Robert Wood Johnson Foundation
P.O. Box 2316
College Road East and Route 1
Princeton, N.J. 08543-2316
(888) 631-9989
www.rwjf.org

The Robert Wood Johnson Foundation is one of the largest philanthropic organizations in the country. It donates grants to fund everything from research on addiction to models for the construction of new nursing homes.

The foundation began after its namesake, the man behind the Johnson & Johnson medical empire, left the majority of his estate to begin what would become the nation’s largest philanthropy devoted exclusively to improving the health and health care of Americans. Working with a variety of organizations and individuals, the foundation funds research, education and other efforts at hospitals; medical, nursing and public schools; hospices; professional associations; research organizations; government agencies and community organizations.

Reducing Disparities in Health Care

Among the foundation’s key areas of focus are addressing disparities and public health issues and building human capital in the health care workplace. Last fall, the foundation announced three national initiatives—and dedicated $23 million—aimed at eliminating racial and ethnic disparities in health care treatment. Their goal is to reduce disparities in the next three years by examining patient care and current health systems and by making suggestions for improved care.

Researchers at George Washington University, the University of Chicago and Harvard University are leading the three programs. They will focus on cardiac care received by minority patients and fund various organizations to focus on disparities in health plans, hospitals and community clinics. They will also collect and analyze results from other research on disparities to inform efforts at improving care and technical processes in health systems.

Among other reports, the foundation’s health research publications dealt with covered care at big-city hospitals, the effects of anthrax on those exposed, how federal health dollars are being spent in the states, and protecting public health in the face of bioterrorism.

Building Human Capital

Not all of the foundation’s work is research-related, however. One area allied health students and professionals should keep an eye on is the foundation’s focus on building human capital. Robert Wood Johnson funds training and education programs for doctors, nurses and other health care workers. In 2005, the foundation hosted a series of one-day informational workshops, Frontline Workforce Development: Promoting Partnerships and Emerging Practices in Health and Health Care, to share research and tips for the advancement of the allied health workforce.

The foundation has particularly focused on those professionals who receive the smallest compensation, such as nurse aides, home health aides, psychiatric technicians, and others because, according to the Robert Wood Johnson Foundation Web site, these health care workers are “often the first and most frequent point of contact for patients and clients. Despite their importance, these essential workers are often poorly paid and have limited opportunities for training, advancement and reward.”

One of the programs in this area aims to train workers in hospitals and other facilities so that employees at all levels—from housekeeping to nurses—can receive continuing education to encourage their advancement.

Addressing Needs

Like many organizations and schools interested in addressing both health disparities among their patients, as well as career advancement and adequate pay for their allied health care workers, the Robert Wood Johnson Foundation also values assisting their minority students and professionals to receive the training they need to be successful in the field of allied health.

“The biggest challenge is the anti-affirmative action climate in this country,” says Contance Pechura, senior program officer at the Robert Wood Johnson Foundation. “Because of the Supreme Court decisions in the Michigan cases, it puts any program that’s based on selection by ethnicity or race in very murky legal territory.” As a result, the foundation has expanded its criteria for some programs to include economically disadvantaged rural areas.

The Basics

The Robert Wood Johnson foundation maintains an informative and up-to-date Web site (www.rwjf.org) that you can check out for interesting developments in research and current health care and public health trends. Visit the site to stay informed or to check its “Job Opportunities” section under “About Us.”

Web site: www.rwjf.org

Number of grants and contracts made in 2004: 823

Total amount awarded in 2004: $249.3 million

Celia Colista is a New York-based free-lance writer who specializes in career issues.

One of the Alliance's missions is to raise 'cultural proficiency' among providers. What does the term mean and why is it significant in the medical treatment of Hispanics?

One of the things we're preparing for is the Annual Symposium on Career Opportunities in Biomedical Sciences. We bring together approximately 1,000 high school and university students to highlight the kinds of health professions and biomedical careers they could pursue. Our aim is to encourage and motivate participation of underrepresented minorities in the sciences and health professions and thereby increase their presence in the physician and scientific workforce.

The changing ethnic/racial climate in the United States demands an increase in the number and diversification of biomedical scientists and health professionals. However, African Americans and other underrepresented minorities (URMs) continue to be significantly underrepresented among the Nation's scientists and health professionals.

According to the 2000 U.S. Census Report, the U.S. population consisted of approximately 12.3% blacks, 0.9% American Indian/Alaska Natives, 3.6% Asians, 12.5% Hispanic/Latino and 75.1% whites. URMs remain well below the national average with regard to education, employment and health status. While today these minorities make up more than 25% of the U.S. population, historically they continue to be underrepresented in the medical and research professions. Among the nation's scientists, blacks represent 2.3%, Hispanics 2.8% and American Indian/ Alaskan Natives 0.3%. There have been modest increases of underrepresented minority physicians over the past 20 years. In 2000, the U.S. physician workforce was comprised of 5.1% Hispanics, 4.4% African Americans and 0.2% American Indians.

The symposium features people in health and science fields who can talk to students about what they do and serve as live role models. We're expecting over 1,000 students from across the country who will attend 16 workshops led by caring professionals from similar backgrounds who role model the lifestyle, behavior and determination that it takes to become a scientist or health professional.

How does Minority Health Professions Foundation connect with students on a national level?

We work with Historically Black Colleges and Universities from all over the country to recruit students. We recruit American Indian and Hispanic students from national organizations similar to the MHPF that focus on the specific interests of these groups, i.e., the American Indian Higher Education Consortium and the Hispanic Serving Health Professions Schools. These students include high school students in the 11th and 12th grades and college students.

We get a lot of requests for not only for steering students to majority schools but also to recruit minority faculty. For example, we'll contact the HBCUs to post jobs at majority schools when we hear of them.

Do you also work with community colleges to connect with students who are studying in one of the allied health fields?

One of the things we will probably do more of this year is have direct contact with community colleges for the symposium. More students are going to community colleges as an introduction to four-year colleges.

We are cooperating with the U.S. Agency for International Development to support faculty to attend training for tuberculosis prevention and elimination. Through this program, we provide support for MHPF faculty to receive training and to serve on international assessments teams with organizations like the World Health Organization (WHO). This training is held in Tanzania and Vietnam.

Does the foundation help provide any other training programs for students or professionals?

Yes. One way the MHPF is currently supporting professional development of students is through an internship program at Florida A&M University where the emphasis is on the development of research skills related to assessing and analyzing disease and health problems that primarily affect disadvantaged populations. This includes the human affects associated with environmental pollution, environmental and occupational health concerns, and health promotion and disease prevention through community involvement and education. Through the internship process, students learn about public health data sources, such as medical data, environmental data and survey data.

Part of the foundation's mission is to support research. What is MHPF doing now in terms of research?

The Foundation is participating in a Cooperative Agreement with the CDC/Agency for Toxic Substances and Disease Registry where research projects in the MHPF member institutions are being undertaken to understand the link between exposure to several hazardous substances and their human health effects. Results will reduce the uncertainties of public health assessments and will provide the most effective measures to prevent or mitigate the adverse human health effects of these toxic substances. Lead exposure, for example, remains a significant health threat to the nation's population, especially children. Yet it is not clear at what level of exposure this damaging effect occurs. The relationship between lead exposure and elevated blood pressure needs also to be clarified. Human studies at Charles Drew University of Medicine and Science and Morehouse School of Medicine as well as animal and cellular studies at the Colleges of Pharmacy of Texas Southern and Florida A&M Universities are being conducted to answer these uncertainties about lead toxicity.

An environmental multimedia study of lead, cadmium, zinc and manganese is being conducted at Xavier University College of Pharmacy. The aim of this study is to develop a comprehensive understanding of routes of exposure of toxic substances from an urban environment and from environmental media of soils, water, sediments and aquatic organisms to people. Analysis of these different environmental media in various areas of New Orleans revealed that these hazardous substances co-exist and are higher in the inner city regions. These findings have been shared with the scientific community through many peer-reviewed publications.

Health care has been changing a great deal in the last few years. How has this affected the evolution of the MHPF's work?

We are about to develop a five-year strategic plan based on what we see in health care today and what the role of an organization like the MHPF should be. The health profession's workforce is aging. We've got to ensure that a younger generation of minorities becomes a part of the workforce of the future.

We need to encourage, motivate and train young people to be a part of the health professions. People now who are in those professions are retiring, so we've got to get a new group of people in those fields.

Part of our challenge is getting the word out to young people. A lot of the kids just don't know about the opportunities. We have a charge to make known what you can do. Students often say to us, "Oh, we never knew that these fields existed."

At the symposium, we conduct over 16 workshops on different professions. In addition, one of the things we're going to do with the Web site is highlight health professions. All of the kids who have ever attended a symposium can go to the Web site and access this information.

What do you see as Minority Health Professions Foundation's primary task for the future?

I see our focus being how we can impact the health profession's workforce. Even now we're seeing that minorities are not appropriately represented. I think its been shown that people of the same ethnic group can better serve and identify with that group's needs. It's important that we increase the numbers of minorities who provide health care services so that minority populations are better served.

Celia Colista is a New York-based free-lance writer who specializes in career issues.

The National Alliance for Hispanic Health was founded in 1973 by a group of mental health professionals to improve the treatment of Hispanics by the mental health system. Within a few short years, the group had expanded its mission to addressing the health care needs of Hispanic families. Thirty-one years later its mission is multifaceted and includes helping consumers and providers, as well as promoting the appropriate use of technology, improving the science base for accurate decision making, and promoting philanthropy.

Since the Alliance was founded, the percentage of Hispanics in the United States has grown, and the needs of the community have changed. But the Alliance has maintained the same principles since the beginning: seeking out community-based solutions, representing all Hispanic groups, and refusing funding from alcohol and tobacco companies.

The U.S. Census Bureau predicts that by the year 2020, Hispanics will account for 18% of our total population (according to the Alliance, by 2050, that number is expected to reach 25%.) Although Hispanics have longer life expectancies than Americans of other ethnic and racial backgrounds, they are more likely to suffer from chronic illnesses. The exact causes for these discrepancies are unknown, but the Alliance hopes to keep such issues a major area of concern and research for the medical and scientific communities.

What does this mean for allied health care providers? According to Jane L. Delgado, president and CEO of the Alliance, those who provide health care to Hispanic people must understand and appreciate the culture. She adds that merely understanding the language or being tolerant of non-English speakers is not enough. In an interview with DAHC, Delgado talks about the AllianceÕs missions and challenges and what health care workers
can do to help.

One of the Alliance's missions is to raise 'cultural proficiency' among providers. What does the term mean and why is it significant in the medical treatment of Hispanics?

In the 1990s, cultural competency was the term used to encompass the ability to value another language or culture. The lessons learned were that the least competent providers believed themselves to be competent and that competency was inadequate for the often-intimate interaction that underlies the therapeutic encounter. What was needed was at the more advanced level of cultural proficiency in which a different language and culture is held in high esteem. This concept is an essential part of the clinical interaction. The interaction between provider and patient requires that the provider recognize and incorporate the values of the patient into their clinical work.

What can providers do to improve their treatment of Hispanic patients? What are common problems that could be avoided?

To improve treatment of Hispanics, providers must rely on what Pete Duarte, former CEO of Thomason Hospital in El Paso, Texas, defined as the 'R&D'of good clinical care, (i.e., Respect and Dignity.) As a first step, providers should understand that the mentality of compliance is not helpful. Instead, all clinical encounters need to occur in a positive environment where the major theme is 'working together.' While this is true for all patients, it is more so the case with Hispanic patients because of the decades of disconnect with the health provider community.

At a fundamental level, the issue of language spoken must be addressed. While it is unlikely that every provider can communicate in the same language as every patient, there is a need to have mechanisms in place to make possible communication when the language of the patient is not English. At a minimal level, well meaning providers need to understand that interpreting is a skill that must be learned; merely being able to speak a language does not make a person skilled. There are some simple cautions to keep in mind, e.g., use of pantomime is open to misinterpretation and that speaking slowly and loudly will not make English understood by a non-English speaker.

1. Center for Consumers operates national information help lines (for general information (866) SUFAMILIA and for prenatal care (800) 504-7081); develops materials on a variety of health topics; works with youth to involve them in health; reaches out to consumers to make sure they have the latest information to make healthier decisions about their lives; and, through the action forum on our Web site, directs communication by individuals with their elected officials.

2. Center for Providers improves the cultural proficiency of providers through training and technical assistance, works with community-based organizations, and forms local and national coalitions to address health issues.

3. Center for Technology works to ensure that Hispanics benefit from the appropriate use of technology. As founding board members of the Patient Safety Institute, we strive to make sure that the most accurate data are available at the point of care.

4. Center for Science and Policy works with the National Institutes of Health and the greater research community to understand how basic science, risk factors, treatment and outcome apply to Hispanics; to increase the number of Hispanics in the sciences; and to fill the gap between the bench and the bedside. All of our knowledge from consumers, providers, technology and science drive what we do in the policy area.

What is the most significant project the Alliance is involved in now?

All of our projects are significant to the 25 dedicated national staff who have made their life work improving the health of Hispanics. We understand that each project helps us to fulfill our mission regardless of whether it is releasing our report on genes and Hispanics, answering the concerns of a consumer who does not know where there is a clinic close to their home, or launching a national campaign to make sure that older Hispanics obtain the new prescription drug discount card.

In less than 50 years Hispanics are expected to make up one fourth of the population in this country. How far has the medical community come in treating this growing patient population
at the same level as the population at large, and how far does it have to go to meet the resulting challenges?

All of our projects are significant to the 25 dedicated national staff who have made their life work improving the health of Hispanics. We understand that each project helps us to fulfill our mission regardless of whether it is releasing our report on genes and Hispanics, answering the concerns of a consumer who does not know where there is a clinic close to their home, or launching a national campaign to make sure that older Hispanics obtain the new prescription drug discount card.

The answers are simple: 1. Not far enough, 2. How far we have to go varies by where we are. The important point is that by working together we will all get there and enjoy
healthier lives.

Celia Colista is a New York-based freelance writer who specializes in career issues.

What are some examples of disparities in health care for gay and lesbian patients?

"Well, beyond HIV, there are differences in how gay men contract sexually transmitted diseases. Lesbian women have rates of breast and gynecological cancers that are very different from straight women. Both gay men and lesbians smoke at rates about twice that of their straight counterparts. Rates of substance abuse and risk behaviors seem to be higher among gay and lesbian youth than among the general adolescent population.

"Beyond that, though, is the very issue I touched on earlier—we often have only a vague idea of the particular health concerns of gay and lesbian persons because of how difficult it is to get funding for research into our health issues. This leads to a Catch-22: Without the evidence you don’t get the funding, but without the funding you don’t get the evidence. Obviously, this has got to stop, and GLMA is adamant about the need for increased funding to investigate the state of LGBT health."

Why do you think it has taken so long for physicians to become aware of these issues? How is GLMA working to make this change?

“I don’t think most health care providers are actively homophobic; these sorts of issues have just never occurred to them. The problem is, when you don’t know to ask the right questions, you may not get the right diagnosis. For example, men who have sex with men and are sexually active may not know that they may have an elevated PSA level after anal sex. The PSA is a test done to see if the prostate is inflamed, and if you have an elevated level, the doctor will often recommend a prostate biopsy. If a patient isn't comfortable telling his doctor that he’s gay, he may end up getting this procedure—which is painful, expensive, and does have some risk—for no reason.

“GLMA is working on education, not just of LGBT health care providers, but of all providers through materials such as our "Top Ten Health Concerns of Lesbians and Gay Men” and "Guidelines for Creating a Safe Clinical Environment for LGBTI Patients." These and other instructional materials are available at our Web site at www.glma.org. We are also trying to get funding to distribute these materials more widely. In any case there’s still a lot to do. The need for GLMA is not going to disappear soon, and we intend to be here to keep doing that work.”

Celia Colista is a New York-based free-lance writer who specializes in career issues.

What new programs or initiatives are you most excited about?

"Many of our new programs and initiatives are being conducted on our Web site, which is the most comprehensive interactive health Web site in existence for African-American women and their families. Some of the programs that we currently have or will be introducing in the future include:

• An online Walking-for-Wellness program that promotes fitness and cardiovascular health.
  
• A national anti-smoking campaign that includes a counter-marketing campaign targeting African-American women and an online smoking cessation program.


• A cardiovascular risk reduction project (REACH 2010: At the Heart of New Orleans) that is conducted in New Orleans in conjunction with 40 black churches.


• The development of curricula that can be used in women's self-help groups on HIV/AIDS prevention, intimate partner violence prevention and smoking cessation.


• Advocacy training to convene key leaders from our affiliated network to continue dialogue on black women's health policy and promote community activism."

What's the future of the Black Women's Health Imperative? What do you see as your biggest challenges over the next 20 years?

"The National Colloquium on Black Women's Health was more than just a celebration of our 20th anniversary. It was the beginning of a revolution to raise the volume, focus our acuity and elevate our dialogue to declare a national sense of urgency about the deplorable health of African-American women. Our greatest challenge is to successfully launch a groundswell of activism to move the health of black women from the bottom of the heap to the top of the health agenda. We need the 19 million African-American women and girls in this country to become outraged enough about the state of our health to act and to 'act up,' if necessary."

Chris Enstrom has extensive experience in career management issues. He currently works as a career counselor at Indiana University and at the Career Resource Center of Brown County in Nashville, Ind.

Get all the facts about the National Rural Health Association

National Rural Health Association
One West Armour Boulevard, Suite 203
Kansas City , Mo. 64111-2087
(816) 756-3140
www.nrharural.org

Everyone knows that cities have a strong need for medical professionals. After all, we've all seen ER. On television shows, city emergency rooms (and hospitals in general) are always understaffed, with doctors and nurses and other medical professionals scrambling to keep up with an ever-increasing patient load. All of this might make for interesting drama, but the truth is that rural areas have a far greater shortage of medical personnel than urban areas.

In addition, factors such as a lower rate of employer-provided health care, a higher poverty rate, and a greater proportion of elderly residents add up to a health care crisis in rural America . Enter the National Rural Health Association (NRHA). Headquartered in Kansas City , Mo. , the NRHA is working to improve the “health and health care of rural America .” Through legislative initiatives, education, communication and research, NRHA has made some significant progress since it was established in 1977. But there is still a long way to go. Diversity: Allied Health Careers talked with NRHA's executive director, Steven Wilhide, to learn a bit about the association's present initiatives and plans for the future.

Steve Wilhide, Executive Director National Rural Health Association

Can you tell us a little bit about your background? When did you first start working for NRHA?

“After receiving my bachelor's degree from Frostburg State College in Maryland , I became a VISTA volunteer and served in Cherokee, N.C. In 1967 I was drafted into the Army. After a tour in Vietnam , I attended the University of Maryland School of Social Work where I received a Master of Social Work in community organization. After working in a rural community health center in Wilkes Barre, Pa., I accepted a fellowship to the University of Pittsburgh where I received a Master of Public Health in 1976. In the fall of 1976, I accepted a position as executive director of the Southern Ohio Health Services Network (SOHSN), a newly formed community health center serving four Appalachian counties. Today SOHSN operates 12 primary care clinics with a staff of over 250 and a budget of over $17 million. In January 2002, I came on as the Executive Director of the National Rural Health Association.”

What programs and initiatives does NRHA currently have in place to recruit allied health professionals to rural communities?

“NRHA started a Migrant Health Care Fellowship Program to train allied health professionals to work with rural underserved populations; primarily migrant and seasonal farm workers. This program is now being administered by the Migrant Clinicians Network. NRHA has also started a job bank that currently targets opportunities for administrators seeking positions in rural community health centers. However, we plan on expanding this job bank to include positions for allied health professionals later this year. You can find this resource on our Web site (www.nrharural.org) by clicking on the ‘Rural Health Job Bank' link.”

What is the NRHA doing to help improve the quality of health care in rural America ?

“NRHA has many legislative and policy initiatives to improve the quality of health care in rural America . The NRHA's mission is ‘to assure quality, equity, and access for all rural Americans.' Our policy and legislative positions are too exhaustive to go into detail here, but you can view them all on our Web site. We also work to provide assistance to our members on a variety of recruitment and retention (R/R) issues through advocacy work in Washington, D.C. , disseminating R/R research, and providing an opportunity to learn about R/R initiatives from peers at our annual conference.

“In addition, we are involved in efforts to inform rural residents that local care is high quality care. When rural residents start bypassing the local hospital for their health care, the economic impact of those health care dollars leaving the community can have adverse affects on hospital resources.”

What is the quality of the health care provided to minority populations in rural areas? What is NRHA doing to help improve the quality of health care received by rural minority populations?

“Minority populations in both rural and urban areas have greater problems accessing health care services. They receive fewer preventative services and have greater disparities in health outcomes than their white counterparts. Is there a discernable difference in the quality of services provided to minority and multicultural populations in rural areas? No. The problems that face all rural residents are just magnified for minority and multicultural populations. However, one area that is more of a challenge in rural areas is availability of appropriate interpreters for non-English speaking patients.

“In 1988, NRHA launched the Rural Minority Health Advisory Committee, which encourages national rural- and minority-responsive associations to work to improve health care services and access to rural minority and multicultural populations. On May 13, 2003, we held our 9th Annual Rural Minority and Multicultural Health Conference in Salt Lake City . This conference brought together rural health care providers; private sector organizations; federal, state, tribal and local government employees; allied health professionals and anyone else concerned with improving the quality of health care for rural racial and ethnic minority and multicultural populations. Session topics included health disparities between the general populations and rural minority and multicultural populations; HIV/AIDS; disaster planning; community preparedness, bioterrorism, and emerging populations.

“In addition, if you click on the ‘Minority Affairs' link on our Web site, you will also find a list of print and Web resources that we have created to help medical personnel improve the quality of care to rural minority and multicultural populations.”

What are some of the advantages and disadvantages for allied health professionals who chose to work in a rural community?

“Rural communities are a different way of life. People who chose to live and work in rural areas are generally more socially self-sufficient. They rely upon friends and family and small social gatherings for entertainment more so than the cultural amenities one may find in the urban areas such as the symphony, ballet or opera.

“Allied health professionals can expect more autonomy and the opportunity to fully practice their professional skills. There is less competition from physicians and other health care professionals and these other health care professionals rely upon the allied health professionals in order to extend their services to more patients. Many rural communities rely exclusively upon allied health professionals for their routine care with backup from other providers such as physicians. Also, the care you give is often much more personal, and rural people tend to be very appreciative of the care they receive. Therefore, professional satisfaction may be greater.”

What's the future of NHRA? Where do you think the association will be ten years from now?

“I envision NRHA having three to four times the current membership and having a lot more rural consumers as members. We just published our first quarterly magazine that will highlight people and rural communities that are making a difference in health care in their respective communities. Many of these will be allied health professionals. The stories are beginning to pour in and they are very heartwarming. There are many good things going on in rural America and we want people to know. Rural communities tend to be very creative and collaborative in coming together to solve problems or to improve their communities. We hope to tell the world about these unsung heroes.

“NRHA is currently highly respected in the government and Congress for our knowledge of rural health, the expertise of our members and for our educational efforts. As NRHA continues to grow we will become an even greater force politically and in advocacy and education. We are determined to eliminate the health disparities between urban and rural residents, and will work tirelessly to assure ‘quality, access and equity' for all of rural America .”

Chris Enstrom is a free-lance writer based in Nashville, Ind. , and a former editor for Career Recruitment Media.

Get all the facts about the National Center on Minority Health and Health Disparities

National Center on Minority Health and Health Disparities
National Institutes of Health
6707 Democracy Blvd., Suite 800
MSC-5465
Bethesda , Md. 20892
Info: (301) 402-1366
http://ncmhd.nih.gov

The National Center on Minority Health and Health Disparities (NCMHD) is a division of the National Institutes of Health in the U.S. Department of Health and Human Services. NCMHD was established by the United States Congress through the Minority Health and Health Disparities Research and Education Act of 2000 to promote equality in health outcomes for all citizens through research and education.

According to NCMHD's director Dr. John Ruffin, a health disparities population “is a population where there is significant disparity in the overall rate of disease incidence, prevalence, morbidity, mortality or survival rates as compared to the health status of the general population.” According to Ruffin, the following populations are classified as specific health disparity populations: African Americans, Hispanics/Latinos, Native Americans, Alaska Natives, Asian Americans, Native Hawaiians, Pacific Islanders and the medically underserved, such as individuals from the Appalachian region.

The mission of the NCMHD is to reduce and eventually eliminate minority health disparities through conducting and supporting research, training, disseminating information and providing outreach to communities with health disparities.

To accomplish this goal, the NCMHD has a number of federally funded programs: the Research Infrastructure in Minority Institutions Program, the Research Endowment Program, Project EXPORT Centers of Excellence Program and the Loan Repayment Programs. Ruffin states that in the fiscal year 2002, the NCMHD “made $74.5 million in awards to support extramural research and provided over $65 million of support to other NIH institutes and centers to co-fund projects related to minority health or health disparities research and training.”

John Ruffin, Ph.D.,
Director of the National Center
on Minority Health and Health Disparities

What are some examples of disparities in health among various racial and ethnic groups in the U.S. ?

“Compared to Caucasians, African-American adults are twice as likely to develop type 2 diabetes, and Hispanic adults are 1.9 times more likely to develop the disease. American Indians have the highest prevalence of type 2 diabetes. Over 25% of all adults with diabetes in the U.S. are minorities.

“In 1999, age-adjusted death rates for the African-American population exceeded those for the Caucasian population by 38% for strokes and 28% for heart disease.

In addition, death rates for stroke were 31-40% higher for middle-aged Asian-American males than for middle-aged Caucasian males.

“African Americans are about 30% more likely to die of cancer than are Caucasians and more than two times more likely to die of cancer than any other racial and ethnic group. Hispanics have higher rates of cervical, esophageal, gallbladder and stomach cancer. The difference in cancer mortality is about 12% higher for Hawaiian men and 20% higher for Hawaiian women than that of Caucasian Americans.”

Can you describe the Research Infrastructure in Minority Institutions program and the Research Endowment Program?

“The Research Infrastructure in Minority Institutions provides support for institutions that enroll a significant number of students from minority health disparity populations to develop and enhance their capacity and competitiveness to conduct biomedical or behavioral research. For fiscal year 2002, the NCMHD issued $5.6 million in awards to six biomedical and behavioral research institutions. The Research Endowment Program generates funds to help build research and training capacity in institutions that make significant investments in the education and training of underrepresented minority and socio-economically disadvantaged individuals.

“This past year the NCMHD has funded a number of programs. Here's just one example: The University of Montana will expand its infrastructure capacity to offer graduate degrees with an increased focus on minority health disparities research. Additionally, funds generated from the endowment award will be used to establish new tenure track faculty positions for minority professors with a special emphasis on American Indians.”

What are some of the research topics of the health professionals supported by the NCMHD?

“NCMHD-supported health professionals are working on a broad range of scientific topics. Examples of these projects include: (1) mechanisms for racial disparity in pre-term births; (2) Hispanic/non-Hispanic disparities in health-related quality of life and the accessibility and quality of health services; (3) American Indian child development; (4) underrepresentation of African Americans in clinical research; (5) weight loss and obesity in African American individuals with type 2 diabetes; (6) diabetes education multimedia for vulnerable populations; (7) mental health, substance abuse and welfare reform among African Americans; (8) health disparities among infants and children; (9) HIV prevention in communities of color; (10) cultural differences in familial response to heroin dependence; (11) ethnic, racial and gender contributions to understanding suicidal and mental health risk, dysfunction and adaptation; (12) reaching Vietnamese American women to prevent cervical cancer; (13) racial and ethnic health disparities in Arkansas; (14) intervention to prevent Latino youth drug use; and (15) cultural competence in the physician/patient relationship in depression management.”

What are some examples of NCMHD's Project EXPORT Centers of Excellence Program initiatives funded in 2002?

“The Center for Research and Outreach in Hispanic Mental Health at Carlos Albizu University in Puerto Rico , facilitates research on health disparities with a special focus on the diagnosis, prevention and treatment of mental health disorders in Hispanics and also conducts research on hypertension and HIV/AIDS.

“Another project, the Health Disparities Research with Indian Tribes in Montana and Wyoming , in conjunction with Black Hills State University in North Dakota , will develop a research infrastructure to address health disparities issues affecting the American Indian population of the Northern Plains.

“The initiative Reducing Health Disparities in Alabama 's Black Belt with Tuskegee University and University of Alabama, Tuscaloosa, focuses on minority health disparities, bioethics and rural health in Alabama 's African-American community. Partnerships for Diabetes Related Disparities in Health with the University of Hawaii at Manoa and the Medstar Research Institute will establish the Hawaii EXPORT Center, a research center whose mission is to reduce and eliminate diabetes related health disparities in Native Hawaiians and Pacific Peoples.”

Can you describe the Loan Repayment Programs?

“The Health Disparities Research Loan Repayment Program is the congressionally mandated extramural loan repayment program for minority or other health disparities research. The objective is to recruit and retain highly qualified health professionals to research careers that focus on minority health or other health disparities issues. In fiscal year 2002, the NCMHD issued $5.04 million in awards to 112 health professionals engaged in health disparities research.

“The objective of the Extramural Clinical Research Loan Repayment Program for Individuals from Disadvantaged Backgrounds is to recruit and retain highly qualified and culturally competent health professionals from disadvantaged backgrounds into the clinical research field. In fiscal year 2002, the NCMHD issued $2.02 million in awards to 41 health professionals from disadvantaged backgrounds engaged in clinical research.”

What does the NCMHD see as its top priority today?

“Through its mandated programs and collaborations throughout the country, the NCMHD is committed to building a solid and diverse national biomedical research enterprise of individuals and institutions with the goal of eliminating health disparities and ensuring the health of all Americans. Our top priority is to expand these programs and develop new ones to meet the ever increasing health needs of minority and underserved populations in the United States .”

How can someone interested in learning more about or participating in the work of the NCMHD get involved?

“Information about the NCMHD and its programs may be found on the NCMHD Web site http://ncmhd.nih.gov.”

Kristin Anderson, Ph.D. is a freelance writer and licensed clinical psychologist in Elburn, Ill.