At the National Institutes of Health, the premiere biomedical research institution in the United States, the struggle against human disease takes on particular significance when we consider the disproportionate impact these diseases have on the country's minority communities. Through 2003, African Americans and Hispanics accounted for 40% and 19%, respectively, of AIDS-related deaths, according to the Centers for Disease Control and Prevention.¹ That year, African Americans and Hispanic Americans accounted for almost two-thirds of all individuals diagnosed with HIV in 2003. And these types of disparities may only increase as the United States sees a major shift in demographics from minorities to majorities in the coming decades.

Accordingly, it has become increasingly clear to a growing body of scientists and policymakers that building a diverse pool of scientists and clinical investigators is mission critical in our efforts to reduce health disparities. African Americans, however, are hardly represented at all among scientists in the United States working on these problems, either at the bench or in the clinic. According to the Nelson Diversity Surveys, African Americans, who make up 12% of the US population, comprised approximately 1% of the total number of tenured and tenure-track investigators at the top 50 academic institutions in the United States in 2002.²

S&E Doctorates Awarded to US Citizens and Permanent Residents by Field and Race/Ethnicity, 1994-2001 Click to view detailed diagram

Unlike academia, however, the NIH has a Congressional mandate to end health disparities.³ Further, given its stature and the level of public support the NIH receives, one might expect things to be different there. However, that's not the case. Black scientists now represent less than 1% of all tenured investigators, and 1.5% of all tenure-track investigators at the NIH. Those numbers are actually worse than they were a decade ago, when the figures were 2% and 4.5%, respectively, and those figures reflect national trends.⁴

The impact of this dearth of scientists will continue to be felt as we attempt to conduct NIH-sponsored clinical trials and vaccine studies in our respective communities. Where will we get the needed scientific and public-health leadership to address concerns that come with these complex interventions? To whom will our communities turn for answers to questions about stigma and social harm associated with clinical trials?

To some extent, the problems at the NIH reflect the nation's pipeline problem that has resulted in low numbers of minorities pursuing advanced degrees and scientific degrees. The number of African Americans earning PhDs in the biological sciences rose from 78 in 1994 to 136 in 2001, according to the latest figures available from the NSF.⁵ But despite this near doubling, a parallel increase was not seen in the numbers of African American PhD postdoctoral fellows nor tenure-track or tenured-investigator appointments within the NIH. Indeed, the number of tenure-track investigators declined from seven to five.

Compare that to trends for Hispanic Americans. In 1994, 131 Hispanic Americans earned PhDs in the biological sciences; by 2001 that number had grown to 164. But the number of Hispanic Americans in tenure-track positions at the NIH more than doubled, from seven to 17, and the number of tenured investigators grew from 17 to 24. It's unclear as to why such a difference exists between Hispanic Americans and African Americans, but figuring out those reasons might help to address this disparity.

It is important to note that the NIH is committed to, recognizes and prioritizes health disparities. It created the National Center for Minority Health Disparities in 2000, and every institute and center at the NIH has adopted a plan to address the issue. However, the creation of that center did not have an impact on the plight of minority scientists within the agency.

In addition, senior officials within the NIH administration have voiced their concerns over the agency's lack of diversity, particularly for African Americans at senior scientific levels. In a 2004 article in the NIH Catalyst, deputy director for intramural research Michael Gottesman acknowledged the problem of recruitment, retention, and promotion of minority scientists. Further, he lamented the fact that nothing had changed in the 10 years that had passed since he wrote a similar article in 1994.²

The good news is that the NIH has recently initiated several programs to address the challenge of building a more diverse biomedical research workforce at the NIH, with some measure of success. The NIH Academy, which has been in place for several years, and the more recently established NIH Health Disparities Postdoctoral Scholars Fellowship Program, aim to enhance research dedicated to the elimination of domestic health disparities through the development of a diverse pool of biomedical researchers. A major goal of both programs is to increase the numbers of highly trained and qualified minority scientists and clinical investigators who conduct translational biomedical research in areas focused on health disparities. It's too early to know if these programs will be successful, but early signs are promising.

It's clear that the NIH will have to increase its efforts to recruit, retain, and promote highly trained and qualified postdoctoral candidates. One strategy might be to increase the efforts to attract highly qualified PhD and MD graduates from historically black colleges and universities, and to increase efforts to draw from the pool of minority graduates from majority institutions. Second, supporting and expanding efforts such as the NIH Academy and the health disparities fellowship would aid in the effort to retain minority scientists once they arrive at the NIH.

 

 

Third, the NIH should consider creative ways to provide increased access and opportunities for minority scientists, such as private-public partnerships and foundations. The Merck-United Negro College Fund Minority Fellowship Program, which has been operating effectively for 10 years and has successfully trained more than 370 PhD, MD, and MD-PhD scientists, might serve as a good model for this approach. These efforts might begin to fix the leaks in the pipeline and build a pool of NIH-trained scientists prepared for the next level of tenure track and tenure at the NIH and beyond.

Finally, working with groups such as the newly formed National Association for Blacks in BIO, JustGarciaHill, and the Society for the Advancement of Chicanos and Native Americans in Science would facilitate much-needed networking between minority communities and the NIH, and would enhance the NIH's recruitment efforts. These groups are already tied into their respective communities and would be able to amplify NIH's outreach and recruitment efforts.

It is clear that the NIH will continue to occupy a special and unique niche as the centerpiece of our nation's biomedical research enterprise. It will continue to be the premiere institute that, in addition to funding, supports and provides opportunities for the education, training, and employment for the next generation of scientists. If the NIH can develop effective ways to address the scientific workforce diversity issue within its own ranks, then perhaps it can serve as a model for the extramural academic community, which struggles to effectively solve this problem.

Amri Johnson, founder and president of Wellsolve (www.wellsolve.com), a diversity-focused, health and healthcare human resources consulting and training company, is a graduate of Morehouse College and received an MPH from Emory University.