FOOTNOTES December 2000
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The Executive Officer’s Column

Carrying the Sociological “Flag” on Health Disparities

The National Institutes of Health (NIH) have been engaged in a year-long effort to develop strategic plans for investing in research, training, and communication on health disparities. All of the Institutes and Offices at NIH engaged in separate planning processes. Also a trans-NIH plan was developed and posted for public comment by January 31, 2001.

We took advantage of the comment period to commend the importance being placed by NIH on racial and ethnic disparities and the evident inclusion of social and behavioral science perspectives in this plan. We thought, however, that it was well worth urging that the final draft further emphasize social levels of analysis. That letter and how we showed the “sociological flag” is reprinted below. When coupled with elevating the NIH Office of Research on Minority Health to a National Center on Minority Health and Health Disparities and with NIH having received a 2001 appropriation of $100 million in additional dollars for minority health research, the trans-NIH plan should have a major impact.—Felice J. Levine


January 31, 2001
Dr. John Ruffin, Associate Director
Office of Research on Minority Health
Dear Dr. Ruffin:

The American Sociological Association (ASA) is pleased to have the opportunity to provide comments on the National Institutes of Health (NIH) Strategic Plan to Reduce and Ultimately Eliminate Health Disparities. The ASA is the primary scientific association of sociologists with over 13,000 members dedicated to producing scientific knowledge on the structure, relations, processes, and transformations of social life in arenas such as health, education, family, the labor market, and communities. Theoretical and empirical work on racial and socioeconomic disparities in these arenas and their impact on health and well-being is core to our field. The research produced by sociologists is firmly grounded in scientific methods and in ethical principles intended to serve the public good.

On behalf of ASA, I wish to commend you and your colleagues for the leadership and direction taken by the trans-NIH Plan and the significant resources that this plan will bring to understanding and overcoming race and ethnic inequalities in health and well-being. As social scientists, we are gratified by the apparent consensus among the plan’s authors concerning the importance of focusing on social and cultural processes such as inequalities in health treatment that make race and ethnicity appear as such powerful predictors of health disparities. We are also gratified by the plan’s insistence on the importance of moving beyond “black and white” differences to a broader view of race and ethnic diversity.

As sociologists, we are especially optimistic that sustained research that focuses on social and cultural systems and processes as well as individuals—and links these units of analysis—will lead to substantive progress in eliminating racial disparities in health and disease. We urge you in the final document and in the implementation of the plan to emphasize even further the centrality of social and behavioral research to any comprehensive effort to understand health disparities. There is a strong need, for example, for sociological research on whether or how disparities in the location and quality of housing or the distribution of health resources from the government and private sectors affects long-term health behaviors and outcomes.

It is crucial to develop research initiatives that link inequalities in macro-structures (such as social, economic, and political stratification and distribution systems) that often work through mid-level institutions and processes (such as communities, schools, churches, and families) with disparate behaviors, treatments, and outcomes at both group and individual levels. It is best framed in the mandate for the Centers for Health Disparity Research. The ASA would like to see similar linkages between systems and processes with individual outcomes in each area of disease risk, prevention, prevalence, and intervention and in all of NIH’s research initiatives. We believe that this focus is vital if disparities are ultimately to be eliminated. The specific plans of a number of NIH Institutes and Offices (e.g., the plans from the National Institute of Child Health and Human Development and the Office of Behavioral and Social Sciences Research) signal this commitment. More explicit language in the trans-NIH plan would strengthen this resolve and could also have an important impact at the program level.

ASA is particularly pleased with the Strategic Plan’s emphasis on the recruitment and training of minority researchers, especially those who plan to focus on health disparities. As you may know, this past summer ASA received a 5-year renewal award from the National Institute of Mental Health for its Graduate Fellowship Program for Underrepresented Minorities in Sociology. The primary goal of this Program (now in its 27th year) is to support the recruitment and training of underrepresented minority sociologists in the field of mental health. The Program provides predoctoral students with academic and research training and mentoring, in coordination with university and graduate programs, in order to increase the talent pool of minority sociologists engaged in mental health research. By virtue of this investment, several hundred minority scholars— including some of the top sociologists working in the area of disparities and health—have added importantly to our knowledge

ASA is deeply appreciative of the resources and long-term leadership of the National Institute of Mental Health and the involvement of other NIH Institutes in training underrepresented minorities. Nonetheless, ASA would like to see an emphasis in the Strategic Plan on programs that train minority researchers to investigate the impact of social systems and processes on health disparities on a broader arena of health issues and to attract other investigations also to focus on disparities. We would like to see funding for such programs increased, spread out throughout the Institutes, and institutionalized in interdisciplinary training programs that bring together students from the life, behavioral, and social sciences. We also believe that more attention should be paid to the full pipeline—through investments at the undergraduate, graduate, and postdoctoral levels.

On behalf of ASA’s 13,000 members, I commend NIH for its Strategic Plan to Reduce and Ultimately Eliminate Health Disparities. I know that all of our members as well as the Association’s Executive Office are prepared to be of assistance in this significant effort to overcome inequalities in health and well-being. Please feel free to turn to me for additional support (levine@asanet.org or 202-383-9005, ext. 316). Also, Dr. Alfonso Latoni, Director of Minority Affairs (latoni@asanet.org or 202-383-9005, Ext. 321) or Dr. Roberta Spalter-Roth, Director of the Research Program and head of ASA’s project on race (spalter-roth@asanet.org or 202-383-9005, ext. 317), can be called on if you need additional help in this important effort.

Sincerely,
Felice J. Levine, Ph.D.
Executive Officer