National Institutes of Health Minority Health and Health Disparities Strategic Plan 2021 to 2025: Taking the Next Steps

National Institutes of Health

Minority Health and

Health Disparities

Strategic Plan 2021–2025

Taking the Next Steps

NATIONAL INSTITUTES OF HEALTH • MINORITY HEALTH AND HEALTH DISPARITIES

STRATEGIC PLAN 2021–2025

Table of Contents

NIH Director’s Foreword ............................................................................................................ 3

Introduction ............................................................................................................................... 4

Minority Health and Health Disparities: Deﬁnitions and Parameters ...................................... 6

NIH and HHS Commitment ....................................................................................................... 8

Foundation for Planning ............................................................................................................ 9

Structure of This Plan ................................................................................................................ 10

Strategic Plan Categories ......................................................................................................... 11

Scientic Research ............................................................................................................. 11

Research Sustaining ........................................................................................................... 11

Outreach, Collaboration, and Dissemination ...................................................................... 12

Leap Forward Research Challenge .................................................................................... 12

Summary of Categories and Goals ........................................................................................... 13

Scientic Research Goals and Strategies .......................................................................... 13

Research-Sustaining Activities: Goals and Strategies ....................................................... 14

Outreach, Collaboration, and Dissemination Goals and Strategies ................................... 14

Details of Categories and Goals ............................................................................................... 16

Scientic Goals, Research Strategies, and Priority Areas .................................................. 16

Research-Sustaining Activities: Goals, Strategies, and Priority Areas ............................... 23

Outreach, Collaboration, and Dissemination: Goals and Strategies .................................. 28

Leap Forward Research Challenge .......................................................................................... 32

Minority Health and Health Disparities Research ............................................................... 33

Research-Sustaining Goals ................................................................................................ 35

Future Plans ............................................................................................................................... 37

NATIONAL INSTITUTES OF HEALTH • MINORITY HEALTH AND HEALTH DISPARITIES

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NIH Director’s Foreword

“Advancing the science of understanding the causes of health disparities and of developing effective inter-

ventions to reduce health disparities and improve minority health is one of my personal priorities. NIH has a

major role in identifying interventions and causes of health disparities. If we can chip away at health dispari-

ties, everyone can experience the better health they deserve. Using the tools of research and our creativity to

address our task, we have a moral responsibility to address health disparities. What a privilege to be engaged

in this noble enterprise that has real promise to give every person the opportunity to have better health.”

— Francis S. Collins, M.D., Ph.D., Director of NIH

“As health disparities remain a potentially preventable burden, public health is impacted unnecessarily.”

— Eliseo J. Pérez-Stable, M.D., Director of the National Institute on Minority Health and Health Disparities, NIH

The publication of the Institute of Medicine report on

unequal treatment, Unequal Treatment: Confronting

Racial and Ethnic Disparities in Health Care, sum-

marized a legacy of unequal health care and differential

health outcomes for most leading causes of disability

and death in the United States among African Americans

compared with Whites, with selected available data

on other racial and ethnic minority groups. Since then,

sources of data dramatically have improved while scien-

tic advances in basic mechanisms have strengthened

our understanding of etiological pathways and potential

intervention points to improve minority health, reduce

health disparities, and promote health equity. The need

for rigorous scientic approaches to minority health

and health disparities—building on decades of studies

addressing social inequality and health, behavioral

epidemiology, and access to quality health care—is now

increasingly being met by an expanding array of biologi-

cal and data science tools that help us understand health

and disease mechanisms.

The Ofce of Minority Health Research was founded at

NIH in 1990 to provide a focus for research questions that

addressed racial/ethnic minority populations. Through

congressional legislation, the Ofce was upgraded to the

National Center on Minority Health and Health Disparities

in 2000 and to the National Institute on Minority Health and

Health Disparities (NIMHD) in 2010. NIMHD is charged

with coordinating and leading NIH’s vision and programs

on minority health and health disparities research. The

topics are broad and include health determinants per-

taining to the entire life course, including all populations,

diseases, prevention, and health care. Research that

advances understanding and improvement of health and

disease in minority racial/ethnic groups in the United

States requires a basic understanding of the construct of

race and ethnicity, incorporating the social determinants

of health in the context of science. Research to under-

stand the causes of and dene mechanisms leading to

interventions to reduce health disparities is a parallel

mandate, incorporating socioeconomic, geographic,

and cultural factors to address conditions with nega-

tive outcomes in specic populations. NIMHD envisions

an America in which all populations will have an equal

opportunity to live long, healthy, and productive lives.

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Introduction

Medical advances and new technologies have allowed

Americans to live longer and healthier lives for the past

century. These advances, however, have not helped all

Americans equally, and health disparities persist, dispro-

portionately affecting racial and ethnic minority popula-

tions, individuals of less privileged socioeconomic status

(SES), underserved rural residents, sexual and gender

minorities (SGMs),

and any subpopulations that can

be characterized by two or more of these descriptions.

In October 2016, SGMs were formally designated as a

health disparity population for research purposes.

In the 35 years since the Heckler report was published,

pioneering researchers studying health disparities and

minority health have worked to reduce the burden of

premature illness and death experienced by many people

from minority racial and ethnic backgrounds, SGMs, rural

residents, and individuals of less privileged SES.For

example, thanks to the efforts of researchers, advocates,

and other stakeholders, the gap in mortality between

Blacks and Whites was reduced by about half from 1999

to 2015, narrowing from 33 percent to 16 percent.

Not

all health outcomes are worse for disparity populations;

in selected conditions, racial and ethnic minorities of less

privileged SES have better health.

However, the individu-

als comprising these groups still face considerable health

disparities in most conditions. These disparities include

shorter life expectancy; higher rates of cardiovascular

disease, cancer, diabetes, infant mortality, stroke, cogni-

tive impairment, asthma, sexually transmitted infections,

and dental diseases; and differences in prevalence and

outcomes of mental illness.

Health disparities are the result of differences in and

interplay among numerous determinants of health, includ-

ing biological factors, the environment, health behaviors,

sociocultural factors, and the way health care systems

interact through complex multilevel pathways. These

dynamic and complex interactions lead to poor health

outcomes and challenge researchers to identify mech-

anistic pathways to develop interventions that may lead

to reductions in health disparities and improvements in

minority health that promote health equity with a system-

atic applied approach.

Section 10334 of P.L. 111-148 tasks NIMHD with coor-

dinating NIH’s research related to minority health and

health disparities: “The Director of the Institute, as the

primary Federal ofcial with responsibility for coordinat-

ing all research and activities conducted or supported

by the National Institutes of Health on minority health

and health disparities, shall plan, coordinate, review,

and evaluate research and other activities conducted or

supported by the Institutes and Centers of the National

Institutes of Health.” In addition, Section 2038 of P.L.

114-255 (21st Century Cures Act) tasks NIMHD with

fostering partnerships and collaborative projects relating

to minority health and health disparities: “The Director

of the Institute may foster partnerships between the

national research institutes and national centers and may

encourage the funding of collaborative research projects

to achieve the goals of the National Institutes of Health

that are related to minority health and health disparities.”

As part of all strategic planning processes across NIH,

Institutes and Centers (ICs) are tasked with coordinating

with the Directors of NIMHD and the Ofce for Research

on Women’s Health to ensure that the plans account

for the unique perspectives, strengths, and challenges

facing minorities and women, as described in Section

2031 of P.L. 114-255. Furthermore, section 404N of the

Public Health Service Act

encourages increased research

with SGM populations as a response to the mounting

evidence of the health disparities experienced by SGM

populations, as well as an acknowledgment of unique

1 Sexual & Gender Minority Research Ofce (SGMRO).

Strategic Plan

to Advance Research on the Health and Well-being of Sexual & Gen-

der Minorities: Fiscal Years 2021–2025.

2 Heckler MM.

Report of the Secr

etary’s Task Force on Black and

Minority Health.

U.S. Department of Health and Human Services.

3 Cunningham TJ, Croft JB, Liu Y, Lu H, Eke PI, Giles WH. V

ital Signs:

Racial Disparities in Age-Specific Mortality Among Blacks or African

Americans — United States, 1999–2015

. MMWR Morb Mortal Wkly

Rep 2017;66:444–456.

4 Franzini L, Ribble JC, Keddie AM.

Understanding the Hispanic Para-

dox.

Ethn Dis. 2001;11(3):496-518.

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health challenges faced by SGM individuals who may be

affected by a socially disadvantaged position. The plan

will guide NIH in setting scientic goals, such as advanc-

ing the scientic understanding of health disparities, and

research-related activity goals, such as strengthening the

national research capacity to address minority health and

health disparities.

Research supported by NIH has worked to reduce these

disparities and improve minority health across all dis-

eases, disorders, and conditions. As a result, all ICs

contribute to the science and support activities. NIH

also supports training, workforce development, capacity

building, and other activities that work to reduce health

disparities. This NIH strategic plan demonstrates ICs’

commitment to research that improves minority health

and reduces health disparities and to activities like

training and capacity building that enhance the ability to

reveal the new scientic knowledge needed to improve

health for all Americans.

The scientic information discovered in basic research

proposes to move along a continuum through clinical

sciences until a practice or procedure that improves

individual and population health can be implemented.

Minority health and health disparities research can be

viewed in a similar framework. Information about a racial

or ethnic minority group—such as behavioral, biologi-

cal, sociocultural, socio-ecological, and environmental

characteristics and attributes—placed within a health

care or public health setting provides the basis for under-

standing minority health. Once these basic factors are

identied, similarities and differences between population

groups may become apparent. These population differ-

ences may or may not constitute a health disparity, since

the outcome for some conditions may be better for the

population presumed to be disadvantaged, such as in the

Hispanic Paradox.

Understanding why a racial or ethnic minority group has

a specic health outcome is at the core of minority health

science. Minority health research intends to identify

factors contributing to health conditions, independent of

whether a health disparity exists or is identied. When

investigations of differences in health between diverse

groups exist, where the disadvantaged population group

has a worse health outcome, this denes one aspect of

health disparity research. Health disparity research then

strives to understand mechanisms as to why a racial or

ethnic minority group has a worse health outcome com-

pared to a reference group.

Clarifying the difference between minority health and

health disparities research prompted NIMHD to develop

revised denitions for the biomedical research eld.

These distinct denitions provide justication for a new

approach for the next generation of knowledge discovery

to improve minority health and reduce health disparities.

5 Ruiz JM, Steffen P, Smith TB.

Hispanic mortality paradox: a system-

atic review and meta-analysis of the longitudinal literature.

Am J

Public Health. 2013;103(3):e52‐e60.

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Minority Health and Health Disparities:

Deﬁnitions and Parameters

Denitions of the terms “minority health” and “health dis-

parities” have evolved as the research elds have grown

and interacted with the full spectrum of scientists. Initially,

the denitions were intertwined, as the researchers doing

this important work have bridged both elds, and the

assumption was made that minority populations always

had health disparities. For NIH, this plan underscores

the need to separate the science of minority health,

which focuses on the health of racial and ethnic minority

communities, and the science of health disparities, which

focuses on differences in health outcomes for dened

disadvantaged populations that are worse than the White

reference population. There is clear overlap, since for

many conditions, minority populations have well-dened

health disparities compared with the White population

in the United States. However, creating some separation

of these disciplines may prove benecial in enabling

each eld to make greater independent strides. Over

the course of scal years (FYs) 2015 and 2016, NIMHD

undertook a process across NIH to revise the denitions

for minority health and health disparities.

Minority Health Deﬁnition

Minority health (MH) refers to the distinctive health char-

acteristics and attributes of racial and/or ethnic minority

groups, as dened by the U.S. Ofce of Management and

Budget (OMB), that can be socially disadvantaged due in

part to being subject to potential discriminatory acts.

Minority Health Populations

NIH uses the racial and ethnic group classications deter-

mined by OMB in the Revisions to Directive 15, titled

Standards for Maintaining, Collecting, and Presenting

Federal Data on Race and Ethnicity. The minority racial

and ethnic groups dened by OMB are American Indian

or Alaska Native, Asian, Black or African American, and

Native Hawaiian or other Pacic Islander. The ethnicity

used is Latino or Hispanic.

Although these ve categories are minimally required, the

mixed or multiple race category should be considered in

analyses and reporting, when available.

Other NIH efforts that support Tribal Nations can be

found in the NIH Strategic Plan for Tribal Health

Research FY 2019–2023.

Self-identication is the preferred means of obtaining

race and ethnic identity.

Minority Health Research

Minority health research is the scientic investigation of

distinctive health characteristics and attributes of minority

racial and/or ethnic groups who are usually underrep-

resented in biomedical research to understand health

outcomes in these populations.

Health Disparity Deﬁnition

A health disparity (HD) is a health difference that

adversely affects disadvantaged populations, based on

one or more of the following health outcomes:

 Higher incidence and/or prevalence and earlier onset

of disease

 Higher prevalence of risk factors, unhealthy behaviors,

or clinical measures in the causal pathway of a disease

outcome

 Higher rates of condition-specific symptoms, reduced

global daily functioning, or self-reported health-related

quality of life using standardized measures

 Premature and/or excessive mortality from diseases

where population rates differ

 Greater global burden of disease using a standardized

metric

AJPH Supplement: New Perspectives to Advance Minority Health

and Health Disparities Research.

Am J Public Health. 2019;109(S1).

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Health Disparity Populations

NIH denes health disparity populations as racial and

ethnic minority populations (see above OMB directive),

less privileged socioeconomic status (SES) populations,

underserved rural populations, sexual and gender minori-

ties (SGM), and any subpopulations that can be charac-

terized by two or more of these descriptions.

Other NIH efforts that support SGMs can be found in

the NIH FY 2016–2020 Strategic Plan to Advance

Research on the Health and Well-being of Sexual and

Gender Minorities.

Health Determinants

There are many factors that impact an individual’s health

and the risk of experiencing health disparities. These

domains of inuence have been expanded into “health

determinants” in order to capture areas that go beyond

the social determinants and that include factors, such as

individual behaviors, lifestyles, and social responses to

stress; biological processes, genetics, and epigenetics;

the physical environment; the sociocultural environment;

social determinants; and clinical events and interactions

with the health care and other systems. Each of these

health determinants plays an important role in health

disparities and interacts in complex ways to affect an

individual’s health. For example, African American/Black

women and Latinas experience lower survival rates from

triple-negative breast cancer than White women with the

same disease—even with similar access to care, screen-

ing mammography, and insurance coverage—due to the

lack of specialized screening and lack of viable treatment

options available for this form of breast cancer.

7 Ko NY, Hong S, Winn RA, Calip GS.

Association of Insurance Status

and Racial Disparities With the Detection of Early-Stage Breast

Cancer.

JAMA Oncol. 2020;6(3):385–392.

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NIH and HHS Commitment

Healthy People 2020 envisions a society in which all

people live long, healthy lives. The U.S. Department

of Health and Human Services (HHS) aims to enhance

the health and well-being of all Americans by providing

effective health and human services and by fostering

sound, sustained advances in the sciences underlying

medicine, public health, and social services. In April 2011,

HHS released the HHS Action Plan to Reduce Racial

and Ethnic Health Disparities (HHS Disparities Action

Plan), a comprehensive national strategy to reduce health

disparities. The HHS Disparities Action Plan sets out ve

goals to help achieve the vision of a nation free of dispari-

ties in health and health care.

The mission of NIH, as part of HHS, is to seek fundamen-

tal knowledge about the nature and behavior of living sys-

tems and the application of that knowledge to enhance

health, lengthen life, and reduce illness and disability.

In 2015, NIH released the NIH-Wide Strategic Plan,

Fiscal Years 2016–2020, outlining a vision for biomedical

research that capitalizes on new opportunities for scien-

tic exploration and addresses new challenges for human

health. The NIH Minority Health and Health Disparities

Strategic Plan also aligns with the health promotion and

disease prevention objective of the NIH-Wide Strategic

Plan by advancing opportunities in biomedical research

through evidence-based reduction of health disparities.

The NIH Minority Health and Health Disparities Strategic

Plan follows the missions and goals outlined in these

plans and addresses the current insufcient progress in

improving MH and reducing HDs in the United States.

The plan integrates NIMHD’s vision of an America in

which all populations have equal opportunity to live long,

healthy, and productive lives with NIH’s mission to seek

fundamental knowledge of the nature and behavior of liv-

ing systems and apply new knowledge to enhance health,

lengthen life, and reduce illness and disability.

The NIH Minority Health and Health Disparities Strategic

Plan represents a commitment by NIH to support

research aimed at addressing the risk and protective

factors that operate and interact on multiple levels to

impact the well-being of HD populations. NIH is also

committed to supporting research-sustaining activities—

such as research capacity building, workforce devel-

opment, outreach, and inclusion of minorities in clinical

trials—that improve MH and reduce HDs, as well as

activities that promote collaboration and dissemination

in different elds.

The NIH Minority Health and Health Disparities Strategic

Plan aligns NIH’s efforts to address MH and HDs with

advancing scientic knowledge and innovation in the

HHS Disparities Action Plan.

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Foundation for Planning

This strategic plan was created with the input of sev-

eral NIH working groups, including teams of staff and

researchers. To ensure that stakeholders at multiple levels

were involved in this strategic planning process, NIMHD

gathered input from experts within and outside of NIH. A

few of these foundational activities are described below.

 In FY 2012, during the Science of Eliminating Health

Disparities summit, NIMHD conducted town hall

meetings to collect data on critical minority health and

health disparity research issues.

 In FY 2015, NIMHD led an analysis of NIH’s portfolio of

minority health and health disparities research to sur-

vey the status of both fields, analyze investments, and

gauge gaps in the science or supporting structures.

 During FY 2015 and FY 2016, NIMHD undertook a sci-

ence visioning process to produce recommendations

for advancing the fields of minority health and health

disparities. Participating NIH staff and outside stake-

holders suggested 10 priority recommendations each

in defining etiologies and mechanisms, developing

and evaluating interventions, and identifying innovative

methods from a wide range of needs, to r

educe dis-

parities and improve minority health. After review by

the National Advisory Council on Minority Health and

Health Disparities (NACMHD), the relevant recommen-

dations were woven into the current strategic planning

efforts, which include strategies beyond the visioning

process and the Minority Health and Health Disparities

Research Framework. Details are available in the

American Journal of Public Health (AJPH) supplement

New Perspectives to Advance Minority Health and

Health Disparities Research.

 During FY 2018, NIMHD held three virtual sessions and

four listening sessions across the country to collect

community-level input for the NIH Minority Health and

Health Disparities Strategic Plan.

These activities—in coordination with NIH working groups

and input from a range of NIH Institutes, Centers, and

Ofces—were reviewed by the National Advisory Council

on Minority Health and Health Disparities (NACMHD) and

provide the foundation for the NIH Minority Health and

Health Disparities Strategic Plan.

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Structure of This Plan

FIGURE 1: NIH MH and HD Research Strategic Plan Priority Areas Framework

SCIENTIFIC

RESEARCH

SUSTAINING

OUTREACH,

COLLABORATION,

& DISSEMINATION

Starting Line

Activities that

will span

5 years

Building

Momentum

Actvities that will

continue for the next

5-10 years

Visionary activities

that will take up to

20 years

Leap

Forward

The NIH Minority Health and Health Disparities Strategic

Plan 2021–2025 has been designed with three cate-

gories to represent a long-term framework: scientic

research; research-sustaining activities; and outreach,

collaboration, and dissemination to encompass the range

of NIH’s MH- and HD-related work. Embedded in each

category are goals that encompass up to 10 years of

expected research. There are four research goals; three

research-sustaining activities goals; and two outreach,

collaboration, and dissemination goals.

This plan describes scientic goals with related research

strategies and priority areas that represent key opportuni-

ties and needs to advance MH and HD research. Rather

than reecting a comprehensive listing of all relevant NIH

activities, this plan describes how NIH can best advance

minority health and health disparities research. Each goal is

divided into strategies that are intended to capture strategic

ways in which NIH can advance the sciences of MH and

HD or develop key supporting structures. The priority areas

consist of Starting Line and Building Momentum research

efforts and activities that encompass MH and HD efforts

across NIH. This plan includes 48 Starting Line activities

that will span 5 years and 56 Building Momentum activities

that will continue for the next 5 to 10 years (see Figure 1).

Eliminating health disparities is an indenite priority for

NIH, and NIH’s efforts in this space will continue well into

the future. This plan lays out a focused vision for the next

10 years, specifying short-, intermediate-, and long-range

research strategies and activities that will facilitate prog-

ress toward long-term goals.

These priority areas are described below:

 Starting Line priority areas represent concrete, current

efforts and initiatives aimed at improving minority

health and/or reducing health disparities that are

underway at NIH or with NIH partners.

 Building Momentum priority areas represent concepts

and potential initiatives for advancing the sciences of

minority health and health disparities. These concepts

include early ideas and initiatives being developed and

considered for potential implementation.

 Leap Forward priorities represent trans-NIH visionary

goals that can have a significant impact on improving

minority health or reducing health disparities in disease

and disorders.

The NIH Minority Health and Health Disparities Strategic

Plan 2021–2025 includes performance tracking and evalua-

tion components to meet federal requirements. Most impor-

tantly, the plan aims to advance the science of minority

health and health disparities and produce meaningful, mea-

surable improvements in minority health and reductions in

health disparities through the dissemination and implemen-

tation of both existing and novel scientic breakthroughs

over the duration of the strategic plan and beyond.

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Strategic Plan Categories

Scientiﬁc Research

Scientic research encompasses the continuum of

research activities, from basic through applied research.

Research is systematic study directed toward advancing

scientic knowledge and/or gaining understanding of

etiology and interventions to improve minority health and/

or to reduce health disparities. This section also focuses

on the need to strengthen and promote analytic methods

that will enable a better understanding of the indicators

and underlying causes of health disparities and facilitate

ongoing monitoring.

Research Sustaining

Beyond conducting research, NIH also promotes the

strengthening and expansion of structures that support

research throughout the scientic process. NIH supports

a variety of training programs, including those that work

to promote diversity of the national biomedical workforce

and those that work to increase the number of scientists

studying minority health and health disparities. NIH also

supports strengthening the national research capacity for

minority health and health disparities research, capacity

building for institutions that offer doctoral degrees in the

health professions or the sciences related to health and

have a historical and current commitment to educating

underrepresented students, and programs to facilitate

their inclusion in biomedical research. These activities are

essential components of NIH’s minority health and health

disparities research-sustaining activities.

 Biomedical Workforce Diversity

The overall composition of the biomedical work-

force—not just individuals’ skills—plays a role in its

effectiveness. The Notice of NIH’

s Interest in Diversity

(NOT-OD-20-031) states, “Research shows that

diverse teams working together and capitalizing on

innovative ideas and distinct perspectives outperform

homogenous teams. Scientists and trainees from

diverse backgrounds and life experiences bring differ-

ent perspectives, creativity, and individual enterprise

to address complex scientific problems. There are

many benefits that flow from a diverse NIH-supported

scientific workforce, including: fostering scientific

innovation, enhancing global competitiveness, contrib-

uting to robust learning environments, improving the

quality of the research, advancing the likelihood that

underserved or health disparity populations participate

in and benefit from health research, and enhancing

public trust.”

 Minority Health and Health Disparities Scientic

Workforce

As the sciences of minority health and health dispar-

ities become more complex, the need for scientists

with expertise in minority health and health dispari-

ties issues and for collaboration in a multidisciplinary

team must be addressed. Recruitment, training, and

retention of investigators with state-of-the-art skill sets

in minority health and health disparities science are

essential, throughout all stages of career development.

 Research Capacity Building

The fields of minority health and health disparities

research are growing, r

equiring greater academic

infrastructure. NIH continues to strengthen programs

and initiatives aimed at building scientific infrastructure

and capacity at academic institutions and other orga-

nizations to support resear

ch in minority health and

health disparities. These activities will help to develop

vibrant communities of researchers to move both fields

forward.

 Including Racial and Ethnic Minorities and SGM

Populations in Clinical Research Involving Human

Participants

NIH is committed to ensuring that individuals who

identify as racial and ethnic minorities, SGMs, and

women are included in clinical research. This plan

suggests additional actions intended to ensure that

appropriate and meaningful representation occurs in

NIH-funded research.

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Identifying and addressing the barriers to inclusion

of minorities (i.e., racial and ethnic and other HD

populations, such as SGMs) in clinical research and

developing tools to help researchers enhance minority

recruitment should facilitate efforts to promote minority

health and reduce health disparities. Furthermore,

NIH-funded investigators need to be held account-

able for proposed recruitment targets when launching

research studies with human participants. Including

minority populations in clinical studies and data sets is

critical to ensure that people from all racial and ethnic

backgrounds and other HD populations share in the

benefits of new scientific discoveries.

Outreach, Collaboration, and

Dissemination

NIH supports outreach, collaboration, and dissemi-

nation efforts that are needed to ensure that key MH

and HD research ndings are shared with the people

and communities that need them. This plan focuses on

expanding community outreach and enhancing dissemi-

nation efforts, as well as building community to enhance

networks of MH and HD researchers and stakeholders

across the nation and within NIH.

 Outreach and Dissemination

Promoting the capacity to translate resear

ch findings

into recommendations to be implemented in clinical

and public health practice is essential for reducing

health disparities. NIH can support appropriate stew-

dship by considering factors related to dissemination

of MH and HD research at every stage of the research

process. These efforts are needed to ensure that

evidence-based interventions become part of estab-

lished, everyday practice and integrated into the public

health process.

 Community Engagement and Building

As part of the outreach and dissemination pr

ocess,

broadening and str

engthening the community of

minority health and health disparities stakeholders—

including health disparity communities, researchers,

clinicians, advocacy groups, government employees,

and policy makers—expands the potential avenues

for collaboration and progress toward evidence-based

practice and policy. This plan offers strategies for

engaging and enhancing MH and other HD communi-

ties at multiple levels to help support the research of

both fields.

Leap Forward Research

Challenge

Leap Forward priority areas are expected to have a sig-

nicant impact on advancing the eld of minority health

and health disparities research over the next 10 to 15

years. NIH challenged itself and the research commu-

nity to be bold and strive for transformational progress

across the continuum of research in minority health and

health disparities. Leap Forward priority areas represent

aspirational activities that NIH hopes to embark upon to

improve minority health or to reduce a health disparity in

scientic research and in research-sustaining activities.

NATIONAL INSTITUTES OF HEALTH • MINORITY HEALTH AND HEALTH DISPARITIES

STRATEGIC PLAN 2021–2025

Summary of Categories and Goals

Scientiﬁc Research: Goals and

Strategies

Goal 1: Promote research to understand and

to improve the health of racial/ethnic minority

populations

 Strategy 1.1: Examine health determinants that

underlie resilience or susceptibility to diseases and

conditions experienced by minority populations.

 Strategy 1.2: Develop and assess interventions to

improve the health status of minority populations.

Goal 2: Advance scientic understanding of the

causes of health disparities

 Strategy 2.1: Investigate health determinants through

basic, behavioral, clinical, and applied research to

better understand the contributions to health disparity

outcomes.

 Strategy 2.2: Support research to explore multilevel

pathways and dynamic interrelationships of health

determinants that affect health disparity outcomes

over the life course and across generations.

 Strategy 2.3: Identify relevant critical periods and

feasible targets for health disparity interventions.

Goal 3: Develop and test interventions to reduce

health disparities

 Strategy 3.1: Design and test interventions that target

known health determinants within the context of

specific populations and appropriate life course time

points to influence specific health disparity outcomes.

 Strategy 3.2: Embed implementation science within

intervention studies to inform efforts to scale, sustain,

and translate efficacious interventions within and

across populations and settings.

 Strategy 3.3:

omote pr

evention and evaluate the

impact of upstr

eam interventions on distal health

disparity outcomes acr

oss the lifespan and acr

oss

generations.

Goal 4: Cr

eate and impr

ove scientic methods, met

rics, measur

es, and tools that support health dispari-

ties r

esear

 Strategy 4.1:

Identify and test the adoption of

common indicators to quantify the status of health

disparities acr

oss dif

fer

ent diseases/conditions

and populations.

 Strategy 4.2: Define the continuum from health dif-

fer

ences to health disparities, both qualitatively and

quantitatively across multiple dimensions, as well as

develop contextually informed clinical and statistical

measures of disparities reductions.

 Strategy 4.3: Apply complex systems modeling

approaches, including biological models, to identify

and predict relationships between health determinants

and health disparity outcome measures.

 Strategy 4.4: Support movement toward standardiza-

tion, collection, reporting, and leveraging of measures

of health determinants in both existing and emerging

data sources, including administrative clinical data, to

foster linkages between health, sex and gender, and

relevant health determinants data for use in identify-

ing health disparities and underlying causes through

emerging techniques found in data science.

 Strategy 4.5: Identify and strengthen rigorous quan-

titative and qualitative methods to enable analysis on

small populations and subpopulations.

 Strategy 4.6: Evaluate minority health and health

disparities proposals, programs, and policies to assess

the effectiveness in improving minority health and/or

reducing health disparities.

NATIONAL INSTITUTES OF HEALTH • MINORITY HEALTH AND HEALTH DISPARITIES

STRATEGIC PLAN 2021–2025

Research-Sustaining Activities:

Goals and Strategies

Goal 5: Support training to enhance diversity and to

promote training and career advancement of minority

health and health disparities researchers

Workforce Diversity

 Strategy 5.1: Support individual-level programs to

train individuals from health disparity populations in

the biomedical sciences.

 Strategy 5.2: Support current and novel institution-

level programs at institutions that have a historical and

current commitment to educating underrepresented

students and at less research-intensive institutions to

enhance the ability of these programs to recruit, train,

and retain a diverse biomedical research workforce.

 Strategy 5.3: Promote diversity-supporting recruiting

programs at research-intensive institutions to expand

the pool of applicants from health disparity groups

underrepresented in biomedical research.

Minority Health and Health Disparities Scientic

Workforce

 Strategy 5.4: Support training and mentorship

programs for minority health and health disparities

researchers at all stages of career development and

leadership development.

 Strategy 5.5: Incorporate development of specialized

research skills into health disparities training programs,

including core and emerging skills that are important

for measuring, understanding, and identifying solu-

tions to address minority health and health disparities

complexities.

Goal 6: Strengthen the national capacity to conduct

minority health and health disparities research

 Strategy 6.1: Support programs to enhance capacity

for minority health and health disparities research at

institutions of all sizes.

 Strategy 6.2: Develop and test methods to foster,

coordinate, and promote the field of health disparities

among research institutions and organizations.

Goal 7: Ensure appropriate representation of minority

and other health disparity populations in NIH-funded

research

 Strategy 7.1: Provide guidance, recommendations,

and technical assistance for NIH-funded researchers in

appropriate study design and best practices for recruit-

ment to ensure compliance with laws, regulations, and

policies regarding the inclusion of minorities and other

health disparity populations in research.

 Strategy 7.2: Promote and enforce accountability for

inclusion of diverse populations by tracking originally

proposed recruitment strategies and objectives to

ensure sufficient samples for analyses of subpopula-

tion data.

 Strategy 7.3: Promote inclusion of minorities and other

health disparity populations in big data sets, clinical

research, and future big science initiatives.

Outreach, Collaboration, and

Dissemination: Goals and Strategies

Goal 8: Promote evidence-based community engage-

ment, dissemination, and implementation of minority

health and health disparities research best practices

 Strategy 8.1: Develop and test best practices for dis-

semination and implementation of minority health and

health disparities research discoveries into different

settings and with different populations.

 Strategy 8.2: Conduct studies to determine strate-

gies for effective population-specific communication

and outreach to inform recruitment and retention into

clinical research studies and databases, design of

culturally tailored health interventions, and community

engagement and participation in research.

 Strategy 8.3: Generate strategies and tools to trans-

form minority health and health disparities best prac-

tices into policies.

NATIONAL INSTITUTES OF HEALTH • MINORITY HEALTH AND HEALTH DISPARITIES

STRATEGIC PLAN 2021–2025

Goal 9: Cultivate and expand a community of minority

health and health disparities researchers and

advocates

 Strategy 9.1: Build an NIH interdisciplinary community

of scholars around minority health and health dispar-

ities research to coordinate disparities science and to

foster accountability and integration of minority health

and health disparities science within NIH research

activities.

 Strategy 9.2: Promote interagency collaboration and

coordination with federal departments and agencies,

including use of common data elements (CDEs) and

data sharing relevant to minority health and health

disparities research.

 Strategy 9.3: Establish partnerships with nongovern-

mental groups (e.g., mentoring networks, advocacy

groups, industry and private groups, science commu-

nities, grantees) to advance the development, improve-

ment, and utilization of minority health and health

disparities definitions, methods, measures, metrics,

interventions, and best practices.

DETAILS OF CATEGORIES AND GOALS

SCIENTIFIC GOALS,

RESEARCH STRATEGIES,

AND PRIORITY AREAS

There are challenges measuring health

disparities, including identifying how

to measure the health disparity and

selecting appropriate benchmark pop-

ulations. The following scientic goals

and research strategies focus on mea-

surement to provide solutions to these

obstacles and advance minority health

and health disparities research.

STRATEGIC PLAN 2021–2025 Scientiﬁc Goals, Research Strategies, and Priority Areas

NATIONAL INSTITUTES OF HEALTH • MINORITY HEALTH AND HEALTH DISPARITIES

GOAL 1: Promote research to under-

stand and to improve the health of

racial/ethnic minority populations

This goal advances the understanding of health deter-

minants that contribute to the health status of minority

populations, including subpopulations. Scientic knowl-

edge generated should span the life course and address

sociocultural variations and within-group differences. As

the understanding of the interplay between biology and

environment advances, better interventions can continue

to be developed to improve the health of minority groups.

In addition, research into the determinants that affect

minority health may lead to new knowledge about the

health differences experienced by minority groups.

STRATEGY 1.1: Examine health determinants

that underlie resilience or susceptibility to

diseases and conditions experienced by racial/

ethnic minority populations.

ACTION PRIORITY AREAS

Starting Line:

 Expand support for large-scale observational, epide-

miologic, and longitudinal cohort studies focused on

multiple co-occurring chronic diseases and conditions

in minority populations.

 Support ancillary etiologic studies using existing cohorts

to examine the interplay between biological, behavioral,

socioecological, sociocultural, and environmental health

determinants in minority populations, as well as interac-

tions with health care and public health systems.

 Support interdisciplinary minority health studies to

delineate mechanisms of embodiment of social,

cultural, and environmental factors experienced over

the life course to better understand how those factors

influence individual early development, physiology,

cognitive processes, biopsychosocial processes and

behavior, and disease trajectories.

Building Momentum:

 Support research, including international research, to

identify genomic factors that contribute to U.S. racial

and ethnic differ

ences in health outcomes.

 Support research to identify key developmental origins

or stages of susceptibility to common diseases and

conditions or exposures where interventions would

most likely have the greatest effect.

 Expand research efforts to delineate risk factors for

developing obesity in early childhood and adolescence

as well as identify opportunities for developing more

effective and contextually tailored interventions.

 Accelerate efforts to define the critical contributions

of oral health to overall health and disease in minority

populations through studies to identify genetic and

genomic risk or protective factors that contribute to

racial and ethnic differences in health outcomes, medi-

ating or moderating influences of the microbiome, diet

and nutrition, access to preventive dental and health

care across the life course, and co-occurring chronic

diseases and conditions.

 Expand support for research to identify sociocultural

factors and other positive resources that promote

population health and contribute to resiliency at the

individual, family, and community levels.

 Support oversampling of racial/ethnic minority partici-

pants in population-based and patient-oriented studies

to increase power to detect hypothesized racial/ethnic

differences and enable analysis and comparison of

racial/ethnic subpopulations.

STRATEGY 1.2: Develop and assess interven-

tions to improve the health status of minority

populations.

ACTION PRIORITY AREAS

Starting Line:

 Develop and implement individual-, family-, peer

group-, and community-level health promotion and

disease prevention interventions tailored to address

the specific needs and cultural contexts of minority

populations.

 Develop and implement evidence-based health care

system interventions that reduce socioecological

barriers to care and promote coordination and integra-

tion of preventive care, primary care, and behavioral

health services.

STRATEGIC PLAN 2021–2025 Scientiﬁc Goals, Research Strategies, and Priority Areas

NATIONAL INSTITUTES OF HEALTH • MINORITY HEALTH AND HEALTH DISPARITIES

 Support secondary data analyses of ongoing cohort

studies and public use surveys, as well as other

approaches such as simulation modeling, to deter-

mine whether minority health differences observed in

population studies reflect health disparities arising from

social, economic, and/or environmental disadvantages

based on group characteristics historically linked to

discrimination or exclusion.

Building Momentum:

 Establish a national consortium to develop, validate,

and implement assessment tools that can be used

in primary care settings for early detection and diag-

nosis of cognitive impairment and decline, as well as

Alzheimer’s disease and related dementias, which are

frequently underdiagnosed in aging minority popula-

tions, often due to cultural and logistic barriers.

 Expand research to improve access to and coordina-

tion of health care services across specialties through

innovative care delivery models and the use of health

information technology, including research on the use

of electronic health records (EHRs) and e-prescrib-

ing databases to address potential risks of adverse

drug reactions and drug–drug interactions in minority

patient populations.

 Support rigorous research on patient–clinician commu-

nication factors in primary care and specialty settings

that lead to an increase or decrease in health dispari-

ties in patient outcomes.

 Support rigorous evaluation of community-engaged

interventions to address gaps and improve implemen-

tation of evidence-based interventions in community

settings and to better understand factors that influence

intervention effectiveness and adaptability.

 Support innovative research incorporating strengths-

based approaches, behavioral economics principles,

and multilevel intervention strategies to promote

overall health in disadvantaged minority populations

and reduce the incidence of preventable diseases and

conditions in early childhood, such as dental decay

and overweight/obesity.

 Expand local, regional, and national efforts to assess

the impact of policies and policy changes on racial/

ethnic minority population health and delineate specific

mechanisms by which policies or policy changes miti-

gate or exacerbate social, economic, and environmen-

tal disadvantages.

 Strengthen the capacity of community members,

health professionals, policy makers, and community

organizations to assess and utilize research findings

to effect positive, systemic changes to reduce health

disparities.

GOAL 2: Advance scientiﬁc under-

standing of the causes of health

disparities

This goal seeks to examine the etiology of health dispar-

ities and the inuence of health determinants on various

stages of the life course trajectories and across genera-

tions, including the intersection of sex, gender, geogra-

phy, and race and ethnicity. It also seeks to further the

scientic understanding of both the individual effects on

health disparities and the complex interactions among

health determinants that affect health disparities. These

health determinants include both studied and unstudied

determinants as well as known and unknown determi-

nants. Research is needed to identify and better under-

stand the integrated relationship of these determinants,

especially in real-world settings. These complexities often

require interdisciplinary systems science approaches to

understand interactions among multiple factors and over

time. Results from such research should provide a robust

foundation for designing effective interventions to reduce

health disparities.

STRATEGY 2.1: Investigate health determinants

through basic, behavioral, clinical, and applied

research to better understand the contributions

to health disparity outcomes.

ACTION PRIORITY AREAS

Starting Line:

 Identify risk factors that act as health determinants in

creating and/or sustaining health disparity outcomes

for NIH-designated health disparity populations.

STRATEGIC PLAN 2021–2025 Scientiﬁc Goals, Research Strategies, and Priority Areas

NATIONAL INSTITUTES OF HEALTH • MINORITY HEALTH AND HEALTH DISPARITIES

Building Momentum:

 Support research that seeks mechanisms and

pathways behind health determinants that confer

worse outcomes in health disparity populations

and identify feasible intervention targets for health

disparity outcomes.

 Identify disparities in understudied health disparity

populations—for example, sexual and gender minori-

ties (SGMs) and Native Hawaiians and other Pacific

Islanders.

 Support research in understudied health conditions

and risk factors that affect health, such as comorbid-

ities and/or violence, that disproportionately affect

health disparity populations.

STRATEGY 2.2: Support research to examine

multilevel pathways and dynamic interrelation-

ships of health determinants that affect health

disparity outcomes over the life course and

across generations.

ACTION PRIORITY AREAS

Starting Line:

 Explore associations between established determi-

nants of health disparity outcomes occurring at

multiple levels (e.g., environmental, health care,

sociocultural, biological) to identify mechanisms

and pathways for health disparity outcomes.

Building Momentum:

 Examine how health disparities develop or are sus-

tained over the life course and across generations.

 Replicate mechanistic and pathway analyses of

determinants for additional, related health out-

comes, health disparity populations, and life course

approaches and/or across generations.

 Support the collection of diverse ancestral back-

grounds in NIH-funded and analyzed -omics data

sets to achieve representation similar to the U.S.

population.

STRATEGY 2.3: Identify modiﬁable or reversible

determinants of health disparities during rele-

vant critical periods that can serve as feasible

targets for health disparity interventions.

ACTION PRIORITY AREAS

Starting Line:

 Link data on environmental, health care, sociocultural,

behavioral, and/or biological health determinants in

racial, ethnic, socioeconomically, sexual identity, geo-

graphically, and ancestrally diverse cohorts to existing

systems for specific outcome ascertainment (e.g., hos-

pitalizations, incidence of specific conditions, mortality,

emphasizing life course, age cohort perspectives).

Building Momentum:

 Support research that enables culturally relevant and

appropriate interventions to disrupt fundamental deter-

minants at critical periods that produce health disparity

outcomes for priority populations.

GOAL 3: Develop and test interven-

tions to reduce health disparities

This goal advances the development and testing of

population-specic interventions that reduce adverse

health differences and poor health outcomes. This

research should capitalize on existing evidence on health

determinants to develop interventions that are cultur-

ally appropriate and develop new evidence, drawing on

research from many different scientic disciplines. Health

disparities can include biological, behavioral, socio-

cultural, environmental, and health care system–level

factors. The interventions should be intentional about

which populations, time points in the life course, and risk

or protective factors are targeted for reduction of health

disparity outcomes. Implementation science methods

should be employed to inform feasibility, generalizability,

and validity assessments of efcacious interventions.

STRATEGIC PLAN 2021–2025 Scientiﬁc Goals, Research Strategies, and Priority Areas

NATIONAL INSTITUTES OF HEALTH • MINORITY HEALTH AND HEALTH DISPARITIES

STRATEGY 3.1: Design and test interventions

that target known health determinants within

the context of speciﬁc populations and appropri-

ate life course time points to inﬂuence speciﬁc

health disparity outcomes.

ACTION PRIORITY AREAS

Starting Line:

 Adapt evidence-based interventions for implementa-

tion and evaluation within health disparity populations

in culturally appropriate ways that consider the role of

cultural processes in health disparity outcomes.

 Develop and test interventions that target multiple

socioecological levels at appropriate life course time

points to improve health disparity outcomes within

community-based populations.

Building Momentum:

 Design and test strategies to improve access to and

quality of care for health disparity populations within

the health care system.

 Assess the implementation of interventions within

clinical system processes and settings, and deter-

mine the effects on health disparity outcomes and

populations.

 Develop and test interventions to improve symptom

self-management and health-related quality-of-life

outcomes in health disparity populations experiencing

chronic and overlapping health conditions.

STRATEGY 3.2: Embed implementation

science within intervention studies to inform

efforts to scale, sustain, and translate

efﬁcacious interventions within and across

populations and settings.

ACTION PRIORITY AREAS

Starting Line:

 Develop and test practical and sustainable adaptations

within routine health care settings to improve health

disparity outcomes and enable dissemination of effec-

tive practices.

 Incorporate elements of implementation and scalability

into the design and testing of interventions to enhance

related effectiveness in real-world settings, particularly

low-resource clinical and community settings that

serve health disparity populations.

Building Momentum:

 Develop guidance for NIH-supported researchers

conducting intervention studies to include analyses

of the pathways and mechanisms by which health

disparity interventions produce observed effects.

 Use implementation science approaches to under-

stand and promote the adoption of evidence-based

interventions to reduce health disparities.

 Expand research in areas of implementation science

with emphasis on clinical and public health systems

processes for delivering preventive and treatment

interventions in health disparity populations.

 Develop criteria to assess whether interventions have

sufficient evidence for demonstrating success, and

create and maintain a compendium of evidence-based

interventions with demonstrated success in reducing

health disparities in the United States.

STRATEGY 3.3: Promote prevention and

evaluate the impact of upstream interventions

on distal health disparity outcomes across the

lifespan and across generations.

ACTION PRIORITY AREAS

Starting Line:

 Develop, implement, and evaluate participatory multi-

level interventions to reduce exposures to environmen-

tal factors for which exposures create adverse health

effects in disadvantaged populations, and assess the

impact on early biomarkers of associated chronic dis-

eases and conditions.

 Develop and evaluate school-based prevention and

health promotion interventions related to health behav-

iors and mental health.

Building Momentum:

 Promote research on the benefits of preventive

interventions, including assessments of the long-term

STRATEGIC PLAN 2021–2025 Scientiﬁc Goals, Research Strategies, and Priority Areas

NATIONAL INSTITUTES OF HEALTH • MINORITY HEALTH AND HEALTH DISPARITIES

impact on direct measures of health, health-related

outcomes, and inter-generational transmission of

health disparities.

 Review available evidence to identify key gaps in

prevention science related to health disparities, and

promote targeted research on preventive services with

the aim to increase population health equity.

 Develop and evaluate workplace-based prevention

and health promotion interventions related to health

behaviors and mental health.

GOAL 4: Create and improve scientiﬁc

methods, metrics, measures, and tools

that support health disparities research

The science of health disparities is a relatively new disci-

pline, drawing on expertise from many different elds of

study. This diversity of thought presents unique opportuni-

ties, allowing researchers to bring methodologies from all

parts of academia to bear on reducing health disparities.

Researchers have access to a variety of powerful meth-

ods, metrics, measures, and tools to identify when health

disparities exist, what causes a disparity, and when a

disparity is affected. This diversity can present a challenge,

however, in understanding health disparities data across

the eld. Development and adaptation of common indica-

tors, measures, and methods is needed to enable compar-

isons among populations, to quantify the roles of various

health determinants in inuencing and impacting a health

disparity, and to promote interdisciplinary collaboration.

Population-based data systems should include represen-

tative samples of minority and health disparity populations

to facilitate methods development and testing.

STRATEGY 4.1: Identify and test the adoption

of common indicators to quantify the status of

health disparities across different diseases/con-

ditions and populations.

ACTION PRIORITY AREAS

Starting Line:

 Compile measurement tools (surveys and administered

tests) in non-English languages applicable to the region.

 Develop common standards for capturing data on

health disparities, including health determinants that

encompass social determinants, with support from the

National Library of Medicine.

Building Momentum:

 Develop tools to measure health indicators for health

disparities research.

 Develop measurement tools in non-English languages

that can measure differences in population responses

applicable to the region.

STRATEGY 4.2: Deﬁne the continuum from

health differences to health disparities, both

qualitatively and quantitatively across multiple

dimensions, and develop contextually informed

clinical and statistical measures of disparities

reductions.

ACTION PRIORITY AREAS

Starting Line:

 Set priorities and a research agenda around health

disparities measures and metrics.

 Determine the metric that can be established to

standardize a disparity reduction.

Building Momentum:

 Collect and disseminate longitudinal data about spe-

cific health disparity conditions to develop measures

of clinical change over time that apply to different

subpopulations.

STRATEGY 4.3: Apply complex systems model-

ing approaches to identify and predict relation-

ships between health determinants and health

disparity outcome measures.

ACTION PRIORITY AREAS

Starting Line:

 Promote interdisciplinary collaboration among health

researchers and experts in computational approaches

to further the development of modeling- and simula-

tion-based systems science methodologies.

STRATEGIC PLAN 2021–2025 Scientiﬁc Goals, Research Strategies, and Priority Areas

NATIONAL INSTITUTES OF HEALTH • MINORITY HEALTH AND HEALTH DISPARITIES

Building Momentum:

 Assess multilevel interventions in the context of

these simulation modeling and systems science

research projects.

 Develop innovative model systems to advance

understanding of disabilities that can lead to

disparities and inequities in access and utilization

of health care, rehabilitation treatments, and knowl-

edge of preventive measures.

STRATEGY 4.4: Support movement toward stan-

dardization, collection, reporting, and leveraging

of measures of health determinants in both

existing and emerging data sources, including

administrative clinical data, to foster linkages

between health, sex and gender, and relevant

health determinants data for use in identifying

health disparities and underlying causes through

emerging techniques found in data science.

ACTION PRIORITY AREAS

Starting Line:

 Promote analysis and publication of research results

that include relevant and appropriately sized samples

from health disparity populations.

Building Momentum:

 Sponsor and support workshops that result in techni-

cal reports and publications related to specific mea-

surement issues in health disparities research, such as

statistical analysis of small samples, self-identified race

and ethnicity, and ancestry informative markers.

 Review and compile major papers on measures and

metrics in health disparities to create a repository of

technical papers, tools, and publications.

 Identify a representative from NIMHD and the NIH-wide

Minority Health and Health Disparities Measurement

and Methods Committee to collaborate with NIH’s

Office of Data Science Strategy (ODSS) to facilitate

the inclusivity and external validity of calculations and

labels that affect health disparity populations.

STRATEGY 4.5: Identify and strengthen rig-

orous quantitative and qualitative methods

to enable analysis on small populations and

subpopulations.

ACTION PRIORITY AREAS

Starting Line:

 Foster methodologies for conducting small population

analyses.

Building Momentum:

 Map the state of the science for qualitative and

quantitative studies with small populations and

subpopulations.

 Develop research agendas for health disparity mea-

surement in small populations and subpopulations.

STRATEGY 4.6: Evaluate minority health and

health disparities proposals, programs, and

policies to assess the effectiveness in improv-

ing minority health and/or reducing health

disparities.

ACTION PRIORITY AREAS

Starting Line:

 Develop educational materials for program officers,

program analysts, evaluators, and policy analysts on

measures, metrics, and their use in outcome assess-

ments of health disparity research.

Building Momentum:

 Assess the effects of social policies on minority health

and health disparities.

 Assess the impact of previous NIH grants that were

identified as focusing on minority health and/or health

disparities.

RESEARCH-SUSTAINING

ACTIVITIES: GOALS,

STRATEGIES, AND

PRIORITY AREAS

DETAILS OF CATEGORIES AND GOALS

Programs that promote diversity of

biomedical workforce, enhance and

strengthen the minority health and

health disparities research workforce,

and provide infrastructure for research

capacity-building activities are needed.

Continued efforts to include minori-

ties in research and clinical trials are

essential components of NIH’s minority

health and health disparities activities.

STRATEGIC PLAN 2021–2025 Research-Sustaining Activities: Goals, Strategies, and Priority Areas

NATIONAL INSTITUTES OF HEALTH • MINORITY HEALTH AND HEALTH DISPARITIES

GOAL 5: Support training to enhance

the diversity of the biomedical work-

force and to promote training and

advancement of minority health and

health disparities researchers

NIH’s continued promotion of a skilled and diverse work-

force will facilitate further advancements in the elds of

minority health and health disparities research. A modern

and robust workforce with diverse skill sets and core

competencies unique to minority health and health dis-

parities research is needed to address complex research

questions. Programs that address MH and HD workforce

preparedness at the individual level will enhance the

expertise of the eld and lead to improved capacity for

promoting minority health and addressing health dispari-

ties. Individuals identifying as racial and ethnic minorities,

individuals with less privileged SES, and individuals with

disabilities are often underrepresented in the biomedical

research workforce. Diversity of the biomedical workforce

can be improved through both individual-level programs

and institutional infrastructure aimed at increasing

domestic and international opportunities for individuals

from health disparity populations, including underrepre-

sented groups, to pursue scientic careers. A diverse

biomedical workforce also ensures an assortment

of ideas, perspectives, and backgrounds among the

researchers and scientists contributing to breakthroughs

in biomedical research.

STRATEGY 5.1: Support individual-level pro-

grams to train individuals from health disparity

populations in the biomedical sciences.

ACTION PRIORITY AREAS

Starting Line:

 Link interested students and early-career scientists

from diverse backgrounds, including underrepre-

sented groups, to researchers across various research

disciplines, both at NIH and in the extramural research

community. NIH encourages these links to be estab-

lished from pre-college or university stages through

junior faculty stages to enhance the biomedical

research training pipeline.

 Enable individuals from diverse backgrounds, including

underrepresented groups, to achieve research career

independence by providing networking events, best

practices, and guidance on NIH grantsmanship and the

peer review processes to facilitate (1) both short- and

long-term success in NIH grant application submis-

sions and (2) achievement of tenure in a suitable time-

frame and reentry into the biomedical workforce. These

resources may be offered at symposia and workshops,

in NIH announcements, at scientific meetings, and on

training websites.

Building Momentum:

 Take steps to enhance, renew, or expand NIH’s portfo-

lio of scientific education and training opportunities for

individuals from health disparity populations, including

underrepresented groups, for all career stages from

pre-college or university through tenure-track faculty.

STRATEGY 5.2: Support current and novel insti-

tution-level programs at institutions that have

a historical and current commitment to edu-

cating underrepresented students and at less

research-intensive institutions to enhance the

ability of these programs to recruit, train, and

retain a diverse biomedical research workforce.

ACTION PRIORITY AREAS

Starting Line:

 Support intramural NIH and extramural programs that

enable institutions that have a historical and current

commitment to educating underrepresented students

and less research-intensive institutions to recruit, train,

and retain scholars from health disparity populations,

including underrepresented groups, in biomedical

science across all career stages from undergraduate

through junior faculty stages across various basic,

clinical, and data science research domains.

Building Momentum:

 Take steps to enhance research and training

environments at NIH and in the extramural research

community for undergraduate, graduate, and medical

institutions serving underrepresented students.

STRATEGIC PLAN 2021–2025 Research-Sustaining Activities: Goals, Strategies, and Priority Areas

NATIONAL INSTITUTES OF HEALTH • MINORITY HEALTH AND HEALTH DISPARITIES

STRATEGY 5.3: Promote diversity-supporting

recruiting programs at research-intensive insti-

tutions to expand the pool of applicants from

health disparity groups underrepresented in

biomedical research.

ACTION PRIORITY AREAS

Starting Line:

 Support recruiting efforts to interest individuals from

underrepresented backgrounds to apply for oppor-

tunities to access and make contributions to NIH-

supported research projects in research-intensive

institutions. These opportunities will help them develop

the essential skills and knowledge required to achieve

their next level of career goals.

Building Momentum:

 Take steps to enhance diversity and inclusion efforts

at research-intensive institutions to provide a more

welcoming environment for prospective researchers

from underrepresented backgrounds from pre-college

or university stages through junior faculty stages.

STRATEGY 5.4: Support training and mentorship

programs for minority health and health dispari-

ties researchers at all stages of career develop-

ment and leadership development.

ACTION PRIORITY AREAS

Starting Line:

 Support programs to train and mentor researchers with

expertise in minority health and health disparities from

pre-college or university through early-stage investiga-

tor career stages.

Building Momentum:

 Take steps to enhance, renew, or expand NIH’s port-

folio of scientific education, training, and mentoring

opportunities for minority health and health disparity

researchers from pre-college or university stages

through established senior investigator careers.

STRATEGY 5.5: Incorporate development of

specialized research skills into health disparities

training programs, including core and emerging

skills that are important for measuring, under-

standing, and addressing minority health and

health disparities complexities.

ACTION PRIORITY AREAS

Starting Line:

 Support programs to provide researchers opportunities

to enhance existing research capabilities or to acquire

new research capabilities in MH- and HD-related

science at the graduate student, junior scientist, and

senior scientist levels of career stages.

Building Momentum:

 Take steps to enhance, renew, or add to NIH’s portfo-

lio of intramural and extramural programs dedicated

to the development of specialized research skills into

minority health and health disparities research pro-

grams, including those fostering the development of

scientists from medical, dental, veterinary, and other

health science disciplines.

GOAL 6: Strengthen the national

capacity to conduct minority health

and health disparities research

This goal promotes the expansion of the national

capacity to conduct minority health and health disparities

research. Creating and/or enhancing infrastructure to

support novel and existing research approaches will

facilitate further advancements in the elds of minority

health and health disparities. Programs that address

workforce preparedness at the institutional level will

strengthen the capability of the elds to conduct novel

and applied research.

STRATEGIC PLAN 2021–2025 Research-Sustaining Activities: Goals, Strategies, and Priority Areas

NATIONAL INSTITUTES OF HEALTH • MINORITY HEALTH AND HEALTH DISPARITIES

STRATEGY 6.1: Support programs to enhance

capacity for minority health and health dispari-

ties research at all institutions.

ACTION PRIORITY AREAS

Starting Line:

 Support relevant investigator-initiated research

projects and multidisciplinary research centers in

less research-intensive academic institutions—such

as institutions that have a historical and current

commitment to educating underrepresented students

and primarily undergraduate institutions—that train

significant numbers of individuals from health

disparity populations.

 Support multidisciplinary centers and networks with

local, regional, national, and international shared

research resources such as databases, informatics

cores, and biospecimen repositories that have mean-

ingful inclusion to foster collaborative translational

research relevant to U.S. health disparity populations.

 Build research capacity in community-based and tribal

organizations that are positioned to conduct popula-

tion health research on understudied racial and ethnic

minority populations because of their trusted relation-

ships with those populations.

 Support annual meetings, symposia, and research

education programs across the United States to foster

the development of a diverse cadre of faculty, students,

and community partners who are committed to pursu-

ing research on minority health and health disparities.

Building Momentum:

 Build community-based research hubs that serve as

resource centers in order to foster collaborative, com-

munity-engaged research to address minority health

and health disparities.

 Accelerate efforts to advance understanding of links

between environmental exposures and health out-

comes to promote environmental health literacy and

support disease prevention efforts targeted to entire

communities or regions at risk.

 Develop innovative ways to sustain community-based

environmental health disparities research beyond

individual grant cycles, and provide the means for

community partners and citizen scientists to be more

actively engaged with research.

STRATEGY 6.2: Develop and test methods to

foster, coordinate, and promote the ﬁeld of

health disparities among research institutions

and organizations.

ACTION PRIORITY AREAS

Starting Line:

 Disseminate the NIMHD Health Disparities Research

Framework to inform and attract researchers from

various scientific disciplines to explore the interplay

between biological, behavioral, social, cultural, envi-

ronmental, and clinical determinants of health.

Building Momentum:

 Partner with organizations that certify/license commu-

nity health workers (CHWs) to standardize training of

CHWs in intervention research, and assess the impact

on health disparity intervention research, efficiency,

safety, scientific rigor, and reproducibility.

 Expand NIH efforts to advance citizen science in the

field of health disparities as a distinct research enter-

prise led by citizen scientists and community organiza-

tions, going beyond traditional approaches to commu-

nity-engaged research led by academic institutions.

GOAL 7: Ensure appropriate repre-

sentation of minority and other health

disparity populations in NIH-funded

research

This goal promotes the inclusion of individuals from

minority and other health disparity populations (e.g.,

SGMs, rural, less privileged SES) in all federally funded

research with human participation. Promoting inclusion

in research requires attention throughout the research

process, encompassing study design, implementation,

and analyses. Using evidence-based strategies for

STRATEGIC PLAN 2021–2025 Research-Sustaining Activities: Goals, Strategies, and Priority Areas

NATIONAL INSTITUTES OF HEALTH • MINORITY HEALTH AND HEALTH DISPARITIES

outreach within minority communities and study design to

enable subpopulation analyses, researchers can promote

higher levels of representation among minority groups

and SGMs to understand whether clinical advances

are equally effective among all population groups.

Appropriate inclusion of minorities may also support more

meaningful insight into the etiology of minority health

concerns and could inform more effective, culturally com-

petent interventions in minority populations.

STRATEGY 7.1: Provide guidance, recommenda-

tions, and technical assistance for NIH-funded

researchers in appropriate study design and

best practices for recruitment to ensure compli-

ance with laws, regulations, and policies regard-

ing the inclusion of minorities and other health

disparity populations in research.

ACTION PRIORITY AREAS

Starting Line:

 Support the development of technical assistance

and best-research-practice centers to ensure that

researchers have knowledge of proper study design

and recruitment practices for including underrepre-

sented health disparity populations in research.

Building Momentum:

 Develop general guidance for NIH researchers on how

to best incorporate and include underrepresented

health disparity populations in research.

 Expand local, regional, and national efforts to assess

the impact of policies and policy changes on minority

population health, and delineate specific mechanisms

by which policies or policy changes mitigate or exac-

erbate systemic social, economic, and environmental

disadvantages.

STRATEGY 7.2: Promote tracking of originally

proposed recruitment strategies and objectives

to ensure sufﬁcient samples for analyses of

subpopulation data.

ACTION PRIORITY AREAS

Starting Line:

 Educate and provide support to research centers

regarding optimal recruitment strategies for inclusion

of underrepresented health disparity populations

in research.

Building Momentum:

 Develop Requests for Information (RFIs) to generate

recommendations for improved tracking of recruitment

strategies and objectives to ensure sufficient sample

sizes for analyses of health disparity populations and

related subpopulation data.

STRATEGY 7.3: Promote inclusion of minori-

ties and other health disparity populations in

big data sets, clinical research, and future big

science initiatives.

ACTION PRIORITY AREAS

Starting Line:

 Support established and new research centers in

the engagement of underserved health disparity

communities for recruitment and retention in big

data science research.

Building Momentum:

 Develop systematic monitoring mechanisms to

assess successful recruitment and retention of health

disparity populations in NIH-supported research.

 Strengthen national efforts to increase representation

of health disparity populations in disease registries

and public health surveillance systems to improve

understanding and awareness of population health

differences within and between groups and across

geographic regions.

DETAILS OF CATEGORIES AND GOALS

OUTREACH,

COLLABORATION,

AND DISSEMINATION:

GOALS AND STRATEGIES

Outreach, collaboration, and dissemina-

tion efforts enable the communication of

key ndings of minority health and health

disparities research to be shared with

the people and communities that need

them. These activities help advance the

development of dissemination plans to

enhance networks of minority health and

health disparities researchers and stake-

holders across the nation and within NIH.

STRATEGIC PLAN 2021–2025 Outreach, Collaboration, and Dissemination: Goals and Strategies

NATIONAL INSTITUTES OF HEALTH • MINORITY HEALTH AND HEALTH DISPARITIES

GOAL 8: Promote evidence-based

community engagement, dissemina-

tion, and implementation of minority

health and health disparities research

best practices

This goal advances evidence-based community out-

reach and dissemination, and implementation of ndings

from minority health and health disparities research into

clinical, community, and everyday settings. Dissemination

and implementation strategies should be embedded as

core components of the research process from the initial

stages. Developing and testing strategies for dissemina-

tion and implementation of scientic advances will facili-

tate the translation of research into policy and practice.

STRATEGY 8.1: Develop and test best prac-

tices for dissemination and implementation of

minority health and health disparities research

discoveries into different settings and with

different populations.

ACTION PRIORITY AREAS

Starting Line:

 Test best practices for dissemination and implementa-

tion of minority health and health disparities research

discoveries in diverse diseases and conditions into

rural communities, communities with a high proportion

of populations with limited English proficiency, and

communities with a high proportion of populations with

low health literacy.

Building Momentum:

 Develop and test an agency-wide Language Access

Plan (LAP) to improve access to health communication

modalities, such as online and/or written materials, for

dissemination and implementation of minority health

and health disparities research discoveries for condi-

tions in rural communities, communities where English

is not the primary language, and communities with low

health literacy.

STRATEGY 8.2: Conduct studies to determine

strategies for effective population-speciﬁc

communication and outreach to inform recruit-

ment and retention into clinical research studies

and databases, design of culturally appropriate

health interventions, and community engage-

ment and participation in research.

ACTION PRIORITY AREAS

Starting Line:

 Disseminate culturally appropriate educational mate-

rials and evidence-based interventions to appropriate

communities to increase participation in research

studies and clinical trials amongst health disparity

populations.

Building Momentum:

 Design and conduct educational interventions to

engage underserved communities and encourage

participation in health disparity research and evaluate

the effects of culturally appropriate outreach strate-

gies related to basic, behavioral, clinical, and genomic

research participation.

STRATEGY 8.3: Generate strategies and tools to

transform minority health and health disparities

best practices into policies.

ACTION PRIORITY AREAS

Starting Line:

 Assess outreach tools and strategies that address

minority health and health disparity concerns, including

risk and prevention, to determine best evidence-based

practices to be implemented and promoted into poli-

cies for care.

Building Momentum:

 Enhance targeted efforts that result in shorter lag

time between collecting evidence and adopting evi-

dence-based efforts in dissemination/implementation

that drive policy decisions.

STRATEGIC PLAN 2021–2025 Outreach, Collaboration, and Dissemination: Goals and Strategies

NATIONAL INSTITUTES OF HEALTH • MINORITY HEALTH AND HEALTH DISPARITIES

 Ensure that culturally appropriate strategies and tools

are properly disseminated and implemented in rele-

vant populations, in an effort to influence policy with

successful evidence-based methods.

 Establish working relationships with policy think tank

organizations to inform policymakers on successful

minority health and health disparity practices that

should be disseminated and implemented on a larger

scale.

GOAL 9: Cultivate and expand a com-

munity of minority health and health

disparities researchers and advocates

This goal promotes a community of minority health and

health disparities–focused research within NIH, HHS,

and beyond. The community should include NIH, other

government agencies, academia, and the private sector.

Through collaboration and partnerships, the commu-

nity should advance the sciences of minority health and

health disparities as well as integrate supporting struc-

tures and activities, such as quarterly or biannual science

highlights and discussions at major NIH meetings. The

development of this community also may help to ensure

that MH and HD research questions are integrated into

mainstream, disease-focused scientic communities and

ensure that the impact of health disparities is considered

across disciplines.

STRATEGY 9.1: Build an NIH-wide interdisci-

plinary community of scholars around minority

health and health disparities research to

coordinate disparities science and to foster

accountability and integration of minority

health and health disparities science within

NIH research activities.

ACTION PRIORITY AREAS

Starting Line:

 Promote intramural training opportunities that support

minority health and health disparities science, such

that projects are designed with enough power for

subpopulation or granular analysis in conjunction with

primary analyses.

 Promote extramural training opportunities that support

minority health and health disparities science, such

that projects are designed with enough power for

subpopulation or granular analysis in conjunction with

primary analyses.

Building Momentum:

 Ensure the dissemination and diffusion of health

disparity research activities and results to diverse

groups within NIH.

 Create an annual event at NIH to showcase health

disparities science with regard for the health determi-

nants and integration into biomedical research.

STRATEGY 9.2: Promote interagency collabora-

tion and coordination with federal departments

and agencies, including use of common data

elements and data sharing relevant to health

disparities research.

ACTION PRIORITY AREAS

Starting Line:

 Improve the generalizability of health disparity research

findings by coordinating with other federal agencies

in the development and administration of population

surveys that use common data elements.

 Improve health literacy by working with sister

agencies to develop and disseminate research-based

educational information to specific health disparity

communities.

Building Momentum:

 Provide research results to working groups for the

Healthy People 2030 initiative and similar federal

initiatives to facilitate health disparity data sharing

for decisionmaking.

STRATEGIC PLAN 2021–2025

NATIONAL INSTITUTES OF HEALTH • MINORITY HEALTH AND HEALTH DISPARITIES

STRATEGY 9.3: Establish partnerships with

nongovernmental groups, such as mentoring

networks, foundations, professional organiza-

tions, advocacy groups, industry, science

communities, and grantees, to advance the

development, improvement, and utilization

of minority health and health disparities

deﬁnitions, methods, measures, metrics,

interventions, and best practices.

ACTION PRIORITY AREAS

Starting Line:

 Disseminate NIH health disparity research priorities

and research results through lecture series and work-

shops to a variety of audiences, including current and

potential health disparities researchers.

 Generate interest in NIH health disparity research

priorities and research results through onsite activities

at NIH campuses to diverse populations of secondary

school and undergraduate students.

 Improve health literacy through nationwide initiatives

that increase the public’s access to science-based

information about specific health disparity illnesses

and conditions.

Building Momentum:

 Improve health literacy through nationwide initiatives

that increase the public’s access to science-based

information about specific illnesses and conditions

in culturally appropriate formats that influence

minority health.

 Provide overall coordination of community groups

to identify minority health and health disparities

research priorities for specific illnesses or conditions

to disseminate relevant findings and/or foster addi-

tional research venues.

Outreach, Collaboration, and Dissemination: Goals and Strategies

LEAP FORWARD

RESEARCH CHALLENGE

Leap Forward priority areas represent

visionary science that aims to reshape

the sciences of minority health and

health disparities. These leaps present

bold progressive actions to improve

minority health and to reduce health

disparities across relevant diseases,

disorders, and conditions.

STRATEGIC PLAN 2021–2025 Leap Forward Research Challenge

NATIONAL INSTITUTES OF HEALTH • MINORITY HEALTH AND HEALTH DISPARITIES

The Leap Forward priority areas represent one way the

ICs will comply with the 21st Century Cures Act, as

described in Section 2031 of P.L. 114–255, to promote

collaborations of research projects across all NIH ICs and

Ofces focused on reducing and/or eliminating health

disparities.

Minority Health and Health Disparities

Research

 Promote research that reduces new HIV infections by

75 percent by 2030, especially in African American or

Black, Hispanic or Latino, and SGM populations, which

are disproportionately affected by HIV.

 Promote research that increases viral suppression to

85 percent of persons with HIV from health disparity

populations, especially African American or Black and

Hispanic or Latino men who have sex with men and

other SGM populations, by 2030.

 Promote research that increases pharmacological

curative treatment of hepatitis C infection among

American Indian and Alaska Natives by 50 percent by

2030.

 Foster research that uncovers contributors and develops

interventions to reduce maternal mortality and severe

maternal morbidity in the United States over the next 10

years in order to address the disparities between African

American or Black and American Indian and Alaska

Native women compared with White women.

 Reduce racial and ethnic, socioeconomic, and/or geo-

graphic disparities in pre-term birth and infant mortality

over the next 10 years.

 Implement measures to increase diverse ancestral

representation from African Americans or Blacks,

Hispanics or Latinos, American Indians, Alaska

Natives, and Pacific Islander populations in NIH-

supported and analyzed genomic data sets, in order

to approach proportional representation of the U.S.

population by 2030.

 Increase rates of colorectal cancer screening, fol-

low-up, and referral to care among racial and ethnic

minority populations, persons of less privileged SES,

SGM populations, and underserved rural populations,

to attain targeted national standards by 2030.

 Increase access to medications for opioid use disorder

among those incarcerated or recently released so that

75 percent of persons in all racial and ethnic subpopu-

lations of the incarcerated or recently released persons

are linked with such care by 2030.

 Improve understanding of incidence patterns, symp-

toms, diagnosis, and disease trajectories for vascular

cognitive impairment and dementia in racial and ethnic

minority populations by 2030.

 Bring curative genetic therapies for sickle cell disease

(SCD) into first-in-human clinical trials within five years

and increase the proportion of Medicaid and Medicare

beneficiaries with SCD who receive disease-modifying

therapies.

 Support community-engaged, community-based

implementation research to reduce cardiovascular

health disparities, sustain adoption of evidence-based

interventions, mitigate disparities in adoption of health

behaviors, and promote enhanced characterization of

social determinants of health to improve cardiovascu-

lar health and disease prevention across the lifespan

and maximize impact on overall population health in

five high-burden communities by 2030.

 Build on global experiences to dramatically transform

health care and clinical outcomes in rural and socio-

economically disadvantaged populations in the United

States by engaging 25 percent of the training programs

in certified biomedical engineering departments in the

United States (approximately 30) by 2030, to drive

the development of recognized and active health care

disparities technology development.

 Support research to test at least three multilevel

approaches to improve adoption of evidence-based

asthma interventions in African American or Black,

Hispanic or Latino (e.g., Puerto Rican), and socioeco-

nomically disadvantaged communities with the goal

of reducing asthma-specific emergency room visits,

hospitalizations, and symptom days in these popula-

tions by 2030.

STRATEGIC PLAN 2021–2025 Leap Forward Research Challenge

NATIONAL INSTITUTES OF HEALTH • MINORITY HEALTH AND HEALTH DISPARITIES

 Support development of one synthetic or hybrid data

set which conforms to FAIR (findable, accessible,

interoperable, and reusable) open data principles and

models racially and ethnically diverse communities in

order to test methods and metrics and address possi-

ble biases due to underrepresentation of minorities and

women within the next 10 years.

 Define the rates of hearing impairment by race and

ethnicity by 2030.

 Support research that advances implementation of

evidence-based interventions and tools for reducing

untreated dental decay in racial and ethnic minority

and low-income populations across the lifespan by

10 percent to 25 percent by 2030, with the long-term

potential for improved health for all communities.

 Identify differences in factors that cause progression

to end-stage renal disease (ESRD) and find infor-

mative subpopulations among African Americans or

Blacks, Hispanics or Latinos, American Indians, Alaska

Natives, Pacific Islanders, and Asians with chronic

kidney disease by 2030.

 Identify factors contributing to the disparity between

Whites and African Americans or Blacks, Hispanics

or Latinos, American Indian, Alaska Natives, Pacific

Islanders, and Asians in control of HbA1c (glycated

hemoglobin), and target those factors through rigorous

clinical trials and adaptive population-based interven-

tions by 2030.

 Address the leading causes of morbidity and mortality

in NIH-designated health disparity populations by 2030

by leveraging the network of Clinical and Translational

Science Awards (CTSA) Program to (1) develop

research into underlying factors related to clinical

trial design and conduct to improve outcomes and/or

reduce disparities, (2) demonstrate the effectiveness

of delivering treatments that consider the health care

context of a given minority or health disparity popu-

lation(s), and (3) assess strategies for the pragmatic

dissemination and uptake of these interventions into

routine health care settings by 2030.

 Identify mechanisms that account for marked differ-

ences in suicide rates across racial and ethnic groups

and SGM populations, as well as develop and test

strategies to improve suicide risk prevention and

detection among population groups at risk within the

next 10 years.

 Develop and test innovative approaches to remedi-

ate barriers that contribute to documented inequities

in access, engagement, and quality of mental health

treatment and services, and/or the effectiveness and

outcomes of evidence-based mental health interven-

tions for health disparity populations by 2030.

 Understand the underlying etiologic pathways for the

higher rates of systemic lupus among African American

women and Latinas compared to White women by 2030.

 Assess the efficacy of interventions to reduce dispari-

ties between racial and ethnic minority populations and

Whites in access to and use of existing surgical and

nonsurgical interventions for osteoarthritis by 2030.

 Characterize and understand how adverse environ-

mental exposure profiles that occur during early life

stages may enhance vulnerability to diseases of adult-

hood disproportionately in health disparity populations.

 Understand the acute and long-term health impacts of

natural and human-made disasters on less privileged

SES and minority populations and the health care

systems serving them. In addition, understand the indi-

vidual, community, and health care system response

prevention factors to improve the acute and long-term

health, well-being, and resiliency of those affected.

 Assess differences and similarities in wellness and dis-

ease prevention behaviors given the intersectionality of

race and ethnicity, geographic area, SGM populations,

and SES by 2030.

 Understand the underlying etiologic pathways that help

explain the higher rates of glaucoma among African

Americans or Blacks compared with Whites by 2030.

STRATEGIC PLAN 2021–2025 Leap Forward Research Challenge

NATIONAL INSTITUTES OF HEALTH • MINORITY HEALTH AND HEALTH DISPARITIES

 Within the next 5 years, synthesize the latest evidence

regarding the immigrant paradox in health outcomes

to better define protective factors, such as resilience

or social support; differentiate the protective factor

profiles of various immigrant groups; and/or determine

the extent to which methodological, measurement, or

sampling artifacts explain the paradox.

 By the year 2030, conduct research to examine the

impact of laws, policies, and structural determinants

of health on defined health disparities with emphasis

on non-health societal sectors, such as transportation,

housing, communications, water and energy providers,

agriculture, land use, public safety, education, and

criminal justice.

 Support research to document and understand occu-

pational health disparities as determined by the type

of employment and work conditions (e.g., safety, work

shifts, paid leave, health insurance) controlling for race

and ethnicity, SGM populations, SES, and geographic

residence by 2030.

 Over the next 5 years, support research to examine the

effectiveness, financing, and sustainability of programs

using community health workers, patient care coor-

dinators, and other peers to deliver prevention and

self-management interventions to reduce disparities.

 By the year 2030, support research to achieve health

equity in the use of recommended preventive services

that target three leading causes of death in the United

States—cancer, heart disease, and diabetes—through

culturally derived and community-engaged interven-

tions that include multiple clinical and community

settings.

 Promote research examining the role of the built

environment and its interactions with multiple individ-

ual behavioral, biological, and cultural factors as well

as health care systems that promote health equity in

screening, early diagnosis, treatment and self-man-

agement, and prevention of complications of chronic

diseases in the clinical setting across the next 5 years.

 Support experimental research using simulations to

understand potential bias in peer review of minority

health and health disparity-related applications due to

characteristics of applications or of reviewers by 2030.

 Identify evidence-based interventions to prevent and

reduce alcohol misuse, including underage and exces-

sive alcohol use, among health disparity populations.

 Over the next five years, support research that exam-

ines health information technology and its impact on

minority health and health disparity populations access

to care, quality of care, and overall health outcomes.

Research-Sustaining Goals

 Increase the overall proportion of participants from

diverse populations included in NIH-funded clinical

research to 40 percent by 2030 and within specific

major disease categories.

 Increase the diversity of institutions conducting

genomic research and training by investing in faculty

at such institutions, along with curriculum-building

partnerships, to accelerate workforce development in

underrepresented and under-resourced communities

within the next 10 years.

 By 2030, promote research collaborations between

U.S. and Latin American scientists addressing preven-

tion of childhood obesity and diabetes in U.S. Latinos

and in Latin America.

 Increase training opportunities for students from health

disparity populations, including underrepresented

groups, to learn about health equity and biomedical

research in low- and middle-income countries.

 Increase our understanding of cancer trends and

outcomes in the context of disparities and subpop-

ulations through the expansion of the Surveillance,

Epidemiology, and End Results program to include 50

percent of the population by 2030.

 Increase the number of underrepresented biomed-

ical scientists as defined by the National Science

Foundation from current levels by 25 percent by 2030.

STRATEGIC PLAN 2021–2025 Leap Forward Research Challenge

NATIONAL INSTITUTES OF HEALTH • MINORITY HEALTH AND HEALTH DISPARITIES

 Cultivate a cadre of biomedical and behavioral investi-

gators trained in implementation research who are fully

prepared to bridge NIH mission areas in both clinical

and nonclinical, real-world settings by increasing (a)

the number of investigators overall and (b) the number

of investigators from underrepresented backgrounds

with requisite skills by 25 percent by 2030.

 Develop a toolbox of consensus common data ele-

ments (CDEs) on sociodemographic characteristics,

population descriptors, and social determinants of

health, and require use of CDEs in future Funding

Opportunity Announcements (FOAs) by 2030.

 Develop a new program to enable investigators who

have participated in diversity-enhancing programs

sponsored by NIH to recognize and apply for con-

tinuing educational opportunities, such as the Ruth L.

Kirschstein National Research Service Award (NRSA)

and institutional training awards for predoctoral or

postdoctoral training positions, K99-R00, and other

training grant opportunities.

 Support individual-level programs to train individuals

from health disparity populations, including those that

are underrepresented in the biomedical sciences

FUTURE PLANS

STRATEGIC PLAN 2021–2025 Future Plans

NATIONAL INSTITUTES OF HEALTH • MINORITY HEALTH AND HEALTH DISPARITIES

Implementation Plan

Progress will be monitored annually by tracking NIH’s

progress toward the set goals and the targets under

Starting Line and Building Momentum. This process will

assess progress, monitor budgets, and provide feedback

to NIH on the implementation process (see Figure 2).

 Promote the implementation of goals, strategies, and

priorities.

 Create a system to track and monitor progress toward

achieving the goals, strategies, and priorities.

Evaluation Plan

 Evaluate strategic plan through qualitative and quanti-

tative metrics without overly prescriptive endpoints.

 Measure utility of strategic plan to multiple stakeholders.

 Measure impact by co-sponsored Funding Opportunity

Announcements (FOAs, changes in portfolio, project

self-evaluations, and others.

 Gap analysis based on NIH’s ICs responses to priority

area requests.

FIGURE 2: Strategic Plan Monitoring and Tracking

STEP

NIH Work

Groups

STEP

Portfolio

analysis of

current

operation

STEP

Identify gaps,

barriers, and

opportunities

Selection

strategies

Baseline of

strategies

Progress of

strategies

STEP

Measurement

of goals

STEP

Achievement

of goals

STEP

Strategic plan

implementation

synthesis

Yearly and

ﬁnal evaluation

NIH