Taking the Next Step Toward Eliminating Health Disparities

VOLUME 10, NUMBER 4

JORDAN J. COHEN, M.D., PRESIDENT

JANUARY 2001

Taking the Next Step Toward Eliminating Health Disparities

By Jennifer Proctor

With a sweeping new law and a series of multimillion-dollar grants to fund research at medical schools and schools of public health, the federal government is laying the groundwork to address and abolish health disparities in our nation.

In November, President Clinton signed the Minority Health and Health Disparities Research and Education Act, which includes a host of initiatives designed to aid the government in achieving its goal of eliminating disparities by 2010. "This legislation will help establish a solid foundation as we work to rectify inequalities in health status and access to health care among various racial and ethnic groups," AAMC President Jordan J. Cohen, M.D., said in a statement.

Specifically, the law establishes the Center on Minority Health and Health Disparities at the NIH and creates a loan repayment program to attract health disparity researchers. In addition, the law provides millions of dollars to the Health Resources and Services Administration to fund cultural-competency training and education at academic medical centers and other nonprofit entities.

The Agency for Healthcare Research and Quality's (AHRQ) health disparities research will also get a boost from the new legislation. But the agency hasn't been waiting for the law to take action on the issue: In November, AHRQ announced five-year grants totaling $45 million to fund health disparity research at health professions schools. The grants are made possible through the agency's Excellence Centers to Eliminate Ethnic/Racial Disparities (EXCEED) initiative, launched in partnership with the Office of Research on Minority Health and the National Cancer Institute. (See sidebar for a list of projects.)

EXCEED-funded projects go beyond identifying disparities to understanding why they exist and eliminating them, says Daniel Stryer, M.D., a researcher at AHRQ and head of the EXCEED initiative. "They also identify and cultivate researchers interested in minority health."

Originally, AHRQ expected to provide funding to two to four grantees. But after receiving an overwhelming number of applications, AHRQ expanded its original plan to nine projects. "It's gratifying to see this widespread interest and commitment to reducing disparities," Dr. Stryer says.

Each project consists of three to eight studies organized around a central theme. Dr. Stryer explains that this approach gathers a critical mass of inves-tigators, who can share resources and ideas as well as a common infrastructure, data management and analysis, and manuscript production.

The Mount Sinai School of Medicine, an EXCEED grantee, is working with residents in Harlem to investigate whether underuse of effective medical and surgical treatments causes health disparities in minority populations. Researchers hope to understand from the patients' point of view the barriers to receiving effective care and adhering to complicated treatment regimens.

"We'll see if we can intervene to fix these problems of underuse and, therefore, improve the delivery of care to these people," says Mark R. Chassin, M.D., MPH, principal investigator for the project. Cultural sensitivity can make the interventions "stick," he stresses. "If the program isn't sustainable after the research goes away, you haven't done much to improve the health of the community."

The Morehouse School of Medicine, another EXCEED grantee, is forming interdisciplinary partnerships to ensure its work in improving access and quality of care for vulnerable black populations can be maintained. "We're bringing experts together to form true community partnerships that lead to better research and, ultimately, better care," says Robert M. Mayberry, Ph.D., MPH, principal investigator of the Morehouse EXCEED project and director of the school's Program for Healthcare Effectiveness Research.

Dr. Mayberry says that while much has been done to examine health disparities between blacks and whites, the Morehouse project will dig deeper into the reasons for disparities within black populations, focusing on chronically ill adults and low-income children.

For his part, AHRQ's Dr. Stryer is already working to secure additional funding, so the projects can keep going after five years. EXCEED is "only going to expand," he stresses.

Information: Daniel Stryer, M.D., (301) 594-4038