NATIONAL INSTITUTES OF HEALTH 

National Institutes of Health 

Strategic Research Plan and 

Budget to Reduce and Ultimately 

Eliminate Health Disparities 

Volume I 

Fiscal Years 2002-2006 

U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES

FY 2002 
TABLE OF CONTENTS 

VOLUME 1 

Foreword..................................................................................................1

Executive Summary.................................................................................4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section I: Introduction.......................................................................7

NIH Organizational Structure .............................................................7

NCMHD Role ....................................................................................8

Objectives of the Strategic Plan .........................................................9

Organization of the Strategic Plan.....................................................10

Development of the Strategic Plan....................................................11

Section II: Background on Minority Health and Health 

Disparities...............................................................................................12

Multifactorial Basis of Health Disparities........................................15

Coordination of an Interdisciplinary Approach.................................17

Section III: Department of Health and Human Services (HHS)

and NIH Efforts to Reduce and Ultimately Eliminate Health 

Disparities................................................................................................19

HHS Efforts......................................................................................19

NCMHD Efforts...............................................................................20

NIH Efforts.......................................................................................21

Section IV: Strategic Planning Model for Reducing and 

Ultimately Eliminating Health Disparities..........................................22

Mission to Reduce and Ultimately Eliminate Health Disparities......22

Vision to Reduce and Ultimately Eliminate Health Disparities........22

Goals and Objectives to Reduce and Ultimately Eliminate Health 

Disparities...........................................................................................23

Overview of NIH Programs to Reduce and Ultimately Eliminate 

Health Disparities...............................................................................25

NIH Minority Health and Health Disparities Budget.........................29

Conclusion ..............................................................................................31

VOLUME II 

Individual IC, OAR, and OBSSR Strategic Plan Submissions 

(Separately Attached) 
Foreword 

Medical and scientific advances have introduced new opportunities for the 

continued improvement of health for all Americans. However, in spite of 

notable improvements gained as a result of the advancement of knowledge 

through basic and applied research, diagnostics and treatment, there continues to 

be an alarming disproportionate burden of illness among minority and medically 

underserved populations. NIH’s mission of “uncovering new knowledge that 

will lead to better health for everyone” lays the foundation for the overall goal 

of understanding the causes of health disparities and for developing effective 

interventions to eliminate these disparities. 

All of us who have been privileged to participate in this age of scientific 

discovery have a responsibility to ensure that the new knowledge generated in 

our laboratories and our clinics benefits all of our citizens and all of our 

communities. Our aim at the NIH is to promote the development and transfer of 

research-based information from the biomedical, behavioral, and social sciences 

for use by health professionals, communities, and others in working toward the 

elimination of health disparities. 

In order to address the constant and confounding problem of health disparities 

experienced by the affected communities including the medically underserved 

population, the NIH is committed and remains vigilant in supporting research to 

understand biological, socioeconomic, cultural, environmental, institutional, and 

behavioral factors affecting health disparities. Research is but only one solution 

in a multifaceted effort. In addition to devoting resources toward the application 

of research programs, the NIH is also planning and conducting education and 

training programs and increasing outreach activities, to translate new knowledge 

from research into improved health outcomes for all Americans. 

This strategic plan, NIH Strategic Research Plan and Budget to Reduce and 

Ultimately Eliminate Health Disparities, is the first step in implementing Public 

Law (P.L.) 106-525, The Minority Health and Health Disparities Research and 

Education Act of 2000, and represents NIH’s assurance and commitment to this 

effort. The plan was developed through an open process with substantial input 

from the public, particularly from representatives of groups who 

disproportionately experience disparities in health, in addition to those in 

academia and health care professionals. It describes the activities underway and 

planned to bring the full strength of NIH's research, training and outreach 

programs to bear on the challenge of eliminating domestic health disparities, 

increasing participation by minorities in clinical research, and increasing the 

number of minority clinical and basic medical scientists who are essential to the 

success of our efforts. 

1 
While the diversity of the American population remains one of our Nation's 

greatest assets, the discrepancies in health status described here represent a

challenge to better understand these disparities, and to reduce and ultimately

eliminate them. 

Public Law 106-525 requires the NCMHD to report to the Congress by 

December 2003 recommendations for the methodology the NIH will use to 

determine the amount of NIH resources dedicated to the conduct and support of 

health disparities research.

 

The budget data for health disparities activities contained within the budget table 

in Volume I of this version of the NIH Strategic Research Plan and Budget to

Reduce and Ultimately Eliminate Health Disparities used a definition of minority 

health and health disparities research that the NIH is currently refining in

accordance with Public Law 106-525. 

Because of concerns about current definitions, we are unable to provide the 

Congress with valid and reliable data on minority health disparities research in

this report. In order to overcome this problem for our next report, and to further 

improve the quality of data, we submit to Congress, NIH has established an NIH 

Committee on Minority Health and Health Disparities Research Definitions and 

Application Methodology. The Committee is developing new definitions and a 

revised application methodology that will be used by the NIH for future reporting 

purposes. The Committee will develop a uniform NIH Guidance that: 

Provides NIH operational definitions, based on Public Law 106-525, 

for minority health and health disparities research, 

 

 

 

 

Provides a consistent methodology for applying the definitions, 

Contains the criteria necessary to identify both minority health and 

health disparities population groups and diseases, and 

Serves as the foundation for identifying, coding, tracking, and reporting 

on NIH activities and resources. 

2
The NIH will be updating the Strategic Research Plan and Budget each year.

Accordingly, the budget figures to be contained within the next iteration (2003)

of the NIH Strategic Research Plan and Budget will be more precise, based upon 

the revised definitions and application methodology. 

Elias A. Zerhouni, M.D. John Ruffin, Ph.D. 

Director Director 

National Institutes of Health National Center on Minority

Health and Health

Disparities, National 

Institutes of Health

 

 

3
Executive Summary

Over the last two decades the overall health of the Nation has improved 

significantly. Yet there continue to be striking disparities in the burden of illness 

and death experienced by African Americans, Hispanics, Native 

Americans, Alaska Natives, Asians, and Pacific Islanders. The 

most striking disparities include shorter life expectancy as well

as higher rates of cardiovascular disease, cancer, infant mortality, 

birth defects, asthma, diabetes, stroke, sexually transmitted

diseases, and mental illness. These disparities are believed to be

the result of the complex interaction among biological factors, 

the environment, and specific health behaviors. Inequalities in 

income and education also appear to underlie many health 

disparities in the United States. Disparities in income and

education levels are associated with differences in the occurrence

of illness and death, including heart disease, diabetes, obesity, 

elevated blood lead level, and low birth weight. 

MISSION 

The NIH mission on minority 

health and health disparities is to 

support and promote biomedical 

and behavioral research, research 

training, research capacity, and 

research information 

dissemination, with the goal of 

improving the health status of 

minorities and other health

disparity populations. 

Overcoming persistent health disparities and promoting health 

for all Americans rank as our Nation's foremost health challenge. 

To overcome this challenge, the National Institutes of Health

(NIH) is supporting and conducting a wide range of research, 

and seeking new knowledge, strategies, and methodologies about

disease and disabilities. This new knowledge has and will

continue to lead to innovative diagnostics, treatments, and

preventative strategies to reduce, and eventually eliminate, health

disparities. 

VISION 

A time when all Americans have 

the opportunity for long, healthy,

and productive lives regardless of 

race, ethnicity, or socioeconomic 

status. 

Within the NIH, the National Center on Minority Health and Health Disparities 

(NCMHD) serves as the focal point for planning and coordinating minority health 

and other health disparities research. According to P.L. 106-525, the NCMHD was 

established by Congress to foster, coordinate, and assess the progress of all NIHsponsored research activities involving minority health and other health disparities 

by working in collaboration with NIH's Institutes and Centers (ICs) and other 

program offices within the NIH Office of the Director (OD). 

The initiatives described in this plan represent the major priorities and broad range 

of activities that the NIH will undertake to reduce and ultimately eliminate health

disparities. The plan is not merely a compilation of all the activities of the NIH 

entities, but an aggregation of primary areas of emphasis and activities conducted 

across the NIH. This plan is the first step of an evolving process by which the

strategic plan will be revised on a yearly basis based on public comments 

received, public health need, scientific opportunity, changes in available funds, 

and other factors. The plan will be posted on the NCMHD website on a continuing

4
basis and public comments on the plan will be encouraged and considered at any

time. The strategic plan follows a methodological planning model, which presents 

mission, vision, goals, objectives, and programs for reducing and eventually 

eliminating health disparities. 

The Strategic Plan is focused on three major goals: 

 

 

 

Research - to advance the understanding of the development and 

progression of diseases and disabilities that contribute to minority health 

and other health disparities 

Research Infrastructure - to increase minority health and health 

disparity research training, career development, and institutional capacity 

Public Information and Community Outreach - to ensure the public, 

healthcare professionals, and research communities are informed and 

educated concerning the latest advances in minority health and health 

disparities research. 

RESEARCH 

 OBJECTIVES 

RESEARCH INFRASTRUCTURE 

OBJECTIVES 

OUTREACH 

OBJECTIVES 

the development and 

progression of diseases 

and disabilities that 

contribute to health 

disparities 

approaches for detecting 

or diagnosing the onset or 

progression of diseases 

and disabilities that 

contribute to health 

disparities 

approaches for preventing 

or delaying the onset or 

progression of diseases 

and disabilities that 

contribute to health 

disparities 

approaches for treating 

diseases and disabilities 

that contribute to health 

disparities 

clinical trials from minority and ethnic 

populations and other special 

populations experiencing health 

disparities 

and career development for, and provide 

research supplements to, research 

investigators from minority and other 

populations experiencing health 

disparities 

and renovation of research facilities 

across the Nation aimed at enhancing 

the ability of these institutions to conduct 

health disparities research 

across the country for resources, new

equipment, and shared equipment

programs for use in health disparities 

research 

from minority and ethnic populations and 

other populations experiencing health 

disparities 

information to healthcare providers to 

enhance the care provided to individuals 

within populations experiencing health 

disparities 

based information into the curricula of 

medical and allied health professions 

schools, and into continuing education 

activities of health professionals 

and dialogue with minority, ethnic, and 

other populations, including the underserved, who experience health disparities 

resources to disseminate current 

information about scientific research and 

discoveries and other activities regarding 

health disparities 

programs focused on particular disease 

areas in order to reach those individuals 

within minority, ethnic, and other 

populations who experience health 

disparities within these disease areas 

5

Advance understanding of Increase the number of participants in Provide the latest research-based 

Develop new or improved 

Expand opportunities in research training Facilitate the incorporation of scienceDevelop new or improved 

Increase funding support for construction 

Maintain ongoing communication linkages 

Develop new or improved 

Increase representation in peer review

Develop targeted public health education 

Provide increased funding at institutions 

Develop computer databases and internet 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
Specific initiatives to support each objective are highlighted in Section IV of this

plan. The programs presented are a representative sampling, selected for their

depth of activities and breadth of scope in addressing minority health and health

disparities. They do not represent the totality of the NIH program. Further 

information about each of the initiatives and a complete list of all IC initiatives, 

can be found in Volume II of this strategic plan. 

All of these many initiatives cut across a variety of areas representing a myriad of 

diseases, disabilities, and organizational boundaries. These initiatives represent a

trans-agency commitment to exploring and solving many of the health disparities 

problems our citizens and our Nation face. Much needs to be done, but we are 

confident that the medical research community working with, and informed by, 

the public, patients, health care providers, policymakers, and others will continue 

to develop new knowledge that will lead to improvements in the prevention,

diagnosis, and treatment of diseases and disabilities that contribute to health 

disparities among minority and medically underserved populations. 

6
Section I: Introduction 

Despite notable improvements in the overall health of the Nation in the last two

decades, there continue to be striking disparities in the burden of illness and

death among African Americans, Hispanics, Native Americans, Alaska Natives, 

Asians, and Pacific Islanders and underserved groups such as disadvantaged rural 

Whites. Overcoming such persistent health disparities, and promoting health for 

all Americans ranks as one of our Nation's foremost challenges. 

According to P.L. 106-525, the Minority Health and Health Disparities Research

and Education Act of 2000, health disparity populations refer to

"a population where there is a significant disparity in the

overall rate of disease incidence, prevalence, morbidity, 

mortality, or survival rates in the population as compared to the 

health status of the general population." To meet this challenge, 

the NIH is focusing its efforts on minority health disparities as 

well as other health disparity populations. Health disparity 

efforts transcend the bounds of gender, except in certain

instances of specialized research (i.e. lupus in women, cervical

cancer in Vietnamese women). 

Minority Health Disparities 

Diseases, disorders, and 

conditions that disproportionately

afflict individuals who are 

members of racial and ethnic 

minority groups 

Other Health Disparity

Populations 

Population groups who suffer from 

health disparities when compared 

to the general population 

Research activities may include basic and applied research, research and 

development with respect to products, behavioral research, social sciences

research, cultural research, and linguistic research. 

It is imperative that the Nation make a concerted effort to reduce health 

disparities. The National Institutes of Health (NIH) has a unique and central role 

in this endeavor. By supporting and conducting a wide range of research, the 

NIH seeks new knowledge, strategies, and methodologies about disease and 

disabilities. This new knowledge has, and will continue to, lead to innovative 

diagnostics, treatments, and preventive strategies to reduce, and eventually 

eliminate, health disparities. 

NIH Organizational Structure 

The mission of the NIH is to improve the Nation's health by uncovering new 

knowledge about the prevention, detection, diagnosis, and treatment of diseases 

and disabilities. NIH's mission is, thus, central to expanding national efforts to 

address differences in incidence, prevalence, morbidity, mortality and burden of 

diseases and other adverse health conditions that exist among specific population 

groups in the United States. 

7
The NIH, comprised of twenty-seven Institutes and Centers (ICs) and other 

program offices in the Office of the Director (OD), has long been committed to 

addressing and eliminating health disparities. The National Center on Minority 

Health and Health Disparities (NCMHD) serves as the focal point for planning and 

coordinating minority health and other health disparities research across the NIH. 

National Institute 

on Aging

National Institute 

on Aging

National Institute of 

Arthritis and 

Musculoskeletaland 

Skin Diseases

National Institute of 

Arthritis and 

Musculoskeletaland 

Skin Diseases

National Institute on 

Alcohol Abuse and 

Alcoholism

National Institute on 

Alcohol Abuse and 

Alcoholism

National Institute of 

Allergy and Infectious 

Diseases

National Institute of 

Allergy and Infectious 

Diseases

National Cancer

Institute

National Cancer

Institute

National Institute of 

Child Health and 

Human Development

National Institute of 

Child Health and 

Human Development

National Institute on 

Deafness and Other

Communication

Disorders

National Institute on 

Deafness and Other

Communication

Disorders

National Institute on 

Drug Abuse

National Institute on 

Drug Abuse

National Institute of 

Dental and 

Craniofacial

Research

National Institute of 

Dental and 

Craniofacial

Research

National Institute of

Diabetes and 

Digestive and Kidney 

Diseases

National Institute of 

Diabetes and 

Digestive and Kidney 

Diseases

National Institute of 

Environmental Health 

Sciences

National Institute of 

Environmental Health 

Sciences

National

Eye Institute

National

Eye Institute

National Institute of 

General Medical

Sciences

National Institute of 

General Medical

Sciences

National Institute of 

Mental Health

National Institute of 

Mental Health

National Heart, Lung,

and Blood Institute

National Heart, Lung,

and Blood Institute

National Human

Genome Research 

Institute

National Human

Genome Research 

Institute

National Institute of 

Neurological

Disorders and Stroke

National Institute of 

Neurological

Disorders and Stroke

National Institute of 

Nursing Research

National Institute of 

Nursing Research

National Center for 

Research Resources

National Center for 

Research Resources

National Center for 

Complementary and 

Alternative Medicine

National Center for 

Complementary and 

Alternative Medicine

Fogarty International

Center

Fogarty International

Center

National Library of

Medicine

National Library of

Medicine

Center for Scientific

Review

Center for Scientific

Review

Clinical Center

Warren Grant 

Magnuson 

Clinical Center

Center for 

Information 

Technology

Center for 

Information 

Technology

National Center for

Minority Health and

Health Disparities

National Center on

Minority Health and

Health Disparities

Office of 

the Director

Office of 

the Director

National Institutes of Health Role in 

Minority Health and Health Disparities

National Institute of 

Biomedical Imaging 

and Bioengineering

National Institute of 

Biomedical Imaging 

and Bioengineering

NCMHD Role

According to P.L. 106-525, the NCMHD was established by Congress to work in 

collaboration with other NIH IC's to foster, coordinate, and assess the progress of all 

NIH-sponsored research activities involving minority health and other health 

disparities. 

The NCMHD leads the federal effort at the National Institutes of Health to 

stimulate new research, improve the health status of minority Americans and 

other underserved groups across their lifespan and promote programs aimed at 

expanding the participation of underrepresented minorities in all aspects of

biomedical and behavioral research. 

Specific priorities for the Center include: 

Developing an integrated, cross-disciplinary national research agenda on 

health disparities 

 

 Promoting and supporting research capacity-building activities in the 

minority and medically underserved communities 

8
Establishing broad aspects of two-way communication and outreach with 

the Center's many stakeholders 

 

 

 

Collaborating with NIH research partners to sponsor activities involving 

minority health and health disparities 

Assessing, tracking, and monitoring the results of NIH minority health 

and health disparities research progress 

NCMHD's effort cuts across disease areas and organizational boundaries and 

involves a trans-agency commitment. It coordinates and augments the efforts of 

each Institute, Center, and program office in the NIH Office of the Director.

Furthermore, the Center functions as the central repository for minority health 

and health disparity research information and fosters knowledge sharing among 

the IC's. More information regarding NCMHD's mission, vision, and strategic 

objectives can be found in the NCMHD's section in Volume II. 

Objectives of the Strategic Plan 

In response to P.L. 106-525, the five-year TransNIH Strategic Plan describes an ambitious 

approach to reduce and ultimately eliminate 

health disparities among racial and ethnic

minorities and other health disparity groups. The

scope of the problem of health disparities among 

minorities and other populations, the specific 

objectives for solving the problem, and the means 

for advancing those objectives are the substance

of this strategic plan. The initiatives described 

here represent the major priorities and the broad 

range of activities that the NIH will undertake to 

reduce and ultimately eliminate health disparities. 

This plan allows for the evaluation of NIH's progress and the extent to which NIH

meets its projected goals. The plan is not merely a compilation of all the activities 

of the relevant NIH entities, it aggregates the primary areas of emphasis and 

activities conducted across the agency and provides the reader with an

understanding of the cross-cutting nature of disease and scientific discovery. 

Objectives of the Trans-NIH Strategic Plan

• Present NIH's role in minority health and health 

disparities, including the function of the 

NCMHD 

• Discuss the methodology used to develop the 

Trans-NIH Strategic Plan

• Examine factors that contribute to minority 

health and health disparities 

• Outline Department of Health and Human 

Services (HHS) and NIH efforts to reduce and 

ultimately eliminate health disparities 

• Present the structured planning model used to 

support minority health and other health 

disparities activities; including the mission, 

vision, goals, objectives and sample programs 

that support reducing and eliminating minority

health and other health disparities

This plan is an evolving document. It will be updated and revised on a yearly

basis based on public comments received, public health need, scientific

opportunity, changes in available funds, and other factors. 

9
Organization of the Strategic Plan 

This strategic plan sets forth NIH's goals for reducing and, ultimately, 

eliminating health disparities among racial and ethnic minorities and other

populations and describes some of the many initiatives that will be expanded or 

created to meet these goals. Volume I contains background on minority health

and health disparities, future initiatives to address these issues, and NIH longterm goals and objectives. Volume II includes strategic plan submissions from all 

the IC's, as well as from NIH’s Office of AIDS Research (OAR) and Office of 

Behavioral and Social Sciences Research (OBSSR). 

SECTION TOPICS 

VOLUME I 

I. Introduction Describes the NIH organizational structure, the 

objectives of the Trans-NIH Strategic Plan, the 

organization of the plan, and the methodology used

to develop the strategic plan.

II. Background on Minority Health

and Health Disparities 

Presents the factors that contribute to the problem

of minority health and other health disparities 

III. Department of Health and Human 

Services (HHS) and NIH Efforts to

Reduce and Ultimately Eliminate 

Health Disparities 

Describes HHS, and NIH efforts to address 

minority health and other health disparities and the 

coordination of the interdisciplinary approach

IV. Strategic Planning Model Presents the strategic planning model; including

the mission, vision, goals, objectives, and sample

programs established to support reducing and 

eventually eliminating health disparities among 

minorities and other populations. In addition, the 

NIH Minority Health and Health Disparities 

Budget and the conclusion are presented in this 

section. 

VOLUME II 

Individual IC, OAR, and OBSSR

Strategic Plan Submissions 

Provides IC, OAR, and OBSSR strategic areas of

emphasis, objectives, action plans, timelines and 

performance measures to reduce and ultimately 

eliminate health disparities in the United States. 

10
Development of the Strategic Plan 

The NIH followed a structured strategic planning model in developing this

strategic plan. The initial draft five-year Trans-NIH Strategic Plan incorporated 

the efforts of a Trans-NIH working group, which consisted of each NIH Institute

and Center Director. The draft was published on October 6, 2000 for technical 

and public review. The plan was developed through an open process with 

substantial public input, particularly from representatives of groups who 

disproportionately experience disparities in health. Comments were received and 

archived up until February 23, 2001. Next, each IC, the OBSSR, and the OAR 

developed a mission-specific submission for the strategic plan that sets forth in

greater detail ongoing and future efforts to reduce health disparities among 

minority and other health disparity populations. The NCMHD synthesized and 

analyzed all IC submissions to develop the Trans-NIH Strategic Plan. 

1. Develop Initial Draft

Trans-NIH Plan

2. Solicit and Analyze

 Public Comments

3. Develop Institute and Center 

 Planning Submissions

4. Synthesize and Analyze 

 Institute and Center 

 Planning Submissions 

7. Receive Feedback 

 from Evaluation

5. Finalize Trans-NIH

 Strategic Plan

Strategic

Planning 

Process

6. Implementation of 

 Trans-NIH Plan

This strategic plan incorporates input from the public, professional and patient 

advocacy groups, health care organizations, academic institutions, 

ethnic/minority groups, federal agencies, and the scientific community. The input

from these stakeholders is reflected throughout the plan. 

During the implementation of the Strategic Plan, the NCMHD will seek

additional public comment to aide in revising the plan. The Center also will

provide support to the other ICs to assist them in convening workshops that will 

include outside experts to assess their health disparities agendas, progress and

outcomes in health disparities research. This process will enable further

refinement of the IC submissions to the Trans-NIH Strategic Plan in future years. 

11
Section II: Background on Minority Health and Health Disparities 

The health disparities that afflict ethnic and racial minorities as well as other

underserved populations are not limited to one or two disease categories. They

apply to a broad spectrum of disease types that encompass infectious diseases,

vascular diseases, endocrine diseases, arthritic diseases, connective tissue

diseases, malignancies, mental illness and others. Health disparities also exist 

within different geographic regions of the United States. Consequently, "health 

disparity" is an issue that is relevant to the work of every NIH Institute and 

Center, and certain offices within the NIH Office of the Director. A brief sample 

of relevant diseases follows: 

Infant Mortality – Over the last decade, the infant mortality rate 

remains more than twice as high among African Americans as compared 

to Whites, even when controlling for socioeconomic factors. American

Indians and Alaska Native infants also have a death rate almost double

that of Whites. 

 

 

 

Heart Disease and Stroke – Coronary heart disease mortality is 20 

percent higher for African Americans than Whites. Fewer African

Americans survive severe cardiomyopathy as compared to Whites – a

difference that is attributed to both biological and socioeconomic factors. 

The incidence of stroke is disproportionately high in African Americans, 

where the mortality rate is nearly 27.5 percent higher than in Whites. 

Cancer – Minority groups suffer disproportionately from cancer, and

disparities exist in both mortality and incidence rates. African

Americans have both a higher overall incidence and a higher death rate 

than any other racial or ethnic group. The difference in cancer mortality 

is about 12% higher for Hawaiian men and 20% higher for Hawaiian

women than that of white Americans. 

The mapping of U.S. Cancer incidence and mortality rates indicate 

distinct regions of the country where disparities in cancer exist. NCI’s 

Atlas Of Cancer Mortality in the United States map geographic mortality 

distribution by county and by race for all major cancers. By mapping 

cancer rates, disparities by region have been identified for further study.

These regions include the Mississippi Delta Region, and the Appalachia

Region. The average cervical cancer mortality rate among African

American women is more than double that of white women and the 

national average for all women. Rates are particularly high among black 

women in the rural South, primarily in the Mississippi Delta region that

encompasses 235 counties and parishes within the states of Alabama, 

Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri and 

Tennessee. Cervical cancer mortality is higher than average among 

Latina women living on the Texas-Mexico border, among white women

12
in Appalachia, rural New York State, and northern New England.

Mortality from the disease also is higher than average among Vietnamese

and some Native American and Native Alaskan women. (NCI sponsored

registry of the Surveillance, Epidemiology, and End Results (SEER)

program.) 

While incidence rates for all cancer sites in the Appalachia Region 

compared to the national SEER population was similar, incidence of 

reported lung, colon, rectal and cervical cancer was each substantially 

higher in the Appalachian region which includes regions within thirteen 

states. In rural Appalachia, incidence of lung and cervical cancer was

approximately one-third higher than the national average. In addition,

the ratio of unstaged cancers at all sites was elevated for rural

Appalachia. (Central cancer registries of Kentucky, Pennsylvania, and

West Virginia established by the Appalachia Cancer Network 

Surveillance Task Force.) 

Mental Health – Disease burden associated with mental disorders falls 

disproportionately on ethnic minority populations. Native American and 

Alaska Natives not only suffer disproportionately from depression, but 

this population also experiences a higher rate of suicide. 

 

 

 

Diabetes – The prevalence of diabetes in African Americans is twice as

high than in whites. Certain racial and ethnic communities, including 

African Americans, Hispanic Americans, American Indians and Certain

Pacific Islander and Asian American populations as well as economically

disadvantaged or older people, suffer disproportionately compared to

white populations. 

HIV and AIDS – AIDS incidence for African Americans is

disproportionately higher than for other populations. African American

females are diagnosed with AIDS at a rate that is nearly 4 times higher 

than for Hispanic American females, 10 times higher than for American

Indian or Alaska Native females and 24 times more often than white

females. African American males experience a rate of AIDS incidence

that is almost 3 times higher than for Hispanic American males, nearly 6 

times greater than for American Indian or Alaska Native males and 

nearly 8 times higher than for white males.

13
The table that follows further describes, in quantitative terms, health 

disparities of certain conditions in selected populations. It is clear from 

this overview that the nature of the disparity may vary significantly from 

group to group, and that for certain groups there is a paucity of data to 

adequately assess the problem. This data was compiled from the

following resources: “Health, United States 2002”; “Trends in Racial

and Ethnic-Specific Rates for the Health Status Indicators: United States, 

1990-98”; “HIV/AIDS Surveillance Report 2001”; “Healthy People 

2010: Understanding and Improving Health”; and National Vital 

Statistics Reports, “Deaths: Leading Causes for 2000”.

 

HEALTH DISPARITIES OF CERTAIN CONDITIONS IN SELECTED POPULATIONS 

INDEX IN SELECTED POPULATIONS 

HEALTH CONDITION AND 

SPECIFIC EXAMPLE WHITE 

AFRICAN 

AMERICAN

HISPANIC 

or LATINO

ASIAN or

PACIFIC

ISLANDER 

AMERICAN

INDIAN or 

ALASKA

NATIVE 

Infant mortality rate per 1000 live births1 5.9 13.9 5.8 5.1 9.1 

Cancer mortality rate per 100,0002 199.3 255.1 123.7 124.2 129.3 

Lung Cancer - age adjusted death rate3 38.3 46.0 13.6 17.2 25.1 

Female Breast Cancer age adjusted death 

rate 

18.7 26.1 12.1 9.8 10.3 

Coronary Heart Disease mortality rate per 

100,0002 

206 252 145 123 126 

Stroke mortality rate per 100,000 58 80 39 51 38 

Diabetes diagnosed rate per 100,000 36 74 61 DSU DSU 

End-Stage Renal Disease rate per million2 218 873 DNA 344 589 

AIDS – diagnosed rate per 100,0004 

 Female 2 48 13 1 5 

 Male 14 109 43 9 19 

DSU = Data are statistically unreliable

DNA = Data have not been analyzed

1 Chartbook on Trends in the Health of Americans. Excerpted from Health, United States 2002. Department of Health and Human Services. 

National Center for Health Statistics. DHHS Publication No. 1232-1. August 2002. 

2 Healthy People 2010. Understanding and Improving Health (Second Edition). Department of Health and Human Services. November

2000.

3 Keppel, Kenneth, Jeffrey Pearcy and Diane Wagener. Trends in Racial and Ethnic-Specific Rates for the Health Status Indicators: United 

States, 1990-98. Statistical Notes. Number 23. January 2002, pgs. 1-16.

4 HIV/AIDS Surveillance Report. U.S. HIV and AIDS Cases Reported Through December 2001 Year-End Edition. Slides 13 &14.

(Available at URL: http://www.cdc.gov/hiv/graphics/surveill.htm)

5 National Vital Statistics Reports. 2002 Deaths: Leading Causes for 2000. Vol. 50:16:1-41. 

14
Multifactorial Basis of Health Disparities 

The genesis of health disparities is multifactorial and hence will require a 

coordinated and interdisciplinary approach to eliminate them. Below we present

one author’s perspective of the various factors contributing to the

disproportionate burden of morbidity and mortality suffered by racial and ethnic 

minorities. Other schema and classifications could be created as well, however 

they would have in common many of the factors cited below. With the 

exception of race, many of these factors apply to non-ethnic underserved

populations as well. The common denominator in the latter case is related to low 

socio-economic status and the protean effects of poverty on health. 

A Framework for Understanding the Relationship Between Race and Health1

BIOLOGICAL

FACTORS

CULTURAL

FACTORS

SOCIO-ECONOMIC

FACTORS

RACISM

POLITICAL

FACTORS

RACE BIOLOGICAL

PROCESSES

HEALTH PRACTICES

Smoking

Alcohol

Nutrition

PSYCHOLOGICAL

STRESS

Family Stress

Financial Stress

ENVIRONMENTAL

STRESS

Residential Stress

Occupational Stress

PSYCHOSOCIAL

RESOURCES

Social Ties

Perceptions of Control

MEDICAL CARE

Need

Access

Quality

HEALTH

OUTCOMES

BIOLOGICAL

FACTORS

CULTURAL

FACTORS

SOCIO-ECONOMIC

FACTORS

RACISM

POLITICAL

FACTORS

RACE BIOLOGICAL

PROCESSES

HEALTH PRACTICES

Smoking

Alcohol

Nutrition

PSYCHOLOGICAL

STRESS

Family Stress

Financial Stress

ENVIRONMENTAL

STRESS

Residential Stress

Occupational Stress

PSYCHOSOCIAL

RESOURCES

Social Ties

Perceptions of Control

MEDICAL CARE

Need

Access

Quality

HEALTH

OUTCOMES

Not only are there multiple factors, there is great overlap between them that 

produces a destructive synergy. We describe several of these factors in greater

detail below: 

Socioeconomic Status/Education Level. An extensive body of literature has 

demonstrated a strong association between health and socioeconomic status. 

(The highest educational level achieved is often considered one of the best 

measures of socio-economic status.) For instance Marmot and colleagues have

shown that illness and mortality decreased in British civil servants as measures of

socioeconomic status rose. Low socioeconomic status and poor health were most

closely correlated with a perception of reward imbalance and lack of control in

 

15

1 King G. and William D.R., 1995. Race and Health: A multidimensional approach to African 

American Health. In: Amick BC, Levine S, Tarlov AR, Walsh DC, eds. Society and Health:

New York: Oxford University Press (Taken from Workshop Summary: Pharmacokinetics 

and Drug Interactions in the Elderly, National Academy Press 
the work place. This also correlated with an increase in fibrinogen, a biological

marker of inflammation and certain chronic disease states. The negative health 

effects of depressed socioeconomic status are relevant to many racial and ethnic 

minorities, as well as to underserved white populations. 

Biology. Even after controlling for socioeconomic status there seem to be factors 

that further influence disease states in racial and ethnic populations. Some of this 

residual effect may be biological in nature. For instance differences in socioeconomic status do not completely explain the higher rates of hypertension,

glaucoma and lupus in African Americans. "Thrifty genes" and other 

predisposing genetic factors have been proposed to explain the epidemic of 

obesity and diabetes in Pima Indians. Biological differences seem responsible 

for different rates of drug metabolism in various populations. This may help

explain why immunosuppressive agents may not be as effective in African

Americans. 

 

Access and Quality of Health Care. Health care access and quality are often 

substandard in the same populations that suffer from health disparities. Lack of 

access may result in failure to prevent disease, delayed detection and inadequate

treatment of disease. In the United States racial minorities and other health 

disparity groups suffer from barriers to medical care for multiple reasons i.e., 

lack of insurance, which is in turn related to unemployment or employment in the 

small business sector; language barriers; travel barriers; immigration status; and

issues related to culture, trust and discrimination. Among racial and ethnic 

minorities Hispanics seem to face particularly high barriers to access, though 

disadvantaged whites who are unemployed or work in the small business sector 

are frequently uninsured and face many of the same issues. However, equalizing 

access will not be sufficient to eliminate health disparities. Even in countries that

have optimized and equalized access, for example Britain and Finland, health 

disparities persist and closely track socioeconomic status. 

Racial and Ethnic Discrimination. Racial and ethnic discrimination creates

additional barriers to care. Even if discrimination is not overt, perceived 

discrimination that occurs as a consequence of insensitivity or a lack of cultural

competence can create further barriers to care and an ineffective therapeutic 

relationship. The struggle to "advance and achieve" in the face of discrimination 

creates stress that may manifest itself in disease. This phenomenon, known as 

John Henryism, has been thought to contribute to the disproportionate degree of

hypertension in African Americans. Hypertension is a major risk factor for 

stroke, which is also disproportionately elevated in African Americans. 

Cultural Issues. Culture may be interpreted in the traditional sense as applying 

to a racial or ethnic group, or more broadly to include socioeconomic status, 

urban, rural or suburban lifestyles, as well as geographic location and other 

16
factors. Cultural practices may influence diets and other behaviors that influence 

health status. In addition cultural factors may include alternative methods of

healing that may conflict with mainstream medicine. Many racial and ethnic 

minority patients who employ traditional methods of healing often feel 

uncomfortable informing non-ethnic caregivers of these modalities, which may 

include pharmacologically active herbs. African Americans may be less likely to 

be fully engaged in a therapeutic relationship with a psychiatrist when it is 

involuntary than when it is based on self-referral. 

Coordination of an Interdisciplinary Approach 

While this list of factors is not meant to be exhaustive, it is illustrative of the 

complexity of the problem and points to the need for a coordinated

interdisciplinary approach if we are to reduce and ultimately eliminate the "health

gap". The coordination must occur within the NIH as well as among the other 

federal agencies devoted to this objective. The goal of the coordinated 

interdisciplinary approach is to promote synergies and reduce redundancy in this 

formidable effort. This has implications for the trans-NIH plan on multiple 

levels: 

Many of the disease complexes that afflict health disparity groups cut 

across boundaries of several Institutes and Centers (IC’s). Examples 

include coronary artery disease, diabetes, obesity, anger and depression, 

and behavioral factors that contribute to all these. This suggests a need

for enhanced collaboration among the Institutes and Centers in

conducting health disparity research. In addition, IC’s that are 

traditionally biological must develop an increased awareness of, and an

integration with, the non-biological factors contributing to disease. For

instance establishing more extensive correlation between disease states

and educational status, or using surveys and other instruments that are 

more tailored to minority populations. 

 

 

 

It is important to build infrastructure for health disparity research by

supporting minority-serving institutions that may not have adequate 

resources, increasing the number of minority researchers, and increasing 

the scope and depth of research that focuses on health disparities.

Sharing "best practices" in attracting minority researchers is an obvious

way different IC's can collaborate. 

It is essential that the IC's develop new and innovative ways to reach 

health disparity populations so that the fruits of research can benefit the 

target populations. This outreach must go beyond mere information 

dissemination. It must strive to influence behaviors that are relevant to 

health. Collaboration between biologically focused and behaviorally

17
focused IC's and offices is important in this effort. Once again 

establishing and sharing best practices in this regard would be highly

beneficial. 

Finally, in order to achieve the Congressionally mandated goal of

reducing and ultimately eliminating health disparities, it is important that 

we establish interim goals and objectives with outcomes that are, where

possible, quantifiable. This is a challenging task and IC's can learn from 

each other in establishing best practices in measuring outcomes related to 

the reduction of health disparities. 

 

Congress established the NCMHD to play the central role in leading, 

coordinating and monitoring this effort and one of the first steps was to produce 

this trans-NIH plan to reduce and ultimately eliminate health disparities in the 

United States. 

18
Section III: Department of Health and Human Services 

(HHS) and NIH Efforts to Reduce and Ultimately Eliminate 

Health Disparities 

HHS Efforts

In developing the Trans-NIH Strategic Plan, a review of existing Department of 

Health and Human Services (HHS) activities to address minority health and other 

health disparities was undertaken to ensure the Trans-NIH Strategic Plan is 

aligned with similar HHS efforts and to ensure that the NIH is leveraging the full 

breadth and depth of programs and activities directed toward minority health and 

other health disparity populations. Two key cross cutting initiatives, the HHS

Initiative to Eliminate Racial and Ethnic Disparities in Health and Healthy 

People 2010, were considered given that aspects of their goals and objectives are

related directly to this Plan. 

 

 

The Initiative to Eliminate Racial 

and Ethnic Disparities in Health 

was initiated by the HHS to 

eliminate the disparities in six areas

of health status experienced by 

racial and ethnic minority 

populations. 

Initiative to Eliminate Racial and 

Ethnic Disparities In Health 

Infant Mortality 

Cancer Screening and Management

Cardiovascular Disease and Stroke 

Diabetes 

HIV/AIDS Rates 

Child and Adult Immunization Levels 

Complementing the Initiative to 

Eliminate Racial and Ethnic 

Disparities in Health is another 

HHS initiative, Healthy People 

2010, a national health promotion

and disease prevention initiative 

involving several federal agencies 

such as the U.S. Department of

Agriculture and the U.S.

Department of Education. Healthy 

People 2010 sets forth the Nation's

health objectives for the next 

decade, which include a major goal

for eliminating health disparities 

among different segments of the population.

Healthy People 2010

Conduct New Outreach Campaign 

Develop New Approaches to Build on 

Existing Successes to Address 

Racial and Ethnic Health Disparities 

Major New Foundation/Public Sector 

Collaboration to Address Disparities 

Develop more Effective Ways to 

Target Existing Federal Programs to 

Address Health Disparities 

Involve Communities, Foundations, 

Advocacy Organizations, and

Businesses to Develop Ways to 

Target Racial and Ethnic Health 

Disparities 

The Trans-NIH Strategic Plan is consistent with these HHS-wide efforts and 

furthers the objectives of HHS to prevent disease, promote health, and deliver

care to the US population, especially the racial, ethnic and other health disparity

populations. 

19

 

 

 

 

 

 

 

 

 

 

 
The coordination of HHS health disparities research activities will be further 

enhanced by NIH participation in the HHS Research Coordination Council.

NCMHD Efforts 

The NCMHD co-funds projects with other NIH Institutes and Centers, and 

various Federal Offices and Agencies to improve the quality and efficiency of 

NIH health disparities research.

For example, the Center provides support to increase the number of funded 

meritorious programs through the Centers for Disease Control and Prevention’s 

Racial and Ethnic Approaches to Community Health (REACH 2010) and the 

Agency for Healthcare Research Quality’s Excellence Centers to Eliminate 

Racial and Ethnic Health Disparities (EXCEED) programs.

In addition, the Center and the Office of Minority Health, Office of Public Health

and Science, co-fund several projects to support other organizations, including:

Interamerican College of Physicians and Surgeons (ICPS) - The National 

Hispanic Youth Initiative in Health, Biomedical Research and Policy

Development includes a rigorous curriculum and comprehensive approach to

increasing Hispanic manpower in health care and biomedical research. It 

comprises a series of lectures and round table/group discussions on health care 

issues and scientific research, academic preparation, and opportunities in the 

health sciences and research, health legislation and public policy, the health

status of Hispanic communities, and clinical and scientific preceptor ships. This

program contributes to retaining students in the academic pipeline and serves as a

pre-college program to increasing the number of Hispanic youth pursuing careers

in the health sciences and/or scientific research arenas. 

National Medical Association (NMA) - The National African American Youth 

Initiative in Health and Policy Development Scholars Program increases the 

awareness of African American youth on national health issues, scientific

research, public policy and the role and impact of the Federal Government in the 

development of health policy. The Youth Initiative prepares, motivates, and 

encourages young African Americans to pursue careers in the health and 

scientific fields. 

American Indian Youth Initiative - This project will recruit promising high 

school students into biomedical careers and further expansion of the Indian 

Health Network, an on-line electronic service designed to link isolated tribes and 

urban organizations with physicians and other providers, health facilities, and

educational institutions to enhance the health of all Indian communities. 

20
The Asian and Pacific Island American Health Forum - This project will

establish and maintain a national on-line Asian and Pacific Islander (A/PI)

Health Information Network to expand and enhance health promotion and disease

prevention, health advocacy, mental health and substance abuse, education,

health services research opportunities, and cultural competency. NIH can use 

this information network to target information about research opportunities and 

clinical trials to A/PI communities. 

NIH Efforts

The NIH occupies a unique place in the federal effort to eliminate health

disparities among minorities and the medically underserved. The NIH works with 

the public, health care providers, scientists, and policymakers to identify the 

relevant issues; develop the research plans to address these issues; and support

and conduct a broad range of studies in this area. These studies include 

epidemiological; biological, behavioral, and social science research; as well as

health services research. In addition, the NIH provides support for the

infrastructure that underpins the research enterprise, such as training, 

instrumentation, and research facilities. The NIH carries out public information

and community outreach programs to communicate research findings to 

individuals, organizations, and other entities that can put the research results into

practice. 

While NIH-funded research yields information important to addressing the 

complex problems among racial and ethnic minorities and other underserved

populations, it is only a part of a multi-faceted effort to prevent disease, promote 

health, and deliver appropriate care to these communities. 

 

21
Section IV: Strategic Planning Model for Reducing and 

Ultimately Eliminating Health Disparities 

The strategic plan follows a methodical planning model, which presents the 

mission, vision, goals, objectives, and programs for reducing and eventually 

eliminating health disparities among minorities and other populations - elements 

of the model that will guide the remainder of this volume. 

Strategic Planning Model 

Goals

Objectives

Programs

Vision

Mission

Identifies programs to support meeting the

objectives.

Provides additional specificity about how the goals will be 

accomplished. Objectives are more near term and 

measurable, and clearly describe an intended outcome.

Captures the enduring focus of the organization – the organization's grand 

purpose; why it exists and what needs it fulfills.

Captures the desired end state of the organization and describes

future direction. Provides unity of direction and long-term focus.

Identifies how the vision will be realized. Goals are longer term

in nature, and are broad statements describing a desired future 

condition or achievement.

Mission to Reduce and Ultimately Eliminate Health Disparities

The mission is to promote minority health and to lead, coordinate, 

support, and assess the NIH effort to reduce and ultimately eliminate 

health disparities. In this effort the NCMHD will conduct and support

basic, clinical, social, and behavioral research; promote research

infrastructure and training; foster emerging programs; disseminate 

information; and reach out to minority and other health disparity

communities.

Mission

Vision

Programs

Objectives

Goals

Mission

Vision

Programs

Objectives

Goals

Vision to Reduce and Ultimately Eliminate Health Disparities 

The vision to support minority health and health disparities is to 

envision an America in which all populations will have an equal 

opportunity to live long, healthy and productive lives. 

22
Goals and Objectives to Reduce and Ultimately Eliminate Health Disparities 

The Strategic Plan is focused on three major goals: 

Mission

Vision

Programs

Objectives

Goals

 

 

 

Research 

Research Infrastructure; and 

Public Information and Community Outreach 

Each goal area has multiple objectives on how each goal 

will be accomplished. 

Research. Research to advance our understanding of the development and

progression of diseases and disabilities that contribute to health disparities in 

minority populations is central to this effort. Research includes advancing the 

understanding of diseases and disabilities. In addition, it includes developing new 

and improved approaches for detecting, diagnosing, preventing, treating or 

delaying onset or progression of diseases and disabilities that contribute to health 

disparities. 

GOAL OBJECTIVES 

Research

disabilities that contribute to health disparities 

progression of diseases and disabilities that contribute to health disparities

progression of diseases and disabilities that contribute to health disparities

that contribute to health disparities 

23

Advance understanding of the development and progression of diseases and 

Develop new or improved approaches for detecting or diagnosing the onset or 

Develop new or improved approaches for preventing or delaying the onset or 

Develop new or improved approaches for treating diseases and disabilities

 

 

 

 
Research Infrastructure. Just as a building is only as solid as its foundation,

the success of the biomedical research enterprise depends on a solid 

infrastructure. Broadly defined, research infrastructure includes biomedical

researchers and personnel and the means and resources for supporting and 

training them, as well as research facilities, equipment, and supportive services. 

The NIH recognizes that our ability to reduce health disparities through the 

research proposed in this plan requires a strong commitment to training and

supporting investigators in these areas. Our ability to sustain and even increase

the momentum of recent scientific progress and our international leadership in 

medical research depends upon recruitment, training, support, and retention of

biomedical investigators from diverse population groups. To ensure this, the NIH 

has identified five research infrastructure objectives:

GOAL OBJECTIVES 

Research

Infrastructure provide research supplements to, research investigators from minority and

other special populations experiencing health disparities 

conduct health disparities research 

new equipment and shared equipment programs for use in health disparities 

research

regarding health disparities 

Public Information and Community Outreach. Communicating the scientific 

and health information gained from research into health disparities is of

paramount importance. These efforts extend beyond dissemination of the results 

of research to other scientists, and include the transmission of all information that 

may improve the health of minorities to the general public, patients, advocacy

groups, health care providers, media, and policymakers. Additionally, this

includes a comprehensive and aggressive outreach to those groups whom the

research is intended to help and their health care providers. These messages must 

be tailored to the communities at highest risk for the adverse consequences of the

health disparity in question. The efforts must also include producing health

information that is culturally applicable, ensuring that it is disseminated to the 

appropriate communities, and assessing the effectiveness of these communication 

efforts. In the arena of public information and community outreach, our

objectives include the following: 

24

Expand opportunities in research training and career development for, and 

Increase funding support for construction and renovation of research facilities 

Provide increased funding at institutions across the country for resources, 

Increase representation in peer review from minority and ethnic populations 

Improve research data collection systems and enhance data quality

across the nation aimed at enhancing the ability of these institutions to 

 

 

 

 

 
GOAL OBJECTIVES 

Public 

Information and 

Community

Outreach

enhance the care provided to individuals within populations experiencing 

health disparities 

of medical and allied health professions schools, and into continuing 

education activities of health professionals 

ethnic, and other special populations, including the underserved, who 

experience health disparities

current information about scientific research and discoveries and other 

activities regarding health disparities 

disease areas in order to reach those individuals within minority, ethnic, 

and other special populations who experience health disparities within

these disease areas 

 

Overview of NIH Programs to Reduce and Ultimately Eliminate Health 

Disparities 

This section highlights a number of the NIH programs related to minority

health and health disparities research, research infrastructure, and public

information and community outreach. The specific programs presented in this 

section are a representative sampling, selected for their depth of activities and

breadth of scope in addressing minority health and health disparities. They do 

not represent the totality of the NIH program.

Mission

Vision

Programs

Objectives

Goals

 

Each program outlines how objectives will be accomplished and identifies 

specific examples of how program performance will be measured through 

performance measures and/or outcome measures. Further information about each 

of the initiatives listed below, and a complete list of all IC initiatives and 

corresponding performance/outcome measures, can be found in Volume II of this 

strategic plan. 

Sample Programs – Research. The research programs listed below are a

representative example of the variety of ongoing and new research studies that 

NIH supports as part of its strategic plan for understanding and reducing health

disparities among ethnic and racial minorities and other populations. The 

ultimate goal of these research efforts is to develop improved means for 

prevention, diagnosis, and treatment of diseases and disabilities that

disproportionately affect specific populations. The table below outlines sample 

ongoing research programs and provides selected examples of program 

performance measures: 

25

Provide the latest research-based information to healthcare providers to 

Facilitate the incorporation of science-based information into the curricula 

Maintain ongoing communication linkages and dialogue with minority,

Develop computer databases and internet resources to disseminate 

Develop targeted public health education programs focused on particular 

 

 

 

 
Selected Examples of Ongoing Programs: Research 

IC RESEARCH OBJECTIVES IC PROGRAMS 

NHBLI

Support research to increase understanding of the 

development and progression of heart, lung, and blood

diseases and sleep disorders that contribute to health

disparities

 Multi-Ethnic Study of Atherosclerosis,

 Specialized Centers of Research (SCOR) on Ischemic

Heart Disease in Blacks

 Glucose Tolerance and Risk for Cardiovascular 

Disease in the Elderly

NHGRI

Study genetic factors that contribute to diseases

disproportionately affecting minority populations

 African America Diabetes Mellitus Study (AADM) 

 African American Hereditary Prostate Cancer Study 

Network (AAHPC), 

 Barbados Prostate and Breast Cancer Study 

 Study of Hereditary Hemochromatosis and Iron 

Overload Disease in Diverse Populations

NIAID 

Reduce disparities in the incidence and prevalence of

asthma

 Inner-City Asthma Study 

NIDA

Epidemiology of Drug Abuse, Health Consequences and 

Infectious Diseases among Minority Populations

Addressing Disparities in Treatment and Health Services 

Research

 National Household Survey on Drug Abuse 

 Behavioral Therapy Development Program

 National Drug Abuse Treatment Clinical Trials Network

(CTN) 

NIDDK 

Combine genetic linkage data from collaborating research

groups and identifies regions of the human genome that

show evidence for linkage in type 2 diabetes. 

 Diabetes Prevention Program (DPP) 

NIMH

Identify Factors that Overcome Health Disparities Related 

to Health Service Delivery and Use by Ethnic Populations

 National Institute of Mental Health's Child and 

Adolescent Research Consortium, the American 

Psychological Association, and Fordham University's

Center for Ethics Education

Selected Examples of Measuring Program Performance

 Track the number of articles published in scientific journals

 Percentage increase mechanisms for healthcare providers to better diagnose, prevent, and treat minority health and 

health disparities

 Percent of studies which are “targeted studies” 

 Percent of studies that are “Inclusion studies” 

 Percent of total research budget spent on addressing minority health and health disparities

 Percentage research that influence policy 

 Track rates of health disparity indicators and project a percent reduction of the those rates over a set period of time

26
Sample Programs – Infrastructure. Ongoing research infrastructure programs provide selected

examples of the variety of ongoing and new research infrastructure activities that the NIH will

support as part of its strategic plan for understanding and reducing health disparities among ethnic

and racial minorities. The ultimate goal of these efforts is to support research, expand

opportunities in training, foster career development, and increase research funding for health

disparities research. The table below outlines sample ongoing research infrastructure programs in

this area and provides selected examples of program performance measures: 

Selected Examples of Ongoing Programs: Infrastructure 

IC INFRASTRUCTURE OBJECTIVES IC PROGRAMS 

NIAID 

Provide training opportunities for minority scientists

 Introduction to Biomedical Research Program

 Bridging the Gap Program

 Training Grants Program

NHLBI

Expand the opportunities in research training and 

career development for underrepresented 

minorities.

 Historically Black Colleges and Universities (HBCU) 

 Research Scientist Award 

 NHLBI Mentored Development Award for Minority Faculty 

 Biomedical Research Training Program for 

Underrepresented Minorities

 NHLBI Minority Institution Research Scientist Development

Award 

NIDDK 

Expand the genetic/familial studies of diabetic

nephropathy to include more minority patients

 FIND Study – Family Investigation in Nephropathy of

Diabetes

NINR 

Enhance research infrastructure allowing for an 

increased emphasis on projects relating to health

disparities

Enhance mentorship, training and research

opportunities for minority students and researchers

 Center for Health Promotion and Risk Reduction in Special

Populations

 Mentored Research Scientist Development Award for 

Minority Investigators (RFA: NR-00-002) 

 Research Supplements for Underrepresented Minorities

(RSUM)

NCI

Increase the number of minority scientists in

biomedical research and enhance the careers of

those already in the field

 Center to Reduce Cancer Health Disparities (CRCHD) 

 Comprehensive Minority Biomedical Program (CMBP)

 Continuing Umbrella of Research Experiences (CURE) 

NCRR 

Increase research competitiveness through 

Institutional Development

 Institutional Development Award (IDeA)

 Biomedical Research Infrastructure Networks (BRIN)

 Centers of Biomedical Research Excellence (COBRE) 

Selected Examples of Measuring Program Performance

 Monitor number and progress of minorities entering training programs (% increase in minorities entering training 

programs over previous years and number completing training programs)

 Increase and track the number of minority scientists engaged in research (establish targets)

 Increase and track minority subjects enrolled in research and clinical trails

 Percentage increase in partnerships with minority institutions

 Increase number of research projects addressing minority health and health disparities 

 Track the number of articles published in scientific journals by minority investigators

 Number of minority faculty, post doctoral fellows, and graduate students trained while conducting research

 Number of competitive grants issued to minority researchers

27
Sample Programs – Outreach. NIH is continuing its efforts to translate highly technical

research advances into clear, culturally relevant explanations of the steps individuals can take to

improve their health. The matrix below describes sample programs for enhancing

communications and outreach related to the goal of reducing health disparities and provides

selected examples of program performance measures:

Selected Examples of Ongoing Programs: Public Information and Community Outreach 

IC OUTREACH OBJECTIVES IC PROGRAMS 

NIDCR 

Ensure the development, collection, and distribution of proven 

oral health communication and education methods/materials for 

populations associated with health disparities, to oral health

education program planners

Ensure the integration of science-based oral health messages 

and materials into existing federal health communication and 

education programs for racial/ethnic minorities and the

underserved 

 Health Communication and 

Information Dissemination Research:

Opportunities in Oral Health

 Health Information National Trends

Survey (HINTS) 

 Administration for Children and 

Families' Head Start program 

 USDA's Women, Infants, and 

Children program (WIC) 

NHLBI

Expand and strengthen our programs of outreach and education 

for minority populations.

 Asian American and Pacific Islander 

(AAPI) ASPIRE Project 

 Strengthening the Heartbeat of

American Indian/Alaska Native

Communities

NIDA

Put research into practice in minority communities by providing 

science-based prevention and treatment information to service

providers serving these populations

 NIDA Toolkit Program

NLM

Explore the use of new information technologies to enable

diabetes patients, especially patients from minority and 

medically underserved populations, to manage their disease 

and avoid or delay the onset of costly and debilitating 

complications 

 Naomi Berrie Diabetes Center at

Columbia/Presbyterian Hospital in

New York City to study Type 1

diabetes

 Children’s Hospital in Los Angeles 

Project

Selected Examples of Measuring Program Performance

 The number of materials developed or adapted for minority and underserved populations

 Linkages with minority organizations

 Collaborative relationships with federal, state and local agencies to improve communication to minority

and underserved populations

 Research on communication methods that are effective for minority and underserved populations

 Utilization of published materials by schools and institutions

 Greater participation in, and awareness of, health disparity studies
NIH Minority Health and Health Disparities Budget 

Table I provides total health disparities research budget figures for each NIH 

Institute and Center. These financial resources demonstrate the commitment 

of the NIH to help close the health disparity gap among ethnic minority 

populations and those living in rural areas. In order to make notable progress 

in the overall health of the nation, this funding will be used for conducting 

and supporting research, addressing the national need for minority scientists 

and health professionals and providing information to the relevant 

communities for improving health conditions. 

Public Law 106-525 requires the NCMHD to report to the Congress by 

December 2003 recommendations for the methodology the NIH will use to 

determine the amount of NIH resources dedicated to the conduct and support 

of health disparities research. 

 

The budget data for health disparities activities contained within the budget 

table in Volume I of this version of the NIH Strategic Research Plan and 

Budget to Reduce and Ultimately Eliminate Health Disparities used a 

definition of minority health and health disparities research that the NIH is 

currently refining in accordance with Public Law 106-525. 

Because of concerns about current definitions, we are unable to provide the 

Congress with valid and reliable data on minority health disparities research 

in this report. In order to overcome this problem for our next report, and to 

further improve the quality of data, we submit to Congress, NIH has 

established an NIH Committee on Minority Health and Health Disparities 

Research Definitions and Application Methodology. The Committee is 

developing new definitions and a revised application methodology that will 

be used by the NIH for future reporting purposes. The Committee will 

develop a uniform NIH Guidance that: 

 Provides NIH operational definitions, based on Public Law 106-

525, for minority health and health disparities research, 

 Provides a consistent methodology for applying the definitions, 

 Contains the criteria necessary to identify both minority health and 

health disparities population groups and diseases, and 

 Serves as the foundation for identifying, coding, tracking, and 

reporting on NIH activities and resources. 

The NIH will be updating the Strategic Research Plan and Budget each year. 

Accordingly, the budget figures to be contained within the next iteration (2003) 

of the NIH Strategic Research Plan and Budget will be more precise, based upon 

the revised definitions and application methodology. 

29
NATIONAL INSTITUTES OF HEALTH

Health Disparities

(Dollars in millions)

 

Participating FY 2001 FY 2002 FY 2003

ICs Actual Estimate Estimate

NCI $350.3 $392.4 $439.4

NHLBI 218.2 240.0 256.8

NIDCR 19.0 21.7 23.3

NIDDK 126.0 145.0 157.0

NINDS 33.7 36.5 39.4

NIAID 579.5 659.5 743.9

NIGMS 149.8 169.4 180.4

NICHD 242.9 276.4 301.3

NEI 36.3 41.5 45.0

NIEHS 30.4 34.0 41.1

NIA 73.3 83.3 90.2

NIAMS 38.8 44.0 47.7

NIDCD 4.5 3.4 3.7

NIMH 160.0 181.1 196.3

NIDA 26.9 29.5 32.1

NIAAA 33.4 36.4 41.5

NINR 28.9 31.2 33.2

NHGRI 10.2 14.9 16.0

NIBIB** n/a n/a n/a

NCRR 64.9 72.3 78.2

NCCAM 12.5 13.8 14.5

NCMHD 125.1 149.9 178.5

FIC 1.1 1.2 1.2

NLM 3.0 3.9 4.8

CC*** [1.2] [1.2] [1.2]

OD 2.8 2.6 2.6

 NIH 2371.5 2683.9 2968.1

 

* Figures for FY 2002 and FY 2003 are the most current estimates available and do not reflect final 

FY 2002 awards or FY 2003 Congressional action. Figures will be updated when the new 

definitions are available. 

** New Institute to be included in future reporting. 

*** Clinical Center figures for FY 2002 and FY 2003 were not included in original estimates in the FY

2002 President’s Budget and are therefore shown as non-add. 

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Conclusion 

This document describes an ambitious plan being undertaken by the NIH for

reducing and ultimately eliminating the increased burden or disease and premature 

mortality suffered by minority and medically underserved populations. This effort

cuts across disease areas and organizational boundaries and involves a transagency commitment. It augments the efforts of each Institute and Center, and 

relevant program offices in the NIH Office of the Director in this important arena. 

As in many areas of research, more remains to be done. The medical research 

community working with, and informed by, the public, patients, health care 

providers, policymakers, and others has and will continue to develop new 

knowledge that leads to improvements in the prevention, diagnosis, and treatment

of diseases and disabilities that contribute to health disparities. 

In fiscal year 2001, the NIH spent over $2 billion on research, research 

infrastructure, and public information and community outreach efforts to reduce

health disparities. This provided a strong basis for further investments over the 

longer term – investments that promise substantial progress in reducing the 

incidence, prevalence, severity, and social and economic burdens of diseases and 

disabilities that affect racial and ethnic minorities and other health disparity

populations. 

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