The National Institute on Minority Health and Health Disparities (NIMHD), part of the National Institutes of Health, has committed approximately $31 million over five years, pending available funding, to launch a new program for Transdisciplinary Collaborative Centers (TCCs) for health disparities research exploring the potential for precision medicine to promote health equity and advance the science of minority health and health disparities.
Priority research areas for NIMHD’s precision medicine initiative include:
• Development of new tools and analytic methods for integrating patient data with information about contextual factors acting at the community or population level to influence health outcomes
• Development of pharmacogenomic and other precision medicine tools to identify critical biomarkers for disease progression and drug responses in diverse populations
• Translation of pharmacogenomic discoveries into clinical practice including effective treatments
• Investigation of facilitators and barriers to implementing precision medicine approaches in disparity populations
• Understanding mechanisms that lead to differential health outcomes in common diseases in minorities and disparity populations
Although scientific and technological advances have improved the health of the U.S. population overall, racial/ethnic minority populations, socioeconomically disadvantaged populations and rural populations continue to experience a disproportionate share of many diseases and adverse health conditions. As the Nation’s steward of biomedical and behavioural research, NIH has devoted considerable resources to characterize the root causes of health disparities, uncovering complex webs of interconnected factors (e.g., biological, behavioural, social and environmental factors) acting at multiple levels across the life course. As an important next step, research is needed that capitalizes on this knowledge to develop interventions that reduce or eliminate health disparities.
Designed for broad impact, TCCs comprise regional coalitions of research institutions and partners working together to develop and disseminate effective health interventions that can be implemented in real-world settings. TCCs supported through this initiative are expected to focus on at least one priority research area, each combining expertise in precision medicine, population health disparities, and the science of translation, implementation and dissemination to address one or more documented health disparities. The proposed work must focus on one or more health disparities populations, which include Blacks/African Americans, Hispanics/Latinos, American Indians/Alaska Natives, Asian Americans, Native Hawaiians and other Pacific Islanders, socioeconomically disadvantaged populations and rural populations. Each centre will support 2-3 multidisciplinary research projects examining complementary aspects of precision medicine, focusing on interactions between biological, behavioural and contextual predictors of disease vulnerability, resilience and response to therapies in patients from disadvantaged communities.
Benefits of medical advances are not always distributed equitably, often because structural or systemic factors limit the effectiveness of new diagnostic or therapeutic approaches in disadvantaged populations. Precision medicine is an emerging approach for disease prevention, early detection and treatment that takes into account individual variability in genes, environment, demographic factors, social determinants and lifestyle. While it holds great promise for improving patient care, its potential for reducing health disparities hinges on better understanding of the dynamic interplay between biological, behavioural, social and environmental health risk and protective factors experienced across the life course, coupled with greater inclusion of health disparity populations in research aimed at developing precision medicine interventions.
The approach of this new program, which focuses on health disparity populations, including racial and ethnic minorities, rural populations and low socioeconomic populations, shares the transformative vision represented by President Obama’s Precision Medicine Initiative (PMI), which supports the NIH’s recently implemented PMI Cohort Program, a nationwide effort which seeks to build a longitudinal research cohort of 1 million or more U.S. volunteers, to produce new knowledge with the goal of developing more effective ways to prolong health and treat disease.
“The core values of the President’s PMI challenge the scientific community to advance population health in ways that create true benefits to all populations,” said NIMHD Director Dr. Eliseo J. Pérez-Stable. “Precision medicine research endeavours must go beyond biologic and clinical markers and include social determinants of health, such as the economic, social and political conditions that influence health status. Ultimately, the TCCs will generate new knowledge about precision medicine that resonates from the community level to the national population level.”