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Eliminating Health Disparities: Community-Based Participatory

Research and Loan Repayment Program Francisco S. Sy, MD, DrPH

Chief, Office of Community-Based Participatory Research and Outreach

National Center on Minority Health & Health Disparities National Institutes of Health

July 27, 2006 Hispanic Association of Colleges and Universities

Capacity Building Workshop

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OBJECTIVES

To give an overview of the research programs at NIH/NCMHDTo discuss the definition, principles, challenges and rationale for using community-based participatory research (CBPR) in eliminating health disparitiesTo describe the NCMHD CBPR intervention research initiativeTo describe the NCMHD loan repayment (LRP) program for health disparities research (HDR) and clinical research for individuals from disadvantaged background (ECR)

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Public Law 106-525

The Minority Health and Health Disparities Research and Education of 2000

Public Law 106-525

The Minority Health and Health Disparities Research and Education of 2000

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NCMHD MISSION

To promote minority health and to lead, coordinate, support,and assess the NIH effort to reduce and ultimately eliminatehealth disparities. In this effort, the NCMHD will:

conduct and support basic, clinical, social science, and behavioral research

promote research infrastructure and training

foster emerging programs

disseminate information

reach out to minority and other health disparity communities.

To promote minority health and to lead, coordinate, support,and assess the NIH effort to reduce and ultimately eliminatehealth disparities. In this effort, the NCMHD will:

conduct and support basic, clinical, social science, and behavioral research

promote research infrastructure and training

foster emerging programs

disseminate information

reach out to minority and other health disparity communities.

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Public Law 106-525

Minority Health Disparities Research

Basic, clinical, and behavioral research on minority health conditions

PRIORITY FOR NCMHD

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NCMHD Statutorily Mandated Programs:

Centers of Excellence (Project EXPORT) Community-Based Participatory Research and

Outreach Endowment Loan Repayment

Centers of Excellence (Project EXPORT) Community-Based Participatory Research and

Outreach Endowment Loan Repayment

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NCMHD Programs

• Centers of Excellence Program ( Project EXPORT) N=77

• Community-Based Participatory Research and Outreach N=25 • Research Endowment Program N=12 • Research Infrastructure in Minority Institutions Program N=21

• Loan Repayment Program (LRP) Scholars N=474

• Small Business Innovation Research (SBIR) Program N=18 Small Business Technology Transfer (STTR) Program N=3

• Minority Health International Research Training Program N=24

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NCMHD Community-Based Participatory Research Initiative

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RFA-MD-05-002 NCMHD Community Participation in Health Disparities Intervention Research

The goal is to support community intervention research studies using CBPR principles to reduce and eliminate health disparities in any disease or condition of major concern to the community with emphasis on racial & ethnic minorities.This initiative will start with a 3 year planning grant, followed by a competitive 5 year intervention research grant, and conclude with a competitive

3 year dissemination research grant. In the 3 year planning grant, the first year is devoted to partnership development, community needs assessment, identifying the disease/condition for intervention research, & planning the intervention methodology. A pilot intervention research study will be conducted during the second and third year.

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Definition of CBPR

“ Collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community with the aim of combining knowledge and action for social change to improve community health and eliminate health disparities.”

W.K. Kellogg Community Scholar’s Program (2001)

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CBPR Relevance in U.S.

Paradoxical Timing for Interest in CBPRBiotechnology and genetic revolution, yet Biomedical and behavioral advances insufficient

Impact of Hurricane KatrinaFoundations: Kellogg, Ford, Annie E. Casey, Aspen, California Endowment, othersGovernment: NCMHD, NCI, AHRQ, CDC, NIH Health Disparities/CBPR grants, ReportsAcademic: AJPH, AJPM, AJPHMP, Env. Health Perspectives, HEB, JGIM, New booksIOM Report: Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century, 2002

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Principles of CBPR

Recognizes community as a unit of identityBuilds on strengths and resources Facilitates partnership and capacity building in all research phases Emphasizes socio-ecological perspective of multiple determinantsDisseminates findings and knowledge to all Involves long-term process and commitmentSeeks balance between research and action

Israel, Schulz, Parker, Becker, Allen, Guzman, “Critical Issues in developing and following CBPR principles,” Community-Based Participatory Research in Health, Minkler and Wallerstein, Jossey Bass, 2000.

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Rationale for CBPR in Eliminating Health Disparities

Complex health and social problems ill-suited to “outside expert” research Increasing community and funder demands for community-driven research /collaborationDisappointing results in intervention research Increasing understanding of importance of local contextIncreasing interest in use of research to improve best practices /best processes

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University Control

Shared University/

Community Control

Community ControlCBPR

Challenge of Research/Community Relationships

Shared University/

Community Control

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Challenge of Participation in Community

Minimal Consultative versus Comprehensive throughout ProcessParticipation Questions:

Who is included? Who is excluded?Who is representing the community?Service providers vs. community membersHidden discourse (what will never be known)

Scientific/Academic Time vs. Community Time

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Ethnic/Racial Challenges

Institutional Racism:

Predominance of white academics working in minority communitiesHistorical “helicopter” researchSocial labeling of communities•Reproduced inaccurate

representations•Resistance is ignorance

Academy norm of research•Western approaches are universal•Knowledge is uni-linear

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Purpose: Support biomedical and behavioral researchtraining for members of “health disparity populations”

Award Period: Not more than 5 years, pending annual approval of the NCMHD Director and availability of appropriations for the program

Purpose: Support biomedical and behavioral researchtraining for members of “health disparity populations”

Award Period: Not more than 5 years, pending annual approval of the NCMHD Director and availability of appropriations for the program

Centers of Excellence Program

Centers of Excellence in Partnerships for Community Outreach, Research on Health Disparities and Training (Project EXPORT)

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Administrative Core (required)

Research Core (required)

Community Outreach and Information Dissemination Core

Training/Mentoring Core

Minority Health and Health Disparity Education

Shared Resource Core

CENTERS OF EXCELLENCE PROGRAM STRUCTURE

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CENTERS OF EXCELLENCE FUNDING MECHANISMS

The P20 or Exploratory Grant Awards: are targeted to institutions that have research programs but need additional funding to develop a health disparity research program. Funds will provide a mechanism to strengthen the infrastructure for minority health and other health disparities research and training. In addition, program funds will provide resources to assist successful applicants in the development of innovative partnership models.

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CENTERS OF EXCELLENCE FUNDING MECHANISMS

The P60 Center Awards: are targeted for research-intensive institutions pursuing research in health disparities. Funds will be used to establish a health disparities research center.

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Purpose: To build Health Disparities Research Capacityand other health disparities research

Participants: Targets “Section 736 Public Health Service Act (PHS) Institutions with currently funded Programs of

Excellence in Health Professions Education for Underrepresented Minority Individuals (HRSA)

Eligibility: Non-research Intensive InstitutionsResearch Institutions with endowment investmentsbelow the ceiling established in Public Law 106-525

Purpose: To build Health Disparities Research Capacityand other health disparities research

Participants: Targets “Section 736 Public Health Service Act (PHS) Institutions with currently funded Programs of

Excellence in Health Professions Education for Underrepresented Minority Individuals (HRSA)

Eligibility: Non-research Intensive InstitutionsResearch Institutions with endowment investmentsbelow the ceiling established in Public Law 106-525

RESEARCH ENDOWMENT PROGRAM

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Research Infrastructure in Minority Institutions Program (RIMI)

USE OF FUNDS

The RIMI Program was originally created by the Office of Research on Minority Health (ORMH), the predecessor to the NCMHD, and the National Center for Research Resources (NCRR).

The program 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. Specifically, the RIMI program assists non-doctoral degree institutions in

the development of their research infrastructure, primarily through collaborations with research-intensive universities

USE OF FUNDS

The RIMI Program was originally created by the Office of Research on Minority Health (ORMH), the predecessor to the NCMHD, and the National Center for Research Resources (NCRR).

The program 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. Specifically, the RIMI program assists non-doctoral degree institutions in

the development of their research infrastructure, primarily through collaborations with research-intensive universities

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Health Disparities Research (HDR-LRP)Encourages health professionals to engage in basic, clinical or behavioral research directly relevant to health disparities issues.

The program seeks to recruit and retain highly qualified health professionals in research careers that focus on minority health disparities research related to the medically underserved.

The HDR program serves as an avenue for NIH to engage and promote the development of research programs that reflect the variety of issues and problems associated with disparities in health status.

Extramural Clinical Research (ECR-LRP)Encourages health professionals from disadvantaged backgrounds to conduct clinical research.  The emphasis on “clinical research”and on individuals from “disadvantaged backgrounds” highlight the need for the involvement of a cadre of physician scientist in clinical research to strengthen the twenty first century biomedical and behavioral workforce.

LOAN REPAYMENT PROGRAM

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NCMHD Health Disparities Research (HDR) Loan Repayment Program: New Applications and Awards, 2002-2005

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NCMHD Health Disparities Research (HDR) Loan Repayment Program: Renewal Applications and Awards, 2002-2005

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NCMHD Clinical Research for Individuals from Disadvantaged Background (ECR) Loan Repayment Program:

New Applications and Awards, 2002-2005

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NCMHD Clinical Research for Individuals from Disadvantaged Background (ECR) Loan Repayment Program:

Renewal Applications and Awards, 2002-2005

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NCMHD LRP Funding, 2002-2005

HDR ECR Total

FY02 $5,040,000 2,020,000 $ 7,060,000

FY03 $6,212,000 2,131,000 $ 8,343,000

FY04 $8,702,000 1,672,000 $10,374,000

FY05 $9,092,000 1,562,000 $10,654,000

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HDR ECR Total

FY02 5,040 2,020 7,060

FY03 6,212 2,131 8,343

FY04 8,702 1,672 10,374

FY05 9,092 1,562 10,654

0

1,500

3,000

4,500

6,000

7,500

9,000

10,500

FY02 FY03 FY04 FY05

ECR

HDR

Total

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Current NCMHD Funding Opportunities

RFA-MD-06-003 Establishing Exploratory NCMHD Research Centers of Excellence (P20)RFA-MD-06-002 Establishing Comprehensive NCMHD Research Centers of Excellence (P60)

* See handouts for additional funding opportunities

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“You must be the change you want to see in the

world.” — Mahatma Gandhi

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Facing the future ...

“The best way to Predict the future

Is to invent it”Alan Kay