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L Summary of Recommendations 1. The National Institutes of Health (NIH), through the National Center on Minority Health and Health Disparities (NCMHD) and the Institutes and Centers (ICs) and, when appropriate, collaborating agencies, should undertake research to further refine and develop the conceptual, definitional, and methodological issues involved in health disparities research and to further the understanding of the causes of disparities. 2. The NIH director should assure that the Strategic Plan is reviewed and revised annually using an established, trans-NIH process subject to timely re- view, approval, and dissemination. 3. The Strategic Plan research objectives should promote more integration of research on the multifactorial nature of health disparities, including non- biological factors; population research to further the understanding of the pres- ence, prevalence, trends, and other elements of health disparity conditions; and when opportunity exists, an understanding of the causes of disparities in health care. 4. The Strategic Plan should include measurable targets and time periods for the research capacity objectives. NIH, through NCMHD's oversight, should develop methods of measuring, analyzing and monitoring the results of programs that address research capacity, including workforce, institutional, infrastructure, and community-based participatory health disparity research objectives. 5. The Strategic Plan's communication programs should be organized as a specific trans-NIH effort with centralized coordination with particular attention to the strategic planning, design, prioritization, implementation, and evaluation of efforts across NIH. The initiative should: be informed by advisory expertise; develop a surveillance system to identify information needs and availability, 278

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APPENDIX L 279 sources, behaviors, and use patterns; and promote attention to the issue of in- equalities in health communication. 6. The development of updated Strategic Plans should include assessments of the appropriateness of the individual strategic plans of the ICs, including whether they adequately reflect the overall goals and objectives of the NIH Strategic Plan. Objectives should be time-based and targeted with measurable outcomes. 7. NCMHD should consider the designation of additional health disparity groups based on an informed process and developed criteria. It should promote development of, and access to, a registry of diseases and conditions for which disparities exist with regard to race, ethnicity, socioeconomic status, geographic locale, and other designated health disparity populations. 8. Within NIH, a clear and timely budget process should be linked to the Strategic Plan, and it should be updated in a timely manner. Annual budgets should include information for NIH as a whole, and for each involved IC and office, and should detail allocations for the Strategic Plan goal areas and each objective. Trans- NIH budget information on efforts made in the major categories of research, re- search capacity, and communication also should be made available. 9. The NIH director should review and assess the administrative staffing of NCMHD to assure that it is sufficient to attend to the Center's responsibilities. Increasing the science leadership and presence within NCMHD should be pursued by the NIH and NCMHD directors. This entails the appointment of additional eminent scientists, recognized in the areas of minority health and health disparities, and the establishment by NCMHD of committees and panels with relevant expertise from within and outside NIH. 10. The NIH director, through the established authority of the NCMHD director, should assure continuous, effective coordination of the health disparities research program across the NIH including: Timely development of Strategic Plan revisions; Effective, ongoing participation of the ICs in the Strategic Plan and the health disparities research program. Establishing appropriate committees involving the directors of the ICs and others to facilitate collaboration and coordinated approaches to health dis- parities research and the setting of priorities; Fostering of conferences and the use of committees and panels involving the NIH, extramural scientific communities, and others to inform and advise on initiatives and directions; and Monitoring of the execution of the Strategic Plan to ensure that its ele- ments are implemented.