Scientific research supported by the National Institutes of Health (NIH) has resulted in great benefits to the general population of the United States. NIH-funded research has led to improved diagnostic approaches, better treatment, and enhanced prevention; as a result we have witnessed significant declines in morbidity and mortality from numerous diseases. Consequently, the overall US population can expect not only to live longer but to be more productive and to enjoy a higher quality of life. However, not all segments of the American population have experienced these gains to the same degree. For example, African American, Native Americans, and low socioeconomic status (SES) populations continue to experience substantial disparities in the burden of disease and death when compared to the European-Americans and higher SES populations. Because the existence of racial/ethnic, social class, and rural-urban health disparities are to a large extent influenced by behavioral and social factors, the Office of Behavioral and Social Sciences Research is committed to developing better knowledge of their specific causes and participating in finding solutions.
BREAKING NEW GROUND IN OUR UNDERSTANDING OF THE DETERMINANTS OF HEALTH DISPARITIES AND HOW WE CAN ELIMINATE THEM
The Network on Inequality, Complexity, and Health is an interdisciplinary leadership network of expert researchers who together will establish the feasibility, utility, and importance of applying complex systems approaches to health disparities and related aspects of population health. Supported by the NIH Office of Behavioral and Social Sciences Research (OBSSR) through a contract with the University of Michigan, the network will develop an inventory of areas of health disparities research that appear amenable to the application of complex systems approaches (including those which are potentially high risk/high payoff), identify data needs, analytical challenges, and areas where strategic development is particularly promising. Network members also will collaborate to illustrate the importance of complex systems approaches to the understanding of links between biological, behavioral, social, community, environmental and policy determinants of health disparities and population health. The network will produce reports and publications, including possible books or special journal issues, that bring together the work of network members and other experts, focused on illustrating, explaining, promoting, and translating the application of complex systems approaches to critical health disparities areas that require inter/multi/trans-disciplinary development.
About the Network
The Economic and Social Research Council of the United Kingdom (ESRC) and the National Institutes of Health (NIH) signed a Joint Statement in mid-2008 to promote research collaborations between USA-based and UK-based behavioral and social scientists. As an initial attempt at collaboration, ESRC and OBSSR staff decided to focus efforts on the topic of health disparities/inequalities. It was noted that strong traditions of research on this topic exist in both countries and that it is of major social, political, and public (health) policy concern.
The National Cancer Institute (NCI); the National Heart, Lung and Blood Institute (NHLBI); and the Office of Behavioral and Social Sciences Research (OBSSR) at the National Institutes of Health (NIH) are partnering to provide funds to continue the Centers for Population Health and Health Disparities (CPHHD) program. This program responds to a strategic priority at the NIH to address disparities and inequities in the prevalence and outcomes of several diseases, particularly cancer and heart disease. The CPHHD program requires transdisciplinary research involving social, behavioral, biological, and genetic research to improve knowledge of the causes of health disparities and devise effective methods of preventing, diagnosing and treating disease and promoting health. Some of the previously funded Centers will continue to be supported, while others are new Centers. The applications that were selected for funding were those that received the top scores during NIH peer review.
February 2011 Grantee Workshop
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- Behavioral and Social Science Research on Understanding and Reducing Health Disparities (R01) (PAR-10-136)
- Behavioral and Social Science Research on Understanding and Reducing Health Disparities (R21) (PAR-10-137)
Pathways Linking Education to Health
On January 8, 2003 the Office of Behavioral and Social Sciences Research (OBBSR), in collaboration with NCI, NIA, and NICHD, issued a RFA calling for R01 grant applications on Pathways Linking Education to Health. The goal of this RFA was to increase the level and diversity of research directed at elucidating the causal pathways and mechanisms that may underlie the association between education and health. Ultimately, OBSSR provided funds for 13 grants, involving several methodological approaches and study populations. (See Table.) During the first two years of the awards, OBSSR convened the PIs in informational exchanges concerning their projects.
A Sample of Findings
Using changes in state compulsory schooling laws as natural experiments (instruments) for estimating the effect of education on memory and mental status among the elderly, researchers found that increases in mandatory schooling lead to improvements in performance on memory tests many decades after school completion. Results help to establish a causal effect of education on old age cognition (Berkman, AG023399).
Higher education significantly increased the odds of being screened for hypercholesterolemia overall and within each race/ethnic group. Focusing public health policy on increasing screening for individuals with low education might greatly improve their chances of preventing or mitigating morbidity related to hypercholesterolemia and subsequent cardiovascular disease (Crimins, AG03347).
Literacy mediated the relationship between education and gylcemic control in a low-income population with diabetes (Karter, HD046113).
The benefits of education for health operate not only through improvements in economic status, but also by affecting patterns of thinking and decision-making (Paxson, HD046162).
The gender gap in depression disappears among persons with a college degree or higher. Education increases work creativity more sharply for women than for men, thereby reducing depression. Education increases the sense of control for both sexes equally, but depression declines more steeply for women as sense of control increases (Ross, AG023380).
The health benefits associated with additional years of schooling have risen sharply over time. One component of this increasing health value to schooling rests in a growing disparity by education in the probability of having major chronic diseases during middle age. A component of the rising value of schooling rests in improved disease management (Smith, AG023363).
A study of the effects of health on education examined the effects of a childhood nutritional supplementation program on schooling outcomes, cognitive achievement, and abstract reasoning. Results indicate significantly positive, and fairly substantial, effects of the randomized intervention a quarter century after it ended (Stein, HD046125).
Mothers with a higher education are less likely to be smoking at conception and are more likely to quit during pregnancy, in effect widening the educational disparity in smoking over the course of pregnancy. However, women with less education were no more likely to relapse after pregnancy than women with a higher level of educational attainment (Hair, HD046123).
Pathways Linking Education to Health
Grants Awarded under RFA OB-03-001
Issued January 8, 2003
||BEHRMAN, JERE R
||Causal Effects of Schooling on Adult and Child Health
||BUKA, STEPHEN L
||Pathways Linking Education/Health in Middle Adulthood
||CRIMMINS, EILEEN M.
||Biological Risk Underlying Education Health Differences
||DESAI, SONALDE B.
||Parental Education and Child Outcomes
||ENSMINGER, MARGARET E.
||Value of Education-Paths to Well Being over Life Course
|| HAIR, ELIZABETH C
|| Parent education to child health: Longitudinal pathways
||KARTER, ANDREW JOHN
||Educational Disparities in Diabetes Complications
||PAXSON, CHRISTINA H
||The Relationship Between College Education & Health
||ROSS, CATHERINE E
||Education, Resource Substitution, and Health
||SCHAPIRA, MARILYN M
||Establishing a Link between Numeracy and Health
||SMITH, JAMES PATRICK
||Education , Self-Management and Adherence
||SOLDO, BETH J
||Comparative Approach to SES Gradient: Aging & Selection
||STEIN, ARYEH DAVID
||Education and Health Across the Life course in Guatemala
- NIH Conference on Understanding and Reducing Disparities in Health, October 23-24, 2006, Bethesda, MD.
- Racial/Ethnic Bias and Health: Scientific Evidence, Methods, and Research Implications Conference, April, 2002. Papers from the conference were published in the American Journal of Public Health, February 2003, Vol. 93, Issue 2.