The marginalization of groups based on socially constructed categories of race, ethnicity, sexual orientation, gender, and other identities produces biological consequences that contribute to health disparities in a variety of diseases and conditions, including many under the purview of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). For example, substantial racial and ethnic disparities exist in obesity, diabetes, and end-stage kidney disease. Racism, marginalization, and discrimination (RMD) is embedded into the structure of American society, which increases exposure to adverse social determinants of health—or social risks—for marginalized populations. These social risks are known to affect health outcomes by constraining or modifying health-related behaviors (e.g., diet, physical activity, smoking). However, experiences with RMD—as well as exposure to social risk—may also directly alter biology by triggering stress pathways and modifying biological homeostasis.

Meeting Objectives

Research questions to be addressed in the workshop include:

What are the direct biological mechanisms and pathways underlying the relationship between RMD, social risks, and NIDDK diseases/conditions? How do these biological mechanisms interact with social and behavioral drivers of disease?

Specific biological mechanisms, pathways, and systems of potential interest for this workshop include, but are not limited to, weathering, stress, allostatic load, hypothalamic-pituitary-adrenal axis, developmental programming, epigenetics, microbiome, immune function, inflammation, neuroendocrine status, endocrine disruption, and telomere shortening, among others.

How do these biological mechanisms/pathways differ or overlap across the various population groups that experience RMD? How do these mechanisms combine for populations crossing multiple intersecting, marginalized identities (e.g., class, sex, gender, race)? How can we use an intersectionality lens to examine risk and protective factors?

How do these biological mechanisms/pathways differ or overlap in the context of structural versus interpersonal forms of RMD, as well as between RMD and associated social risks?

What biopsychosocial factors confer resilience to disease despite exposure to structural and interpersonal RMD, and what are the biological mechanisms through which this resilience occurs?

How do we identify biological marker(s) to describe the experience of RMD?

Does RMD contribute to the population-level differences in markers of key biological functions (e.g., differences in serum creatinine observed between Black and non-Black people in the United States)?

What tools (e.g., measures, assessments, assays, wearables, apps) do we need to employ or develop to assess the impact that RMD may have on biology and health outcomes?

Co-Sponsors/Organizing Committee

NIA, NHLBI, NICHD, NIMHD, NINDS, NINR, OBSSR, ODP, ONR, ORWH, SGMRO, All of Us Research Program

Shakira Suglia, ScD, Emory University (Co-chair)

Tracy Bale, University of Maryland (Co-chair)

Glenda Roberts, Kidney Research Institute- University of Washington

Phyllis Harris, LGBT Cleveland

Keith Norris, M.D., Ph.D., University of California, Los Angeles

Sheena Martenies, Ph.D., University of Michigan

Nicole VanKim, Ph.D., University of Massachusetts

Lisa Diamond, Ph.D., University of Utah

David Chae, ScD, M.A., Tulane University

John Carethers, M.D., University of Michigan

Debra MacKenzie, Ph.D., University of New Mexico

Oluwaferanmi Okanlami, M.D., M.S., University of Michigan

For more information go to https://www.niddk.nih.gov/news/meetings-workshops/2024/understanding-the-biological-mechanisms-2024