We are pleased to feature this guest post from our colleagues Eliseo J. Pérez-Stable, MD, Director, National Institute on Minority Health and Health Disparities, NIH and Shannon N. Zenk, PhD, MPH, RN, FAAN, Director, National Institute of Nursing Research, NIH. It was originally published on July 17 in the NIMHD Insights blog as well as the NINR News and Notes newsletter.
Why does the statement “Your ZIP code is more important to your health than your genetic code” surprise people but resonate with many population scientists?
In the United States, 21 percent of the population lives in concentrated poverty areas, limiting access to health-promoting resources and services. Research shows people living in concentrated poverty areas have poorer health outcomes across a wide range of diseases and conditions and are also more likely to die than those living in other areas.
Recognition that concentrated poverty along with other social and economic factors have profound and prolonged impacts on health has recentered attention on identifying evidence-based solutions to address them.
Social determinants of health (SDOH) have emerged as an increasingly high-priority research area for the National Institutes of Health (NIH), other Federal agencies, and organizations across a variety of sectors and NIH is at the forefront of building this evidence base to improve health and advance health equity.
The NIH-wide Social Determinants of Health Research Coordinating Committee (SDOH RCC), established in 2022, was created out of an urgent need to develop a coordinated strategy to propel discoveries to improve individual and population health, reduce health disparities, and advance health equity. Growing out of a grassroots effort by staff across NIH, the SDOH RCC’s overarching goal is to accelerate NIH-wide SDOH research across diseases and conditions, populations, stages of the life course, and SDOH domains. It also focuses on effectively leveraging SDOH investments and innovations across NIH Institutes, Centers, and Offices (ICOs) to advance discoveries in this dynamic multi-disciplinary scientific field, ranging from foundational research to intervention research to implementation science. Importantly, it is a cross-cutting effort with 20 ICOs participating in the leadership committee and even more represented in the larger SDOH RCC.
As a leader in research discovery and funding, a unified conceptualization of SDOH is essential for NIH-wide coordination and strategic growth of the evidence base for SDOH impacts on health and mechanisms, advancement of methods, and intervention development and testing. The conceptualization that the SDOH RCC developed builds on existing conceptualizations but is refined to help the NIH effectively communicate with the scientific community and, over time, continue to strengthen and expand a framework for SDOH research. The NIH conceptualization underscores that SDOH are the conditions in which people are born, grow, learn, work, play, live, and age and the broader set of structural factors shaping the conditions of daily life. These structural factors include social, economic, and legal forces, systems, and policies that determine opportunities and access to high-quality jobs, education, housing, transportation, information and communication infrastructure, food and health care; the social environment; and other conditions of daily life. Our conceptualization recognizes that SDOH can improve, maintain, or hinder health through multiple direct, indirect, and interacting mechanistic pathways. And SDOH may have different health consequences within and across populations due to differences in exposure or susceptibility to health-promoting or health-compromising conditions of daily life. The unequal allocation and distribution of power and resources based on race, ethnicity, sex, gender identity, sexual orientation, socioeconomic position, geography, and their intersections manifest in inequitable conditions of daily life, contributing to the large and persistent health disparities we see in this country.
In fiscal year 2022, NIH invested about $4.1 billion, funding more than 8,300 SDOH research and training programs. In addition, not only does NIH’s 2021-2025 strategic plan call for research on SDOH, but most NIH ICOs explicitly mention SDOH in their strategic plans. Further, several NIH-wide research initiatives were established to specifically focus on advancing SDOH research. Here are a few examples of NIH-wide SDOH research initiatives and their aims:
- The Community Partnerships to Advance Science for Society (ComPASS) Program seeks to 1) develop, share, and evaluate community-led health equity structural interventions that leverage partnerships across multiple sectors to reduce health disparities and 2) develop a new health equity research model for community-led, multisectoral structural intervention research.
- Addressing the Impact of Structural Racism and Discrimination on Minority Health and Health Disparities is a cross-collaborative initiative, encompassing 14 ICOs that is supporting 38 applications with more than $125 million committed over 5 years for 1) observational research to understand the role of structural racism and discrimination (SRD) in causing and sustaining health disparities, and 2) intervention research that addresses SRD in order to improve minority health or reduce health disparities. This funding opportunity has been reissued by NIMHD, NINR, and other ICOs.
- Firearm Injury and Mortality Prevention Research complements existing ICO initiatives focused on many types of violence like child maltreatment, intimate partner violence, or elder abuse. Since fiscal year 2020, Congress has appropriated $12.5 million a year to NIH for firearm injury and mortality prevention. Initiatives using the appropriated funds have focused on a wide range of populations and settings, capacity building, and research on implementing and testing innovative community-level interventions that address SDOH in various ways.
There are many more Notices of Funding Opportunities (NOFOs) focused on SDOH in addition to parent NOFOs that provide opportunities for scientists to propose new SDOH research.
NIH seeks research that yields rigorous and actionable evidence, including a focus on:
- Upstream structural factors to address the fundamental causes of poor health and health disparities and involves meaningful partnerships with communities; local, state, and federal agencies; and multiple sectors.
- Viewing and approaching SDOH research through a lens of intersectionality.
- Linkable high-quality data and measures of SDOH at multiple levels to comprehensively understand independent and combined contributions and to identify intervention targets and policy levers.
As we continue to expand and innovate in accelerating SDOH research, we invite you to visit the respective ICO websites and reach out to program officers that align with your research to understand SDOH priorities and to view current and upcoming SDOH NOFOs.
SDOH research is essential to fulfilling NIH’s mission of enhancing health for all people. The progress in recent years has increased the depth and breadth of the NIH SDOH research portfolio, but there is more to be done. The SDOH RCC is committed to integrating and accelerating SDOH research across NIH. The ultimate goal of this coordinated effort is to increase the impact of the research so that the findings support individuals, communities, and populations in a manner that improves health, reduces health disparities, and advances health equity.
So, the answer is yes. Your residential ZIP code may be more important to your health than your genetic code. Like gene therapy, “ZIP code therapy” will entail new scientific challenges. The prospect of discovering structural interventions that will eliminate disparities and achieve equity makes it a frontier well worth our collective commitment.
Dr. Pérez-Stable practiced primary care internal medicine for 37 years at the University of California, San Francisco, before becoming the Director of NIMHD in 2015. His research interests have centered on improving the health of individuals from racial and ethnic minority communities trhough effective prevention interventions, understanding underlying causes of health disparities, and advancing patient-centered care for underserved populations. Recognized as a leader in Latino health care and disparities research, he spent 32 years leading research on smoking cessation and tobacco control in Latino populations in the United States and Latin America. Dr. Pérez-Stable has published more than 300 peer-reviewed papers.
Dr. Zenk joined NINR as Director in September 2020. She was previously a Nursing Collegiate Professor in the Department of Population Health Nursing Science at the University of Illinois Chicago (UIC) College of Nursing, and a fellow at the UIC Institute for Health Research and Policy. Dr. Zenk’s research focuses on social inequities and health with a goal of identifying effective, multilevel approaches to improve health and eliminate racial/ethnic and socioeconomic health disparities.