Why Health Disparities Matter & Why Diversity Matters

1. Why Health Disparities Matter&Why Diversity Matters • UIC Chancellor’s Lecture Series April 10, 2013

2. Specific Topics • History of NIMHD • Why we should care about health disparities • Diversity in Biomedical Research Workforce • NIH’s Response

3. 1985 1986 Important Milestones 1990 2000 2010

4. Health Disparities Definition • NIMHD: • A particular type of health difference (in a specific group of people as compared to the general population) that is closely linked with social, economic, and/or environmental disadvantage.

5. Health Disparities Definition • World Health Organization (WHO): • Differences in health which are not only unnecessary and avoidable but, in addition, are considered unfair and unjust.

6. Equity and Justice • “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” • Martin Luther King Jr., 1966 • “With improved sanitary conditions, improved education, and better economic opportunities, the mortality of the race may and probably will steadily decease until it becomes normal.” • Health and Physique of the Negro American • W.E.B. Dubois, 1906

7. Economic Consequences • What would be the cost savings for society if disease rates for all racial and ethnic groups were the same as those for non-Hispanic whites?

8. Colorado (2005): • United States • (2009): • (2050): *Colorado Department of Health **The Urban Institute

9. Indirect Costs • Lost Income and Labor Productivity

10. Quality Issue • Shared responsibility • Health Plan Employer Data and Information Set (HEDIS)

11. Improved Quality of Care

12. * Anthem and WellPoint have merged. UPMC denotes University of Pittsburgh Medical Center Source: Lurie, N. (2005). Health Disparities-Less Talk, More Action. The New England Journal of Medicine, 353;7, 727-729.

13. Improved Health for All • “The health of the individual is almost inseparable from the health of the larger community and… the health of every community in every state and territory determines the overall health status of the nation.” • Healthy People 2010 • Department of Health and Human Services, 2000

14. Why Diversity Matters • Enhanced quality of education in multiple settings • Racially and culturally concordant staff aid recruitment of individuals from minority groups into clinical trials • Racially similar physician-patient dyads related to greater patient satisfaction in ways that could enhance communication and participation in clinical research settings • Underrepresented groups may preferentially conduct research in areas related to health disparities or minority health • A diverse workforce permeates all aspects of the nation's health-related research effort

16. Award Probability – Institution and Race/Ethnicity* *Courtesy of Dr. Donna Ginther

17. Diversity of the NIH-Funded Research Workforce 0.2% 0.2% 0.1% 9.1% 3.5% 11.2% 0.9% 16.3% 16.4% 4.8% 1.1% 12.6% 72.4% 71% 2010 NIH Principal Investigators on RPGs 2010 US Census Bureau Report Sources: US Census Report 2010; IMPACII; AAMC

18. NIH Response • June 2011: formed Working Group on Diversity in the Biomedical Research Workforce – within the Advisory Committee to the Director (ACD) • June 2012: Working Group provided recommendations to ACD and NIH Director on: • Pipeline • Mentoring • Infrastructure • Peer Review

19. ACD Working Group on Diversity in the Biomedical Research Workforce • Reed Tuckson, M.D., co-chair UnitedHealth Group • John Ruffin, Ph.D., co-chairNIH • Lawrence Tabak, D.D.S., Ph.D., co-chairNIH • Ann Bonham, Ph.D.AAMC • Jordan Cohen, M.D.AAMC • José Florez, M.D., Ph.D.Harvard Medical School • Gary Gibbons, M.D.Morehouse School of Medicine • Renee Jenkins, M.D.Howard University • Tuajuanda Jordan, Ph.D. Lewis and Clark College • Wayne Riley, M.D., M.P.H., M.B.A., MACP Meharry Medical College • Samuel Silverstein, M.D.Columbia University Medical Center • Dana Yasu Takagi, Ph.D.University of California, Santa Cruz • Maria Teresa Velez, Ph.D.University of Arizona • M. Roy Wilson, M.D., M.S.Charles R. Drew Univ of Medicine and Science • Keith Yamamoto, Ph.D.University of California, San Francisco • Clyde Yancy, M.D., M.Sc., FACC, FAHA, MACP Northwestern University NIH NIH

20. The Challenges We Must Address • Time: No one set of initiatives will diversify NIH-funded workforce overnight; long range view of cultural change • Mistrust: NIH must gain trust within many communities • Develop partners: Success will require collaboration and cooperation of extramural partners Diversifying the NIH-funded workforce requires effective collaborations with HBCUs and other institutions that educate students from underrepresented backgrounds

21. Demographics for Underrepresented Minorities (URMs) in the Educational Pipeline as of 2008 10,947/yr* 507/yr* *Degree in Biology, Chemistry, and Physics to URMs Sources: NCES Digest of Education Statistics-2010, Tables 20-21; NSF Women, Minorities, and Persons with Disabilities Report 2011, Table 7.4

22. Diversity Initiative: Overarching Strategy Four interrelated approaches will be implemented: • NIH Building Infrastructure Leading to Diversity (BUILD) Program • National Research Mentoring Network (NRMN) • Ensuring Fairness in Peer Review • Increased Engagement by all NIH Leadership

23. BUILD Program: Institution Requirements • Primary Site • <$7.5M of NIH research project grant funding annually,* and • ≥ 25% of undergraduate students receiving Pell Grants • Pipeline or Research Partner • All other organizations are eligible to be included as part of primary site’s application • Medical/Graduate School Partners • No undergraduate program, and • <$7.5M of NIH research project grant funding annually* *Average RPG support over past three fiscal years

24. Building Infrastructure Leading to Diversity (BUILD) Program • Student Support: • Rigorous mentored research experience for 2 summers (college) and up to 2 years (post-graduation) • Tuition scholarships for up to 2 years as undergraduate • Possibility of loan repayment in graduate school • Faculty Support: • Salary offset and other infrastructure support for key faculty responsible for undergraduate research training • Resources for highly effective mentors to train new mentors • Support for “Innovation Space” to enable organizations to develop novel approaches to increase diversity of those entering Ph.D. training

25. Diversity Initiative: Overarching Strategy Four interrelated approaches will be implemented: • NIH Building Infrastructure Leading to Diversity (BUILD) Program • National Research Mentoring Network (NRMN) • Ensuring Fairness in Peer Review • Increased Engagement by all NIH Leadership

26. National Research Mentoring NetworkRetaining Scientists through Mentoring • Grantee will engage and assemble multiple people and/or organizations into a single, nationwide consortium • Goals: • Connect students, postdoctoral fellows, and faculty to experienced mentors both in person and virtual • Develop standards for good mentorship • Provide training to individuals interested in learning how to become better mentors

27. National Research Mentoring Network • Goals (cont.) • Provide or arrange for relevant workshops and training opportunities in grantsmanship (grant writing; mock study sections; feedback on grant applications) and career “survival” strategies • Link with BUILD consortium primary institutions and all student participants • Network students, postdoctoral fellows, and faculty to the larger biomedical research community

28. Support for BUILD/NRMN Consortium:A Common Fund Program • Planning grants to issue March 8, 2013 • Conduct webinars early on BUILD and NRMN planning grants (late March/early April) • Anticipated statistics: • ~10 primary site institutions • ~600 undergraduate schools in all program phases • ~ $50M/year support, on average • 1 National Research Mentoring Network • 1 Coordinating and Evaluation Center • Partnerships with other funding sources to expand program would be welcome

29. Diversity Initiative: Overarching Strategy Four interrelated approaches will be implemented: • NIH Building Infrastructure Leading to Diversity (BUILD) Program • National Research Mentoring Network (NRMN) • Ensuring Fairness in Peer Review • Increased Engagement by all NIH Leadership

30. Ensuring Fairness in Peer Review • Pilot anonymizing of applications by removing identification of applicant and/or applicant organization • Enhance feedback to applicants that have not discussed applications • Develop better SRO practices for highly discrepant reviews • Provide more guidance to reviewers on using additional comments section of critique template • Provide Next Step information on every summary statement • Continue Early Career Reviewer Program Pilot • Implement implicit bias and diversity awareness training for both Scientific Review Officers (SRO) and members of review panels

31. Diversity Initiative: Overarching Strategy Four interrelated approaches will be implemented: • NIH Building Infrastructure Leading to Diversity (BUILD) Program • National Research Mentoring Network (NRMN) • Ensuring Fairness in Peer Review • Increased Engagement by all NIH Leadership

32. Increased Engagement by all NIH Leadership • Create NIH Steering Committee Working Group on Diversity • Thus making diversity a core consideration of NIH governance • Recruit Chief Officer for Scientific Workforce Diversity who will: • Coordinate NIH initiatives designed to enhance diversity of NIH-funded research workforce • Oversee rigorous prospective evaluation of existing NIH programs designed to enhance diversity of NIH-funded extramural and intramural research workforce • Remain a practicing scientist and work collaboratively across NIH to increase diversity of intramural investigators • For more information: http://www.jobs.nih.gov/vacancies/executive/odcoswd.htm • Applications must be received by 11:59 p.m., April 30, 2013

33. Key Dates • BUILD and NRMN Planning Grant • March 8, 2013: Funding Opportunity Announcement (FOA) released • May 10, 2013: applications due • September, 2013: awards issue • Coordinating and Evaluation Center (CEC) • July 2013: FOA to be released • August 2013: CEC informational webinar • November 2013: CEC applications due • June 2014: CEC award issues • BUILD and NRMN • November 2013: FOAs to be released • Early December 2013: BUILD and NRMN webinars; possibly regional workshops • March 2014: BUILD and NRMN applications due • September 2014: BUILD and NRMN awards issue