Examining the Health Disparities Research Plan of the National Institutes of Health Unfinished Business (2006) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-14
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From page 1... ...
Goals and objectives in research, research capacity, and communication are expected to form the foundation for the NIH health disparities research program. The study committee viewed the Strategic Plan in the context of the need for NIH health disparities research to be conducted as an integrated and inclusive field of study rather than an aggregate of independent research plans and activities occurring in separate research domains.
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Needed additions to the Strategic Plan include attention to the inte gration of research on the multifactorial nature of health disparities; population research; targeted and timed objectives; collaborative, inte grated research on disparate health care; identification of additional affected populations; access to a registry of conditions for which differ ences between populations exist; assessments and evaluations of pro grams intended to increase institutional and research-personnel capaci ties to conduct health disparities research; and attention to public and professional communication regarding health disparities as a specific, trans-NIH program. The health of racial and ethnic minorities, poor people, and other disadvantaged groups in the United States is worse than the health of the overall population.
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The legislation called for the establishment of the National Center on Minority Health and Health Disparities (NCMHD) to administer special grant programs, coordinate minority health and health disparities research across NIH and lead the development of an NIH-wide strategic plan on health disparities.
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Findings: · Lack of consensus regarding conceptual and operational defini tions of disparities and the complexity of measuring health and health determinants pose challenges for the identification, under standing, monitoring and elimination of health disparities. · There is a continuing need for NIH-funded research to develop, test, and refine measures and conceptual approaches for assessing and monitoring health disparities.
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· Disparities research embedded into large studies (molecular, clinical, and epidemiological) , national data sets, and public health monitoring measures through the greater inclusion of appropriate measures of race, ethnicity, socioeconomic status, and residential characteristics, and of the psychosocial and environmental factors that are likely to shape health disparities in the population being studied at each time point of data collection.
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Additional research objectives warrant emphasis and inclusion. Minority health and health disparities research should include attention to the nonbiological and biological multifactorial background of disease and disability.
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on the capacity to conduct minority health and health disparities research. This information is needed to evaluate the effectiveness of programs, identify approaches in need of modification, set priorities, and make evaluations available for internal and external reviews.
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Recommendation: The Strategic Plan should include measurable tar gets and time periods for the research capacity objectives. NIH, through NCMHD's oversight, should develop methods of measuring, analyzing and monitoring the results of programs that address research capacity, including workforce, institutional, infrastructure, and community-based participatory health disparity research objectives.
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, the Strategic Plan and the minority health and health disparities research program required working definitions. The legislation and the Strategic Plan indicate that in addition to racial and ethnic minorities and low socioeconomic and rural populations there may be other population groups that warrant inclusion in health disparities research and the Strategic Plan.
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The enabling legislation recognized the need for incremental funding to be provided to the NIH and authorized up to $100 million in additional annual funding for minority health and health disparities research to be added to separate appropriations for the conduct and support of the health disparities research program, but the incremental funds were not allocated to the NIH. The committee expressed concern that the absence of such funding might have impeded the establishment of new health disparities research programs, which would reasonably incur additional research and management costs.
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Based on information provided by the NIH Budget Office, the Committee attempted to compare funding for minority health research (involving minority populations) and health disparities research (minority health plus groups with low socioeconomic status and rural populations)
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MANAGEMENT AND COORDINATION OF THE STRATEGIC PLAN AND MINORITY AND HEALTH DISPARITIES RESEARCH The breadth and complexity of the health disparities research agenda and the Strategic Plan present an extraordinary challenge for trans-NIH management. To best manage these efforts, NIH needs to: · Ensure concerted involvement of the ICs and Offices to develop and regularly update the Strategic Plan; · Ensure that all ICs and pertinent Offices are attentive to the Strategic Plan's mission, goals, and objectives; · Avoid gaps, such as populations, conditions, needs, and approaches, that would otherwise not be identified or addressed by the independent operation of the ICs; · Involve the best expertise from across the NIH and from the external scientific community; · Avoid duplicating administrative and research efforts; · Facilitate collaboration and coordinated research approaches; · Coordinate outreach and communication; · Create an organized program structure for effective monitoring and research articulation with other government agencies; and · Devote attention to research and budget priorities.
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From page 13... ...
The Committee saw the need to be certain that there is clearly designated authority to coordinate and manage the Strategic Plan and health disparities research program. Although the legislation indicates that the NCMHD director is responsible for coordinating all NIH minority health and health disparities research, the responsibility for monitoring and managing the Strategic Plan and the program falls on the NIH director, the NCMHD director, and the IC directors.
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The mandates of the NIH director are key elements in structuring and assuring effec tive management. Recommendation: The NIH director, through the established authority of the NCMHD director, should ensure continuous, effective coordina tion of the health disparities research program across NIH, including: · Timely development of Strategic Plan revisions; · Effective, ongoing participation of the ICs in the Strategic Plan and the health disparities research program; · Establishment of appropriate committees involving the directors of the ICs and others to facilitate collaboration and coordinated ap proaches to health disparities research and the setting of priorities; · Fostering of conferences and the use of committees and panels involving the NIH, extramural scientific communities, and others to inform and advise on initiatives and directions; and · Monitoring of the execution of the Strategic Plan to ensure that its elements are implemented.
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