research towards the elimination of health disparities yvonne t. maddox, ph.d. deputy director...
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Research Towards the Research Towards the Elimination of Health Elimination of Health
DisparitiesDisparities
Yvonne T. Maddox, Ph.D.
Deputy Director
National Institute of Child Health and
Human Development
National Institutes of Health
““Advances in scientific knowledge have provided Advances in scientific knowledge have provided the foundation for improvements in public health the foundation for improvements in public health and have led to enhanced health and quality of life and have led to enhanced health and quality of life for all Americans. Much of this can be attributed to for all Americans. Much of this can be attributed to the groundbreaking work carried on by, and funded the groundbreaking work carried on by, and funded by, the National Institutes of Health (NIH).”by, the National Institutes of Health (NIH).”
Tommy G. Thompson
Secretary
Department of Health and Human Services
NIH MissionNIH Mission
To improve the health of the Nation through Biomedical Research and Research Training
Advancing Clinical ResearchAdvancing Clinical Research
Delaying the onset of Alzheimer’s Disease Improving treatment for Parkinson’s Disease Conquering diabetes Improving treatments for spinal cord injury Making AIDS treatment safer, easier and
better Improving outcome for cancer and heart
disease patients
Changing Profile of the Nation Changing Profile of the Nation
Life ExpectancyRacial Breakdown of PopulationSocial Economic Status
Child Poverty: Percentage of related children under 18 living below selected poverty levels by
race (all families)
*Persons of Hispanic origin may be of any race.
Source: America’s Children: Key National Indicators of Well-Being 2000
There are Racial and There are Racial and Ethnic Differences in Ethnic Differences in many Diseases and many Diseases and
ConditionsConditions
Death rate from stomach cancer is substantially higher among Asian and Pacific Islanders, including Native Hawaiians, than among other populations.
CancerCancer
DiabetesDiabetes
Native Americans, Hispanics, African Americans, and some Asian Americans and Pacific Islanders, including Japanese Americans, Samoans, and Native Hawaiians, are at particularly high risk for development of type 2 diabetes.
DiabetesDiabetes
African-Americans are 1.7 times more likely to have diabetes than whites
Hispanics/Latinos are twice as likely to have diabetes than whites
Diabetes has reached epidemic proportions among Native Americans, among the Pimas of Arizona, prevalence is 50%
Source: American Diabetes Association
AsthmaAsthma
Asthma is 26 percent more prevalent in African-American children than in white children
Among 5 to 24 year olds, African-Americans are 4 to 6 times more likely to die from asthma than whites
The hospital discharge rate for asthma is 3.7 times higher for African-Americans than for whites
Source: CDC, American Lung Association
Growing Mortality Disparity for Growing Mortality Disparity for American Indians Compared to U.S. American Indians Compared to U.S.
All Races 1994-1996 RatesAll Races 1994-1996 Rates
Pneumonia and influenza – 71% greaterHomicide – 63% greaterGastrointestinal disease – 42% greaterInfant mortality – 22% greaterHeart disease – 13% greater
Growing Mortality Disparity for Growing Mortality Disparity for American Indians Compared to U.S. American Indians Compared to U.S.
All Races 1994-1996 RatesAll Races 1994-1996 Rates
Alcoholism - 627% greaterTuberculosis – 533% greaterDiabetes – 250% greaterInjuries – 230% greaterSuicide – 72% greater
DHHS Initiative to Eliminate Racial DHHS Initiative to Eliminate Racial and Ethnic Disparities in Healthand Ethnic Disparities in Health
Infant MortalityCancer ManagementCardiovascular DiseaseDiabetesHIV/AIDSImmunizations
Historical PerspectiveHistorical Perspective
DHHS Response to the President’s Race Initiative
“Eliminating Racial and Ethnic Disparities in Health in six areas by the year 2010 (Infant Mortality, Cancer Screening and Management, Cardiovascular Disease, Diabetes, HIV/AIDS, and Immunizations”
Definition of Health DisparitiesDefinition of Health Disparities
“Differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States”
First NIH Working Group on Health Disparities
Focus of the InitiativeFocus of the Initiative
Initially, NIH will focus on racial/ethnic minority populations (African-Americans, Asians, Pacific Islanders, Hispanics and Latinos, Native Americans, and Native Alaskans)
Research on health disparities related to socioeconomic status is also included in the definition.
NIH Plan of Action (Goals)NIH Plan of Action (Goals)
Develop a Five-Year Strategic Research Agenda
Recruit and Train Minority InvestigatorsAdvance Community Outreach ActivitiesForm PartnershipsDefine, Code, Track, Analyze, and
Evaluate ProgressEnhance Public Awareness
Research Objectives (1)Research Objectives (1)
Advance the understanding of the development of diseases and disabilities that contribute to health disparities
- Epidemiology and Risk Factors
- Environment/Socioeconomic Status
- Mechanisms of Disease
- Genetic Variation
Research Objectives (2)Research Objectives (2) Develop new or improved approaches for
detecting or diagnosing the onset or progression of disease and disabilities that contribute to health disparities
Develop new or improved approaches for preventing or delaying the onset or progression of disease or disabilities that contribute to health disparities
Develop new or improved approaches for treating diseases and disabilities that contribute to health disparities
Research Infrastructure Research Infrastructure ObjectivesObjectives
Support research training and career development
Provide support for institutional resources
Public Information, Public Information, Outreach, and EducationOutreach, and Education
Develop research-based information resources
Communicate research-based information to increase public awareness
Transfer knowledge to health care providers
Provisions That the Provisions That the Projects are of Benefit Projects are of Benefit
to the Communityto the Community
Infant Mortality RateInfant Mortality Rate (By Race and Hispanic Origin, Selected Years 1983-99)(By Race and Hispanic Origin, Selected Years 1983-99)
Sudden Infant Death Syndrome Sudden Infant Death Syndrome (SIDS)(SIDS)
Leading Causes of Infant Mortality – 1992
Congenital anomalies (21%) Sudden Infant Death Syndrome ( 15%) Low birth weight (11%) Respiratory Distress Syndrome (7%) Maternal complications (4%)
Theories of SIDS Cause circa Theories of SIDS Cause circa
•Bacterial sepsis
•Viral infection
•Status thymicolymphaticus (with venous or atrial compression)
•Mechanical suffocation
•Vagal reflex, etc.
•Hypogammaglobulinemia
•Mucous obstruction of trachea
•Hypocalcemia with laryngospasm
•Cardiac arrhythmia
•Hypersensitivity
•Bronchospasm Adrenal Insufficiency
•Chromaffin deficiency
•Maternal “overlay”
•Gastric aspiration
•Poisoning
•Inborn error of metabolism
•Parathyroid insufficiency
•Anaphylactic shock
•Endotoxemia
Impact of the Impact of the Back to SleepBack to Sleep
CampaignCampaign
A public-private partnership to reduce the risk of Sudden Infant Death Syndrome.
BACK TO SLEEPBACK TO SLEEP CAMPAIGN LAUNCHED CAMPAIGN LAUNCHEDNATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENTNATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT
Launch of Back to Sleep Campaign Press conference, June 1994, Surgeon General
BTS Campaign Partners American Academy of Pediatrics SIDS Alliance Association of SIDS and Infant Mortality Programs National Heart, Lung, and Blood Institute, NIH Maternal and Child Health Bureau, HRSA
Campaign ComponentsCampaign Components
Media Materials (radio, TV, print)
Video Posters Crib Stickers Magnets
SIDS Rate and Sleep Position, 1985-2000(Deaths per 1,000 Live Births)
1.41 1.41 1.37 1.4 1.391.3 1.3
1.2 1.17
1.03
0.87
0.74 0.770.72
0.670.62
7074
78 8185 85
54
39
28
0
0.5
1
1.5
1985 86 87 88 89 90 91 92 93 94 95 96 97 98 99 2000
Year
SID
S R
ate
0
50
100
Per
cen
t B
ack
and
Sid
e S
leep
ing
Pre-AAP recommendation Post-AAP BTS Campaign
Sleep Position Source: NICHD Household Survey SIDS Rate Source: National Center for Health Statistics, CDC
Sudden Infant Death Syndrome Sudden Infant Death Syndrome (SIDS)(SIDS)
Leading Causes of Infant MortalityLeading Causes of Infant Mortality
Congenital anomalies
Short gestation/low-birth weight
Sudden Infant Death Syndrome
SIDS Rates, United StatesDeaths per 1,000 live births
1.4 1.391.3 1.3
1.2 1.17
1.03
0.870.78 0.77 0.72
0.67 0.62
1.221.18 1.11 1.1
1 0.970.85
0.710.63 0.64
0.58 0.53 0.5
2.38 2.42.31 2.33
2.18 2.19
1.941.79
1.651.53
1.38 1.35 1.32
0
0.5
1
1.5
2
2.5
3
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Total White BlackSource: National Center for Health Statistics, CDCFinal Data, 2000
Back to SleepBack to SleepFocus on African American Focus on African American
CommunitiesCommunities
SIDS rate is 2.2 times higher in the black population than it is in the white population
Black mothers are twice as likely as white mothers to place their babies on their stomachs to sleep
Success of the Back to Sleep campaign demonstrates that a focused campaign can increase back sleeping and reduce the risk of SIDS
Reducing SIDS in Reducing SIDS in African American CommunitiesAfrican American Communities
Institute makes strong commitment to eliminating disparity in rates of SIDS between white and minority populations
NICHD’s SIDS Strategic Plan
Community ParticipationCommunity Participation
Campaign strategies targeted to the particular minority group “ Input from the people”
Provide the resource materials for health fairs and community events
Give progress reports on results
National Center on Minority Health National Center on Minority Health and Health Disparities (NCMHD)and Health Disparities (NCMHD)
• Congress Established December, 2000 as part of the National Institutes of Health (NIH)
• Has Research and Research Training Grant Authority
• Special Research and Research Training Opportunities
Strategies to Eliminate Health Strategies to Eliminate Health DisparitiesDisparities
• Communicate evidenced-based results
• Increase access to care for low income and minority populations
• Improve quality and outcomes in the health care system
• Develop preventive approaches at the community level
• Build a knowledge base to understand the connection between SES, race, prevention, and health
• What is it?
• Establishing and Promoting Cultural Education Curricula
• Creating a Health Delivery Process that Supports an Environment for its Culturally Diverse Clients
Cultural CompetencyCultural Competency
“…“…. we're taking prevention directly to . we're taking prevention directly to the people of America. Throughout this the people of America. Throughout this year, we're going to give Americans the year, we're going to give Americans the tools, help and encouragement to live tools, help and encouragement to live healthier …. we're raising the profile of healthier …. we're raising the profile of prevention.”prevention.”
TOMMY G. THOMPSONSECRETARYDEPARTMENT OF HEALTH AND HUMAN SERVICES