September 12, 2023

Minority Health and Health Disparities Research: Running the Marathon, Maintaining the Momentum

UNITE Co-Chairs’ Corner

Word cloud consisting of words related to health disparities. For example: equity, age, race, ethnicity, disability, mental health, violence, care opportunities, mortality, disease, society, system.

The UNITE N Committee is charged with enhancing the transparency, accountability, and equitable conduct of NIH-supported research as well as that of the broader extramural research community. We focus on health disparities and minority health research to mitigate the impact of structural racism on health, improve the health of racial and ethnic minority populations, and promote health equity.

UNITE and N committee efforts were inspired by the events of 2020, which highlighted stark inequities in healthcare access and outcomes, as already-disadvantaged communities were affected disproportionately by both the pandemic and systemic racial and ethnic biases. While many applaud NIH for establishing UNITE as a direct response with ambitious goals for both short- and long-term impact, some expressed skepticism and concern that the momentum would subside. Fast forward to the summer of 2023 and the efforts continue.

We view UNITE and the work of the N Committee as a marathon—reaching our goals will require a steady drumbeat of thoughtful discourse, meaningful programs and initiatives, consideration of research policy changes, and resolute action to advance the conduct of minority health and health disparities research.

Several key reasons underscore the importance of maintaining momentum in this critical endeavor:

Health disparity reduction and social justice. The COVID-19 pandemic exposed the deep-rooted health disparities that disproportionately affect certain groups, particularly racial and ethnic minority persons and those who are socioeconomically disadvantaged. The experiences over the past few years have elevated the urgent need for more innovative, impactful, and sustainable health disparities science.
The N committee serves as a work engine in this space, curating and developing resources and tools to assist NIH staff, internal and external investigators, and community partners in conducting meaningful work. We encourage “out of the box” thinking and research ideas that can lead to better insights and interventions that are targeted and tailored to the needs of diverse underserved populations. These advancements will benefit the whole of society, not just those directly affected by disparities.
There are a multitude of NIH initiatives in health disparities science. Relative to calendar year 2019 (i.e., pre-pandemic), we observed a positive trend in new NIH funding opportunities (between 2020 and 2022) that include an explicit focus on minority health and health disparities research.
Crosscutting themes across these funding opportunities include research applying lifespan or community-engaged approaches, examining the roles of social determinants of health (SDOH) as drivers of both health and health disparities, multilevel interventions, as well as inclusive participation in research. And in turn, applications are being funded to support this work. As one example, 24 Institutes and Centers joined the National Institute on Minority Health and Health Disparities (NIMHD) in funding 38 R01 grants on understanding and addressing the impact of structural racism and discrimination on minority health and health disparities. Continued robust responses from the extramural research community via applications to these funding opportunities will provide a positive feedback loop to continue pursuing these important topics.
Healthcare and public health preparedness. The pandemic served as a stark reminder of the importance of robust health care systems and public health infrastructures. By leveraging lessons learned from the pandemic to inform innovative research questions and approaches, we can reduce health disparities, enhance our ability to respond effectively to future health crises via strong community-engaged and resilient healthcare systems in underserved areas, and embed equity into clinical practice and research. This work will also have implications for global health disparities.
Economic impact. Persisting health disparities have profound economic consequences. Recently published analyses co-authored by the NIMHD Director, Dr. Eliseo Pérez-Stable, found that the economic burden of racial and ethnic health disparities approximated $451 billion in 2018, and $978 billion was attributed to education-related disparities. Investments to address these disparities have strong potential to reduce the economic burden caused by preventable illnesses and ensure a healthier, more productive society. Advances in health disparities science are needed to contribute to the generation of knowledge needed to inform changes at the individual, community, healthcare system, and society levels.
Public trust. Among the goals of UNITE is to recognize and rectify the systemic inequities that perpetuate health disparities. Continued prioritization of health disparities research and efforts to promote equitable opportunities for health and well-being will foster trust in science and medicine. When individuals and groups observe that there is a genuine interest in understanding and meeting their health and healthcare needs, they are more likely to seek preventive care and follow medical advice, leading to better health outcomes.

The N Committee has established three workstreams to spearhead the charge and maintain the momentum. The N data & tools workstream facilitates analyses of grant application and award data to identify structural elements that may affect the advancement of health disparities research. The N resource & support workstream provides findable and accessible resources, tools, and services to support the equitable conduct of NIH-supported research to promote health equity. The N research innovation & collaboration workstream convenes researchers and partners from diverse academic backgrounds, community-based organizations, other government agencies and the private and non-profit sectors to move forward on developing and evaluating bold and novel research approaches toward eliminating structural racism and health disparities.

Keeping up the momentum in these areas and others is important to address longstanding and new health disparities. Scientific approaches are critical to strengthening the evidence needed to tackle structural racism, adverse SDOH that drive disparities, and associated challenges. The N committee is fully committed to this work.