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The link between disparity and disease.

It's no mystery to scientists and medical professionals that all diseases are not created equal in all population groups--disproportionately high numbers of people in certain ethnic and socioeconomic groups suffer from certain illnesses such as heart disease, obesity, and cancer. Scientists do puzzle, however, over the complex interplay of biological, social, environmental, and even economic factors that appear to influence the rate of disease in a susceptible population. In an effort to understand these health disparities better--and to reduce and, hopefully, eventually eliminate them--the NIH recently established eight Centers for Population and Health Disparities.

"Today, people in this country of various backgrounds, ages, or socioeconomic levels bear an unequal burden of disease. These centers will perform innovative research, collaborating extensively to address the important and complicated issue of health disparities," said NIH director Elias A. Zerhouni upon the formal announcement of the centers' launch.

Over five years, four NIH entities--the NIEHS, the National Cancer Institute, the National Institute on Aging, and the Office of Behavioral and Social Sciences Research--will funnel $60.5 million toward transdisciplinary research efforts to explore how the social and physical environment, behavioral factors, and biological pathways interact to influence human health and cause disease in certain populations. Together, the eight centers will collaborate with community partners who will help plan and carry out research on conditions including obesity, cardiovascular disease, mental health, gene-environment interactions, psychosocial stress, and breast, prostate, and cervical cancer.

The centers will address recommendations made in numerous recent reports from the National Academy of Sciences and the Institute of Medicine calling for research efforts that integrate multiple levels of analysis of biological pathways of disease as well as social and cultural influences. Rather than focus on individual participants, center investigators will study disease causes and health interventions among specific population groups within the environment in which they live, focusing on low-income whites, blacks, Hispanics, and the elderly. "It's a novel paradigm for looking at disease and health outcomes in specific populations," explains Fred Tyson, a program administrator in the NIEHS Susceptibility and Population Health Branch who has coordinated the effort to establish the new research centers.

"We know that multiple factors are at play in determining the risks of groups and individuals for various diseases and [health] conditions," says J. Michael McGinnis, senior vice president and director of the Health Group of the Robert Wood Johnson Foundation in Princeton, New Jersey, who has experience in interdisciplinary research. Many factors conspire to determine the expression of a genetic predisposition to disease in an individual. "Characterizing and understanding the profiles of the biological, the behavioral, the environmental, and the social circumstances--and how they interact--requires the skills of multiple disciplines," McGinnis explains.

Although some research institutions have attempted to foster interdisciplinary work in the past, such collaboration, McGinnis explains, is "not a natural act for scientists and institutions. The multi-institute, multi-year commitment is a strong signal that our progress [toward] really understanding the forces that forge differences among groups and individuals depends on a broader analytic framework."

The centers and their planned projects are as follows:

Researchers from The Ohio State University in Columbus and the University of Michigan in Ann Arbor hope to increase early detection of cervical cancer in Appalachian women by boosting the proportion of these women who receive regular Pap tests and follow-up care.

RAND Corporation investigators based in Santa Monica, California, will team up with several Los Angeles-area community organizations to study whether park improvements positively impact the physical activity and health of local residents, primarily Latinos.

In Boston, researchers from Tufts and Northeastern Universities will study how specific stressors affecting older residents of Puerto Rican descent may lead to poor health outcomes in that population group.

A team of researchers from the University of Chicago and Nigeria's University of Ibadan will employ animal models to determine if social isolation and high stress levels among black women of African descent increase the risk of early, lethal breast cancers.

A team from the University of Chicago and the Healthcare Consortium of Illinois will study the effects of social context on the stage at which breast cancer is diagnosed.

At the University of Pennsylvania in Philadelphia, researchers hope to transform attitudes and beliefs about prostate cancer among black men that may prevent this high-risk population from being diagnosed while the cancer is still treatable.

Investigators at The University of Texas Medical Branch in Galveston will study the relationship between neighborhood enviromnent and measures of health in Hispanic populations.

At Wayne State University in Detroit, Michigan, researchers hope to better understand salt sensitivity in blacks who are at high risk for developing hypertension and cardiovascular disease by studying the effects of stress, obesity, and genetics on oxidative stress and salt sensitivity.

The centers will have strong elements of community involvement and partnership, bringing the results of these scientific endeavors directly to the populations being studied and providing health education and outreach. According to Tyson, the community-based component of these research projects will be critical to their success: "If you translate the results of biomedical research and make it accessible to the public, you make an impact on public health," he says. "You have a better opportunity for a faster payoff in the community."
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Title Annotation:NIEHS News
Author:Medlin, Jennifer
Publication:Environmental Health Perspectives
Date:Jan 1, 2004
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