March 2009 Issue • Volume 37 • Issue 3

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Sociologists Headlined
Plenary at NIH Summit

National Institutes of Health hosted 4,000 attendees at DC summit to examine what science knows about health disparities that could help eradicate them.

by Lee Herring, ASA Public Affairs and Public Information Office

Prominent sociologists headlined the marquee of one of nine plenary sessions of a major NIH (National Institutes of Health) summit, titled "The Science of Eliminating Health Disparities," in mid-December. With more than 4,000 attendees, including policymakers, senior federal agency staff, members of Congress, health practitioners, academics, and other stakeholders, the three-day meeting brought the spotlight on the discrepancies in both the delivery of American health care and the health status of Americans across racial/ethnic categories. This impressive meeting featured some 300 speakers.

The summit was organized by the National Center on Minority Health and Health Disparities (NCMHD), a component of the NIH Director's office, which Congress established in 2000. Some in the research community viewed the summit as a step toward redefining NIH's disparities research agenda.

But among the summit's explicit purposes was to help educate scientists, stakeholders, and policymakers about NIH and community progress in ameliorating health disparities, and to highlight NIH's progress in disparities research activities to improve prevention, diagnosis, and treatment. Besides helping to identify research gaps, the summit was intended to help raise awareness and understanding of health disparities and to elucidate best practices in research, capacity-building, prevention outreach, and strategic solution generation. The summit allowed participants to make recommendations that will shape the NIH health disparities strategic plan. Finally, the summit sought to establish a framework for ongoing dialogue and creation of innovative and unique partnerships to address disparities in health.

Opening on a Positive Note

Poet laureate Maya Angelou, of the Maya Angelou Center for Health Equity, gave an engaging and memorable opening plenary address challenging the community to begin to conceptualize the disparities issue from a positive perspective of achieving health equity for all. Despite that challenge, unpleasant realities of health disparities became the focus of the summit panels, including the keynote address on national health insurance reform delivered by Governor Howard Dean, Chair of the Democratic National Committee, and an impassioned address by Rep. Elijah Cummings (D-MD) in a session on policy implications for eliminating health disparities. Cummings indicated that when the upcoming health care reform legislation comes before Congress, legislators will specifically address issues that are critical to ameliorating disparities.

Sociologists Featured

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NIH health disparities panel [left to right]:
Stephen Katz, NIAMS;
David Williams, Harvard University;
Meredith Minkler, University of California-Berkeley;
Margarita Alegría, Harvard Medical School;
David Takeuchi, University of Washington.

In the "Health Disparities and the Intersection of Science, Policy and Practice" plenary, presentations were delivered by two former ASA MFP Fellows, sociologists David R. Williams, Harvard University, and David Takeuchi, University of Washington. Williams gave a presentation titled Moving Upstream: How Interventions that Address Social Determinants of Health Can Improve Health and Reduce Disparities, and Takeuchi spoke on Creating, Maintaining, and Blurring the Boundaries of Science, Policy and Practice. This session was moderated by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Director, Stephen Katz, and included two other speakers.

Williams stated, "There is a growing body of scientific evidence . . . that points to the important solutions . . . in terms of addressing disparities." But he cautioned that there are a number of obstacles. For example, according to his research with colleagues Manuela Costa, Adebola Odunlami, and Selina Mohammed, "there's a large racial gap in health, with African Americans and American Indians having higher death rates than Whites in the early years. Latinos have comparable death rates, though slightly higher at . . . younger ages." Gaps persist into midlife, with death rates in the two groups at almost twice or as much as twice as high as that of the White population. This pattern continues into late life, so, "from the cradle to the grave, we see large disparities," said Williams.

"We need to understand the patterns of disparities in the light of the contribution of immigration," Williams continued. His research reveals that immigrants of all racial and ethnic groups have better health trajectories than their native-born counterparts. "White immigrants have better health outcomes than Whites born in the United States. Black immigrants do better than Blacks born here. Latinos and Asians do the same and given the composition of Latino and Asian populations, their very good health profile must be understood in the context of these high levels of immigration."

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David R. Williams
at the NIH summit

Thus, a major challenge is to identify relevant factors that shape "this pronounced pattern of worsening health with increasing length of stay in the United States." In other words, "the American way of life appears to be dangerous for your health." Consequently, health interventions focused solely on individual health behaviors will be ineffective, Williams said. Using tobacco smoking as an example of where there has been success, Williams said this has required the "contribution of many organizations working through multiple intervention channels to inform the public through multiple mechanisms, to provide economic inducements to reduce tobacco smoking, and also laws and regulations." Williams emphasized that we need to "move upstream" toward the non-medical determinants of health.

Takeuchi described the role of conceptual boundaries in preventing better progress in health disparities. Adopting concepts of sociologist Thomas Gieyrn, Indiana University, who studied early American Society, Takeuchi said that socially constructed boundaries (e.g., academic versus applied, scientist versus non-scientist, science disciplinary boundaries) weaken our attack on disparities. Given their social origin, boundaries can be particularly rigid and easily morph into "etiological battles that don't tend to move the field forward," said Takeuchi. He discussed issues such as the stock of knowledge that legitimizes each of these boundaries and the values and work organization of boundaries. For example, "Scientists set up boundaries, both informally and formally, and thereby enlarge the material and symbolic resources" of disciplines or professions to protect professional authority, he explained.

Takeuchi discussed formal and informal ways that etiologies are used to maintain boundaries. First, "strain theory," developed by Talcott Parsons, "maintains that etiologies provide ways to integrate conflicting demands, competing expectations, and deals with the ambiguities in social life. This is a notion where things become a little unclear in life and scientists often want to distinguish themselves [formally] from practitioners." An excellent example, Takeuchi said, are the many economists who advocated for the policies that created the current fiscal and monetary crises. They are now distancing themselves, saying, ‘Well, we didn't tell you how to implement them.'"

Second, Karl Marx's "conflict theory" addressed etiologies as social levers or weapons used by groups to further their political and economic interests for power and advantage, said Takeuchi. Boundaries emerging from such informal mechanisms wield powerful influence. "In sociology, those who focus on medical sociology are often called too applied. That is, we're not sociological enough. It creates this boundary about what is sociology." Takeuchi suggests blurring boundaries through incentives. For example, NIH's recent attempt to engage researchers and community organizations in community-academic research partnerships is excellent, he said.

Sociologists James S. Jackson, University of Michigan Institute for Social Research, and Amy Schulz, University of Michigan School of Public Health, participated as speakers in breakout sessions and/or thematic track sessions at the summit as well. Jackson spoke on the topic of disentangling race, immigration, culture and ethnicity effects on disparities in mental disorders.

New NIH Program

Discussing the effort to make the elimination of health disparities a priority across NIH, NCMHD director John Ruffin presided over a panel, introduced by Mary Woolley of Research!America. The panel also included NIH Acting Director Raynard Kington, former NIH Directors Harold Varmus and Bernadine Healey, as well as former HHS Secretary Louis Sullivan, former Surgeon General David Satcher, and NCMHD Deputy Director Joyce Hunter.

"This is the first time since the establishment of the National Center on Minority Health and Health Disparities that all of the NIH institutes and centers and their partners have come together to collectively showcase the breadth of our accomplishments in health disparities," explained Ruffin.

To much applause, Kington announced the newly approved enhancement and rejuvenation of the NCMHD's intramural research program on eliminating health disparities. The expanded NIH-campus-and-disparity-community program will be comprised of two major aspects: (1) a five-year health disparities career development element, and (2) a health disparities research intervention element, in which biological and behavioral aspects of health disparities will be examined.

Kington referred to W.E.B. DuBois' The Philadelphia Negro, describing his chapter on health that included a discussion of the social factors that might account for the poor status of health among African Americans in the late 1800s' Philadelphia. DuBois was in charge of an annual conference to address the problems of the African American population in the country at the time, Kington said, which he steered increasingly toward science. "He had tremendous faith in the ability of science to solve the Negro problems, as they were called then, problems of disparities between Black and White populations that ranged from economics and education to morbidity and mortality," Kington stated.

"This was, however, a time not only of deep racism but also of growing scientific racism, the belief that such disparities were grounded almost exclusively in biology. Du Bois rejected such arguments and firmly held this conviction that progress could be made but that it could only be made by following scientific methods." Du Bois' argument "could serve as a charge for our efforts to integrate science and policy in practice in the elimination of health disparities today," Kington concluded.

Awards to Sociologists

Among the handful of awardees honored at the gala were sociologists David Takeuchi and James S. Jackson, who received a Health Disparities Innovation Award for their work with colleague Margarita Alegría, on the National Survey of American Lives.

NCMHD is the focal point for leading the planning and coordination of minority health and health disparities research within NIH, which is part of the U.S. Department of Health and Human Services. The NCMHD is authorized to head the development and updating of the NIH health disparities research agenda. In 2002, NCMHD, in collaboration with NIH's 27 institutes and centers and the Office of the Director, developed the first comprehensive NIH health disparities strategic plan: NIH Strategic Research Plan and Budget to Reduce and Ultimately Eliminate Health Disparities, Fiscal Years 2002–2006. It was developed with involvement of academia, health care professionals, and representatives of affected communities to address the fact that large segments of populations in the United States and globally continue to suffer disproportionately from premature death, disability, and illness. logo_small

See more information, disparities facts, and video and audio archives of the meeting at www.ncmhd.nih.gov/. For research opportunities, see NCMHD's newly released Request for Applications (RFA-MD-09-004). Visit grants.gov for more information. Letters of intent are due March 17, 2009, and applications are due April 17, 2009.

 

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