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3 Development and Availability of the Strategic Plan
Pages 34-59

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From page 34...
... A draft plan was published in October 2000 for technical and public review. This early version of the Strategic Plan established goals for research, research infrastructure, and public information and community outreach that are used in the 2002 and 2004 Strategic Plans (NIH, 2000)
From page 35...
... October 6, 2000 The draft Strategic Plan is published for technical and public review. November 22, 2000 The Minority Health and Health Disparities Research and Education Act of 2000 (P.L.
From page 36...
... The Plan itself stipulates that it "will be updated and reviewed on a yearly basis." However, as of July 2005, the Strategic Plan for 2004­2008-which should have officially updated the previous Strategic Plan -- had not yet been approved by NCMHD or its advisory council, nor had it been submitted to the director of NIH. Compared with the 2002 Strategic Plan, the draft of the 2004 TABLE 3-2 Public Comment Themes Theme Illustrative Example General · Include among health disparities populations: lesbian, gay, bisexual, and transgender communities; Haitians; individuals suffering from orphan diseases; underrepresented Asian subpopulations; the mentally ill; men; prisoners; the handicapped Research · Increase the scope of research to include cultural, psychological, behavioral, social, racial, and gender-based influences on health · Study racial/ethnic disparities in access to health care · Produce accurate, uniform definitions of health disparities and improve data collection and the quality of data on health disparities Research infrastructure · Sponsor programs to mentor, educate, and provide grant support to minorities who pursue health career opportunities · Promote partnerships between minority-serving and research intensive institutions · Support and expand community outreach efforts and community participation · Broaden partnerships and leverage resources available from professional associations, health care organizations, academic institutions, and other community members that serve minority communities · Identify and make available successful community-based intervention strategies Outreach and public · Ensure that all communications with health disparities communication populations and their subgroups address their needs and perspectives SOURCE: Adapted from NCMHD, 2004.
From page 37...
... The text emphasizes the need for a coordinated, trans-NIH approach in order to achieve the Strategic Plan's goals. For instance, the Strategic Plan identifies the need for ICs to integrate nonbiological factors in health disparities research.
From page 38...
... The 2004 Strategic Plan expands upon the 2002 Plan's objectives for each goal, as indicated by italics in Boxes 3-1 to 3-4 and shading in Table 3-3. Research The 2004 Strategic Plan research goal "to advance the understanding of the development and progression of diseases and disabilities that contribute to health disparities in racial and ethnic minority populations and other health disparity populations, including the medically underserved, by increasing and diversifying biomedical, behavioral, social science, and health services research, as well as cultural, linguistic, and social epidemiology research conducted and supported by the NIH" reflects significant changes from the 2002 Strategic Plan goal.
From page 39...
... : To advance the understanding of the development and pro gression of diseases and disabilities that contribute to health disparities in racial and ethnic minority populations and other health disparity populations, including the medically underserved, by increasing and diversifying biomedical, behavioral, social science, and health services research, as well as cultural, linguistic, and social epidemiology research conducted and supported by the NIH. Research Infrastructure (2002)
From page 40...
... 40 EXAMINING THE HEALTH DISPARITIES RESEARCH PLAN OF THE NIH TABLE 3-3 Objectives for the Fiscal Year 2004 Strategic Plan Research Objectives Research Capacity Objectives Outreach Objectives · Advance understanding of · Increase the number of · Provide the latest the development and participants in clinical research-based progression of diseases trials from racial and information to health care and disabilities that con- ethnic minority popula- providers to enhance the tribute to health disparities tions and other health care provided to disparity populations individuals within racial · Develop new or improved and ethnic minority approaches for detecting or · Expand opportunities in populations and other diagnosing the onset or research training and health disparity progression of diseases career development for, populations and disabilities that con- and provide research tribute to health disparities supplements to, research · Facilitate the investigators from racial incorporation of science· Develop new or improved and ethnic minority popu- based information into the approaches for preventing lations and other health curricula of medical and or delaying the onset or disparity populations allied health professions progression of diseases schools, theological and disabilities that con- · Increase the number of education institutions, tribute to health disparities researchers conducting public health schools, and health disparities research · Develop new or improved into continuing education approaches for treating · Increase funding support activities of health diseases and disabilities for the construction and professionals that contribute to health renovation of research · Maintain ongoing disparities facilities across the nation communication linkages aimed at enhancing the · In partnership with other and partnerships with ability of these institutions agencies of the Depart- community-based and to conduct health dispari ment of Health and Hu- faith-based organizations, ties research man Services, advance health care associations, understanding of the · Provide increased funding foundations, and academic multifactorial causes of at institutions across the institutions, and foster health disparities, includ- country for resources, new dialogue with racial and ing nonbiological bases of equipment, and shared ethnic minority disease incidence and equipment programs for populations and other progression use in health disparities health disparity research populations, including the underserved · Increase the peer review representation in peer · Develop computer review of individuals from databases and Internet racial and ethnic minority resources to disseminate populations and other current information about health disparity populations scientific research and discovered and other activities regarding heath disparities
From page 41...
... This new objective will need to be translated into more attention to interdisciplinary, transdisciplinary, and transprofessional science that will advance the understanding of health disparities by working across the spectrum of biological, behavioral, and social determinants. Also, research on the multifactorial nature of health disparities should be integrated as part of the first objective on "understanding the development and progression of diseases and disabilities that contribute to health disparities" rather than only taking place in partnership with other agencies.
From page 42...
... Moreover, current definitions and designations of minority and health disparity groups do not identify important subgroups with specific health disparities, such as those within the Asian American and Pacific Islander population. To plan research and to properly identify groups and their health disparities, population information for subgroups is needed.
From page 43...
... Recommendation 3: The Strategic Plan research objectives should pro mote more integration of research on the multifactorial nature of health disparities, including nonbiological factors; population research to fur ther the understanding of the presence, prevalence, trends, and other elements of health disparity conditions; and when opportunity exists, an understanding of the causes of disparities in health care. Research Capacity The research capacity goal is "to increase minority health and health disparity research training, career development, and institutional research capacity and infrastructure." Objectives for this goal in the 2002 Strategic Plan addressed several appropriate aspects of research infrastructure and capacity, including: increased representation of racial and ethnic minorities and other health disparity populations in clinical trials; support for biomedical career development of underrepresented minorities; increased minority representation in peer review; and improvement of physical research capacity to enhance the ability
From page 44...
... · Increase the number of participants in clinical trials from racial and ethnic mi nority populations and other health disparity populations · Expand opportunities in research training and career development for, and provide research supplements to, research investigators from racial and ethnic minority populations and other health disparity populations · Increase the number of researchers conducting health disparities research · Increase funding support for the construction and renovation of research facil ities across the nation aimed at enhancing the ability of these institutions to conduct health disparities research · Provide increased funding at institutions across the country for resources, new equipment, and shared equipment programs for use in health disparities research · Increase the peer review representation in peer review of individuals from ra cial and ethnic minority populations and other health disparity populations · Promote the development of inter-institutional partnerships between histori cally research-intensive and historically minority-serving institutions that seek to build research infrastructure · Improve research data collection systems, and enhance data quality regarding health disparities, and develop uniform data systems that facilitate strategies for the elimination of health disparities · In collaboration with schools and programs of public health, state and local health departments, and academic health departments, support and promote community-based participatory research
From page 45...
... . Minority scientists' general knowledge and understanding of their communities can facilitate health disparities research and ultimately inform the solution of medical problems in both minority and nonminority communities (Committee for the Assessment of NIH Minority Health Research Training Programs, 2005; Smedley et al., 2004)
From page 46...
... . Interventions to improve minority participation in clinical trials typically concentrate on community education, elevating levels of trust in the health care system, and cultural strategies (Ard et al., 2003; CDC, 1998; Corbie-Smith et al., 1999; Partridge et al., 2005; Spruill, 2004)
From page 47...
... DEVELOPMENT AND AVAILABILITY OF THE STRATEGIC PLAN 47 4,500 600 4,000 500 $509 mil 3,500 $454 mil 3,000 400 2,500 $351 mil K-Awards 300 Awarded of millions) 2,000 (in Dollars Number 1,500 200 1,000 100 500 8.4% 7.9% 7.6% 7.9% 0 0 FY2001 FY2002 FY2003 FY2004 Nonminority Awardees Minority Awardees Current Dollars 2001 Constant Dollars FIGURE 3-2 Amount of funding for NIH Research Career program, distribution of Research Career (K)
From page 48...
... report The Unequal Burden of Cancer (Haynes and Smedley, 1999) , which concluded that "without a concerted effort to enhance this process, ethnic minority and medically underserved communities will continue to lag behind the American majority in benefiting from .
From page 49...
... has the aim of combining knowledge with action and achieving social change to improve health outcomes and eliminate health disparities." Proponents of community-based participatory research see it as a way to incorporate historical and structural factors, such as poverty, discrimination, and culture, into the study of health issues in the community while drawing on partnerships among investigators, respondents, and other community members and stakeholders (Gebbie et al., 2003)
From page 50...
... At NIH, 17 of 26 ICs queried indicated that in general they had supported community-based participatory research projects (Powe and Yeung, 2005) , though a review of the ICs' strategic plans revealed that only 6 ICs and Offices had included community-based participatory health disparities research projects in their strategic plans.
From page 51...
... . Also, the Strategic Plan should include assessments of programs that support: the construction and renovation of research facilities aimed at enhancing the ability of institutions to conduct health disparities research; the provision of equipment and shared equipment programs for use in health disparities research; the promotion of inter-institutional partnerships between historically researchintensive and historically minority-serving institutions; and the improvement of data collection and attempts to develop uniform data systems.
From page 52...
... Community Outreach, Information Dissemination, and Public Health Education In the Strategic Plan, the community outreach, information dissemination, and public health education goal is "to ensure [that] the public, health-care professionals, and research communities are informed and educated concerning the latest advances in minority health and health disparities research." The communication goal encourages efforts that "extend beyond dissemination of the results of research to other scientists and include the transmission of all information that may improve the health of racial and ethnic minorities and other health disparity populations to the general public, patients, advocacy groups, health-care providers, media, and policy makers." The Strategic Plan proposes "a comprehensive and aggressive outreach to those groups whom the research is intended to help and their health-care providers.
From page 53...
... · Provide the latest research-based information to health-care providers to en hance the care provided to individuals within racial and ethnic minority popula tions and other health disparity populations · Facilitate the incorporation of science-based information into the curricula of medical and allied health professions schools, theological education institu tions, public health schools, and into the continuing education activities of health professionals · Maintain ongoing communication linkages and partnerships with community based and faith-based organizations, health-care associations, foundations, and academic institutions and foster dialogue with racial and ethnic minority populations and other health disparity populations, including the underserved · Develop computer databases and Internet resources to disseminate current information about scientific research and discoveries and other activities re garding heath disparities · Develop targeted public health education programs focused on particular dis ease areas in order to reach those individuals within racial and ethnic minority populations and other health disparity populations who experience health dis parities within these disease areas · Facilitate, document, and disseminate practical strategies responsive to the health-care needs, and appropriate to the cultural and linguistic needs, of com munities throughout the United States · Collaborate with public health and other health-oriented policy centers to trans late research findings into policy documents that can be used by policy groups and other stakeholders to explain new discoveries from a policy perspective to decision makers health care associations, foundations, and academic institutions -- in addition to population groups that experience health disparities. These are relevant and significant additions to the Strategic Plan (Box 3-4)
From page 54...
... . As more reliable and effective methods are sought, opportunities to design, implement, assess, and improve the particularly demanding and important problems of translating minority health and health disparities information will be developed for the benefit of communication programs other than those focused on minority health and health disparities research.
From page 55...
... The ICs and Offices used various methods to identify objectives and programs for their individual strategic plans within the overall framework of the Strategic Plan goals and objectives. This resulted in a variety of objectives, reflected in initiatives that address a broad range of diseases, disabilities, and strategies.
From page 56...
... Recommendation 6: · The development of updated Strategic Plans should include assess ments of the appropriateness of the individual strategic plans of the ICs, including whether they adequately reflect the overall goals and objectives of the NIH Strategic Plan.
From page 57...
... As primary causes of health disparities, it identifies factors that have been widely discussed -- i.e., socioeconomic status, education, biological factors, access and quality of health care, racial and ethnic discrimination, and cultural issues. For reporting purposes, the 2004 Strategic Plan used the methodological guidelines developed by the NIH Committee on Minority Health and Health Disparities Research Definitions and Application Methodology, effective January 2004 (see Chapter 4 and Appendix H)
From page 58...
... Rather, low socioeconomic status is a description of the end result of a social stratification process in which some individuals end up with less access to opportunities, such as quality schooling, adequate income, or safe jobs. In addition to continued attention to the definition of health disparities, there is a need for a registry or clearinghouse of health disparity diseases and conditions, including regularly updated information on the prevalence of diseases and conditions and the populations affected.
From page 59...
... It should promote development of, and access to, a regis try of diseases and conditions for which disparities exist with regard to race, ethnicity, socioeconomic status, geographic locale, and other desig nated health disparity populations.


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