Biennial Report of the Director

Centers of Excellence
National Institute on Minority Health and Health Disparities Centers of Excellence

Establishment of National Institute on Minority Health and Health Disparities Centers of Excellence

The Minority Health and Health Disparities Research and Education Act of 2000 (Pub. L. No. 106-525) included provisions for the creation of NCMHD to conduct and support research, training, and dissemination of information with respect to minority health conditions and other populations with health disparities. The statute specifically mandated establishing COEs in research institutions for the purpose of conducting biomedical and behavioral health disparities research and training. In FY 2010, the NCMHD was re-designated the NIMHD, and all the responsibilities of the NCMHD authorized under Public Law 106-525 were transferred to the Institute in accordance with the Patient Protection and Affordable Care Act (Public Law 111-148).

NIH defines health disparities as differences in the incidence, prevalence, morbidity, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups. These population groups are African Americans, American Indians, Alaska Natives, Asian Americans, Hispanic Americans, Native Hawaiians, and Pacific Islanders, subpopulations of all of these racial/ethnic groups, socioeconomically disadvantaged individuals, and medically underserved populations residing in rural areas.

The COE program supported by the National Institute on Minority Health and Health Disparities (NIMHD), formerly the National Center on Minority Health and Health Disparities (NCMHD) is one of several programs that are central to NIH’s scientific investment strategy for addressing and ultimately eliminating health disparities. That strategy encompasses:

How the NIMHD Centers of Excellence Function within the NIH Framework

NIMHD established COEs to create a comprehensive platform in academic institutions to address health disparities in priority diseases and conditions through the fundamental strategies of research, training a diverse scientific workforce, and engaging the community. The COE program supports the Department of Health and Human Services Action Plan to Reduce Racial and Ethnic Health Disparities and the National Prevention Strategy.

Since 2002, NIMHD has established COEs in 35 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands (see Table 4-4). Initially, the program used three different funding mechanisms for Resource-Related Centers (R-24), Exploratory Centers (P20), and Comprehensive Centers (P60). The use of these different funding mechanisms allowed NIMHD to support institutions with varying levels in biomedical research expertise and capacity. This approach also enabled NIMHD to leverage resources to support the capabilities of the nation’s geographically and culturally diverse institutions that have longstanding partnerships with local and regional health disparity organizations and communities. The Resource-Related Centers mechanism, which NIMHD no longer uses, enabled institutions with emerging or modest research infrastructures to begin building research capacity to address health disparities. Several institutions that received these R24 awards have since successfully established an NIMHD COE using the Exploratory Centers mechanism.

NIMHD supported 51 COEs in FY 2010 and FY 2011 and all COEs funded since 2005 have had project periods of five years. The types of institutions funded directly by the NIMHD COE program or through partnerships with NIMHD COEs include research-intensive institutions, medical schools, historically black colleges and universities, Hispanic-serving institutions, tribal colleges/universities, and liberal arts colleges. NIMHD COEs have also been successful in developing novel partnerships with different types of non-academic institutions, such as community-based organizations or foundations. These partnerships provide a means for non-academic institutions to engage in the research on improving minority health and or eliminating health disparities.

Description of Disease or Condition

The research and other COE activities that NIMHD supports are not limited to or focused on a single disease, illness, or condition. As described in various solicitations published in the NIH Guide for Grants and Contracts, the NIMHD COEs conduct research on health disparities associated with the following priority diseases and conditions: cardiovascular disease, stroke, cancer, diabetes, HIV/AIDS, infant mortality, mental health, and obesity. The NIMHD COE program also supports research on lung disease, liver disease, psoriasis, scleroderma, and glomerular (kidney) injury; all of these diseases and conditions disproportionately affect racial and ethnic minorities.

Burden of Illness

The diversity of the contemporary American population is one of the nation’s greatest assets. However, the richness of this diversity is diminished by the disproportionate burden of disease and illness and the reduced access to quality health care that racial and ethnic minority populations and the rural and urban poor experience. Compelling evidence of the disparate health status of America’s racial and ethnic minority and economically disadvantaged populations includes their shorter life expectancies and higher rates of cancer, birth defects, developmental disorders, infant mortality, asthma, diabetes, obesity, cardiovascular disease, and stroke. Racial and ethnic minorities and the medically underserved also suffer a disproportionate burden of morbidity and mortality associated with HIV/AIDS, autoimmune diseases (such as lupus and scleroderma), oral health, sexually transmitted diseases, mental disorders, violence, and substance abuse.

Scope of NIH Activities: Research and Programmatic

Guided by the NIH Health Disparities Strategic Plan and Budget, the scope of activities conducted by NIMHD COEs includes research, research capacity (including training and education), and community outreach. This broad scope provides considerable flexibility for COEs to design and implement multi- and transdisciplinary strategies, studies, interventions, and activities needed for reducing and ultimately eliminating health disparities.

The NIMHD COE program requires all COEs to establish mandatory cores:

NIH Funding for FY 2010 and FY 2011

NIH funding for the NIMHD COE program was $67.9 million in FY 2010 and $68.8 million in FY 2011. In FY 2011, in partnership with the EPA, funding of $5 million enabled 10 NIMHD COEs to establish research programs for addressing environmental factors contributing to health disparities.

FY 2010 and FY 2011 Progress Report

Programmatic Activities and Outcomes

Funding for the NIMHD COEs has resulted in several FY 2010 and FY 2011 research accomplishments. The COEs conduct research on minority health and the biologic and non-biologic factors contributing to health disparities. As shown by the following examples, NIMHD researchers are exploring the role of social and cultural factors in the prevalence of priority diseases and conditions.

The NIMHD Center of Excellence in Eliminating Disparities (CEED) at the University of Illinois, Chicago addresses racial/ethnic disparities through research in cancer prevention, early detection and treatment management. Research conducted by this COE has found that multi-level hierarchical models based on an existing population-based ovarian cancer survival cohort in which disadvantage measures were computed with the 2000 census data, suggest that women living in disadvantaged neighborhoods were more likely to be diagnosed at later stages of ovarian cancer and have shorter survival.

The NIMHD COE program at the University of Montana has established diverse partnerships with seven or more of the tribes in Montana and is engaged in community based participatory research (CBPR) projects. CBPR is a research approach that is preferred by many tribes. One such project has been established to address Apsáalooke (CROW) community cancer risks from contaminated water. This partnership includes Little Big Horn College, the CROW tribe, the Indian Health Service, the Apsáalooke Water and Wastewater Authority, the 107 Committee (of Tribal Elders), Montana State University and the University of New England. This partnership has conducted over 120 well surveys.

Collaborations between NIMHD COEs and Clinical Translation Science Awards (CTSA) and Clinical Translation Science Institutes (CTSI) have been an important part of the success of the COE program. Seventeen (81 percent) of the 21 active NIMHD P60 COE institutions have also received CTSA program funding and several of these institutions are leveraging their joint interests and capabilities in community engagement and outreach and health disparities by establishing partnerships. For example, the NIMHD COE established at the New York University (NYU) Center for the Study of Asian American Health has partnered with the CTSI established by NYU and New York City Health and Hospitals Corporation (HHC). The NIMHD COE and the NYU CTSI have developed the Community-Empowered Research Training (CERT) Program for building research capacity among community organizations and providers interested in conducting community-initiated research.

Recommendations for Improving the Effectiveness, Efficiency, and Outcomes of the NIMHD COEs

Since their inception in year 2002, NIMHD COEs made progress toward the elimination of health disparities. However, much more needs to be done in designing and taking the critical steps needed to translate research findings to meaningful actions that will improve the quality of life experienced by those overburdened by health disparities. Efforts need to be more targeted toward interventions that work. As a result of the 2008 NIH Summit to Eliminate Health Disparities and subsequent Funding Opportunity Announcements recognizing and stressing the multifactorial and multidisciplinary nature and complexities of health disparities, NIMHD COEs established in 2010 have placed emphasis on research and interventions addressing the social determinants of health. NIMHD and its COEs cannot and are not acting alone; NIMHD has sought and continues to seek new partners and also encourages each NIMHD COE to establish partnerships with other NIH-funded centers and programs, other federal agencies, and others committed to eliminating health disparities. The partnerships established with other federal agencies in FY 2010 and FY 2011 expanded the scope of research and research activities conducted by NIMHD COEs. In FY 2012, NIMHD will continue to pursue the recommendations previously published in the 2008-2009 Biennial Report:

Evaluation Plans

NIMHD program staff evaluate the COEs’ annual progress by examining each COE’s published peer-reviewed articles, books, and book chapters; conferences sponsored and presentations given on health disparities; community engagement activities, such as health fairs and other forums for disseminating health-promotion materials; community participation in research and clinical trials (if applicable); training of junior faculty from health disparity populations, postdoctoral fellows, and graduate and undergraduate students; and K–12 educational efforts. This review ascertains the COE’s progress in meeting the aims and objectives of the grant and assists in identifying areas of concern that need to be addressed. The Office of Minority Health, HHS, will assist the NIMHD in evaluating the effectiveness of the NIMHD COEs funded to promote patient–centered outcome research.

Future Directions

The NIMHD COE program will continue to intensify research efforts to understand, reduce, and eliminate health disparities, with an emphasis on sustaining current partnerships and establishing new ones. The 2012 Summit on the Science of Eliminating Health Disparities involved agencies across the federal government and resulted in several new partnerships for the NIMHD and for the NIMHD COEs and several significant recommendations for future research themes. With the establishment of new partnerships, NIMHD expects that its COEs will continue to discover new biomedical and behavioral knowledge for improving minority health and eliminating health disparities within and across the priority areas of cardiovascular disease, stroke, cancer, diabetes, HIV/AIDS, infant mortality, mental health, and obesity, as well as in lung and liver diseases, psoriasis, scleroderma, and glomerular injury. It is also expected that NIMHD COEs will embrace future research themes that will expand beyond these areas to include research recognizing and integrating the environmental sciences, bioethics, social and political sciences, and policy with translational practices and interventions to build a healthier society.

The COEs also will continue to develop new technologies for measuring the diverse interactions between health disparities and social and policy level factors and new paradigms. The resulting new knowledge and technologies will lead to the development of bio-psychosocial and other interventions and strategies for improving minority health and eliminating health disparities.

The success of these and future research efforts by the NIMHD COEs will continue to depend, in part, on the development of improved methodological tools, measures, validated instruments, and novel research designs for disentangling the contribution to health disparities of biologic, behavioral, and social factors, and health policies and practices. Conducting population-based studies for reducing the incidence and prevalence of health disparities among individuals living in different geographical regions of the United States (especially the Mississippi Delta, Appalachia, the U.S.-Mexico border region, and tribal communities) will continue to be important. NIMHD will continue to support studies to eliminate or decrease the impact of factors, including natural disasters, that contribute to the excess risks, morbidity, and mortality associated with living in these regions.

Table 4-4. NIMHD Centers of Excellence Active in FY 2010 and FY 2011
Institution and Location
Arizona State University, Tempe, AZ
Case Western Reserve University, Cleveland, OH
Charles R. Drew University of Medicine & Science, Los Angeles, CA
Clark Atlanta University, Atlanta, GA
Columbia University Health Sciences, New York, NY
Dillard University, New Orleans, LA
Florida International University, Miami, FL
Georgia State University, Atlanta, GA
Howard University, Washington, DC
Johns Hopkins University, Baltimore, MD
Medical College of Georgia, Augusta, GA
Meharry Medical College, Nashville, TN
Montana State University, Bozeman, MT
Mount Sinai School of Medicine of NYU, New York, NY
New York University School of Medicine, New York, NY
North Carolina Central University, Durham, NC
San Diego State University, San Diego, CA
State University of Albany, Albany, NY
Texas A&M University System, College Station, TX
Uniformed Services University of the Health Sciences, Bethesda, MD
University of Alabama, Birmingham, AL
University of Arkansas Medical Sciences, Little Rock, AR
University of California, San Diego, CA
University of Colorado Denver and Health Sciences Center, Aurora, CO
University of Hawaii, Manoa, HI
University of Illinois, Chicago, IL
University of Kansas Medical Center, Kansas City, KS
University of Maryland, College Park, MD*
University of Massachusetts, Boston, MA
University of Miami, Coral Gables, FL
University of Michigan, Ann Arbor, MI
University of Minnesota, Twin Cities, MN
University of New Mexico, Albuquerque, NM
University of North Carolina, Chapel Hill, NC
University of North Carolina, Greensboro, NC
University of Oklahoma Health Sciences Center, Oklahoma City, OK
University of Puerto Rico Medical Sciences, San Juan, PR
University of South Alabama, Mobile, AL
University of South Carolina, Columbia, SC
University of South Dakota, Vermillion, SD
University of South Florida, Tampa, FL
University of Southern California, Los Angeles, CA
University of Texas Health Sciences Center, Houston, TX
University of Texas M.D. Anderson Cancer Center, Houston, TX
University of Texas, El Paso, TX
University of the Virgin Islands, St. Thomas, VI
University of Wisconsin, Madison, WI
Virginia Commonwealth University, Richmond, VA
Weill Medical College, Ithaca, NY
Winston-Salem State University, Winston-Salem, NC
Yeshiva University, New York, NY
*Formerly located at the University of Pittsburgh, since 2002.