVICES
DELIVERY.
WE NEED TO HAVE MORE COMMUNITY
BASED CARE THAT PROMOTES
PREVENTION, BUT ALSO THAT IS
DEDICATED TO MAKING SURE THAT WE
RESPOND TO THE NEEDS OF THE
COMMUNITY.
SO HERE IS WHERE COMMUNITY
PARTNERSHIPS ARE VITAL, LIKE
CONSUELO WAS SAYING IN TERMS OF
HAVING COMMUNITY ENGAGED MODELS
OF CARE WHERE WE HAVE THE
COMMUNITY AS PARTICIPATING NOT
ONLY IN TERMS OF TELLING US WHAT
THEY NEED BUT ALSO SO IMPORTANT
IN MAKING SURE THEY HAVE A SAY
IN OW WE DESIGN THIS PARTICULAR
MODELS OF CARE.
SO ADDRESSING SOCIAL
DETERMINANTS FOR EXAMPLE IN HOW
TO MAKE SURE THAT WE REACH THE
POPULATIONS EARLY ON IN THE
HARDSHIP AND STRUGGLES THEY
MIGHT BE CONFRONTING.
SEVERAL OF THE FIELD STRATEGIES
THAT WERE MENTIONED IN THE
REPORT HAVE TO DO WITH
ADDRESSING STIGMA, YOU KNOW
MAKING SURE THAT WE HAVE
ANTISTIGMA MESSAGES TO MAKE SURE
THAT WE ARE NOT HAVING A DEFICIT
MODEL TO ADDRESS MINORITIZED
POPULATIONS THAT WE HAVE
PROVISION OF NONTRADITIONAL
SERVICE LIKE HOME VISITS THAT
ARE NOW BECOMING MORE PART OF
HEALTHCARE THAT WE HAVE A BILING
Y'ALL BI-CULTURAL STAFF THAT WE
INCREASE DIVERSITY AMONG
PROVIDERS TO MAKE SURE THAT WE
HAVE THE TRUST AND CONFIDENCE OF
PEOPLE FROM THE COMMUNITY, THE
FAMILY INVOLVEMENT THAT I TALKED
ABOUT, BUT ALSO INCORPORATION OF
RELIGIOUS AND SPIRITUAL
PRACTICES AND COMMUNITY NETWORKS
TO MAKE SURE THAT WE REACH
PEOPLE EARLIER AND THINKING OF
CULTURE AND CONTEXT AS CENTRAL.
I CANNOT EVEN EMPHASIZE SO MUCH
OF THE DISCUSSION OF THE
IMPORTANCE OF MAKING SURE THAT
WE DIVERSIFY THE HEALTHCARE WORK
FOR US AND HOW CAN WE REDUCE
BIAS, AND THIS IS AN AREA THAT
ACTUALLY WAS VERY IMPORTANT AND
DEBATED BECAUSE MANY OF THE
INTERVENTIONS OF REDUCING BIAS
MIGHT NOT BE DOING THAT WORK SO
WE NEED EVIDENT BASED
INTERVENTIONS THAT ARE MORE THAN
1 OR 2 HOURS OF ANTIBIAS BUT
ACTUALLY LONG-TERM INTERVENTIONS
THAT ARE MORE INCISIVE ABOUT
WHAT PEOPLE ARE DOING AND HOW TO
CHANGE WHAT THEY'RE DOING.
REDUCING PRACTICE BARRIERS TO
MAKE SURE PEOPLE COME IN.
USING COMMUNITY HEALTH WORKERS
AND PEERS, TO MAKE SURE THAT WE
CONNECT EARLIER AND WITH AN
EXPANDED WORKFORCE AND CLINICAL
ALGORITHMS AND THEIR
IMPLICATIONS FOR RACIAL
INIQUITIES.
THERE'S GOING TO BE A LOT OF --
WITH AI CLINICAL ALGORITHMS AND
THIS WAS AN AREA THAT WE
DISCUSSED.
I WANT TO EMPHASIZE 1 OF THE
THINGS WE ALSO DISCUSSED IN THE
REPORT AND THIS IS WHERE WE HAVE
A PREDICTED SHORTAGE BETWEEN
20,000 TO 40,000 PRIMARY CARE
PHYSICIANS BY 2036 AND YOU CAN
SEE HERE THAT THIS IS GOING TO
BE PARTICULARLY, ALTHOUGH IT'S
ACROSS THE BOARD FOR BLACK
POPULATIONS BEING SERVED AND FOR
HISPANIC POPULATIONS BEING
SERVED BECAUSE WE HAVE VERY FEW
FULL-TIME EQUIVALENT PHYSICIANS
THAT ARE PRIMARY CARE PHYSICIANS
AND THOSE ARE THE VERY DARK BLUE
AND PRIMARY CARE.
SIXTY-FIVE FOR EVERY -- FOR
EVERY HUNDRED THOUSAND PEOPLE.
SO YOU CAN SEE VERY, VERY HUGE
AND DRAMATIC SHORTAGES OF
PRIMARY CARE PHYSICIANS AND 61
FOR EVERY HUNDRED THOUSAND
PRIMARY CARE PHYSICIANS FOR THE
POPULATION.
I WANT TO ALSO SHOW YOU THAT
EVEN THE WORKFORCE THAT'S COMING
IN, ARE THIS IS THE CATEGORY 6
OF THE TEMWORKFORCE AND YOU CAN
SEE HERE THAT WE ARE NOT REALLY
MAKING BIG IMPACTS IN TERMS OF
EXPANDING THE DIVERSITY OF THE
WORKFORCE.
SO GOING BACK THIS AND SEEING
HOW WE CAN DO MORE PATHWAY
PROGRAMS, HOW WE CAN PARTNER
WITH HISPANICS SERVING AND BLACK
SERVING INSTITUTIONS TO MAKE
SURE THAT WE PROVIDE MORE ENTRY
TO THIS POPULATIONS IN THIS
ROLE.
SO AT THE END, I WANTED TO JUST
SAY THAT WE HAVE TO IMPROVE THE
RATE OF FACULTY DIVERSITY
BECAUSE WE NEED ALSO TO MAKE
SURE THAT WE HAVE ROLE MODELS,
AND HAVE PEOPLE THAT ARE REALLY
DEVOTED TO ACCESSING AND
SPONSORSHIP AND MENTORING THIS
POPULATION AND MAKING SURE THAT
WE INCREASE THE DIVERSITY IN THE
WORKFORCE.
AS YOU CAN SEE HERE, HALF OF
U.S. PHYSICIANS ARE 55 YEARS OR
OLDER SO THIS IS GOING TO BE A
PROBLEM IN THE VERY, VERY NEAR
FUTURE.
I'M GOING TO END BY SAYING THAT
TO OVERCOME INIQUITIES AND END
UNEQUAL TREATMENT WE ALSO HAVE
TO IMPROVE PATIENT PROVIDER
COMMUNICATION.
THIS WAS AN AREA THAT IS
DISCUSSED IN LOTS OF WAY AND
THIS IS WHERE INTERVENTIONS THAT
CAN IMPROVE PATIENT PROVIDER
COMMUNICATION, TO PROMOTE A
WORKFORCE THAT IS REPRESENTATIVE
AND TO EXPAND THE WORKFORCE ARE
ALL THINGS WE CAN DO.
I WANT TO THANK NIMHD, AND NIH
FOR DOING REALLY PROMOTING THAT
WE DO THIS REPORT.
IT'S GOING TO BE VERY, VERY
IMPORTANT AS A ROADMAP OF WHAT
CAN BE DONE IN THE NEXT 20 YEARS
AND I ALSO THINK IT'S VERY
IMPORTANT TO DISSEMINATE THIS
REPORT SO I THANK YOU.
>> THANKS.
I THINK I AM UP NEXT AND I WILL
PULL UP THE SLIDES HERE.
OKAY, SO CIRCLING BACK AGAIN, I
WANT TO EMPHASIZE THIS WAS A
VERY BROAD STATEMENT OF TASK
THAT WAS PUT BEFORE THE EXITEE
WITH RESEARCH ABSOLUTELY
FEATURED IN IT AS A CENTRAL
COMPONENT AND THE HEALTHCARE
SYSTEM AS A CENTRAL COMPONENT
BUT ALSO RECOGNIZING AND THE
COMMITTEE RECOGNIZED THAT THE
HEALTHCARE SYSTEM EXITS WITHIN
THE LARGER SOCIETY AND THAT
RESEARCH IS EVERYWHERE IN ALL
THAT WE DO BUT THAT RESEARCH
ALONE OR THE HEALTHCARE SYSTEM
ALONE ARE NOT GOING TO GET US TO
HEALTH EQUITY AND SO WE REALLY
DID GO VERY BROAD WITH OUR
RECOMMENDATIONS AND
IMPLEMENTATION ACTIONS.
AGAIN, THERE'S MANY OF THEM SO
WILL NOT PRESENT ALL OF THEM BUT
ALSO WANTED TO NOTE THAT WE
ORGANIZED THEM IN A LOGICAL
SEQUENCE RECOGNIZING THAT
TRANSFORMATIVE CHANGE IS NOT
LINEAR BUT THAT WE WANTED TO
PROVIDE A NARRATIVE ON HOW WE
FELT LIKE THE GOALS COULD BE
ACHIEVED TOGETHER AND AGAIN,
RESEARCH FEATURING VERY
PROMINENTLY HERE.
SO FIRST AND CONTINUOUSLY
ACCURATE AND TIMELY DATA ARE
NEEDED TO DESCRIBE THE HEALTH
AND HEALTHCARE INIQUITIES TO
INFORM THE DEVELOPMENT AND
IMPLEMENTATION OF EFFECTIVE AND
SUSTAINABLE INTERVENTIONS.
NEXT HEALTHCARE SYSTEMS NEED TO
BE EQUIPPED WITH INFORMATION AND
THE CAPABILITIES TO MAKE
SUSTAINABLE CHANGE AND
ITERATIVELY MEASURE PROGRESS IN
PARTNERSHIP WITH THE RESEARCH
ENTERPRISE THAT CONTINUES TO
DISCOVER AND RIGOROUSLY EVALUATE
PROMISING NEW INTERVENTIONS THAT
CAN BE WIDELY IMPLEMENTED.
THIS ONGOING PROGRESS NEEDS TO
BE SUPPORTED BY SYSTEMS OF
ACCOUNTABILITY, AND ENFORCEMENT,
FINALLY DELIVERY AND FINANCING
MECHANISMS NEED AS THEIR CENTRAL
GOALS TO INSURE ACCESS TO
EQUITABLE HEALTHCARE AND TO
ACHIEVE OPTIMAL HEALTH FOR ALL.
AND WANT TO AGAIN REMIND US OF
THAT GOAL #3 THAT DR. WILKINs
ALSO FOCUSED ON WHERE THE
COMMITTEE IS RECOMMENDING
INVESTMENT IN RESEARCH AND
EVIDENT GENERATION TO BETTER
IDENTIFY AND WIDELY IMPLEMENT
INTERVENTIONS THAT ELIMINATE
HEALTHCARE INIQUITIES AND AGAIN
THE DETAILS OF OUR GOAL 3.1 AND
3.2 HERE BUT ALSO RECOGNIZING
THAT THIS AGAIN NEEDS TO BE DONE
IN CONCERT WITH THE DATA AND THE
HEALTHCARE SYSTEM AND CONTINUED
FOCUS ON DIVERSIFYING THE
WORKFORCE, BUILDING OUT THE
INFRASTRUCTURE THAT'S NEEDED TO
CONDITION THE RESEARCH AND ALSO
RECOGNIZING THE INCREDIBLE
IMPORTANCE OF RESEARCH WITH THE
ACCOUNTABILITY FUNCTION AS WELL.
SO RESEARCH GENERATING NEW
KNOWLEDGE THAT ABSOLUTELY NEEDS
TO BE WIDELY IMPLEMENTED BUT
ALSO THEN CIRCLING BACK AROUND
TO INSURING THAT WE ARE
MEASURING WHAT IS HAPPENING AND
THAT WE'RE HOLING SYSTEMS
ACCOUNTABLE.
THERE WERE SEVERAL PRIORITY
AREAS FOR RESEARCH THAT I JUST
ALSO WANTED TO HIGHLIGHT HERE
THAT I BELIEVE MANY OF THESE
COME OUT OF THE RESEARCH CHAPTER
THAT DR. WILKINS AND OTHERS LED
LINKING MACROLEVEL POLICIES WITH
THE LIVED PRESENCES OF RACIALLY
AND ETHNICALLY MINORITIZED
POPULATIONS TO FULLY UNDERSTAND
THE VARIOUS PATHWAYS THAT LEAD
TO INEQUITABLE OUTCOMES,
INTEGRATING AND SUSTAINING
INTERVENTIONS TO ADDRESS HEALTH
RELATED SOCIAL NEEDS INTO THE
HEALTHCARE DELIVERY SYSTEM.
DEVELOPING AND TESTING NEW CARE
MODELS DESIGNED TO IMPROVE
EQUITY AND HEALTHCARE ACCESS AND
OUTCOMES.
FURTHER AREAS CONDUCTING THE
IMPLEMENTATION, RESEARCH
INCLUDING HEALTH POLICY RESEARCH
TO ADOPT AND SCALE UP EFFECTIVE
NEW MODELS.
CONTINUING TO ADVANCE INDIGENOUS
GOVERNANCE AND
SELF-DETERMINATION USING
INDIGENOUS AND CLONEICAL
METHODOLOGIES AND INDIGENOUS
ETHICS AND TRANSITIONING FROM
INTERVENTIONS FROM CERTAINLY
OBSERVATIONAL STUDIES AS WELL AS
INTERVENTIONS TO CHANGE
BEHAVIORS TO EFFORTS TARGETING
OTHER LEVELS OF CHANGE INCLUDING
THE MULTILEVEL RESEARCH SUCH AS
INTERVENTIONS AT THE COMMUNITY
AND SOCIETAL LEVEL AS WELL AS AT
THE INDIVIDUAL OR HEALTHCARE
SYSTEM LEVEL.
IDENTIFYING AND DELINEATING BEST
PRACTICES FOR CROSS
ORGANIZATIONAL PARTNERSHIPS,
DEVELOPING SUSTAINABLE MODELS
AND APPROACHES THAT BUILD
COMMUNITY EMPOWERMENT AND
CAPACITY.
EXPANDING BASIC SOCIAL SCIENCE
RESEARCH WHICH FOCUSES ON
UNDERSTANDING HUMAN BEHAVIOR TO
SUPPORT THE DEVELOPMENT OF
EVIDENT BASED INTERVENTIONS.
AND 1 OTHER SLIDE HERE
HIGHLIGHTING A FEW OTHER AREAS,
1 IDENTIFYING APPROPRIATE
COMPARATORS AND STUDYING
RACIALLY AND ETHNIC MINORITY
GROUPS AND UNDERSTANDING VITALS
TO REDUCE INIQUITIES.
AND WE SPENT A LOT OF TIME
TALKING ABOUT THE FACT THAT
EFFORTS TO ACHIEVE OPTIMAL
HEALTHCARE FOR ALL AND
ELIMINATING RACIAL AND ETHNIC
INIQUITIES IN HEALTHCARE IS NOT
A ANSWER SUM GAME.
ADDRESSING THE FACTORS THAT
CONTRIBUTE TO HEALTH AND
HEALTHCARE INIQUITIES BENEFITS
EVERYONE.
WITH CONCERTED NATIONAL EFFORT
AND ADEQUATE RESOURCES, THE
HEALTHCARE SYSTEM CAN BE
TRANSFORMED TO DELIVER HIGH
QUALITY EQUITABLE CARE TO ALL.
AND MANY OF THE TOOLS NEEDED TO
REACH THESE GOALS ARE ALREADY
AVAILABLE AND NEED TO BE FULLY
USED.
AGAIN, HUGE THANKS TO THIS
WONDERFUL COMMITTEE WHO
VOLUNTEERED HUNDREDS OF IF NOT
THOUSANDS OF HOURS OF THEIR TIME
TO DO THE RESEARCH NEEDED AND
GENERATE THE FABULOUS REPORT
THAT AGAIN IS NEARLY 400 PAGES
AND WE HAD A PHENOMENAL STAFF AT
THE NATIONAL ACADEMIES LISTED
HERE AS WELL.
SO THANK YOU AND AGAIN AS A
REMINDER ALL OF THESE
INDIVIDUALS SERVED AS VOLUNTEERS
AMIDST THEIR INCREDIBLY BUSY
LIVE ANDS SCHEDULES.
SO THANK YOU AGAIN TO LEARN
MORE, THE COMMITTEE REPORT IS
ONLINE AND YOU CAN DOWNLOAD
INDIVIDUAL CHAPTERS OR THE
ENTIRE REPORT FOR FREE AT THE
NATIONAL ACADEMIES.
AND I SEE DR. PEREZ-STABLE IS
HERE AND I WILL TURN IT OVER TO
YOU.
>> ALL RIGHT, THANK YOU.
THAT WAS FANTASTIC AND REALLY
APPRECIATE IT.
DID DARREL END UP JOINING US OR
NOT.
>> NO.
>> OKAY, WELL, WE WERE GOING TO
ASK HIM TO PRESENT BUT I WANTED
TO SEE IF HE WANTED TO
PARTICIPATE IN THE CONVERSATION,
SO WE HAVE A FEW MINUTES BEFORE
WE HEAR FROM THE DIRECTORS FOR
QUESTIONS, FIRST ASKING MY
COLLEAGUES WHETHER THEY HAVE ANY
QUESTIONS OR WHETHER THERE WERE
ANY QUESTIONS COMING FROM THE
AUDIENCE.
I GUESS THERE MIGHT BE NO
QUESTIONS.
OKAY, SO I WAS ACTUALLY
IMPRESSED WITH THE CO INCIDENCE
OF SOME OF THE ISSUES THAT WE'VE
BEEN TALKING ABOUT AT LEAST AT
NIMHD AND ALSO BROADER AT NIH,
WHAT YOU PRESENTED MARGARITA,
PARTICULARLY AROUND THE ISSUE OF
PATIENT CENTERED CARE, TEEN
BASED CARE, THE EMPHASIS ON
PRIMARY CARE AND ALTHOUGH THE --
YOU EMPHASIZE THE VISITS THAT
WERE DISPROPORTIONATELY
DIFFERENT BY RACE AND/OR
ETHNICITY, THERE WAS IN FACT
SOME SPECIALTIES THAT WERE
ACTUALLY PRETTY BALANCED AND 1
OF THEM WAS GERIATRICS, INTERNAL
MEDICINE, FAMILY MEDICINE, SO
THERE ARE SOME AREAS WHERE I
THINK WE'RE DOING THE WORK BUT
THE LACK OF PRIMARY CARE
PHYSICIANS, I THINK -- OR THE
PROJECTED DEFICIT, I THINK IS
SOMETHING TO BE VERY CONCERNED
ABOUT IN THE FUTURE.
I ALSO, YOU KNOW EMPHASIS OF THE
IDEA OF ACCOUNTABILITY, THOUGH,
SO WHAT DID DECREASING
INIQUITIES OR DECREASING THE
DISPARITIES GOING TO DO FOR THE
SOCIETY AND WE DID A WORK WITH
ACTUALLY 2 OF THE MEMBERS OF THE
COMMITTEE, DARREL AND TOM, TOM
LAVITSA SHOWING THAT 450 BILLION
DOLLARS WERE DUE TO RACE AND
ETHNIC DISPARITIES AND IF YOU
LOOK AT EDUCATIONAL LEVEL
DISPARITIES INCLUDING THE ENTIRE
POPULATION, IT WAS ALMOST A
TRILLION DOLLARS.
SO IF WE THINK WE COULD MAYBE
SHAVE THAT BY 10%, NOT A VERY
AMBITIOUS GOAL, I THINK, 10%,
THAT WOULD BE THE NIH BUDGET
TIMES 1 OR 2 DEPENDING ON WHICH
WAY YOU ANGLE IT AND CLEARLY IT
IS IMPROVING THE HEALTH OF ALL.
THE OTHER THING ON THE DIVERSITY
OF THE WORKFORCE IS WE DIDN'T
ACKNOWLEDGE THERE ARE SOME LEGAL
BARRIERS THAT HAVE BEEN
SOPHISTICATED -- SOLIDIFYS IN
THE LAST DECADE OR SO AND THE
STRATEGIES NEED TO BE MODIFIED
BURR OUR GOALS HAVE TO REMAIN
STRONG BECAUSE AS I WAS REMINDED
BY TALKING TO A COLLEAGUE A
COUPLE DAYS AGO, SOMETHING LIKE
OVER 50% OF CHILDREN IN THE U.S.
TODAY ARE FROM MINORITIZED
POPULATIONS AND THE
UNDERREPRESENTED POPULATIONS
ACCOUNT FOR A SIGNIFICANT AMOUNT
OF THAT.
SO IT'S ACTUALLY ABOUT NOT SO
MUCH ONLY ABOUT DIVERSITY, BUT
IT'S ABOUT DEVELOPMENT OF FUTURE
HUMAN CAPITAL FOR THE COUNTRY.
SO IT'S REALLY THAT THE
COUNTRY'S FUTURE THAT
TAKEN--THEY MAKES THIS A
STRATEGIC APPROACH, IN THIS
CONTEXT, BUT INDEPENDENT OF
EVERYTHING ELSE THAT WE CAN OR
CANNOT DO.
OKAY, SO, ANY COMMENTS OR
QUESTIONS FROM RICHARD OR JEANNE
OR RICHARD?
YOU GUYS CAN TURN YOUR CAMERAS
ON, JEANNE AND RICHARD AND THEN
YOU WILL JUMP ON INTO YOUR
CONVERSATIONS AND PRESENTATION.
>> I JUST WANT TO RESPOND
QUICKLY TO 1 OF THE POINTS YOU
MADE ABOUT THE WORKFORCE I DO
THINK IT'S WORTH HIGHLIGHTING
AND WE REVIEWED SOME OF THE DATA
AROUND THE KINDS OF RESEARCH
THAT GOT FUNDED AND I KNOW YOU
KNOW THIS, BUT YOU KNOW
SCIENTISTS WHO WERE PROPOSING TO
DO RESEARCH FOCUSED ON MINORITY
HEALTH AND/OR HEGHT DISPARITIES
AND HEALTH INEXPECTATIONS QUITY
-- INIQUITIES WERE LESS LIKELY
TO GET FUNDED OVER THE COURSE OF
THE TIME THAT WE LOOKED AT THE
DATA SO AS WE THINK ABOUT YOU
KNOW THE SCIENTIFIC WORKFORCE
AND THE SETTING OF RECENT SORT
OF RULINGS ABOUT HOW WE CAN LOOK
AT DEMOGRAPHICS, I DO THINK WE
HAVE TO FOCUS ON IT, AND THE
COMMITTEE TALKED ABOUT THIS AS
WELL, YOU KNOW WHAT ARE THE
ACTUAL MEASURES OR METRICS OF
EXCELLENCE THAT WE'RE PUTTING
FORWARD AS WE KNOW SOME SCIENCE
RELATED TO HEALTH DISPARITIES IS
LESS LIKELY TO BE PUBLISHED IN
THE HIGHER IMPACT JOURNALS AND
SO WE NEED NEW AND DIFFERENT
WAYS OF EVALUATING RESEARCH AND
RESEARCHERS THAT REALLY
ACKNOWLEDGE THE STRENGTHS THAT
PEOPLE ARE BRINGING TO THE TABLE
AND NOT JUST AGE INDICES.
>> I ALSO WANTED TO COMMENT ELIS
EO ON I'M GLAD THAT SOME OF THE
THINGS WE FOUND IN THE REPORT
ARE THE 1S YOU'RE THINK BEING AT
NIMHD, BUT I WANT TO ECHICIZE
GOING TO CONSUELO'S POINT ABOUT
THE IMPORTANCE OF MAKING SURE
THAT WE BUILD FOR THE FUTURE,
THAT IT'S NOT ONLY A SHORT-TERM
YOU KNOW ROADMAP WE'RE TRYING TO
DO HERE BUT IT'S A LONG-TERM
ROADMAP PARTICULARLY BECAUSE THE
DEMOGRAPHICS OF OUR CHANGE.
WANTED OR NOT WANTED IT'S COMING
ASK SO WE NEED TO MAKE SURE WE
CAN SERVE THAT POPULATIONS AND I
WANTED TO MENTION THE COMMUNITY
ENGAGE AND COMMUNITY BASED
RESEARCH BECAUSE I THINK THE
OTHER ASPECT WE FOWBD THAT'S SO
IMPORTANT AND WE LOOK AT THE
REPORT BECAUSE OF THE TIME
DIMENSION WE COULDN'T EXPLAIN
ENOUGH BUT COMMUNITY IS CENTRAL
EVEN IN OUR MODEL, AND EVEN IN
HOW WE'RE THINKING PROSPECTIVELY
HOW TO BUILD NEW MODELS OF CARE
THAT MOVE OUT OF THE HEALTHCARE
SYSTEM AND MORE TO THE COMMUNITY
AND I THINK -- I THINK EVERYONE
WAS REALLY PASSIONATE ABOUT
MAKING SURE THAT WE MAKE THAT
RICH AND MAKE THAT BRIDGE EARLY
ON TO REALLY RESPOND TO THE
NEEDS OF THE POPULATION.
NTHANK YOU FOR BOTH OF THOSE
COMMENTS.
I THINK THEY'RE HIGHLY RELEVANT
I WILL JUST EMPHASIZE THAT I
REALLY DON'T WANT US TO THINK OF
COMMUNITY HERE AND HEALTHCARE
OVER HERE AND THEN WITHIN
HEALTHCARE, THERE'S A
SPECIALIST, HOSPITAL, YOU KNOW
THE HIGH-TECH PROCEDURES BECAUSE
50% OF AMERICANS OVER 50, 55, 60
HAVE MORE THAN 1 CHRONIC DISEASE
AND WHEN YOU HAVE A CHRONIC
DISEASE YOU REALLY DEPEND ON THE
HEALTHCARE SYSTEM FOR SOMETHING
AT LEAST.
YOU NEED MORE THAN THE
ACCESSIBLE COMMUNITY AND I THINK
THAT'S THE CHALLENGE.
WE'VE DONE SO MUCH OVER HERE IN
THE HELT CARE AND ESPECIALLY IN
THE HOSPITAL SIDE, AND THE
HIGH-TECH SIDE OF THE HOSPITAL
WHICH IS GREAT BUT WE'VE NOT
BUILT CONTINUED THE QUALITY ON
THE WHOLE SPECTRUM AND SO I
THINK THAT'S -- THOSE ARE THE
CHALLENGES.
I WOULD SAY THAT OVERTHE COURSE
OF THE LAST DECADE WHILE I'VE
BEEN HERE, THE COMMITMENT TO
COMMUNITY ENGAGEMENT HAS REALLY
BLOSSOMED AT NIH WELL BEYOND THE
BOUNDARIES OF NI MHD, WE ALSO
HAVE COMPASS, SEAL, BOTH NINDS
AND NIA HAVE A PROGRAMS THAT
HAVE LAUNCHED THAT HAVE FOCUSED
ON THIS AND I THINK NIAID HAS A
HISTORY OF THIS WITH HIV, AND
SO, I DO THINK THAT THINGS ARE
MOVING.
THEY KIND OF MOVE SLOWLY
SOMETIMES BUT THEY'RE MOVING AND
WE ARE, I THINK IN A PHASE WHERE
WE CAN EMPHASIZE THAT.
I WAS ALSO CURIOUS ABOUT YOUR
TABLE OF MONEY THAT WAS ALL
DERIVED FROM THE RCDC PUBLIC
FACING INFORMATION?
>> YES.
>> YEAH, OKAY.
>> ALL PUBLIC FACING.
>> YOU KNOW WE MODIFIED THE
ALGORITHM, IT USED TO BE ALL
MANUELLY CODED AND NOW WE HAVE
AN AUTOMATED WAY OF DOING THIS.
I BELIEVE THE LAST YEAR OF DATA
THAT ARE GOING TO BE ON THERE
THAT ARE NOT INCLUDED IN THE
REPORT ARE FROM THAT.
THEY WERE SIMILAR IN TERMS OF
TOTAL DOLLARS.
THERE ARE DIFFERENCES IN THE
CATEGORIES, SO WE CAPTURED MORE
AND DROPPED OUT THINGS THAT WERE
NOT REALLY CONSIDERED RELEVANT
IN HELT DISPARITIES AND IT'S IN
THAT 5 BILLION DOLLARS RANGE
GIVE OR TAKE A COUPLE HUNDRED
MILLION, RIGHT?
SO YOU CALCULATE IT'S ABOUT 10%
OF THE NIH BUDGET RIGHT NOW.
SO IT ISN'T -- IT HASN'T -- I
DON'T KNOW IF IT'S HARD TO SAY
IF IT'S INCREASING OR DECREASING
BECAUSE THE METHODOLOGIES IS
MODIFIED BUT IT'S NOT
DRAMATICALLY CHANGED FROM WHAT
HAD BEEN MEASURED BEFORE.
SO LET ME THEN TURN TO THE PANEL
OF NIH LEADERS.
I DON'T KNOW IF YOU HAVE AN
ORDER I HAVE DR. RICHARD BENSON
FROM THE NATIONAL INSTITUTE OF
NEUROLOGICAL DISEASES AND
STROKE, DR. RICHARD HODES, WHO
WILL PRESENT FROM THE NATIONAL
INSTITUTE ON AGING AND
DR. JEANNE MARRASWR, ZO WITH
NIAID.
SO, RICHARD?
>> OKAY, THANK YOU.
CAN YOU SEE MY SLIDES IN
PRESENTATION MOAT MODE. -- MODE.
>> IT IS NOT IN -- NOW IT IS,
YES.
>> OKAY, THANK YOU.
THANK YOU.
I WOULD LIKE TO SAY THANK YOU
DR. PEREZ-STABLE FOR ORGANIZING
THIS DIRECTOR'S SEMINAR TODAY, I
THINK THIS IS VERY IMPORTANT
EMPLOY ALSO DR. DINWIDDIE FOR
ORGANIZING THE NIH GROUP THAT
SORT OF HELPED TO PULL TOGETHER
THIS NASEM COMMITTEE AND ALSO
THANK YOU ALL ON THE COMMITTEE
FOR ALL THE HARD WORK YOU PUT
INTO DEVELOPING THESE
RECOMMENDATIONS TODAY.
I THINK THIS IS EXCELLENT.
IT WAS MENTIONED EARLIER THE
FACT THAT PROGRESS WAS NOT
ALWAYS LINEAR.
WE FORGET THAT SOMETIMES.
WE LIKE FOR IT TO BE BUT IT'S
NOT AND SO THAT'S SOMETHING THAT
WE THINK ABOUT SO I'M REALLY
HAPPY TO SORT OF HIGHLIGHT SOME
OF THE WORK WE'RE DOING AT THE
NINDS, THE DIAGRAM THAT
DR. PEREZ-STABLE REFERENCED, I
WAS ALSO JARRED A LITTLE BIT
LOOKING AT THAT AND I CAN SAY
THAT OUR LEADER SHOULD UPON AT
THE NINDS, WE ARE INTERESTED IN
SORT OF MOVING FORWARD.
OUR NUMBERS WERE NOT THE BEST AT
THAT TIME BUT HOPEFULLY THROUGH
SOME OF THE WORK WE'RE DOING
RIGHT NOW, WE CAN INCREASE SOME
OF THE ACTIVITIES THAT WE'RE
DOING IN THE HEALTH EQUITY
SPACE.
I WILL START BY MENTIONING THAT
THE NINDS, OR THE NATIONAL
INSTITUTE OF NEUROLOGICAL
DISORDERS AND STROKE, OUR
MISSION IS TO REDUCE THE BURDEN
OF NEUROLOGICAL DISEASE FOR ALL
AND THAT INCLUDES ALL GROUPS OF
SOCIETY DOMESTICALLY AND
GLOBALLY.
HOWEVER, DESPITE OUR MISSION FOR
THE LAST ALMOST 75 YEARS, WE
STILL KNOW THAT THERE'S A
DISPROPORTIONATE BURDEN OF
DISPARITIES AND INIQUITIES AND
NEUROLOGICAL DISORDERS AND CARE
BORN BY UNDERSERVED GROUPS OF
SOCIETY AND SO THE NIMHD HAS
DESIGNATED CERTAIN POPULATIONS
AS NIH POPULATIONS THAT
EXPERIENCE HEALTH DISPARITIES
AND WE HAVE THEM LISTED HERE ON
THIS SLIDE, AND IN ADDITION TO
THIS, WE KNOW THAT
INTERSECTIONALITY IS A MAJOR
PROBLEM AS WELL WHEN YOU START
TO THINK OF I GUESS THE
INCREASED BURDEN OF INIQUITIES
OR DISPARITIES AS WELL AS PEOPLE
WITH LIMITED ENGLISH
PROFICIENCY, SO, DESPITE OUR
MISSION AND ALL OF THE
WELL-INTENTIONS WE'VE HAD, WE
KNOW THESE NUMBERS ARE STILL
THERE AND THAT PEOPLE ARE STILL
DISPROPORTIONATELY AFFECTED.
SO, THE NINDS, RECENTLY
COMPLETED A STRATEGIC PLANNING
PROCESS FOR HEALTH EQUITY.
WE HAD A GROUP OF OVER 30 EX
PERS FROM AROUND THE COUNTRY,
SIMILAR TO YOURSELF, SOME OF THE
PEOPLE ON THE COMMITTEE WHO MET
PAIN STAKINGLY TO DISCUSS THE
LITERATURE INPUT FROM THE
COMMUNITY AND TO COME UP WITH
THE SET OF RECOMMENDATIONS ON
WHAT THE NINDS COULD DO TO
ADDRESS HEALTH INIQUITIES.
THEY HAD A TOTAL OF 18 HIGH
LEVEL RECOMMENDATIONS EMPLOY ALL
OF THESE RECOMMENDATIONS WERE
PUBLISH INDEED A DEDICATED
SUPPLEMENT IN THE NEUROLOGY
JOURNAL AND I JUST MENTIONED
THAT.
I JUST SHOWED THAT PREVIOUSLY,
THE NEUROLOGY JOURNAL WHICH IS
THE LARGEST YOWRNAL FOR CLINICAL
NEUROLOGY IN THE WORLD.
WE TOOK THAT INFORMATION FROM
THAT -- OUR WORKING GROUP OF OUR
NATIONAL ADVISORY COUNCIL, THOSE
RECOMMENDATIONS AND WE PUT THEM
-- BUCKETED THEM INTO 4
CATEGORIES AS PART OF OUR
IMPLEMENTATION PLAN, AND THESE 4
CATEGORIES ACTUALLY ALIGN TO
SOME OF THE MAJOR CATEGORIES
THAT WERE OUTLINED IN YOUR NASEM
REPORT, THE 2 I GUESS, THE AREAS
OR LEVERS THAT WE HAVE HERE AT
THE NIH IS FOCUSED ON RESEARCH,
BUT THEY FALL INTO THE 2
CATEGORIES, 1 DEALS WITH THE
COMMUNITY AND THE OTHER RESEARCH
INFRASTRUCTURE AND SO OUR 4
CATEGORIES INCLUDE EXPANDING
RESEARCH FOR HEALTH EQUITY
RESEARCH, PROMOTING COMMUNITY
ENGAGEMENT WITH NIH DEFINED
POPULATIONS THAT EXPERIENCE
HEALTH DISPARITIES, ALSO
DEVELOPING THE HEALTH EQUITY
RESEARCH WORKFORCE WHICH WAS
DISCUSSED IN SLIDES FROM PANEL
MEMBERS, AS WELL AS EXPANDING
COMMUNICATION AND OUTREACH TO
THOSE POPULATIONS AFFECTED AS
WELL.
DURING OUR STRATEGIC PLANNING
PROCESS WE HAD AN NINDS SOCIAL
DETERMINANTS OF HEALTH
FRAMEWORK, THIS WAS DISCUSSED
EARLIER, THERE ARE OTHER FACTORS
UPSTREAM FROM THE INDIVIDUAL
THAT IMPACT PEOPLE AND A LOT OF
THESE INCLUDE STRUCTURAL
BARRIERS HERE, AND THIS NINDS
FRAMEWORK GOES ALONG WITH THE
EXPOETICSOME FRAMEWORK AND ALSO
CONSISTENT WITH THE NIMHD HEALTH
DISPARITIES FRAMEWORK, WE WANTED
ALL OF THESE TO BE CONSISTENT IN
TERMS OF WORKING TOGETHER WITH
THESE VARIOUS TBRAIM WORKS AND
SO WE HAD SEVERAL INITIATIVES
THAT WE CREATED SO FAR, WE HAD 1
CALLED THE COMMUNITY INGEAJED
HELT EQUITY RESEARCH AND
NEUROSCIENCE INITIATIVE.
THIS HAD 3 COMPONENTS, 1 WAS
THAT RESEARCHERS HAD TO BE
FOCUSED ON THE NEUROLOGICAL
DISEASE, THEY HAD TO HAVE SOME
FORM OF COMMUNITY ENGAGEMENT AND
SO WE LOOKED AT BEST PRACTICES
AND COMMUNITY ENGAGEMENT WHERE
THIS WAS A PARTNERSHIP BETWEEN
AN ACCESSING DEMIC INSTITUTION
AND A COMMUNITY ORGANIZATION,
COULD BE FEDERALLY QUALIFIED
HEALTH CENTER, FAITH-BASED
ORGANIZATION OR SOME TYPE OF
COMMUNITY ORGANIZATION THAT
REPRESENTED THE POPULATION THAT
THE INSTITUTION WAS STUDYING AS
WELL AS A HEALTH EQUITY AND
RESEARCH PROJECT INCLUDING
PEOPLE FROM THE REPRESENTATIVE
POPULATION THAT WAS BEING
STUDIED AND AN INTERDISCIPLINARY
TEAM THAT REFLECTED THE PEOPLE
BEING STUDIED.
SO WE HAD SEVERAL INITTIAIVE
ITS, RO-1 INITIATIVES, R34
INITIATIVES AND WE HAD ANOTHER
SIMILAR FUNDING ANNOUNCEMENT
THAT WAS PLACED, THAT WAS
ACTUALLY FOCUSED SPECIFICALLY ON
ALZHEIMER'S DISEASE RELATED
DEMENTIA WORK RESEARCH AND SO WE
CAN TALK ABOUT THAT IF PEOPLE
HAVE QUESTIONS LATER ON.
WE ALSO SUPPORT A DIVERSITY
SUPPLEMENT PROGRAM SPECIFICALLY
RELATED TO ADRD WORK AND SOME
OTHER INITIATIVES HERE.
I WILL HIGHLIGHT 1 OTHER -- 1 IS
SORT OF A NOVEL COMMUNITY
OUTREACH COMPAIN GEARED TOWARDS
AFRICAN-AMERICAN MEN.
WE KNOW THAT AFRICAN-AMERICAN
MEN HAVE THE HIGHEST RATE OF
UNCONTROLLED HIGH BLOOD PRESSURE
IN THIS COUNTRY AND UNCONTROLLED
HYPERTENSION IS ASSOCIATED WITH
MULTIPLE CO-MORBIDITIES AND
OUTCOMES LIKE CARDIOVASCULAR DEC
AND STROKE AND ALSO THERE'S A
CONNECTION WITH COGNITIVE
IMPAIRMENT AND DEMENTIA.
SO WE CREATED THIS COMMUNITY
OUTREACH RELATED PUBLIC HEALTH
CAMPAIGN AND WE PARTNERED WITH
MULTIPLE HEALTH ASSOCIATIONS AND
COMMUNITY ORGANIZATIONS LIKE THE
ALZHEIMER'S ASSOCIATION,
AMERICAN STROKE ASSOCIATION AND
OTHERS.
WE PARTNERED WITH OTHER HBCUs
AS WELL AS PULT PEL MEDIA
PLATFORMS LIKE THE NATIONAL
ASSOCIATION OF BLACK JOURNALISTS
AND OTHERS AS WELL JUST TO NAME
A FEW.
AND WE DID SEVERAL WEBINARS AS
WELL TO GET OUR MASSAGE OUT
THERE AND WE SAW THAT THIS
INFORMATION ACTUALLY DROVE MORE
PEOPLE TO OUR WEBSITE WHICH IS
SORT OF 1 OF THOSE INTERMEDIATE
MARKERS OF IMPACT WE LOOKED AT.
OBVIOUSLY WE CAN'T LOOK AT
OUTCOMES SUCH AS STROKE OR
DEMENTIA BUT WE LOOK AT
INTERMEDIATE IMPACTS OF PEOPLE
COMING TO THE WEBSITE.
I WILL TOP THERE, THIS WAS A
BRIEF OVERVIEW AND HOPEFULLY WE
WILL HAVE A NICE ROBUST
DISCUSSION AT THE END.
I WILL STOP SHARING THE SLIDES.
>> SO I HAVE RICHARD UP NEXT,
NO, YES, RICHARD HODES.
>> SHARING WORKING?
>> THERE YOU GO.
>> OKAY.
WELL, THANKS FOR THE CHANCE TO
PARTICIPATE IN THIS.
A LOST ACTIVITIES AS NOTED BY
RICHARD BENSON HAVE BEEN
COLLABORATIVE ACROSS THE
INSTITUTES AT NIH BUT 1 IN
PARTICULAR TO EMPHASIZE SOME OF
THE ASPECTS WHICH ARE SOMEWHAT
UNIQUE TO NIA AND ITS MISSION.
AS ILLUSTRATED HERE, THE CHARGED
CONGRESSIONAL MANDATE FOR NIH
FROM NIA AT THE TIME WAS
FOUNDATION HAS BEEN BROAD.
IT INVOLVES THE GENETIC CLINICAL
AND BEHAVIORIAL SOCIAL BUT ALSO
ECONOMIC AND VERY POLICY
RELEVANT ASPECTS OF AGING AND IN
THAT SENSE, PROVIDES A CRITICAL
PERSPECTIVE FOR THE RESEARCH
THAT WE SUPPORT AROUND THE
POPULATIONS OF OUR DISCUSSION
TODAY.
>> I WOULD LIKE JUST TO
EMPHASIZE THE PROGRAMS WHICH WE
PARTICIPATE IN AT NIEKSA.
WE HAVE THE GREAT OPPORTUNITY
AND PRIVILEGE IN PARTICIPATING
MANY NIH WIDE INITIATIVES BUT
SUPPORTED THIS ACTION 31A,
LOOKING TO INVEST IN DIVERSITY
OF RESEARCHERS, I WILL JUST
POINT TO A FEW RELATIVELY UNIQUE
1S AS PART OF NIA, 1 IS THE NIA
HEALTHY AGING START UP CHALLENGE
WHICH IS AN ENTREPRENEURIAL
EFFORT IN ADDITION TO OUR USUAL
GRANT MECHANISMS WE PROVIDE A
BOOT CAMP AND TRAINING
OPPORTUNITY FOR INDIVIDUALS FROM
DIVERSE BACKGROUNDS WHO MAKE
THEIR PROPOSAL IN DIVERSE
RESEARCH AREAS AS WELL, THEY GO
THROUGH CHALLENGES, PRIZES,
COMPETITIONS, AND THE PRIZE
WINNERS WHICH IS THE LARGEST
PRIZE AWARD AS WELL AS FUNDING
FOR THEIR SBIR INITIATIVE.
SO IN ADDITION TO WANTING TO
PROVIDE THE NIH MAIN STREAM
SUPPORTED GRANT PROGRAM
REALIZING OPPORTUNITIES
ELSEWHERE, WE'VE HAD GREAT
SUCCESS IN FOSTERING A GREAT
DIVERSITY OF INDIVIDUAL WHO IS
MIGHT NOT HAVE BEEN A PART OF
THE USUAL GRANT APPLICATIONS TO
NIH.
>> THE BUTLER-WILLIAMS SCHOLARS
PROGRAM IS A WEEK LONG PROGRAM
HERE AT NIH AND INVESTIGATOR
STAGE AND THOSE TO AGING
RESEARCH AND PROVIDES AN
OPPORTUNITY TO WORK WITH BOTH
NIH EXTRAMURAL STAFF AS WELL AS
LEADERS IN THE FIELD WHO WILL
CONVERGE FOR INTENSIVE
INTERDISCIPLINARY OPPORTUNITY
WITH EXERCISES SUCH AS GRANT
WRITING AND MOCK REVIEWS, BUT
VERY SUCCESSFUL OVER THESE YEARS
IN ESTABLISHING REAL COHORTS OF
INDIVIDUALS FROM COMPLEEM
DIVERSE COMPOSITION WHO
MAINTAINED THEIR CONTACTS WITH
THE INSTITUTE AND MANY OF WHOM
WHO HAVE GONE ON TO BE LEADERS
OF NIH NATIONALLY AND GLOBAL.
THE BEESON EMERGING LEADERS
AWARD IS 1 FOR EXPANDED
OPPORTUNITIES FOR FUNDING IN
RESEARCH SUPPORT.
GRANT FOR EARLY MEDICAL SURGICAL
SPECIALISTS IS 1 THAT COMBINES
SMALL GRANTS TOGETHER WITH
MENTORING PROGRAMS TO TAKE
PEOPLE AT EARLY STAGES OF
MEDICAL AND SURGICAL SPECIALTIES
AND BRING THEM INTO RESEARCH.
AND THERE TO WE'VE HAD GREAT
SUCCESS IN THE DIVERSITY OF
INDIVIDUALS RECRUITED.
WE HAVE DIVERSITY AND
TRANSLATION PROGRAMS, F31s AND
F32s, SMALL RESEARCH GRANTS
FOR NEXT AGAINERATION OF
CLINICAL RESEARCHERS AND THEN
MSTEM, AGING RESEARCH AGING
RESEARCH DISSERTATION AWARDS AS
WELL.
SO IN THESE SEVERAL AREAS
COUPLED WITH THE LARGE NUMBER OF
INITIATIVES THAT ARE AT NIH
WIDE, WE'RE COMMITTED TO DOING
WHAT WE CAN TO DIVERSIFY THE
RESEARCH FIELD.
LOOKING AT WAYS TO ENHANCE
INFRASTRUCTURE, JUST A NUMBER OF
PROGRAMS HERE, THE NIA FUNDED
RESOURCE CENTERS ARE RICK
NORRIS, A PROGRAM AIMED AT BOTH
FOSTERING RESEARCH WITH PILOT
GRANTS FOR RESEARCH AROUND AREAS
OF MINORITY HEALTH AND HEALTH
DISPARITIES BUT ALSO PROVIDING 1
OF THE GREAT OPPORTUNITIES FOR
TRAINING AND I THINK ONCE AGAIN
MANY OF THE LEADERS OF NIH, AND
NATIONALLY HISTORICALLY OVER THE
PAST YEAR ANDS NOW DECADE VS
COME THROUGH THIS PROGRAM.
THE LARGEST CENTERS PROGRAM AT N
IA EXCUSE ME IS THE ALZHEIMER'S
RESEARCH CENTERS AND THEY ALL
HAVE OUTREACH CORES.
THESE HAVE BEEN VERY MUCH DREKED
TOWARDS DIVERSITY IN THE
POPULATIONS THEY 7 AND HAVE
DIVERSIFIED BOTH BASIC RESEARCH
AS WELL AS THE TRANSLATIONAL
RESEARCH WHICH IS NO LONGER JUST
HYPOTHETICALLY BUT DEMON
STRAIBLLY ILTRAITIVE IN WHICH
THE WAY STUDYING DIVERSE
POPULATION SYSTEM IM PERRATIVE
FOR SERVING THOSE DIVERSE
POPULATIONS BUT ALSO BEING
INFORMATIVE FOR THE RESEARCH
FINDING, BEING THEY GENETIC
MEDICAL, CLINICAL, SOCIAL,
BEHAVIORIAL ACROSS DIVERSE
POPULATIONS.
I WOULD LIKE TO TALK FURTHER
ABOUT THE CHALLENGES WE FACE IN
RECRUIT AM OVER THE TRIALS, SO
WE PUT TOGETHER A SERIES OF
WEB-BASED OUTREACH PROGRAMS,
THAT ARE AVAILABLE FOR
ADAPTATION AND USE
INVESTIGATORS, NATIONAL
STRATEGY, AND I'VE TURNED
FINALLY TO THE MOST RECENT
EDITION PROGRAM, ACCOUNTABILITY
WAS MENTIONED AND WE FOUND A
CHALLENGE IN THE WELL
INTENTIONED BUT SOMETIMES
INADEQUATELY DESIGNED AND
INADEQUATELY TRACKED EFFORTS TO
RECRUIT EFFORTS OF OUR
POPULATION SO WE IMPLEMENTED A
SERIES OF POLICIES WE'VE SEEN
ILLUSTRATED HERE BY A SERIES
EVEN BEFORE INVESTIGATORS HAVE
PERMISSION TO SUBMIT THEIR
APPLICATIONS AND THAT AS YOU
KNOW IS NECESSARY FOR THE
APPLICATIONS OVER $500,000 THAT
ARE REQUIRED IN THEIR PROPOSAL
AS THE PREAPPLICATION TO HAVE A
PLAN FOR RECRUITMENT IN THE
DEMOGRAPHIC SO THAT RECRUITMENT
WITH A JUSTIFICATION THEREOF AND
IT WAS NOT ADEQUATE.
WE WON'T ACCEPT THEM FOR REVIEW.
ONCE THEY ARE ADEQUATE AND
ACCEPTED FOR REVIEW, WE TRACK
VERY CAREFULLY THROUGH THE
REVIEW PROCESS AND CONDITIONS
FOR AWARD BUT IN TERMS OF
ACCOUNTABILITY, CAN YOU SEE
ILLUSTRATED AT THE GRAPHS TO THE
RIGHT IS A NEWLY IMPLEMENTED
SYSTEM IN WHICH A NEAR REALTIME
AS INDIVIDUALS WERE RECRUITED IN
CLINICAL RESEARCH AND STUDIES,
BEGINNING FIRST WITH THE
ALZHEIMER'S STUDIES BUT MORE
GENERALIZED THEIR DATA ARE
ENTERED INTO A CENTRALIZED DOOTA
BASE.
SO NEAR A PERIOD OF TIME WE
SHOULD GET THE, CREWAL AND
SUBPOPULATIONS OF THOSE AND WE
HAVE EARLY WARNING AND SENSE
THERE OF HOW WELL THINGS ARE
GOING IN TERMS OF OVERALL
RECRUITMENT AND IN TERMS OF
RECRUITMENT MEETING THE TARGETED
GOALS OF DIVERSITY AND
POPULATIONS.
THIS MEANS THAT IN EARLY TIME WE
CAN DEVELOP AND HAVE A MECHANISM
FOR DOING SO, RECTIFIED
CORRECTIVE ACTION PLAN TO ASSIST
INVESTIGATORS IN MEETING THE
CRITERIA THAT THEY'VE INDICATED
AS THOSE OF SUCCESS.
IT'S EARLY IN THE PROGRAMS BUT
ALREADY WE'RE COMING ACROSS
SIGNS AND CRITERIA FOR THOSE
STUDIES WHICH WERE SHOWING
PROBLEM AT AN EARLY ENOUGH TAIJ
TO INTERVENE AND ASSIST, SO IT'S
NOT PUNITIVE OR RATHER
CORRECTIVE, AND THEN FINALLY
JUST ILLUSTRATE THE MULTIPLE
WAYS THAT ALL OF US AT NIH, BUT
NIA IN PARTICULAR HAVE TO STAY
INFORMED OF THE PROGRAMS
CARRYING IT OUT.
HERE'S 1 IN DIA OR HERE TOO THE
POINT OF WHICH WE'RE RECEIVING
RECOMMENDATIONS THAT WILL
ULTIMATELY DRIVE THE STRATEGIC
PLANS BY WHICH WE ACT.
SO THAT'S IT FOR THOSE
PRESENTATIONS FROM NIA.
AND THANKS FOR THE OPPORTUNITY
TO PARTICIPATE.
>> THANK YOU RICHARD AND THEN
JEANNE.
NYEAH, HERE I AM HERE PULLING UP
THE END HERE, AM I THE LAST
PERSON.
YEAH, BECAUSE SHANNON'S NOT
HERE.
OKAY.
SO I'M GOING A BIT ROGUE IN A
COUPLE OF WAYS, 1 I HAVE NO
SLIDES AND THERE ARE 2 REALLY
BIG REASONS FOR THAT.
ONE IS THAT WHEN I THOUGHT ABOUT
THIS I QUICKLY GOT VERY
OVERWHELMED BECAUSE THERE IS SO
MUCH TO TALK ABOUT AND RELATING
IT DIRECTLY I THINK TO CARE AND
ADDRESSING UNEQUAL TREATMENT AND
REALLY HARD.
I MEAN LIKE AND I'LL COME BACK
TO MY THOUGHTS ABOUT THAT THE
OTHER REASONS IS I FIGURED YOU
WOULD BE TOTALLY POWER POINTED
OUT BY NOW AND NOT JUST MORE
POWER POINT EVEN THOUGH THE
SLIDES WERE EXCELLENT AND
PROBABLY HELP FOCUS PEOPLE AND I
WOULD RATHER HAVE MORE TIME FOR
DISCUSSION BUT LET ME TELL YOU A
FEW THOUGHTS.
SO FIRST OF ALL WHEN YOU LOOK AT
INFECTIOUS DISEASES AND LET ME
GIVE YOU A SENSE OF OUR MISSION,
WE SUPPORT AND CONDUCT
BIOMEDICAL RESEARCH TO BETTER
UNDERSTAND AND TREAT INFECTIOUS
IMMUNOLOGIC AND ALLERGIC DECS SO
TECHNICALLY A LOT OF PRIMARY
IMMUNOLOGIC RESEARCH IN OUR
INSTITUTE AS WELL AS ALLERGY AND
THAT'S HUGE FOR HEALTH EQUITY
AND I WILL COME BACK TO THAT.
BUT JUST SO YOU'RE AWARE OF THE
SPECTRUM OF WHAT WE DO.
SO THE -- WHEN YOU LOOK AT
INFECT YOURCANDIDATES DISEASES
IN HEALTH EQUITY IT IS NOT HARD
AT ALL.
THE REASON I GOT OVERWHELMED
THINKING ABOUT THIS IS JUST
UNBELIEVABLE EXAMPLES OF HOW
HEALTH EQUITY THROUGH CARE AND
THEREFOREY OF INFECT
YOURCANDIDATES DEC RELATED AND
INTERVENTIONS AND ALLERGY, TOO,
REALLY STAND OUT.
AND I JUFULT WANT -- JUST WANT
TO GIVE YOU A COUPLE EXAMPLES
THAT I THINK WILL HELP SET AND
MAYBE IT WILL INFORM OUR
DISCUSSION IN PARTICULAR.
SO LET'S START BUT WITH 1 THAT
PEOPLE DON'T TALK ABOUT A LOT
AND THAT'S TUBERCULOSIS..
TUBERCULOSIS, SUPPRESSED KOSK 19
AS THE MOST INFECTIOUS DISEASE
IN 2022, WHICH IS THE YEAR
THEY'RE REPORTING ON.
AND PEOPLE OFTEN THINK THIS IS A
DISEASE THAT IS NOT A BIG DEAL
IN THE UNITED STATES BUT I WANT
TO POINT OUT A PAPER IN JARKS
AMA THAT CAME OUT JUST THIS PAST
SEPTEMBER AND IT WAS AN ANALYSIS
LOOKING AT CONTINUED RACIAL AND
ETHNIC DISPARITIES IN TB CASES
AND DEATHS AMONG U.S. PERSONS
BORN IN THE U.S.
AND BASICALLY THEY DID A -- TO
ME THIS IS TERRIFIC HEALTH
EQUITY RESEARCH.
IT'S NOT -- IT'S NOT AGAIN, I AM
NOT A HEALTH QUESHESITY
RESEARCHER PER SE, CERTIFIED BUT
TO ME, THIS IS GETTING AT SOME
OF THE ILLUMINATING SOME OF THE
DATA THAT WE NEED TO USE TO
DESIGN THE INTERVENTIONS TO
ADDRESS THIS, SO WHAT THEY
REPORTED WAS THAT UNDER THE
SCENARIO WHERE THE CURRENT
RACIAL AND ETHNIC INEXPECTATIONS
QUITYS IN TTB INCIDENTS AND
DEATH CONTINUE FROM 2023 TO 2035
AN ESTIMATED 45% OF ALL TB CASES
AND DEATHS IN THE UNITED STATES
AMONG U.S. BOARN PEOPLE THIS IS
NOT EACH THE PEOPLE WE OFTEN
THINK ABOUT AS QUOTE-UNQUOTE
BRINGING TB TO THE UNITED STATES
FROM OTHER COUNTRIES WHERE IT IS
PERCEIVED TO BE MORE COMMON.
SO AN ESTIMATED 45% OF ALL CASES
AND DEATHS WOULD BE ASSOCIATE
WIDE RACIAL AND ETHNIC
INEQUALITIES -- INIQUITIES AND A
GREATER PROPORTION OF CASES AND
DEATHS AMONG RACIAL POPULATIONS
AND IF YOU LOOK AT THE COST HERE
THAT COULD BE REMEDEIABLE IF YOU
ADDRESS THESE HEALTH EQUITY
DISPARITIES IT WOULD COST THE
U.S. ABOUT A BILLION DOLLARS.
SO TB IS A GREAT EXAMPLE OF HOW
INEXPECTATIONS QUITYS ACROSS THE
BOARD JUST CONTINUE TO CREATE
THIS VERY VULNERABLE POPULATION.
THE OTHER EXAMPLE THAT I WILL
JUST TALK ABOUT BRIEFLY IS HIV.
AND I THINK YOU ARE AWARE THAT
FOR EXAMPLE, IF YOU LOOK AT THE
MOST RECENT STATISTIC FOR HIV
INCIDENCE IN THE UNITED STATES,
AMONG WOMEN OVERALL IN 2022, 47%
WERE AMONG BLACK WOMEN.
FORTY-SEVEN% OF THE NEW HIV
INFECTIONS IN 2022 DESPITE THE
FACT THAT BLACK WOMEN ARE LESS
THAN 12% OF THE U.S. POPULATION.
SO I DON'T KNOW HOW YOU CAN GET
MUCH MORE STAGGERINGLY
IMPRESSED.
START TO LOOK AT THE NUMBERS,
PARTICULARLY LATINO HISPANIC MEN
WHO HAVE SEX WITH MEN AND THAT
IS REALLY STRIKING AS WELL, THEY
ACCOUNT FOR A LITTLE UNDER HALF
OF ALL INFECTIONS.
NEW HIV INFECTIONS AMONG GAY,
BISEXUAL AND OTHER MSM, SO I
JUST USE THOSE 2 INFECTION SORT
OF SCENARIOS TO FRAME THE
DISCUSSION OF HOW SEVERE THESE
HEALTH DISPARITIES ARE AND SO
MUCH OF IT IS RELATED TO HEALTH
EQUITY.
I COULD GIVE YOU MANY OTHER
EXAMPLES IF YOU LOOK AT RATES OF
CONGENITAL SYPHILIS, WE HAVE AN
EXPLOSION AS, LISEO AND I AND
OTHERS HAVE TALKED ABOUT IN
WOMEN WHO ARE IN TRIBAL
POPULATIONS, NATIVE AMERICAN
POPPULESS, JUST HUGE NUMBER OF
CASES OCCURRING IN THOSE AREAS,
TALK ABOUT HEALTH INEQUITY IN
TERMS OF ACCESS AND PROVISION OF
APPROPRIATE SCREENING AND CARE
FOR SYPHILIS IN PREGNANCY.
VIRAL HEPATITIS AND OF COURSE
SECTIONUALLY TRANSMITTED
INFECTIONS WHICH IS THE AREA I
KNOW BEST.
SO ALL THAT TO SAY IT'S A GREAT
LAB RAARE TOY FOR I THINK AND
IT'S WHAT BROUGHT MANY OF US
INTO THE FIELD, RIGHT WHO WERE
VERY INTERESTED IN SOCIAL
JUSTICE AND HEALTH EQUITY ISSUES
AROUND HIV CARE PROVISION.
WHEN THE DISEASE FIRST CAME OUT.
SO ELISEO MENTIONED HIV AND I
WANT TO TALK A LITTLE BIT ABOUT
HOW NIAID IN PARTICULAR OVER THE
LAST 3 DECADES HAS DRAMATICALLY
SHIFTED THE LEVEL OF THE CARE
AND DIALOGUE AROUND INVOLVING
COMMUNITIES AND ADDRESSING
HEALTH EQUITY IN RESEARCH
RELATED TO HIV CARE EMPLOY
BECAUSE I TIMES DON'T KNOW IF
PEOPLE REALIZE WHAT A GOLD
STANDARD, SOME OF THE HIV
RESEARCH NETWORKS HAVE SET, OR
ENGAGING COMMUNITY AND
ADDRESSING HEALTH DISPARITIES,
HEALTH INEQUITY WHEN WE THINK
ABOUT PARTICIPATION AND RESEARCH
AND ALSO IN IMPLEMENTATION
SCIENCE WHICH WE HAVE EMBRACED
QUITE A LOT MORE IN THE LAST
5-10 YEARS, 5 YEARS THAN WE EVER
HAVE BEFORE BECAUSE PEOPLE OFTEN
THINK OF NIAID AS DOING BASIC
SCIENCE ONLY AND THAT IS REALLY
NOT -- NOT EXCLUSIVELY TRUE AT
ALL.
SO I THINK I WOULD JUST POINT
OUT THAT THE HIV NETWORKS WHICH
INCLUDE THE HIV VACCINE TRIALS
NETWORK, HIV PREVENTION TRIALS
NETWORK, CLINICAL TRIALS GROUP
WHICH REALLY STUDIES TREATMENT
AND CO-MORBIDITIES IN HIV, VERY
IMPORTANT IN AGING AS RICHARD
HAS MENTIONED, THOSE GROUPS HAVE
PROBABLY SOME OF THE MOST ROBUST
COMMUNITY WORKING GROUPS I HAVE
EVER WORKED WITH AND THEY ARE
REALLY ENGAGED FROM THE CONCEPT
DEVELOPMENT OF AN INTERVENTION
ALL THE WAY THROUGH HOW YOU
DISSEMINATE THE FINDINGS TO THE
COMMUNITY AND WHAT THE IMPACT ON
THE COMMUNITY IS GOING TO BE AND
I THINK THAT THAT SORT OF
SPECTRUM OF INVOLVEMENT CAN
ADDRESS AT LEAST A LOT OF THE
ISSUES AROUND GETTING PEOPLE TO
UNDERSTAND WHAT PARTICIPATING IN
RESEARCH IS ABOUT AND MORE
IMPORTANTLY MAKING SURE THAT THE
RESEARCH SPEAKS TO THE NEEDS OF
COMMUNITIES ESPECIALLY THOSE WHO
HAVE SIGNIFICANT HEALTH
DISPARITIES, SO I'M REALLY PROUD
OF THAT, IT'S NOT PERFECT, I'M
NOT SAYING WE'RE THE ONLY PEOPLE
WHO DO IT, BUT HAVING GOTTEN
INVOLVED IN SOME OTHER NETWORKS
THAT STUDY INFECTIOUS DISEASES,
CAN SAY I THINK IT SETS A VERY,
VERY HIGH STANDARD.
THE OTHER THING THAT WAS
DISCUSSED A BUNCH OF TIMES
TODAY, AT LEAST FROM THE NINDS
TEAM AND ALSO FROM THE NIA TEAM
IS HOW YOU DEVELOP THE WORKFORCE
FOR SCIENTIFIC INVESTIGATION AND
OF COURSE WE DO ALL THE THINGS
THAT YOU ALWAYS MENTIONED IN
TERMS OF PRIMATES PORITIZING
RESEARCHER DIVERSITY, THE
NETWORKS HAVE FELLOWSHIP PILOT
AWARDS SO THAT THEY'RE WORKING
IN AREAS WHERE DISPARITIES ARE
REALLY INTENSE.
SO THEY DO A REALLY GOOD JOB,
BUT YOU KNOW I WANT TO MAKE THAT
LINK BETWEEN THE DIVERSITY OF
RESEARCH TEAMS INVESTIGATORS,
PROVIDERS AND QUALITY OF CARE TO
PEOPLE WHO ARE EXPERIENCING
HEALTH INIQUITIES, DOES IT
MATTER?
AND I KNOW VERY BRIEFLY 1 OF THE
INTRODUCTORY SPEAKERS INVOLVED
IN THIS EXCELLENT REPORT TALKED
ABOUT THE RESEARCH THAT LOOKS AT
CONCORDANCE OF PROVIDERS WITH
THEIR PATIENTS AND WHETHER THAT
RELATES TO OUTCOMES COMES OR
SATISFACTIONS.
AND THINK BEING THAT IN THE
SOUTH, CAN BE STIGMATIZED TO IT
CAN BE DIFFICULT TO TALK TO
PEOPLE WHO DON'T LOOK LIKE YOU,
DON'T UNDERSTAND WHERE YOU CAN
AM FROM, TALK LIKE YOU, AND I
HAVE ANECDOTAL DATA FOR THIS BUT
THERE'S A LOT OF DATA THAT LOOKS
AT THIS.
BUT I CAN'T EMPHASIZE ENOUGH
WHAT IS THE IMPORTANCE OF
CREATING A FORK FORCE WHETHER
YOU'RE TALKING -- WORKFORCE
WHETHER YOU'RE TALKING ABOUT
PATIENT CARE, I THINK THAT'S
SOMETHING WE HAVEN'T DONE A GOOD
JOB OF AND HAVE A REMAINING
CHALLENGE FOR.
THE LAST THING I WILL SAY IS
THAT THERE ARE A COUPLE OF
PROGRAMS AND AS PART OF THIS I
AM REALLY EMBARRASSED BY WHAT
COMES UP IF YOU DO A RESEARCH OF
NIAID AND HEALTH EQUITY BECAUSE
YOU GET A PAGE THAT I JUST TRIED
-- CONTACTED MY COMS PERSON
ABOUT BECAUSE IT IS REALLY LAME.
IT LISTS 2 PROGRAMS THAT ARE
EXCELLENT.
THE REPRIEVE PROGRAM WHICH YOU
MAY KNOW IS A STUDY WE DID WITH
NHLBI, TO LOOK AT EARLY STATIN
THERAPY IN PEOPLE LIVING WITH
HIV, REGARDLESS OF WHETHER THEY
HAD HIGH CHOLESTEROL AND IT
SHOWED BEAUTIFUL RESULT IN
ENHANCING OUTCOMES AND IT ALSO
TALKS ABOUT OUR ASTHMA WORK
WHICH GETTING BACK TO
INIQUITIES.
IF YOU LOOK AT RACIAL
DISPARITIES IN ASTHMA IN
CHILDHOOD, THAT IS REALLY WHAT
SORT OF GALVANIZED A LOT OF
PEOPLE TO STUDY THE PATTERNS OF
INNER CITY ORIGINALLY ASTHMA AND
REALLY DEFINE WHAD WAS MODIFYING
THE LIKELIHOOD OF REACTIVITY AND
INTERVENTIONS DESIGNED TO
ADDRESS THOSE THINGS.
WE HAVE DONE SO MUCH MORE AND 1
THING I WANT TO POINT OUT BAUDS
WE LOOK SO BAD ON THAT TABLE
THAT'S IN THE REPORT, I'M A
LITTLE DEFENSIVE ABOUT THAT
TABLE BECAUSE WHAT'S NOT
REPRESENTED IN THAT TABLE AND
ALSO IT'S A HUGE TIME SPAN, I
WILL TELL YOU THINGS ARE VERY
DIFFERENT THAN THEY WERE IN
2004.
WHAT IT DOESN'T TELL YOU IS THE
INVESTMENT WE PUT FOR EXAMPLE,
IN OUR HIV RELATED NETWORKS THAT
GOES TO THE COMMUNITY PIECES
THAT I THINK DIRECTLY ADDRESS
AND SUPPORT HEALTH EQUITY WORK
BUT IT'S HARD TO SORT OF DRIVE
THAT LINK OR SORT OF, YOU KNOW
SORT OF DEFINE THAT LINK
DIRECTLY.
COUPLE OF OTHER EXAMPLES THAT I
THINK SPEAK TO OUR POWER IN
ADDRESSING HEALTH EQUITY, WE
HAVE DONE AN INTRAMURAL PROGRAM
AND I SEE THIS WORK LARGELY LED
BY HENRY MASSUER, WORKING IN
INNER CITY BALTIMORE, INNER CITY
D. C. SPURRED BY FINDING IN
EARLY 2010s THAT THE HIV
INDENSE IN D. C. WAS HIGHER IN
SOME PLACES THAN IN SUB-SAHARAN
AFRICA, OVER 8% AND WE WORKED
REALLY HARD TO PARTNER WITH
COMMUNITY PARTNERS TO GET
INTERVENTIONS OUT THERE AND
AFFECT SOME OF THE CLIENTS THERE
AND HAD DONE THE SAME IN
BALTIMORE.
SO I WILL TOP THERE.
THERE'S JUST SO MUCH RICH
DISCUSSION TO BE HAD HERE.
AND I REALLY LOOK FORWARD TO
QUESTIONS AND PEOPLE CHALLENGING
ME.
THANKS.
>> WELL WE ONLY HAVE A FEW
MINUTES LEFT BUT THIS WAS REALLY
SPECTACULAR AND JEANNE, YOU'RE
RIGHT.
HIV IS A MAJOR MAJOR PART OF ALL
OF THIS AND IT'S A SUCCESS
STORY, THAT'S WHY WE WANT TO
KEEP PUSHING FOR ELEMINATION
WITH 70% OF BOTH PEOPLE LIVING
WITH HIV AND NEW INFECTIONS
COMING, AND MOSTLY WITH MEN OF
COLOR WHO HAVE SEX WITH MEN BUT
ALSO AS YOU POINTED OUT THE
WOMEN WHO HAVE INTIMACY WITH
THESE INDIVIDUALS I THINK IT'S A
MAJOR AREA OF EMPHASIS THAT WE
ALL HAVE TALKED ABOUT.
SO I ALSO WANT TO SEE IF
MARGARITA AND CONSUELO, AND
DARREL WHO JOINED US HAVE
QUESTIONS FOR YOU GUYS.
>> I JUST WANTED TO MAKE A
COMMENT TO DR. HODES, WE HAVE A
TRIAL THAT WE JUST FINISHED IN
YOU'RE INSTITUTE AND WE WERE
ABLE TO RECRUIT 427 MINORITIZED
INDIVIDUALS, SO IT'S DOABLE,
IT'S REALLY DOABLE, WHEN I HEAR
PEOPLE SAYING IT'S HARD TO
RECRUIT, I THINK IT DEPENDS THE
STRATEGIES THAT ARE DONE, WE ARE
DOING WAY BETTER IN TERMS OF
RECRUITMENT AND ALSO IN
REPRESENTING THE POPULATIONS.
I THINK THE BIGGEST ISSUE IS
HAVING TRUST, THE COMMUNITY
HAVING TRUST IN US.
AND I THINK THAT'S WHERE WE HAVE
FAILED AND I THINK WE NOW NEED
TO MAKE SURE THAT WE INVEST IN
THE NEXT YEARS TO DO THAT
BECAUSE IT'S VERY DOABLE AND
THEN DO DR. MARRAZZO, I'M SO
GRATEFUL FOR THE TB EXAMPLE
BECAUSE I THINK WE'RE MISSING
THE BOAT AND NOT SEEING THIS AS
-- ESPECIALLY HAVING RACIALLY
ETHNICALLY AND LANGUAGE
CONCORDANT PROVIDERS THAT CAN
REALLY LINK TO THE POPULATION.
SO THANKS FOR MAKING THOSE AND
DR. BENSON, I THINK IT'S
COMMENDABLE OF ALL OF YOU THAT
WE ALL HAVE THE SAME GOAL OF
MAKING SURE THAT THE NEXT 10
YEARS WE DON'T DO A REPORT THAT
HAS THE SAME RESULTS.
>> YEAH, I ALSO ECHO THE
COMMENDATIONS, EVERYONE'S
COMMITMENT TO THIS WORK, IT'S
REALLY GREAT TO SEE THIS
HAPPENING AT SO MANY INSTITUTES
AT THE N IH, I ALSO WOULD ECHO
MAGGIES COMMENTS ABOUT THE
RECRUITMENT, YOU KNOW WE SEE
RECRUITMENT INTO STUDIES AND
CLINICAL TRIALS BEING DONE VERY
WELL BY MANY PEOPLE AND THERE
ARE IMPORTANT LEARNINGS, I THINK
1 AREA THAT I WOULD PERSONALLY
CHALLENGE NIH IS AROUND
ACCOUNTABILITY THERE, YOU KNOW
WE HAVE STUDIES WHO SUBMIT THEIR
ENROLLMENT TABLES AND WHEN THEY
DON'T ACHIEVE THOSE GOALS AROUND
RACIAL AND ETHNIC DIVERSITY OR
GENDER DIVERSITY, YOU KNOW THE
FUNDING DOESN'T STOP, YOU KNOW
THERE'S NO 1 REALLY HOLDING THEM
ACCOUNTABLE, NOT THAT THAT
ACCOUNTABILITY IS TOTALLY PLACED
ON THE FUNDER, BUT I THINK
THAT'S AN IMPORTANT LEVER AND I
DO AGREE THAT THE TABLE WE
PRESENTED NEEDS CONTEXT AND
WOULD BE BETTER COMING FROM
THOSE OF YOU WITHIN THE
ORGANIZATION, WITHIN THE NIH WHO
COULD ACTUALLY TELL US WHAT
PERCENTAGES REALLY REFLECT
HEALTH EQUITY AND HEALTH
DISPARITIES RESEARCH BUT WHEN WE
ASK FOR THAT IT WASN'T AVAILABLE
SO WE DID OUR BEST WITH WHAT WAS
AVAILABLE.
>> I DID NOT MEAN TO BE CRITICAL
OF YOU, OBVIOUSLY, IT'S JUST
THAT THOSE NUMBERS TINNING ME
PERSONALLY A LITTLE BIT SO THERE
YOU GO.
>> I THINK THE RANK ORDER IS
CONSISTENT WITH THE ANALYSIS I
HAVE SEEN FOR THE MOST RECENT
YEAR.
IT'S IN THAT BALLPARK BUT THE
BUDGETS ARE DRAMATICALLY
DIFFERENT AND WE HAVE 2
INSTITUTES HERE WITH VERY LARGE
BUDGETS AND NINDS IS A HIGH,
VERY HIGH AS WELL IN THE MIDDLE
GROUP.
SO NURSING IS NIM HD ARE THE 2
HIGHEST AND I THINK NCATS BASED
ALSO ON HOW THEY DEVELOP THEIR
-- THEY'RE DIFFERENT RIGHT?
>> THE INFRASTRUCTURE IS
DEFINITE.
>> YEAH, YEAH.
>> ALSO TO CONSUELO AND
MARGARITA SO IMPORTANT THAT WE
CAPTURE THE LESSONS YOU HAVE TO
TEACH US SO THAT OTHERS CAN
ACHIEVE AS WELL AS YOU AND WE'VE
HEARD SOME COMMUNITY INVOLVEMENT
BUT SOMEHOW THE WORD SAYS HAVE
BEEN EASIER THAN THEIR
CORPORATION INTO ACTION AND
PRINCIPLE AND HOW WE BUILD THOSE
INTO SOLICITATIONS AND
REQUIREMENTS FOR APPLICATIONS
FOR CLINICAL RESEARCH, WE HAVE A
LOT TO LEARN FROM THOSE SUCCESS
CASES.
>> WELL, I WILL SAY THIS FOR
RICHARD AND CONSUELO, WHEN I WAS
ON RICHARD'S COUNSEL MANY YEARS
AGO, I MENTIONED WHAT YOU SAID
CONSUELO, ABOUT ACCOUNTABILITY
AND RECRUITMENT, AND WE ALL SAID
YEAH, THAT'S GREAT.
BUT THERE'S NO LEVERAGE TO DO
THAT, THE NEW REVIEW CRITERIA
INCORPORATE THE HUMAN SUBJEKS
PART INTO A SCORING CATEGORY, SO
NOW IT'S NOT JUST A CHECK BOX OF
YEAH, THEY HAVE AN ADEQUATE
PLAN, BUT NOW IT'S SUPPOSED TO
BE CONSIDERED IN 1 OF THE
SCORING CATEGORIES.
SO WE'LL HAVE TO SEE HOW THAT
PLAYS OUT SO AND I THINK THAT
STARTS IN 25, RIGHT?
NEXT MONTH.
>> QUESTION FOR THE PANEL.
I THINK WHEN YOU THINK IN TERMS
OF ENDING UNEQUAL TREATMENT THAT
MAKES YOU SORT OF CONSIDER THE
HEALTHCARE SYSTEM AND THOSE
HEALTHCARE SYSTEM RELATED
FACTORS, JUST WANT TO KNOW FROM
YOU IN TERMS OF THE ACADEMIC,
EXTRAMURAL INVESTIGATORS WHAT
TERMINOLOGY ARE YOU USING NOW I
THINK IN THIS ENVIRONMENT IN
TERMS OF ADJUSTING THIS TYPE OF
RESEARCH?
ARE YOU CONSIDERING MOVINGA, WAY
FROM INDIVIDUAL LEVEL FACTORS?
AND MORE TOWARDS THOSE
STRUCTURAL BARRIERS THAT IMPACT
TREATMENT VERSUS FOCUSING ON
SPECIFIC GROUPS?
AND HOW THAT IMPACTS YOUR WORK
MOVING FORWARD BECAUSE I KNOW IT
MAY BE DIFFERENT BASED UPON YOUR
INSTITUTION, ANY THOUGHTS ON
THAT?
>> I'M GOING TO JUMP IN BECAUSE
I HAVE TO LEAVE PRETTY SOON, BUT
1 OF THE THINGS I WOULD SAY IT
REALLY DEPENDS BECAUSE ALSO YOU
HAVE TO THINK ABOUT THE BUDGET
OF THE GRANT.
I MEAN THERE'S A LOT OF INTEREST
IN DOING POLICY AND DOING SOME
OF THE SYSTEM LEVEL, BUT THEN
WHEN YOU ARE THINKING ABOUT THE
SYSTEM LEVEL, LET'S SAY,
PRACTICES, HEALTHCARE PRACTICES
WHERE YOU'RE TALKING ABOUT
SCHOOLS, THEN THE UNIT OF
ANALYSIS IS THE SCHOOLS OR THE
PRACTICES AND YOU NEED VERY BIG
FUNDING MECHANISMS TO BE ABLE TO
DO THAT WORK.
SO I WOULD LOVE TO DO MORE
SYSTEM WORK OR I THINK MANY OF
US WOULD DO BUT I THINK WE NEED
TO SEE WHETHER IT'S FEASIBLE
GIVEN THE BUDGETS.
IME VERY GRATEFUL FOR THE
INVITATION, I HAVE TO JUMP OFF
, I
HAVE ANOTHER MEETING.
>> I WILL SAY BOTH AND AS WELL
AND MULTILEVEL IS PROBABLY THE
BEST STRATEGY.
>> I THINK BOTH AND IS THE RIGHT
ANSWER THERE RICHARD AND YOU IT
JUST DEPENDS.
SOMETIMES 1'S AMAZED AT
STRUCTURAL CHANGE AND IMPACTING
INDIVIDUAL BEHAVIOR, YEARS AGO,
I REMEMBERED THERE WAS A GREAT
GRANT THAT WE HAD FUNDED THERE
WAS AN INTERVENTION IN SCHOOLS
IN LA FOR DECREASING SWEETENED
BEVERAGE COMSUMPTION AMONG
ADOLESCENTS, YEAH, I THINK IT
WAS IN MIDDLE SCHOOL OR HIGH
COOL, IT MUST HAVE BEEN MIDDLE
SCHOOL.
THE EDUCATIONAL INTERVENTION
DOESN'T HAVE AN EFFECT BUT WHAT
THEY FOUND WAS THAT IN THE
SCHOOL WHERE THEY ACTUALLY GAVE
FREE COOL WATER, I GUESS LA, IT
WAS IN LA SO IT WAS ALWAYS WARM
THAT'S WHERE THEY SAW THE
BIGGEST IMPACT SO IN THE SCHOOLS
THAT HAD ACCESS TO CHILLED WATER
THEY ACTUALLY DID MAKE A CHANGE.
SO THAT'S A STRUCTURAL CHANGE AS
OPPOSE TO INDIVIDUAL EDUCATIONAL
THEY GET BEHAVIOR CHANGE THAT
WAY.
SO ON THAT POSITIVE NOTE, WE CAN
CLOSE THIS SESSION.
I WANT TO THANK FIRST OF ALL
NEISHA WHO TOOK THIS ON TO
ORGANIZE IT A COUPLE MONTHS AGO
WHEN I ASKED HER TO DO THIS,
DARREL FOR BEING OUR INITIAL
POINT OF CONTACT WITH THE
COMMITTEE, AND ALSO FOR THE
WHOLE COMMITTEE THAT DID THE
REPORT.
IT IS AN IMPORTANT WORK THAT WE
WILL BE PROUD OF FOR YEARS TO
COME AND FOR THE PANEL, THE 2
PANELS THAT PRESENTED, MY
COLLEAGUES HERE AT NIH AS WELL
AS THE 4 OF YOU WHO TOOK TIME TO
PRESENT.
I DON'T KNOW IF YOU WANT TO MAKE
YOUR SLIDES AVAILABLE OR NOT,
BUT WOULD BE HAPPY TO TAKE THEM
IF YOU MAKE THEM AVAILABLE.
SO ... THANK YOU.
>> THANK YOU.
>> GOOD NIGHT.
>> THANK YOU.