Road to Diversity and Inclusion: The Evolution of NIMHD’s Division of Intramural Research
Michele K. Evans, M.D., originally came to NIH to pursue medical oncology fellowship training at the National Cancer Institute in Bethesda, Maryland. As part of the fellowship, she did laboratory research on DNA damage and repair in cancer cells.
In 1992, she followed a mentor to the National Institute on Aging (NIA), in Baltimore—a different world from Bethesda’s suburban houses and lawns. Every day, as she drove through the city, she could see the poverty in which much of Baltimore’s African American community lived.
It felt familiar. Dr. Evans grew up in the South Bronx and returned there after medical school to practice primary care for 2 years. In clinics in the South Bronx and Brooklyn’s Bedford-Stuyvesant neighborhood, she would see women with stage 4 breast cancer, the disease already much too advanced for successful treatment. And she had a feeling that her work on DNA repair wasn’t helping, either. “I’m driving through the streets of Baltimore, saying, ‘It’s nice to be published in Cancer Research, but how will that contribute to fixing the conditions that lead to poor health, which I see every day?’” she said.
NIA’s existing long-term studies had mostly white participants, which made it difficult for scientists to study aging and health disparities in African Americans. In 1997, Dr. Evans proposed a new study that would follow African American and white residents of Baltimore as they aged—and more than half of the participants would be African American. John Ruffin, Ph.D., then director of the newly established Office of Research on Minority Health (ORMH), committed $250,000 to the project. Based on his support, NIH’s then-director Harold Varmus, M.D., agreed to another $250,000 if an expected doubling to NIH’s budget went through. NIA was persuaded to pitch in, too.
Today Dr. Evans is the deputy scientific director of NIA and adjunct investigator at NIMHD, and ORMH has evolved into the National Institute on Minority Health and Health Disparities (NIMHD). Dr. Evans’ Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study, one of the first to be funded by ORMH, is still going strong. Its diverse group of participants has enabled new understanding of how race and socioeconomic status are reflected in age-associated health disparities—all because Dr. Ruffin agreed that her proposal was sound and the work was important.
Under Dr. Ruffin’s leadership, minority health and health disparities research became a major focus area within NIH. Today NIMHD has its own Division of Intramural Research (DIR), with researchers whose work directly benefits the communities that are most impacted by health disparities. Researchers in the DIR study individual, social, and environmental factors that affect the health of individuals, communities and populations. Dr. Ruffin’s dream of an Institute with an intramural research program dedicated to minority health and health disparities research has been realized.
A step toward an IRP dedicated to health disparities.
ORMH became the National Center on Minority Health and Health Disparities (NCMHD) when then‑President Bill Clinton signed the Minority Health and Health Disparities Research and Education Act of 2000 into law. With this change, the Center was able to award funds directly for extramural research, or research outside NIH. However, it still didn’t have its own intramural research program, so NCMHD continued to support intramural research initiatives relevant to minority health and health disparities at other Institutes within NIH. For example, NCMHD supported the work of Charles Rotimi, Ph.D., on genomewide studies in African people at the National Human Genome Research Institute (NHGRI). Rotimi, who has worked to ensure that population genetics studies include African participants, currently leads NHGRI’s Center for Research on Genomics and Global Health.
In December 2008, the Center hosted a summit near Washington, D.C., where several thousand NIH-funded grantees, research advocates, and others working on minority health and health disparities research gathered to showcase best practices, identify gaps and build a framework to move the fields forward. At the summit, Acting NIH Director Raynard Kington, M.D., announced the creation of the intramural research program upon approval granted by then-NIH Director Elias Zerhouni, M.D. Dr. Ruffin was already thinking of staffing the IRP with scientists.
The Center had to set up a search committee to recruit a scientific director, who would then identify and recruit faculty to oversee research programs. In short, the IRP could not bring people in overnight. But Dr. Ruffin, who wanted research activity to get started right away, opened the doors to applicants for a 2-year research period within the IRP. Afterward, they could either return to their original academic institution or conduct research in a health disparity community outside NIH for the next 3 years. The mechanism to train these new investigators was called the Disparities Research and Education Advancing Mission (DREAM) Career Transition Awards, which funded NCMHD’s first intramural research training program in 2009. It was a dream come true for the eight young researchers who received this opportunity.
Because NCMHD’s own intramural research hadn’t yet begun, other NIH Institutes housed the eight DREAM fellows for their 2-year health disparities research projects. Research topics included life-course social determinants of reproductive and cardiovascular health among Black Americans and racial disparities among vulnerable populations with diabetes and depression. In his book, Going the Distance: The Making of a National Health Disparities Research Enterprise1, Dr. Ruffin wrote that it was challenging to identify homes for fellows interested in social determinants of health, because none of the other Institutes or Centers at NIH had an emphasis on this research area. This challenge was also an indication to Dr. Ruffin that NIH needed to include minority research in its portfolios.
Official beginnings of NIMHD’s DIR
When then-President Barack Obama signed the Patient Protection and Affordable Care Act in March 2010, NCMHD became an NIH Institute. NIMHD was born. That meant that not only could the institution fund research extramurally, but now it could set up labs and fund researchers working exclusively for NIMHD.
Meanwhile, the search for a scientific director was on. Nathan Stinson Jr., Ph.D., M.D., M.P.H., who joined the Center in 2007 and is now the director of NIMHD’s Community Health and Population Sciences (CHPS) division, said, “We were fortunate that William G. Coleman Jr., Ph.D., who was working in the IRP of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), accepted the position.” In January 2011, Coleman became NIMHD’s first scientific director—and the first African American scientific director of an NIH Institute. Dr. Ruffin convinced Eddie Reed, M.D., one of the leading oncologists in the nation at the time, to lead the clinical program of the young IRP. Together, Drs. Coleman and Reed started recruiting scientists to work at NIMHD.
Kelvin Choi, Ph.D., M.P.H., was working as a research associate in Minnesota when the position of Earl Stadtman investigator was announced. He interviewed with Coleman and Reed and was selected as NIMHD’s first Stadtman investigator in 2013. He started collaborative studies with other NIH Institutes on topics such as tobacco-use behavior and its relation to food insecurity (with NIA) and the influence of tobacco on young people’s health and social outcomes (with the Eunice Kennedy Shriver National Institute of Child Health and Human Development). As an independent investigator, Dr. Choi brought new projects to NIMHD, such as studying tobacco use within minority populations, assessing tobacco marketing and its role on disparities in tobacco use, and understanding the effects of novel tobacco products such as e-cigarettes on respiratory health.
Since then, the IRP has hired more staff and has added new training programs. Aspiring scientists at NIH working on minority health and health disparities are supported by the NIMHD William G. Coleman Jr., Ph.D., Minority Health and Health Disparities Research Innovation Award, installed in the memory of the first scientific director, who died in 2014. A year later, Anne Sumner, M.D., a tenured investigator from NIDDK and former scientific advisor to Dr. Ruffin, met Rwandan Minister of Health Agnes Binagwaho, M.D., Ph.D., when she came to NIH on July 2015 to give the Barmes Lecture. Their interactions resulted in the creation of the NIMHD-NIDDK-Rwandan Health Program in 2016, which is led by Dr. Sumner and current NIMHD Director Eliseo J. Pérez-Stable, M.D. Now in its 5th year, the program hosts Rwandan physicians for a year of research and training supported by NIMHD and conducted in the Section on Ethnicity and Health at NIDDK under Sumner’s supervision. After their fellowships, the physicians return home to help improve health in Rwanda.
Today the NIMHD Division of Intramural Research conducts clinical, social-behavioral, and population health research to understand why health disparities are prevalent in certain populations. The DIR is led by Anna María Nápoles, Ph.D., M.P.H., the first Latina to serve as the scientific director of an NIH Institute. Dr. Nápoles endeavors to bring scientists and trainees from diverse communities into the DIR. Under her leadership, the DIR focuses on three main areas: Population and Community Sciences, Social and Behavioral Sciences, and Genomics and Molecular Epidemiology. Within these branches, researchers are studying the factors that lead to health disparities and designing interventions to reduce them. With four principal investigators, two staff scientists, 16 researchers and trainees, and nine adjunct faculty members, the young division is making great strides. “There’s a lot of evidence to show that diversity improves science; it leads to groundbreaking discoveries which might not have happened if not for the diversity,” Dr. Nápoles said.
Encouraging workforce diversity and supporting the growth of fellows have been enduring goals of NIMHD. In addition to the Coleman research innovation awards, the division supports other training programs, including the Medical Research Scholars Program (MRSP). This highly competitive program is led by NIH and hosts research-oriented medical, dental, and veterinary students for a year of study on the NIH campus. NIMHD’s partnership in the program, which began in 2014 under Yvonne T. Maddox, Ph.D., then acting director, has led to greater diversity in the applicant pool and expanded training opportunities for health disparities research across NIH intramural programs.
Speaking of the fellows who’ve trained at NIMHD, Dr. Choi, who has hosted several trainees, recalls, “All of them came to NIMHD for career growth and development; it’s interesting to see them go through their training and contribute to the work we do here and move on to bigger and better things.”
NIMHD is proud to have scientists from diverse backgrounds working together to eliminate health disparities. The communities that NIMHD serves are also the ones whose members work in the laboratory, clinic, and community settings to make health care better.
References
- Ruffin, J. (2015). Going the distance: The making of a national health disparities research enterprise: The political and scientific journey behind the creation of the health disparities research discipline. Hilton Publishing.
Page updated February 23, 2021
