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Summary

Health Centers and Systems Virtual Listening Session

Thursday, January 13, 2022, 6:00pm-7:30pm ET

Brief Overview

The purposes of the listening session were to listen and learn about perspectives and experiences related to racial and ethnic equity in the biomedical research enterprise among  individuals who represent, work within, or are otherwise connected to U.S. health centers and systems. The listening session, facilitated by an outside contractor, was attended by more than 70 participants. Dr. Joni Rutter, Acting Director of the National Center for Advancing Translational Sciences (NCATS) at NIH, welcomed attendees and summarized the mission and goals of the UNITE initiative.  

Summary of Discussion

• Topic 1: The overall state of racial and ethnic equity in the biomedical sciences
  Participants described significant racial and ethnic equity challenges in multiple settings, including biomedical research, healthcare, and academia. They observed that these environments have been developed and remain centered on the perspectives, experiences, and needs of the majority (i.e., White) population – and infrequently focus on the experiences and challenges faced by racial and ethnic minority groups. Participants expressed the need to create safe and inclusive environments that welcome diversity and enable healthcare professionals to be their authentic selves. Further, they expressed that racial and ethnic minority persons in the workplace carry the burden of representing their entire group. Participants emphasized that assuring racial and ethnic equity will require culturally competent care for racial and ethnic minority patients, greater representation of racial and ethnic minority persons as participants in biomedical research, as well as more underrepresented minority (URM) scientists.  

• Topic 2: Opportunities and challenges to racial and ethnic equity in career pathways – education, hiring, advancement, and research opportunities
  The dialogue focused on several points, including the importance of – and barriers to – careers in biomedical science. Participants described the importance of increasing the pipeline of URM students and early career researchers to advance science, stimulate more inclusive environments, and increase the diversity of participants in research. They indicated that early introduction (during the K-12 years) to career opportunities in science, technology, engineering, and mathematics (STEM) would have a positive influence on URM students and encourage them to pursue these as viable options. Identified barriers to racial and ethnic equity in research careers included low compensation and inadequate resources to facilitate success among early career individuals, and participants stated that improvements in these areas would increase URM recruitment and retention.

  Participants emphasized the importance of mentorship and sponsorship among URM students and early career researchers. Sponsorship, in particular, was noted as a critical element in increasing the representation of URM scientists in leadership positions. Some participants detailed personal difficulties identifying mentors and sponsors to support their research careers or assist them in navigating healthcare and academic settings.

• Topic 3: Opportunities, needs, and challenges in addressing health disparities and healthcare equity
  Participants identified a lack of advocacy and representation as key challenges in addressing health disparities and healthcare equity. Participants expressed that community advocacy can lead to improvements in long-term health outcomes and bridge the healthcare gaps experienced by underserved groups. Increasing direct, high-quality healthcare experiences would enable racial and ethnic minority persons to advocate effectively for their communities and for themselves. Participants also stated that greater diversity among physicians and other clinicians, as well as researchers would increase healthcare-seeking and research participation among racial and ethnic minority patients.

  Additional challenges and opportunities to advance health equity were noted. Challenges included the need for culturally competent healthcare professionals and researchers, who recognize the diversity within racial and ethnic minority populations, and that health needs may differ within and across groups. Participants also highlighted that inadequate infrastructure and transportation to rural communities can limit patient access to medication and health-related resources, which create and maintain health disparities. Finally, opportunities to advance health equity included increasing support for community-based participatory research (CBPR) and addressing adverse social determinants of health (e.g., by providing access to adequate home healthcare services and improving working conditions).

• Topic 4: Actions and initiatives to address racial and ethnic equity within your institution
  Participants shared their organizations’ actions and initiatives to address racial and ethnic inequities. These efforts were often focused on reducing health disparities or increasing the cultural competence of staff members. Specific activities included focused discussions among researchers, health equity advocates, and communities to identify issues and propose strategies that address health disparities. Organizations are also developing trainings for staff in areas such as respectful and equitable treatment practices for all patients. Given the infrastructure challenges noted above (see Topic 3), participants also described efforts to begin collecting data on social determinants of health to improve infrastructure, medication access, and transportation services in rural communities. Participants also discussed efforts to apply the strategy of cluster hiring – recruiting multiple URM researchers or faculty members concurrently – allowing these professionals to grow as a cohort and avoiding the tokenism that can be experienced with individual URM hires.

• Topic 5: Practices and policies as barriers to racial and ethnic equity
  Participants expressed that a lack of representation and community inclusion throughout the research process is a critical barrier to racial and ethnic equity in research and healthcare. They shared that community members outside of the academic system have valuable perspectives that support evaluation of the research and its impact on the community. Participants recommended establishing the practice or policy of including non-academic community members and community organization leaders in grant review panels to provide a community-based perspective which can counter implicit bias within the panel. They further suggested that researchers forge reciprocal relationships with the communities in which research is being conducted, to ensure research funding and findings are infused into these communities.

• Topic 6: Proposed solutions for NIH – tactics, actions, initiatives, policy, and engagement
  Proposed solutions varied, including actions to support translational science, deepen the understanding of root causes of health disparities, and increase exposure to STEM careers. Participants suggested that NIH continue to fund and support translational science, which turns observations in the laboratory, clinic, and community into interventions that improve the health of individuals and the public. Participants also suggested that NIH require investigators to explain or justify including race as a variable in their research analysis. This could encourage researchers to consider more specific variables, instead of race, to deepen hypotheses regarding the root causes of health disparities. Participants recommended that NIH fund public school STEM programs and career exposure for students, beginning as early as elementary school and continuing throughout their academic careers.

NIH is grateful for the participation and perspectives provided by the wide variety of stakeholders in these listening sessions. For more information about past listening sessions, and to follow the efforts of the UNITE initiative, please visit the UNITE events webpage at nih.gov/ending-structural-racism.

The opinions and perspectives presented in this summary reflect those of listening session participants, and do not necessarily reflect the perspectives or practices of the NIH.