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The National Institutes of Health’s UNITE initiative has responded to over 1,100 comments, including one from Dr. Amelie Ramirez of Salud America! and UT Health San Antonio, calling for racial equity and diversity in research.
UNITE sought comments in spring 2021.
Ramirez submitted a comment—endorsed by 541 Salud America! members—that we believe that increasing diversity among research leaders and clinical trial participants will help achieve true health equity, especially for Latinos and others disproportionately impacted by health issues.
Based on these comments, the UNITE initiative formulated four priority areas in health disparities and minority health research, the internal NIH workforce, and the external research workforce.
“Here at NIH, we saw with fresh eyes the reality of racial inequities in biomedical and behavioral science and were dismayed by the inestimable loss of talent, creativity, and innovation due to the cultures of exclusion that have existed for decades,” according to a UNITE progress report from December 2022. “We recognized that it was time to unite and enact a seismic shift in our systems, policies, and cultures to advance racial and ethnic equity and address disparities.”
Let’s explore Dr. Ramirez’s comment and UNITE’s four priority areas!
Here is the comment Dr. Ramirez submitted to the UNITE initiative:
Increasing racial equity and diversity in the biomedical research workforce will help us achieve true health equity, particularly for marginalized groups like Latinos, who suffer from disproportionate health issues due to historic systemic racism, discrimination, and implicit bias in the healthcare system. Diversity in the biomedical research workforce can be addressed twofold: increasing diversity in higher education for medical degrees and addressing systemic racism and implicit bias within healthcare and clinical trials.
To increase diversity in medical schools, there must be an interest and awareness for a career medicine early on. This can be addressed through mentorship programs, internships, and fellowships that NIH funds with under-resourced communities, increased financial aid for minority students seeking higher education, and organizations that support minority students once in medical school. NIH should support programs that address the lack of diversity in the doctoral and research fields, such as the Éxito! Latino Cancer Research Leadership Training program, which significantly increased Latino and Latino-focused trainees’ confidence to apply to a doctoral program and academic self-efficacy (https://salud.to/exitostudy).
Systemic racism and implicit bias are ingrained in the healthcare field, but steps can be taken to address this. A study in JAMA network found that while 45% of Latino and Black physicians experienced racial epithets or refusal of care from patients, 84% did not report discriminatory instances to their leadership, indicating a lack of support or resources for minority physicians (https://salud.to/physicianbias). Interpersonal training on implicit bias and establishing a support system in instances of bias and racism will help address this. One particular tool is the Salud America! implicit bias action pack (https://salud.to/seebias).
Additionally, steps must be taken to address the large racial/ethnic gap in clinical trials and research. Latinos represent 18.5% of the U.S. population, but are less than 10% of those in federal cancer and drug studies. With the use of culturally relevant digital health communications, advocacy networks, and clinical partnerships, we can reach more diverse communities that are often left out of trials and research.
About the UNITE Initiative
In February 2021, NIH announced the UNITE Initiative.
The UNITE initiative has five committees of 80 NIH staff volunteers who identify ways to improve racial equity.
The aim is to help Latinos and other people of color in many ways. This includes providing more research on minority health. It also includes dismantling racism and discrimination that has impacted healthcare throughout history.
“Historical racism has led to the marginalization and oppression of Indigenous peoples, African Americans, Latinos, and other communities of color. … Structural racism has resulted in persistent health disparities, poor health status, and premature mortality as demonstrated by the current disproportionate burden of morbidity and mortality from COVID-19. Within the biomedical research enterprise, structural and institutional racism has resulted in inequitable access to funding, training, and workforce opportunities,” according to the NIH website.
UNITE Priority 1: Elevating Health Disparities and Minority Research Across Institutes and Centers
In response, UNITE aims to:
- Enable each of 27 NIH institutes and centers to prioritize minority and health disparities research. This includes related disciplines and methodologies.
- Ensure funding levels for health disparities research are on par with other areas of funded NIH research.
This effort has already yielded progress.
UNITE Priority 2: Promoting Equity in the NIH-Supported Biomedical Research Ecosystem
Sadly, NIH research funding rates are lower among Latino scientists and other researchers of color than their White peers.
In response, UNITE aims to:
- Reduce disparities in NIH funding rates so that race and ethnicity are not predictive of or correlated with funding success.
- Ensure that funding success rates for institutions that have shown a historical commitment to educating students from underrepresented groups are on par with that of other institutions.
NIH has already increased the transparency of data on funded researchers.
“NIH is also developing a Diversity, Equity, Inclusion, and Accessibility (DEIA) prize competition to reward and recognize institutions of higher education for innovative interventions that enhance faculty and student DEIA,” according to NIH.
UNITE Priority 3: Promoting Equity in the Internal NIH Workforce
Comments to NIH revealed perceptions of barriers to employment opportunities for underrepresented populations across the internal NIH workforce. It also showed barriers to successful promotion into leadership.
This can hurt the work environment, organizational culture, recruitment, hiring, retention, and more.
In response, UNITE aims to:
- Promote and sustain an equitable work environment and organizational culture. This will occur by ensuring equal opportunity for career success for all employees, including those from underrepresented populations across the internal NIH workforce.
- Ensure that race and ethnicity do not predict staff positions or grade levels at NIH.
UNITE created the Anti-Racism Steering Committee with 500 volunteers to address racial and ethnic equity in the internal workforce.
They also recommend each NIH institute develop a Racial and Ethnic Equity Plan.
UNITE Priority 4: Improving the Accuracy and Transparancy of Racial and Ethnic Equity Data
Comments submitted to NIH also highlight a lack of accurate, comprehensive, and easily accessible data to identify and address any structural racism and discrimination within NIH and beyond.
In response, UNITE aims to:
- Improve the accuracy and transparency of racial and ethnic equity data
- Ensure that aggregate data collected is broadly available and easily accessible to internal and external stakeholders.
The UNITE initiative has hosted 14 external listening sessions with over 1,300 participants.
UNITE also has a data dashboard.
“[The dashboard] provides facts and figures regarding aggregated diversity, equity, and inclusion-related data and analyses related to funding, the internal NIH staff, and the external scientific workforce,” according to NIH.
How Else Can We Help Latinos?
Systemic racism and bias continue to hurt Latinos in healthcare.
But we can help make a difference.
Ask your city to declare racism a public health crisis with help from the Salud America! “Get Your City to Declare Racism a Public Health Crisis Action Pack”!
The Action Pack will help you gain feedback from local social justice groups and advocates of color. It will also help you start a conversation with city leaders for a resolution to declare racism a public health issue, with a commitment to take action to change policies and practices. It will also help build local support.