Introduction: NIH Minority Health and Health Disparities Strategic Plan 2021-2025

NIH Director's Foreword

The publication of the Institute of Medicine report on unequal treatment, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, summarized a legacy of unequal health care and differential health outcomes for most leading causes of disability and death in the United States among African Americans compared with Whites, with selected available data on other racial and ethnic minority groups. Since then, sources of data dramatically have improved while scientific advances in basic mechanisms have strengthened our understanding of etiological pathways and potential intervention points to improve minority health, reduce health disparities, and promote health equity. The need for rigorous scientific approaches to minority health and health disparities-building on decades of studies addressing social inequality and health, behavioral epidemiology, and access to quality health care-is now increasingly being met by an expanding array of biological and data science tools that help us understand health and disease mechanisms.

The Office of Minority Health Research was founded at NIH in 1990 to provide a focus for research questions that addressed racial/ethnic minority populations. Through congressional legislation, the Office was upgraded to the National Center on Minority Health and Health Disparities in 2000 and to the National Institute on Minority Health and Health Disparities (NIMHD) in 2010. NIMHD is charged with coordinating and leading NIH's vision and programs on minority health and health disparities research. The topics are broad and include health determinants pertaining to the entire life course, including all populations, diseases, prevention, and health care. Research that advances understanding and improvement of health and disease in minority racial/ethnic groups in the United States requires a basic understanding of the construct of race and ethnicity, incorporating the social determinants of health in the context of science. Research to understand the causes of and define mechanisms leading to interventions to reduce health disparities is a parallel mandate, incorporating socioeconomic, geographic, and cultural factors to address conditions with negative outcomes in specific populations. NIMHD envisions an America in which all populations will have an equal opportunity to live long, healthy, and productive lives.

Introduction

Medical advances and new technologies have allowed Americans to live longer and healthier lives for the past century. These advances, however, have not helped all Americans equally, and health disparities persist, disproportionately affecting racial and ethnic minority populations, individuals of less privileged socioeconomic status (SES), underserved rural residents, sexual and gender minorities (SGMs),¹ and any subpopulations that can be characterized by two or more of these descriptions. In October 2016, SGMs were formally designated as a population experiencing health disparities for research purposes.

In the 35 years since the Heckler report was published, pioneering researchers studying health disparities and minority health have worked to reduce the burden of premature illness and death experienced by many people from minority racial and ethnic backgrounds, SGMs, rural residents, and individuals of less privileged SES. For example, thanks to the efforts of researchers, advocates, and other stakeholders, the gap in mortality between Blacks and Whites was reduced by about half from 1999 to 2015, narrowing from 33 percent to 16 percent.³ Not all health outcomes are worse for populations experiencing health disparities; in selected conditions, racial and ethnic minorities of less privileged SES have better health.⁴ However, the individuals comprising these groups still face considerable health disparities in most conditions. These disparities include shorter life expectancy; higher rates of cardiovascular disease, cancer, diabetes, infant mortality, stroke, cognitive impairment, asthma, sexually transmitted infections, and dental diseases; and differences in prevalence and outcomes of mental illness.

Health disparities are the result of differences in and interplay among numerous determinants of health, including biological factors, the environment, health behaviors, sociocultural factors, and the way health care systems interact through complex multilevel pathways. These dynamic and complex interactions lead to poor health outcomes and challenge researchers to identify mechanistic pathways to develop interventions that may lead to reductions in health disparities and improvements in minority health that promote health equity with a systematic applied approach.

Section 10334 of (PDF 2.5 MB) P.L. 111-148 tasks NIMHD with coordinating NIH's research related to minority health and health disparities: "The Director of the Institute, as the primary Federal official with responsibility for coordinating all research and activities conducted or supported by the National Institutes of Health on minority health and health disparities, shall plan, coordinate, review, and evaluate research and other activities conducted or supported by the Institutes and Centers of the National Institutes of Health." In addition, Section 2038 of P.L. 114-255 (21st Century Cures Act) tasks NIMHD with fostering partnerships and collaborative projects relating to minority health and health disparities: "The Director of the Institute may foster partnerships between the national research institutes and national centers and may encourage the funding of collaborative research projects to achieve the goals of the National Institutes of Health that are related to minority health and health disparities." As part of all strategic planning processes across NIH, Institutes and Centers (ICs) are tasked with coordinating with the Directors of NIMHD and the Office for Research on Women's Health to ensure that the plans account for the unique perspectives, strengths, and challenges facing minorities and women, as described in Section 2031 of P.L. 114-255. Furthermore, section 404N of the Public Health Service Actencourages increased research with SGM populations as a response to the mounting evidence of the health disparities experienced by SGM populations, as well as an acknowledgment of unique health challenges faced by SGM individuals who may be affected by a socially disadvantaged position. The plan will guide NIH in setting scientific goals, such as advancing the scientific understanding of health disparities, and research-related activity goals, such as strengthening the national research capacity to address minority health and health disparities.

Research supported by NIH has worked to reduce these disparities and improve minority health across all diseases, disorders, and conditions. As a result, all ICs contribute to the science and support activities. NIH also supports training, workforce development, capacity building, and other activities that work to reduce health disparities. This NIH strategic plan demonstrates ICs' commitment to research that improves minority health and reduces health disparities and to activities like training and capacity building that enhance the ability to reveal the new scientific knowledge needed to improve health for all Americans.

The scientific information discovered in basic research proposes to move along a continuum through clinical sciences until a practice or procedure that improves individual and population health can be implemented. Minority health and health disparities research can be viewed in a similar framework. Information about a racial or ethnic minority group-such as behavioral, biological, sociocultural, socio-ecological, and environmental characteristics and attributes-placed within a health care or public health setting provides the basis for understanding minority health. Once these basic factors are identified, similarities and differences between population groups may become apparent. These population differences may or may not constitute a health disparity, since the outcome for some conditions may be better for the population presumed to be disadvantaged, such as in the Hispanic Paradox.⁵

Understanding why a racial or ethnic minority group has a specific health outcome is at the core of minority health science. Minority health research intends to identify factors contributing to health conditions, independent of whether a health disparity exists or is identified. When investigations of differences in health between diverse groups exist, where the disadvantaged population group has a worse health outcome, this defines one aspect of health disparity research. Health disparity research then strives to understand mechanisms as to why a racial or ethnic minority group has a worse health outcome compared to a reference group.

Clarifying the difference between minority health and health disparities research prompted NIMHD to develop revised definitions for the biomedical research field. These distinct definitions provide justification for a new approach for the next generation of knowledge discovery to improve minority health and reduce health disparities.

References

1. Sexual & Gender Minority Research Office (SGMRO). Strategic Plan to Advance Research on the Health and Well-being of Sexual & Gender Minorities: Fiscal Years 2021–2025.
2. Cunningham TJ, Croft JB, Liu Y, Lu H, Eke PI, Giles WH. Vital Signs: Racial Disparities in Age-Specific Mortality Among Blacks or African Americans — United States, 1999–2015. MMWR Morb Mortal Wkly Rep 2017;66:444–456.
3. Franzini L, Ribble JC, Keddie AM. Understanding the Hispanic Paradox. Ethn Dis. 2001;11(3):496-518.
4. Ruiz JM, Steffen P, Smith TB. Hispanic mortality paradox: a systematic review and meta-analysis of the longitudinal literature. Am J Public Health. 2013;103(3):e52‐e60.

Page updated Jan. 12, 2024