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Posts Tagged ‘health disparities

The Impact of Research Funding on Minority Health and Health Disparities

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By: Nancy Chiles Shaffer, Ph.D.


Source: Maxpixel

Federal agencies have attempted to improve minority health and reduce health disparities since the 1980s, and these efforts have continued through today. To briefly highlight some of the progress that has been made, the Department of Health and Human Services (HHS) initially released a report in 1985, “The Secretary’s Task Force Report on Black and Minority Health (Heckler Report)”, that discussed the state of racial health disparities in the United States1. This report led to the creation of the Office of Minority Health in 19861. Subsequently, the Office of the Director of the National Institutes of Health (NIH) created the Office of Minority Programs2. This began the efforts of NIH to address minority health and health disparities. Additionally, in 1993, HHS founded the Office of Research on Minority Health, which was later reauthorized in 20101,2. The Agency for Healthcare Research and Quality (AHRQ), under the Healthcare Research and Quality Act, was directed in 1999 to monitor racial disparities in health care3.  The National Center on Minority Health and Health Disparities was founded in 2000 and later became an NIH institute in 20102. More recently, in 2011, the HHS Action Plan to End Health Disparities as well as the National Stakeholder Strategy for Achieving Health Equity were created to further reduce health disparities1. Over these 33 years, funding also has been explicitly designated to improve minority health in the United States. While only 427 grants addressing minority health and health disparities were funded in 1985, there are currently 7,958 active grants4. How have health outcomes and health care been impacted by funding for minority health and for addressing health disparities?

One of the markers of national health that can be used to examine the success of these efforts so far is life expectancy. In 1990, life expectancy at birth was 71.8 years for men and 78.8 years for women5. Race-specific life expectancy was 72.7 years and 64.5 years for White and Black men, respectively, and 79.4 years and 73.6 years for White and Black women, respectively5. These data reflect 8.2 years shorter life expectancy for Black men and 5.8 years shorter life expectancy for Black women compared to their White counterparts.  Efforts to increase life expectancy led to a 6% (4.5 years) and 3% (2.3 years) increase in life expectancy by 2015 in men and women, respectively. Additionally, the difference in life expectancy between Black and White individuals decreased by 46% (3.8 years) in men and 52% (3 years) in women.

The National Center for Health Statistics (NCHS), a division of HHS’ Centers for Disease Control and Prevention, produced two data briefs examining racial differences in life expectancy. The first report explored the causes of death related to racial differences in life expectancy in 20106. It was found that there was a Black disadvantage in death rates due to heart disease, cancer, homicide, diabetes, and perinatal conditions. The Office of Minority Health stated in a 2011 press release that the Affordable Care Act provided opportunities for “bringing down health care costs, investing in prevention and wellness, supporting improvements in primary care, and creating linkages between the traditional realm of health and social services”7. The second NCHS brief assessed how decreases in racial disparities in life expectancy in 2013 are attributable to decreases in death rates for conditions among Black people, including heart disease, cancer, HIV, unintentional injuries, and perinatal conditions8. Despite these decreases, AHRQ’s “National Healthcare Quality and Disparities Report” in 2016 stated that most racial disparities in health care still exist9.

Beyond federal funding, private organizations and philanthropic organizations have also committed to reducing health disparities. A 2009 workshop that aimed to determine factors associated with health disparities was funded by the California Endowment, Missouri Foundation for Health, Connecticut Health Foundation, United Health Foundation, and Kaiser Permanente, and the CDC7. The Merck Company Foundation in 2009 provided $15 million to fund their Alliance to Reduce Disparities in Diabetes, focusing on reducing disparities in type 2 diabetes in low-income adults, Blacks, Hispanics/Latinos, and Native Americans7. Aetna Foundation, through their Racial and Ethnic Health Care Equity program, funded a report in 2012 addressing how the Affordable Care Act could be used to “advance health equity for racial and ethnic minorities”7. A brief funded by the California Endowment, California Wellness Foundation, and the San Francisco Foundation concluded that language barriers in California inhibited enrollment in the California Health Benefit Exchange7,10. As a result, funding was provided to increase cultural and linguistic competence for health care providers. The Cigna Foundation funded a $200,000 grant in 2015 for the Health Advocates In-Reach and Research (HAIR) program at the University of Maryland School of Public Health’s Center for Healthy equity to train barbers and hair stylists on health education11.

While funding has resulted in improvements in minority health, there is still more work to be done. The Office of Minority Health states that racial and ethnic minorities “…are less likely to get the preventive care they need to stay healthy, more likely to suffer from serious illnesses such as diabetes or heart disease, and when they do get sick, are less likely to have access to quality health care”12. Many of the areas that require additional attention are the focus of several current funding initiatives. The Office of Minority Health currently has grants to address uninsured men, HIV/AIDS, Lupus, and cultural and linguistic competency13. In addition, AHRQ is currently funding research addressing health disparities among the lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) community, as well as mobile technology to improve self-care for HIV/AIDS patients9. Given the improvements that have been observed thus far over the past 33 years, the ongoing continuation of funding to address minority health and health disparities has the potential to help the United States achieve health equity for all.

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Written by sciencepolicyforall

December 7, 2018 at 2:41 pm

Is Novelty Killing Research Science?

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By: Aaron Rising, PhD


source: Sean MacEntee via flickr

Within the past decade or so, researchers have become aware of the prevalence of scientific studies whose results cannot be replicated, which has been dubbed the ‘reproducibility crisis.’ While the phrase may be a slight hyperbole, there is a real concern about how many published scientific studies are valid and reproducible. One of the most eye-opening studies into this issue was in the field of psychology in 2015 where 100 different experimental and correlation studies were redone in order to reproduce the conclusions of the original experiments. Overall, this study found that only 36% of the replicate experiments had significant results, despite 97% of the original set reporting significant results. Combining the two sets of studies (the original and the replicate experiments) resulted in nearly 70% significance of the two experimental sets, essentially meaning that ~25% of the original results were potentially a false positive. While the specific reproducibility percentages are debated (1, 2)  and being talked about in the media (3,4), it is worrying that a sizeable amount of published research, through no fault of the original researchers involved in the study, may turn out to be inaccurate. In a poll by Nature, 70% of researchers reported that they have failed to replicate another groups work. What’s even more troubling? More than half could not replicate their own findings.

There are multiple reasons why reproducibility of a single study can be called into question. Different labs use different mouse strains or cell lines, reagents from different companies or lot numbers can vary, or even two people can inherently perform the same experiment differently. All of these are examples could result in the exact same study ending up on either side of the significance threshold (usually set at p<0.05). And it shouldn’t be ignored that there are laboratories who use more nefarious methods to get positive results such as p-hacking, excessive removal of outliers, or just plain making up or editing data. But a more fundamental issue maybe driving this ‘crisis’, and it is one of ‘novelty.’  As humans, we love novelty. We are attracted to things that are innovative, new or never been done or seen before. It is ‘boring’ to rehash the same topic constantly. This desire or need for novelty flows into how we fund ideas and how we publish scientific results.

To get funding to do research, scientists must apply for and receive grants. In the United States roughly 40 to 50% of the science R&D funding comes from either the federal or local and state governments (5,6,7). Requirements for federally funded grants mostly rely on building on previous work and coming up with new and innovative ideas that have not been done previously. For instance, the U.S. National Institutes of Health (NIH) requires proposed projects to be unique and cannot, by law, use taxpayer money to pay for research that is already done. While not bound by law, other funding sources outside of the government such as Alzheimer’s Association, The Heart Foundation and the Leukemia and Lymphoma Society all emphasize that the research funded by their grants be ‘novel’  in concept, approach, and or strategy. Everything proposed in these grant applications, for the most part, is new, innovative and assumes all prior work is correct and can be reliably built upon.

On the other end of the research pipeline is the publication of results. Like when a researcher is trying to get funding for their work, they must show novelty and innovation to get published. As examples, two top tier journals, Cell and Nature require that the research being submitted for publication is ‘novel.’ Cell states that they are looking for papers ‘that report results that prompt new thinking about a biological problem or therapeutic challenge—work that will inspire others to want to build on it.’ Nature has two criteria points that state the work must be ‘of extreme importance to scientists in the specific field’ and ’ideally, interesting to researchers in other related disciplines.’ These criteria obviously promote and result in good, high quality papers, but such policies also box out research publications that might be important but only conformational.

There are journals such as PLOS One that just look at the quality and rigor of the science itself as criteria for publication, but these types of journals are not nearly as common. PLOS One states: ‘Judgments about the importance of any particular paper are then made after publication by the readership, who are the most qualified to determine what is of interest to them’ and that the journal accepts studies with negative results. However, when ranking journals, using the standard Impact Factor rankings as of 2017, Nature and Cell come in at 10th and 22th respectively and PLOS Medicine (a sub journal of PLOS One and highest ranked PLOS One journal) is ranked 167th. It’s easy to see where a scientist would rather publish to advance their career considering most jobs and tenure track promotions look not just at the number, but the quality (impact factor) of scientific publications.

A few groups have been attempting to solve both the funding and the publishing issues described here. The Dutch Organization for Scientific Research, an organization in the Netherlands similar to the NIH in the U.S., has begun to fund grants for replication research (8,9). Grants can either be for reanalysis of the data already collected or can be a complete repeat of the study to confirm its results. This initiative by the Dutch helps on the front end of the science pipeline by specifically allocating grant money for repeating a set of experiments already done by other groups rather than doing the proposed conformational experiments with ‘extra’ money that was intended for innovative and new work. On the publication end of the scientific pipeline, there are foundations and groups of concerned scientists that are working on publishing replication studies (10,11). In addition, the PLOS One Biology journal has recently announced that it will take ‘scooped’ work as long as it is submitted within 6 months of the original article. As a well-articulated article in The Atlantic points out, this will help the first group that publishes by allowing the ‘second place’ group to confirm their results and thus add to the reproducibility of that original study. The “second place” group still receives recognition through publication of the work they likely spent months if not years doing and does not waste the money and resources on that work that would normally not see the light of day.

While the over emphasis of novelty by the scientific community is not the only reason for the ‘reproducibility crisis,’ it is part of the underlining culture that might be contributing to it. Other factors eluded to above such as the pressure to publish in high impact journals, variable cell and mouse lines, and lab personnel differences also contribute to the problem. The Dutch initiative, PLOS One Biology and Open Science Collaborations are all examples of ongoing projects and attempts to help solve part of this ‘crisis.’ Other ideas to further this effort to increase science reproducibility in the United States would be for a policy change at the NIH funding level. With a slight tweak to current policy, the NIH could allow for one of the specific aims of a grant to specifically verify something that is pivotal or groundbreaking in the field. This explicit allowance would start to make replication studies more acceptable and perhaps make researchers more apt to perform and publicly verify or dispute previous studies. Another idea would be for other journals to take PLOS One Biology’s lead and allow for ‘scooped’ research to be published. Depending on the prestige (impact factor) of the journal, the time frame of said ‘scooped’ research could be shortened from the 6 months of PLOS One and have more stringent review requirements. An additional policy that all journals could adopt that would greatly strengthen scientific confidence in pivotal papers is to attach short communications/addendums that show peer reviewed replication attempts of that work. These addendums would add to the strength of the original paper if conformational, or suggest there is more nuance and the need for further study if they do not confirm the original paper. All found in one place to boot!

Implementation of further replication policies would take a real push by the scientific community, but would beneficial to the ongoing efforts in trying to solve the ‘reproducibility crisis.’  While it may take time before we see any tangible or measurable results from the current endeavors, we should look to other ideas and concepts that enhance science reproducibility. We can’t afford to squander the public’s great faith in the scientific community due to highly touted papers that turn out to be a false positives or simply wrong.

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Written by sciencepolicyforall

April 25, 2018 at 9:32 pm

Old Wounds and Shifting Tides: Potential Consequences of and Remedies for Health Disparities and Inequity in the United States

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By: Calais S. Prince, Ph.D.


By Jsonin [CC-BY-4.0], via Wikimedia Commons

By the year 2060, the percentage of racial and ethnic minorities is expected to increase by 49% in the United States. As the country becomes more diverse, it will become imperative to understand the genetic/epigenetic, molecular, cellular, and environmental differences associated with increased risk for disease onset. Currently, it is still clear that certain minority groups have a greater propensity for several diseases including diabetes, stroke, heart disease, and cancer. Health disparities are preventable differences in disease manifestation that can be attributed to social, political, and environmental factors. These factors can include, but are not limited to: discrimination, poverty, access to education, and exposure to hazardous chemicals.

Segregation in health care and the potential influence on participation in biomedical research

Although commonly perceived as a relic of the past, health care segregation in the United States persists and can be attributed to the Jim Crow laws that were designed and implemented following the Civil War through the 1960s. For example, “[m]any hospitals, clinics, and doctor’s offices were totally segregated by race, and many more maintained separate wings or staff that could never intermingle under threat of law” contributing to “subpar health care standards.” A glaring, present day example is that of Boston City Hospitals and Mass. General, which is both a reflection of the “the referral system that dates back five decades” and the type of care that will be covered by insurance. Another powerful, and personally relevant, example that demonstrates the importance of understanding how environment influences the risk for disease was discussed in a recent article. In African American/Black women, the consequences of racism had a significant impact on intrauterine stress as there are higher incidences of complicated pregnancies, miscarriages, premature births, and infant deaths which correlate with self-reported experiences with racism and discrimination. Conversely, African women were reported to have similar birth rates as Caucasian/White women. However, maternal health, pregnancy, and neonatal health of the grandchildren of African immigrant women born in the United States trend towards the patterns described in African American/Black women. These disparities are believed to contribute to the low percentages of minorities that participate in clinical and biomedical research as some of the barriers to participation are “distrust, provider perceptions, and access to care.” The cyclical nature of disparities: disparate living environments, disproportionate access to education and health care, postnatal complications, wealth inequalities, accelerated aging and morbidity, warrants a multifaceted solution to a pervasive, generational problem.

Mechanism that can potentially facilitate health care integration and improve participation in research

In 2010, the redesigned National Institute on Minority Health and Health Disparities (NIMHD) was established with a vision in which “all populations will have an equal opportunity to live long, healthy, and productive lives.” To accomplish this, NIMHD raises national awareness about the prevalence and impact of health disparities and disseminates effective “individual-, community-, and population-level interventions to reduce and encourage elimination of health disparities.” This vision recognizes the need to study health disparities within a variety of different modalities ranging from biomedical to social sciences as the majority of clinical and translational studies have been conducted in Caucasians/Whites. Specifically, there are four major NIMHD sponsored programs that provide funding to address the components of health disparities, inequity, and inequality at the levels of academe (Research Endowment Program), community (Community Based Participatory Research Program, Small Business Innovation Research/Small Business Technology Transfer Program), and internationally (Minority Health and Health Disparities International Research Training Program). It is also essential to facilitate mentoring of up-and-coming scientists and clinicians from underrepresented groups. The National Research Mentoring Network is a consortium composed of biomedical and clinical professionals that provide “evidence based mentorship professional development” for undergraduates through professionals; this serves as an important way to make inroads to increasing diversity in biomedical sciences. Earlier exposure to the sciences for underprivileged youth, as well as parental and community support, could serve as valuable avenues to combat health inequity.

Concluding thoughts: Demographic changes in the United States and the impact on biomedical research

The conversations surrounding disparities can be difficult, however, they are necessary. A concerted effort to improve the lives of those that are at risk/underserved have the potential to improve the lives of the individual as well as strengthen the scientific community. The projected increase of minorities in the United States warrants improved access to life saving treatment and encouragement of participation in biomedical research, as there is mounting evidence that environmental factors can influences the cellular and physiological response to stress. We also need to examine methodologies that will build trust in the scientific community which starts by: continuing to dismantle the remnants systematic discrimination, introducing science to underrepresented minorities earlier in their didactic training, providing community support, and train future researchers and clinicians to be more sensitive and responsive to the needs of the community in which they serve.

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Written by sciencepolicyforall

April 16, 2018 at 9:57 pm

Healthcare Policy – What’s in Store for Our Future Healthcare Needs?

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By: Emily Petrus, PhD

       There’s no question that the US spends too much on healthcare – in 2015 it cost 18% of its GDP, equivalent to $3.2 trillion dollars. In fact, we spend more on healthcare to cover just 34% of our population via Medicare and Medicaid than other countries who cover their entire population with universal healthcare. Most people assume that this higher spending equals better health, but unfortunately this isn’t the case.

According to a 2015 Commonwealth Fund survey, the US has the highest infant mortality and obesity rates and the lowest life expectancy of the top 13 Organisation for Economic Co-operation and Development (OECD) countries. In addition, we have the highest rates of prescription drug use, amputation due to diabetes mismanagement, and the second highest death rate from ischemic heart disease. Our relatively small percentage (14.1%) of people over age 65 also have the highest rate of at least two chronic illnesses per person. These numbers are estimated to increase as baby boomers age, so the outlook isn’t good when considering how many elderly people we can expect to suffer from chronic health issues.

However, it’s not all doom and gloom – we are in the top 3rd for surviving cancer, boast the lowest smoking rates, and have the highest access to diagnostic imaging services (such as MRI and CT scans). In this light, it makes sense that we spend more, have better access to expensive technology, and use more expensive prescription drugs. Another way to slice the data paints a different picture. The sickest 5% of the population accounts for 50% of medical spending, and accounts for 60% of spending on prescription drugs. Together these data indicate that the US could be in better shape if we had a healthier population.

How could we make the population healthier? Let’s consider that the determinants for health are 30% genetics, 70% behavior, environment and social factors, only 10% is mediated by healthcare. Other OECD countries spend significantly more on social services such as supportive housing, employment programs, retirement and disability programs. Social services are especially beneficial for people in lower income brackets, who incidentally have the poorest health in the US. The life expectancy for the poorest Americans is about 13 years less than the wealthiest. Racial disparities also contribute to gaps in healthcare outcomes for Black, Hispanic, Asian and American Indians/Alaskan Native Americans, all of whom experience worse medical care. The parameters measured included access to care, effective communication with medical staff, and a specific source of ongoing medical care, such as a primary care physician. It is estimated that these disparities amount to billions of dollars in economic loss – $35 billion in excess health care expenditures – for example, a trip to the emergency room for something that could be treated by better access to a primary care physician. Expanding Medicaid would increase medical access to poor and disadvantaged minority groups, for example, Blacks in the south. However, many states thatch have high at-risk populations decided not to expand Medicaid. Spending more on social services aimed at improving people’s health seems to be working in other OECD countries, and the National Academy of Medicine recommends the US increase spending in these areas.

Social services are unlikely to gain support from conservatives, so spending in this area is unlikely to be supported by the current administration. However, there are other areas in healthcare that can gain bipartisan support. 30% of medical expenses are considered wasteful – meaning they are for unnecessary services, fraud, and sky high pharmaceutical or administrative costs. Medicare has already saved billions of dollars by reducing overpayments to private insurers and tying medical provider payments to quality of care. Overall a goal of those involved in healthcare reform should seek to follow this example of prioritizing value over volume of care, which will translate to better outcomes at lower costs for patients and taxpayers.

So what did the Affordable Care Act (ACA, also known as Obamacare) achieve since it was passed in 2010? In the time leading up to the ACA, 82% of the American public wanted healthcare reform. Private insurance premiums were rising 10% per year, and insurance didn’t have to cover expensive benefits, so many plans came without services like mental health or maternity care. Maternity care is not just a women’s issue, healthier pregnancies result in healthier babies who become part of our population. Before the ACA, 50 million (17%) of the population was uninsured; by 2016 20 million people had gained health insurance, leaving only 10% of our population uninsured. Women and people with pre-existing conditions can’t be denied coverage or charged more by insurance companies. Lifetime spending caps were removed, meaning if you were a sick baby in the ICU you can’t be denied coverage for the remainder of your life. The most popular part of the bill allows young adults to stay on their parents’ insurance until age 26, which reduced the uninsured rate for young adults by 47%. Finally, tax credits made health insurance through exchanges more affordable for those at or below 400% of the federal poverty line.

Those are the good parts about the ACA – here’s the bad news.  High deductible plans have increased from 10% of plans offered in 2010 to 51% of plans in 2016, meaning people buying insurance can expect to pay at least the first $1,000 per year out of pocket. If it seems that premiums are jumping, they are: they rose 20% from 2011 to 2016. It’s easy to blame the ACA for rising premiums, but if we consider that premiums rose 10% per year before the ACA, 20% in 5 years doesn’t sound so bad. Some specific states are expecting huge increases, for example Oklahoma will see a 42% increase in 2016. Part of the reason premiums are rising is because healthcare gets more expensive each year – it outpaces inflation and wages. Insurance companies are also losing money because they have enrolled more sick, expensive people than they expected to when they set prices. The ACA attempted to mediate the sticker shock for insurance companies by setting up “risk corridors” to help shoulder the burden, but that part of the bill was scuttled for political reasons, and now insurance companies are passing the buck to consumers. Regarding taxes, under the ACA, those without insurance will face a penalty fee double that of the 2015 amounts.

A central campaign promise of Trump and Republicans was to repeal the ACA and provide better and more affordable coverage for all.  The American Health Care Act (AHCA) proposed several weeks ago by Republicans was a repeal and replace bill which was unpopular from the start. The AHCA was unpopular with conservatives for not going far enough to repeal the ACA, while moderates worried about the 20 million people, including their constituents, being denied or outpriced from insurance due to some elements of the bill. The AHCA removed the mandates requiring insurance companies to provide essential health benefits. This could lower premiums but insurers could also reduce services, leading to “junk plans”. Additionally, tax credits for people buying insurance would be significantly lower than current levels, making insurance too expensive for many middle-income people. Medicaid coverage was also proposed to shrink, resulting in less coverage for poor Americans. Finally, eliminating the community rating of the ACA would enable insurance companies to charge older and sicker people higher premiums, essentially pricing those who need insurance the most out of the market. The AHCA proposed to ameliorate this problem by providing larger tax credits to older individuals and setting up pools of high risk people subsidized by the government.

It is safe to assume that the Republican controlled House, Senate and the White House will try again to present bills that modify the ACA. However, it remains to be seen if they will try a bipartisan effort to fix certain parts of the bill that are flawed, or repeal and replace the ACA with something completely new.

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Written by sciencepolicyforall

April 14, 2017 at 9:22 am

Science Policy Around the Web – November 4, 2016

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By: Courtney Kurtyka, PhD

Source: Flickr, by Wellington College, under Creative Commons

Science Education

Unexpected results regarding U.S. students’ science education released

The National Assessment of Educational Progress (NAEP) is a nation-wide exam and survey used in the United States to ascertain student knowledge and education in key areas. Recently, the 2015 science education results from fourth, eighth, and twelfth graders in the United States were released, and showed some surprising outcomes. Out of seven different hands-on activities that students were asked if they completed as part of their curriculum, only one (simple machines) showed a positive correlation between activity participation and scores on the exam. Some activities (such as using a microscope or working with chemicals) showed no correlation with scores on the exam, while students who engaged in activities such as handling rocks and minerals actually performed worse than students who did not. Furthermore, not as many students engage in scientific activities as part of their curriculum as one might expect. For example, 58% said that they never used simple machines in class, while 62% say they never or rarely work with “living things”.

An anonymous expert on the assessment suggested that one potential explanation for these unexpected results is that the assessment asks whether students completed any of these activities “this year”. Therefore, for the results from twelfth graders, students who use rocks and minerals in class tend to be in lower-level science courses, and are more likely to not perform as well on the exam as students in higher-level courses that would not include that activity. However, this does not account for the low level of reporting of scientific activities overall.

Another concerning aspect of the exam is related to the reporting of the results. The National Center for Education Statistics (NCES), which manages the NAEP, operates a website that is both difficult to use and incomplete. In fact, when using the drop-down menu of results from the survey, only the results of activities that have positive correlations with test scores are listed. NCES has said that they show results based on what they think are of greatest interest to the public.

While some cite the positive results as a reflection of the success of active learning techniques, others note that 40% of twelfth graders who took the NAEP did not have a “basic” knowledge of science. Additionally, these results are interesting for many because the twelfth graders reflect the first students to have spent their entire education under No Child Left Behind, which mandated annual assessment of reading and math for third through eighth graders. Since many have argued that this law leaves less room for teaching topics that are not tested (such as science), examining students’ scientific performance under these guidelines is important. (Jeffrey Mervis, Science Magazine)

Health Disparities

Sexual and gender minorities are officially recognized as a minority health population

The National Institute on Minority Health and Health Disparities (NIMHD), one of the institutes and centers within the National Institutes of Health, recently officially recognized sexual and gender minorities (SGM) as a distinct minority health population. The SGM population is very diverse, including lesbian, gay, bisexual, and transgender communities, as well as those from additional sexual and gender classifications that differ from various norms (such as traditional, cultural, etc.).

Multiple health disparities (meaning that the likelihood of disease and death from particular diseases and disorders in that group differ from the average population) have been identified in the SGM population. Some of these issues include a lower likelihood of women who have sex with women getting Pap smears and mammograms, and higher rates of depression, panic attacks, and psychological distress in gay and bisexual men.

Previously, the NIH requested a report on SGM health that was published in 2011, and later created the Sexual and Gender Minority Research Office (SGMRO) following the results of the report. Now, this official designation will allow researchers focused on SGM health to be able to apply for health disparity funding from the NIH, and Karen Parker (the director of the SGMRO at the NIH) said that she hopes that it will lead to increased interest in applications to support health research related to this population. (Nicole Wetsman, STAT)

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Written by sciencepolicyforall

November 4, 2016 at 9:00 am

Global disparities in cancer treatment and recent policies to address cancer care

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By: Nivedita Sengupta, Ph.D.

photo credit: phalinn via photopin cc

According to American Cancer Society more than 8 million people worldwide die from cancer every year. The number of deaths worldwide from communicable diseases like malaria, HIV and AIDS is insignificant compared to the number of global deaths from cancers which is expected to cross the 13 million mark by 2030, making cancer the leading cause of death worldwide. Cancer as a non-communicable disease has long been considered a disease of developed countries, where people are more likely to succumb to long-term chronic diseases rather than dying from infectious diseases. However, according to statistics from the World Health Organization (WHO) and American Cancer Society, of the 14.1 million new cancer cases reported worldwide in 2012, 6.1 million were from developed countries compared to 8 million in developing countries – and these numbers are still rising. The number of new cancer cases in developing countries is predicted to rise to 13.1 million by 2030. These discrepancies between developed and developing countries are also apparent in childhood cancers. Childhood cancers account for less than 1% of the total cases in developed countries but about 4% in developing countries. Considering that reliable data on incidence are only available for a fifth of the world population consisting of people in mostly high-income countries, the actual statistics on cancer in developing countries may be even higher making cancer a significant and growing health burden in developing countries.

Escalation of cancer cases in developing countries over the past years has resulted in an increase in cancer-related health care costs, building up a global financial burden due to cancer. In 2010, $290 billion was spent to treat 13.2 million new cancer cases worldwide and this spending is projected to increase to $458 billion by 2030. Despite a wealth of data on how to diagnose and treat cancer, funding for cancer remains a low priority in context of health spending for both developing countries and for the nations providing donations. Only 5% of global resources devoted to cancer are spent in developing countries. In 2014, total global funding for development assistance for health was $35.9 billion, and only 2% of that amount was allocated for assistance in the area of non-communicable diseases of which cancer is only one aspect. This sets up an untenable situation as developing countries do not have the resources to tackle the rising human cost of cancer within their borders and necessitates significant global interventions and funding.

One potential in-country way to combat and prevent many of the deaths from cancer could be by raising awareness of the signs and symptoms of cancer among the general population, as well of awareness of proven ways to prevent cancer. A 2007 study on breast cancer in Malaysia found that 52.2% of newly diagnosed patients have stage III and IV cancers due to a lack of awareness of the signs and symptoms of cancer leaving them to seek treatment further into the disease progression. Most of these women were from rural Malaysia, with little or no education. Earlier screening for these and other cancers could help prevent cancer deaths. The major cancer types found in the developing countries are breast, cervical and colorectal cancer. Many of these cancers respond to treatment if detected early and treated adequately. However due to lack of cancer diagnosis facilities, by the time cancer is detected in these poor people it progresses to a stage where palliative care becomes the only option. In another example, potentially up to 20% of cancer deaths in developing countries could be prevented by immunization against HBV and HPV infections. Public-private global health partnerships like GAVI Alliance have partly facilitated the availability of HPV vaccines in the poor countries such as Kenya, Ghana, Madagascar, Malawi, Niger, Sierra Leone and the United Republic of Tanzaniato. However, poor people living in the middle income countries like China, Malaysia, India and Brazil are excluded from this initiative due to their country’s slightly higher income.

Another significant problem needing attention is a lack of proper infrastructure (in terms of equipment and people) for cancer treatment in developing countries. Currently, treatment options in developing countries are very limited and expensive. In developed countries people can have better health care coverage and access to up-to-date cancer care facilities and treatment, in addition to dedicated cancer research centers and specialists. Most developing countries have limited treatment centers with proper infrastructure and oncologists. According to the International Atomic Energy Agency (IAEA), even though 85% of the world’s population resides in developing countries, the average number of pieces of therapy radiation equipment in developing countries is only 0.4 units per million inhabitants, compared to more than six units per million inhabitants in developed countries. The few developing countries who are privileged enough to have access to radiotherapy equipment face considerable financial burdens in then providing the necessary training, equipment set-up and maintenance, protocols and quality control for proper usage of these machines for cancer treatment. Oncology and palliative care training is limited in medical schools and very few doctors and nurses can afford to have training outside their country resulting in lack of sufficiently trained staff in developing countries to deal with the increasing load of cancer cases.

Even treating cancer patients at all can be difficult in developing countries. Apart from expensive cancer drugs themselves, pain medications for palliative care like morphine are not easily available in these countries. Statistics show that 99.9% of cancer patients in developing countries are dying with untreated pain. 84% of the morphine used globally goes to the developed countries, leaving just 16% for the rest of the world. This is not because of limited morphine production but rather mainly because of onerously complicated and expensive narcotic supply regulations set by the International Narcotics Control Board (INCB). The structure of surveillance and accountability requirements implemented by INCB makes it almost impossible for poor nations to comply because of poor infrastructure and lack of educated people to handle issues necessary to comply with the regulatory needs. Moreover, country specific regulatory laws make it harder for the doctors to prescribe these medicines. All patients in need of pain relief could be helped if proper laws are implemented to gain access to pain medication and palliative care.

Drug companies themselves can help to address these health disparities in developing countries. On March 31st 2016, GlaxoSmithKline (GSK) CEO Andrew Witty announced a series of new patent policies designed to make innovative GSK medicines available to more people living in under-developed and developing countries. The new polices have a special focus on improving access to cancer drugs specifically. In the policy, GSK plans to stop filing for patents on its molecules in 50 of the least developed and low-income countries. In developing lower-middle-income countries, GSK will continue to file for patents but will grant licenses to generics manufacturers. This will enable easier access to cheaper generic versions of GSK’s drugs in those countries for the treatment of cancer. Furthermore, GSK will submit patents on future cancer drugs it develops to the United Nations-backed Medicines Patent Pool (MPP). The MPP deals in large-scale licensing agreements between drug developing companies and generics manufacturers thus enabling greater access to medicines in up to 127 developing countries. GSK has been applauded for this venture and the initiative also reveals the growing awareness among people regarding the magnitude of disparities in cancer care around the world. However experts says that a lot more still needs to be done in terms of improving access to needed medications. Ironically, most of the world’s poor live in ‘middle income’ countries such as China, India and Brazil that are not included in these polices and therefore will not gain anything from these new measures.

To reduce the death burden due to cancer in developing countries significant funding is needed, and one key challenge is how to obtain that funding. International advocacy is required to mobilize the international community and individual governments to take action. A number of influential international advocates like the UN, WHO and IARC are already active and trying to form partnerships with international health professionals, non-government organizations (NGOs), and funding organizations to bridge the gap between funding and treatment. By taking the necessary steps in proper direction to strengthen cancer prevention, early detection, treatment and palliation, much can be done to help improve cancer control in developing countries.

Written by sciencepolicyforall

May 23, 2016 at 9:00 am