January 30, 2001

John Ruffin, Ph.D.

Associate Director

Office of Research on Minority Health

Office of the Director

National Institutes of Health

Building 1, Room 252

Bethesda, MD 20892-2520

Dear Dr. Ruffin:

Congratulations on your appointment as the first director of the National Center on Minority Health and Health Disparities at the NIH! The Consortium of Social Science Associations (COSSA) appreciates the opportunity to comment on the National Institute of Health (NIH) Strategic Plan to Reduce and Ultimately Eliminate Health Disparities. Supported by more than a 105 professional associations, scientific societies, universities, and research institutions, COSSA stands along in representing the full range of the social and behavioral sciences. COSSA commends you and your NIH colleagues on the drafting of the NIH-wide health disparities strategic plan.

Social and behavioral science have much to contribute toward examining the factors and conditions that give rise to health disparities. As recognized and acknowledged by Principle Deputy Director Ruth Kirchstein at the NIH-sponsored conference, "Toward Higher Levels of Analysis: Progress and Promise in Research on Social and Cultural Dimensions of Health" (June 28 - 29, 2000), "social and cultural factors play a central role in preventing illnesses, maintaining good health, and treating disease." As also observed by Dr. Kirchstein, social and behavioral science research has shown that individuals' social environment, families, neighborhood, schools and workplaces, have a profound impact on health. Additionally, other factors such as socioeconomic status (regardless of economic condition), as well as gender, race and ethnicity, have been consistently linked to health outcomes. As a result of social and behavioral science we know that cultural factors influence how we view, diagnose, and treat both physical and mental illness.

To eliminate health disparities, COSSA believes that research on social and cultural factors must be a vital part of NIH's efforts to understand health disparities. A valuable contribution that can be made by the social and behavioral sciences are the ability to explain health and disease not solely as an individual biological problem, but as a social phenomenon associated with social ties and other forms of social influences. COSSA believes that in order to make progress on against health disparities, the NIH will have to focus additional resources and attention to the social and behavioral sciences. Just as NIH has made research on human genetics a priority, COSSA believes that if progress is to occur in the elimination of health disparities, similar attention, focus, and resources will have to be given to social and behavioral science research.

Further, COSSA believes that to eliminate racial and ethnic health disparities in the United States the NIH will have to support research that 1) leads to a better understanding of the influences of the social and cultural environment on health; 2) examine the social processes and social structures affected; 3) leads to the development of an integrated understanding of how social, cultural, behavioral, and biological factors combine to produce health and illness.

The social and behavioral science disciplines (e.g., psychology, anthropology, sociology, economics, and political science) have a great deal to say about the factors and conditions that give rise to health disparities. There is a growing body of social and behavioral science research that addressing the consequences of poor health for populations as well as individuals. For instance, psychologists and sociologists are studying the links between experiences of racism and stress, the impact of violent experiences on child development, and the relationship of a variety of behaviors (i.e., exercise, substances, and diet) to health over the life course.

Accordingly, COSSA urges the NIH's support for additional basic social and behavioral research on race ethnicity. The ways in which people view themselves and others in terms of race and ethnicity is strongly influenced by the social settings they occupy and shared ideas about what it means to be of a particular race. "Disparities in health following from ethnic/racial status and related experiences of discrimination, racism, and stigmatization must be key priorities under the broader rubric of social inequalities. There is also a pressing need to study cumulative experience along pathways to adverse health outcomes via long-term tracking of chronic features of economic, educational, and racial/ethnic disadvantage."

We commend the NIH-wide health disparities strategic plan on its attention to the need for research infrastructure support, both in research training and career development, and institutional resources. COSSA is especially concerned with the tremendous need to recruit and train minority researchers, as well as researchers who plan to focus on health disparities. Social and behavioral scientists have benefitted less from NIH's training programs than the bench scientist in recent years. Institutional training grants are critical; too few are available to social and behavioral research programs. Additionally, COSSA is concerned regarding social and behavioral scientists' access to clinical training programs at NIH. We urge as part of the strategic plan's focus on disparities in mental disorders that clinical training opportunities be expanded for the social and behavioral sciences.

As you may know, two of COSSA member associations manage successful long-standing minority fellowship programs with support from the NIH. The American Psychological Association manages its Minority Fellowship Program with support from the National Institute on Aging and the National Institute of General Medial Sciences (as well as the Center for Mental Health Services).

The American Sociological Association's (ASA) Graduate Fellowship Program for Underrepresented Minorities (MFP) was initiated in 1974 with funding primarily from the National Institute of Mental Health and is now in its 27th year of continuous support The MFP Fellowship Program seeks to provide pre doctoral students with financial support, academic and research training, and mentoring, in coordination with university graduate programs, in order to increase the talent pool of minority sociologists engaged in research on mental health and well being throughout the United States. The Program has had a major impact on attracting talented students to research careers in mental health and expanding sociological inquiry on such issues. Some of the leading scholars now addressing health disparities are graduates of the ASA's MFP Program. Each year, the ASA-NIMH Program supports 26 Fellows who typically are trainees for three years.

While these are just two examples of COSSA member organizations attempting to fill the critical shortage of minority researchers, we are aware that there are still many, many opportunities and too much valuable talent that goes untapped due to the lack of resources. COSSA would be more than willing to discuss this issue more fully with you.

COSSA would also like to commend you for your plan to create Centers for Health Disparity Research and Intervention "to foster an interdisciplinary approach to the study of health disparities." As part of the scientific community, you are certainly aware that the domains of science addressing the causes of disease and poor health are changing. We are pleased with your recognition that of the relevance of the social and behavioral sciences. Accordingly, these changes will increasingly require that researchers are able to cut across disciplinary boundaries. The creation of these Centers will foster necessary and essential collaboration between the various disciplines — the social and behavioral sciences with the biological sciences in health research.

NIH's attention to health disparities research is an exciting and positive development. COSSA and our member organizations stand ready to assist the you and the NIH in this wonderful endeavor. Please feel to contact me or Angela Sharpe, Associate Director for Government Affairs at 202/842-3525 if we can assist you and the National Center on Minority Health and in reaching the goal of eliminating health disparities.

Sincerely,

Howard J. Silver, Ph.D.

Executive Director