I am honored to appear before you as the new Director of the National Center on Minority Health and Health Disparities (NCMHD) to present the President's budget request for FY 2002, a sum of $158.425 million, which reflects an increase of $26.356 million over the comparable FY 2001 appropriation.

The NIH budget request includes the performance information required by the Government Performance and Results Act (GPRA) of 1993. Prominent in the performance data is NIH’s second annual performance report which compares our FY 2000 results to the goals in our FY 2000 performance plan. As performance trends on research outcomes emerge, the GPRA data will help NIH to identify strategies and objectives to continuously improve its programs.

The Secretary for Health and Human Services approved the NCMHD on January 16, 2001, as called for in Public Law 106-525. Within the National Institutes of Health, the NCMHD serves as the focal point for planning and coordinating minority health and other health disparities research. The Center coordinates the development of a comprehensive health disparity research agenda that identifies and establishes priorities, budgets, and policy that govern the conduct and support of all NIH-sponsored minority health and other health disparities research and training activities. Significant progress has been made since the establishment of the Center; however, considerable work remains to be done as the Center transitions from an Office to a Center and assumes grant review, funding and financial management functions. The development of a comprehensive research portfolio began with the NIH Office of Research on Minority Health and will be expanded to include the medically underserved and other health disparity groups as designated by the Agency for Health Care Research and Quality. As a part of its mandate to build capacity for minority health and health disparities research, the Center also will expand it’s support of training and the development of research infrastructure at Minority Serving Institutions.

The complexity of the disparity in health status relates to convergence of multiple factors in unsuspecting ways to cause differences in disease progression and in health outcomes. If one tried to identify a priori all of the factors that could potentially impact the overall health of an individual, the results would look something like the attached schema. Accordingly, the Center will promote and increase participation in minority health and health disparities research by expanding the number of investigators involved in such research and by providing sustained funding for a wide breadth of studies--basic, clinical, and population research; studies on the influences of health processes; and research on the societal, cultural, and environmental dimensions of health--all aimed at identifying potential risk factors for disparate health outcomes.

LEVERAGING RESOURCES WITH THE NIH INSTITUTES AND CENTERS

The NCMHD will continue to provide funding support to assist the NIH Institutes and Centers (ICs) in the following ways: piloting new health disparities programs, improving recruitment and retention in clinical trials, and in providing competitive supplements to expand the focus of existing programs. The Center also will share in the support of selected targeted studies that are supported by the NIH ICs. Selected examples of the ways in which the Center leverages its funds with the NIH ICs are provided below.

The Jackson Heart Study (JHS), a targeted study co-supported by the National Heart, Lung, and Blood Institute and the NCMHD, is an investigation of the causes of the high rate of cardiovascular disease in the state of Mississippi. The objectives of the JHS are to: identify risk factors for the development and progression of CVD; build research capacity in a minority serving institution; and expand minority participation in CVD epidemiology research. Initial examinations among the JHS cohort began in the fall of 2000 and will take 3 years to complete. Some of the newer areas of focus will include early indicators of disease, genetics, sociocultural influences such as socioeconomic status and discrimination, and physiological relations between common disorders such as high blood pressure, obesity, and diabetes and their influence on CVD.

The Diabetes Genes, Treatment, and Prevention in Minorities Research program, supported by the National Institute on Diabetes, Digestive, and Kidney diseases and the NCMHD, focuses on the following groups: Hispanic diabetic adults residing in a rural Texas-Mexico border community; centrally obese African-Americans with impaired glucose tolerance; obese Hispanic high school students in Colorado; African American children, adolescents, and adults with diabetes; and Caribbean Latinos with non-insulin dependent diabetes. Its objectives include the development of treatment and prevention interventions that specifically address diabetes in a range of minority populations and elucidation of the genetic basis of diabetes in minority populations and the underlying mechanisms controlled by gene expression.

The National Institute for Nursing Research (NINR) and the NCMHD will pilot planning activities for a new partnership initiative in NINR’s extramural research program. The focus will be on decreasing disparities in the burden of illness and mortality experienced by racial and ethnic populations and the medically underserved through a variety of approaches, which include basic, epidemiological, clinical and prevention, control and population research. Cultural and ethnic considerations, genetic diversity, and social and economic influences on health and health outcomes are potential areas of emphasis. The activity will include partnership research, training, and other activities between Minority Serving Institutions and research-intensive majority institutions in institutions that provide services to the rural and urban poor.

Other potential areas where the NCMHD will leverage its funds with the NIH ICs include: the intersection of non-genetic factors and genes in health disparities, infectious origins of chronic diseases and research training.

AN INDEPENDENT RESEARCH GRANT PORTFOLIO

Independent grant-making authority not only increases the Center's flexibility in leveraging its funds with the NIH ICs, but it also enables the Center to: focus on “gap areas” where such research is not conducted or supported by the NIH ICs; more effectively build research capacity in minority health and health disparities research, address barriers to the participation of minority serving institutions in the research enterprise, and to develop research capacity among community-based organizations.

With respect to research, the NCMHD recognizes several pressing priorities. Our new Division of Research will develop programs to fund interdisciplinary teams of biomedical, clinical, and social science investigators--teams that are crucial to developing strategies and tools for eliminating health disparities. Another priority of the Division of Research is to ensure that the power of bioinformatics and genomics research, including pharmacogenomics, is brought to bear on the health disparity program.

Our new Division of Community-Based Research and Outreach will identify and implement through research, effective and generalizable models of health care delivery, disease prevention and intervention, and communication that will improve community health outcomes in racial and ethnic minority and other health disparities populations. The Division will utilize available data generated by other Federal and state agencies to identify affected communities and to measure progress in outcomes associated with specific interventions. Key areas of focus will be to promote research on investigation of health behaviors, cultural health beliefs and environmental factors in community health. Validated findings will be utilized and incorporated by the Division to develop culturally sensitive and appropriate community-based prevention messages.

CENTERS OF EXCELLENCE PROGRAM

As mandated in its statutory authorities, the NCMHD also will develop and implement a Centers of Excellence Program to support minority health research and other health disparities research and research training for members of health disparity populations. The exploratory grant mechanism will be used to plan for and promote interdisciplinary biomedical and behavioral research and to plan for the establishment of stable research and training programs. Center planning strategies may focus on a specific research theme (e.g., diagnosis, therapy, epidemiology) or integrate a broad spectrum of research to include the basic, clinical, prevention, and population sciences. Partnerships between minority institutions and majority institutions will be encouraged.

RESEARCH ENDOWMENT PROGRAM

The Center also will develop and implement a Centers of Excellence Endowments Program for certain designated centers and those centers at Institutions of Emerging Excellence. Potentially a pilot initiative could begin in 2001. The purpose of the program is to provide enduring, forward-looking, sustainable support for the Center’s minority health and health disparities research programs and to provide continuing research infrastructure support.

LOAN REPAYMENT PROGRAM

In fiscal year 2001, the NCMHD will develop and implement two distinct extramural loan repayment programs recently authorized by the Congress: the Clinical Research Loan Repayment Program (LRP) and the Health Disparities Loan Repayment Program (HD-LRP). The emphasis of the LRP on “clinical research” and on individuals from “disadvantaged” backgrounds is consistent with the objective of building a culturally competent cadre of clinical investigators. Such a cadre of clinical investigators not only will have the potential of having an influence on the medical processes within their communities but can also engage in and promote the development of clinical research programs that reflect an understanding of the variety of issues and problems associated with disparities in health status. The focus of the health disparities LRP is specifically on clinical research related to diseases and conditions having an increased prevalence among racial and ethnic minorities and other designated health disparity groups.

OTHER CAPACITY BUILDING PROGRAMS

To expand the number of investigators participating in minority health and health disparities research the NCMHD will promote, assist, and support research capacity building activities in the minority and medically underserved communities. These activities will focus on research infrastructure development, faculty career development, and increasing the number of under-represented minority students and students from health disparity groups with an interest in careers in biomedical and behavioral research.

HEALTH INFORMATION DISSEMINATION

Our health information dissemination activities will be multifaceted since professionals and the lay-public obtain information from very dissimilar sources. Information will be transmitted to professional medical and scientific organizations for dissemination among their membership, and also will be made available to the public through media that are most likely to reach racial and ethnic minority groups.

CONCLUSION

Recognizing that the process of medical discovery occurs in stages, the Congress has provided many new opportunities to build upon the previous efforts of the Office of Research on Minority Health. Our commitment to the research needed to ultimately eliminate health disparities will be steadfast and enduring, and we will be ever vigilant in our efforts. We are excited about these opportunities and greatly encouraged by the strong support the Center has received from the Congress, the Administration, our fellow NIH IC Directors and from groups and individuals across the Nation.

The NCMHD is part of the National Institutes of Health (NIH), a component of the U.S. Department of Health and Human Services (DHHS).

ABOUT NCMHD

Congressional Testimony

DEPARTMENT OF HEALTH AND HUMAN SERVICES NATIONAL INSTITUTES OF HEALTH