Creating New Research on Health Disparities, Minority Health, and Health Equity

March 31, 2022

N Committee

Creating New Research on Health Disparities, Minority Health, and Health Equity

UNITE Co-Chairs’ Corner

Medical equipment, medicine and scales of justice surrounded by diverse individuals.

Health Equity.Shutterstock

Context

Colonization and persecution of groups based on skin color, ancestry, and race are etched in American history. Equality of opportunity has eluded many and benefitted elite privileged segments of society. According to a January 20, 2021 Executive Order on Advancing Racial Equity and Support for Underserved Communities Through the Federal Government, “Entrenched disparities in our laws and public policies, and in our private and public institutions, have often denied that equal opportunity to individuals and communities.” The net effect of these policies and practices has been to marginalize persons of color in poverty, illness, and unequal access to resources.

The Executive Order defines equity as the “consistent and systematic fair, just, and impartial treatment of all individuals, including individuals who belong to underserved communities that have been denied such treatment, such as Black, Latino, and Indigenous and Native American persons, Asian Americans and Pacific Islanders and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons; persons with disabilities; persons who live in rural areas; and persons otherwise adversely affected by persistent poverty or inequality.” Equity of opportunity is an elusive ethical imperative that we must strive daily to achieve lest we forget the price in human losses we pay as a nation if we do not.

The mission of the ľ��ֱ�� (NIH) is to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability. However, that knowledge has neither been sought nor applied equitably, contributing to stark disparities in the health of the U.S. population that have been exacerbated by a global pandemic whose effects will be felt by historically underserved communities for many years to come.

Charge

The N Committee of the UNITE initiative to end structural racism in biomedical research was charged by the former Director of the NIH, Dr. Francis Collins, with creating new research on health disparities, minority health, and health equity (HD/MH/HE). The N Committee is to guide the NIH to “address long-standing health disparities and issues related to minority health inequities in the United States by ensuring NIH-wide transparency, accountability, and sustainability in marshaling resources for health disparity, minority health, and health equity research.”

Actions

NIH stands against structural racism in biomedical research. Its actions and more specifically, its funding opportunities must promote health equity. The goals of the N Committee reflect a roadmap for improved equity in the allocation of research dollars and results obtained:

Track accurate key performance metrics to allow NIH Institutes, Centers, and Offices (ICOs) to set and monitor targets for funding of HD/MH/HE research.
Identify key gaps in scientific areas requiring additional investments to measurably reduce health disparities and meet goals.
Identify key business processes from ideation to funding that facilitate/impede appropriate allocation of NIH resources to measurably reduce health disparities and meet NIH Minority Health and Health Disparities Strategic Plan 2021-2025 goals.
Stimulate collaborative NIH-wide funding opportunities to ensure robust support for HD/MH/HE research and drive scientific advances in these areas.

The N committee has:

Obtained approval from NIH leadership to develop a data tracking and visualization tool that will achieve the four goals stated above. This tool will allow Institute, Centers and Offices (ICOs) to strategically fund research with the greatest potential to achieve meaningful advances in health equity. As a first step, the N Committee’s Data Work Group will work with the immense portfolio analyses talent pool at NIH to create appropriate and accurate coding structures to accurately capture and characterize NIH-funded HD/MH/HE research.
Stimulated the NIH Common Fund to issue and reissue FY21 and FY22 funding opportunity announcements (FOAs) to fund . The NIH Common Fund addresses pressing challenges in biomedical research that no single Institute or Center (IC) can address on its own but are of high priority for the NIH as a whole. These FOAs resulted in the funding of 11 grants totaling $58 million over five years to support new research to advance health equity. Each award includes an innovative intervention component (e.g., financial interventions that address structural racism, technology-assisted interventions for underserved children living in rural areas) and focuses on one or more NIH-designated populations that experience health disparities in the United States.

Future plans include chartering a new MH/HD/HE Research Work Group led by the National Institute on Minority Health and Health Disparities (NIMHD) and N Committee members to coordinate and optimize business practices to ensure real progress toward equitable funding of HD/MD/HE research and health equity in the United States. The N Committee will continue to work with NIH portfolio analysis and HD/MH/HE research subject matter experts to develop and implement the data tracking and visualization tools needed to accurately and strategically target NIH funds for maximum impact.

On January 27, 2022, the Common Fund Program staff obtained Council of Councils concept clearance for the Community Partnerships to Advance Science for Society (ComPASS). This 10-year, $400 million effort grew out of the FY21 and FY22 efforts to increase funding for HD/MH/HE research, and has been realized by the stalwart efforts of the lead ICOs National Institute of Mental Health (NIMH), NIMHD, National Institute of Nursing Research (NINR), the Office of Research on Women’s Health (ORWH), and the Tribal Health Research Office (THRO) with Working Group support from more than 20 ICOs. The ComPASS goals are to 1) facilitate and implement a cross-IC framework for health equity structural intervention research; and 2) catalyze, deploy, and evaluate community-driven health equity structural interventions that leverage multisectoral partnerships to reduce health disparities. The program was developed with input from more than 500 attendees across eight listening sessions that included community-based organizations, faith-based organizations, tribal communities, academic institutions, and local and state health departments. Development of funding opportunity announcements are now in process ( and ).

The efforts of the N Committee and other UNITE Committees are intended to be disruptive and catalytic. Business as usual is not an option if we are to achieve health equity for all persons in the United States.