Session Description:
The goal of this session is to identify opportunities for the Multiscale Modeling (MSM) community and MSM research to address health disparities and health inequity experienced by socially disadvantaged populations. We hope to provoke thought and discussion about:
• current health disparities and inequity issues,
• how MSM research can contribute to health equity,
• how MSM research might be inadvertently amplifying health disparities,
• funding opportunities that support health disparities research,
• collaborations for pivoting or expanding existing projects, towards health equity,
• how modelers in other fields incorporate public health/health equity data.
Schedule:
10:30-10:55 am: Shalanda Bynum (NIH National Institute of Nursing Research) & Yvonne Ferguson (NIH Office of the Director)
- Presentation:
10:55-11:20 am: Allison Reilly (University of Maryland, Department of Civil and Environmental Engineering)
11:20-11:45 am: Jasmine Miller-Kleinhenz (Emory University, Rollins School of Public Health)
Background Material:
NIH Compass Program
Social Determinant of Health (SDoH) Literature Summaries
Speaker Bios & Presentation Materials:
Dr. Yvonne Owens Ferguson, Ph.D., M.P.H (NIH Office of the Director) is a Program Leader at the NIH Common Fund. Trained as a public health behavioral scientist, her research areas include implementation science, community engaged research, program evaluation, behavioral interventions and health disparities. At NIH, Dr. Ferguson’s portfolio includes the Transformative Research to Address Health Disparities and Advance Health Equity Program and the Community Partnerships to Advance Science for Society (ComPASS) Program.
Previously, Dr. Ferguson served as a Scientific Review Officer (SRO) with the National Institute on Drug Abuse (NIDA) and at the Center for Scientific Review (CSR) where she served as the SRO for the implementation science focused study section 2017-2019. Prior to joining NIH, Dr. Ferguson conducted large-scale regional and program evaluations as a senior global health research consultant with organizations in the United States, Switzerland, and the Caribbean. Dr. Ferguson completed her post-doctoral training as a Kellogg Health Scholar at the University of North Carolina at Chapel Hill (UNC-Chapel Hill) Gillings School of Global Public Health. Dr. Ferguson received her Ph.D., with a certificate in International Development, and her M.P.H. in Health Behavior, also from UNC-Chapel Hill.
Dr. Shalanda Bynum, Ph.D., M.P.H (NIH National Institute of Nursing Research) is a Program Director at the National Institute of Nursing Research (NINR) Division of Extramural Science Programs. In this role, she oversees a research grant portfolio focused broadly on the social determinants of health and health equity. Before joining NINR, Dr. Bynum served as a Scientific Review Officer in the Division of AIDS, Behavioral and Population Sciences at the NIH Center for Scientific Review. Prior to NIH service, Dr. Bynum was a faculty member at the Uniformed Services University of the Health Sciences. As a public health scientist, Dr. Bynum’s research program focused primarily on addressing the unequal burden of cancer among minoritized populations through understanding and intervening upon barriers related to literacy and language, geography, historical mistrust, healthcare system failures, and other social factors.
Dr. Bynum holds a BS in psychology from Florida Agricultural and Mechanical University and an MPH and PhD in Health Promotion, Education, and Behavior from the University of South Carolina Arnold School of Public Health. Dr. Bynum completed postdoctoral training in Behavioral Oncology at H. Lee Moffitt Cancer Center and Research Institute.
Dr. Allison Reilly, Ph.D. (University of Maryland, Department of Civil and Environmental Engineering) is an assistant professor at the University of Maryland in the Department of Civil and Environmental Engineering in the area of risk and infrastructure systems. Her research focuses on unpacking the dynamics between policy and infrastructure vulnerability. She has worked on problems in numerous infrastructure sectors including electric power, water distribution systems, septic systems, transportation systems, residential buildings, and cybersecurity. Much of her recent work has focused on risk equity within rural, coastal areas vulnerable to sea-level rise, and, related, how investments in infrastructure that are integrated within broader resilience strategies may enable more just transitions. Dr. Reilly holds a Ph.D. and an M.S. in Civil and Environmental Engineering from Cornell University and a B.S. in Civil Engineering from the Johns Hopkins University.
Dr. Jasmine Miller-Kleinhenz, Ph.D. (Emory University, Rollins School of Public Health) is a postdoctoral fellow in Dr. Lauren McCullough’s research group in the Rollins School of Public Health at Emory University and is the recipient of the NCI Pathway to Independence Award for Outstanding Early-Stage Postdoctoral Researchers (K99/R00). Dr. Miller-Kleinhenz conducts research at the intersection of molecular biology, epigenetics, and epidemiology to investigate the molecular underpinnings of health disparities. The goal of her research is to understand how socio-structural determinants of health “above the skin” influence biological mechanisms “under the skin” and drive cancer disparities. Her research currently focuses on investigating the impact of socio-structural determinants of health on the tumor epigenome as a potential driver of racial disparities in breast cancer. She is particularly interested in investigating the impact of aberrant epigenetic activation of stem cell signaling via exposure to disadvantageous social factors on the etiology of Triple Negative Breast Cancer (TNBC), a cancer with known health disparities. Employing her unique expertise in a combination of molecular assays, epigenetic techniques, and epidemiologic methodologies, her research aims to provide new insights into molecular mechanisms that contribute to breast cancer disparities.
Moderator Bios:
Kyoko Yoshida is an Assistant Professor of Biomedical Engineering at the University of Minnesota. She received her M.S. and Ph.D. in Mechanical Engineering from Columbia University, where she studied the mechanical property changes of the cervix during pregnancy. She conducted her postdoctoral training at the University of Virginia, focusing on developing multiscale computational cardiac growth and remodeling models. Her lab combines computational systems biology with mechanical growth and remodeling techniques to understand soft tissue adaptation during pregnancy. Specifically, the lab is interested in understanding the interaction mechanisms of hormonal and mechanical signaling in driving maternal heart and uterine growth and remodeling during, after, and in subsequent pregnancies.
Elsje Pienaar is an Assistant Professor in the Weldon School of Biomedical Engineering at Purdue University. She earned her MS and PhD in Chemical and Biomolecular Engineering from the University of Nebraska-Lincoln and did postdoctoral work in Microbiology, Immunology and Chemical Engineering at Linköping University, Sweden, and the University of Michigan. Her lab uses agent-based and ODE-based computational models to simulate and characterize within-host dynamics of host-pathogen-drug interactions. Current projects in the lab involve: TB, HIV, Non-tuberculous mycobacteria, and Ebola virus infections.
Asif Rizwan holds the position of Scientific Program Director at NIH/NHLBI, where he is responsible for supervising NIH grants in various scientific domains such as biophysics, systems biology, diagnostics, imaging, and AI/machine learning. Additionally, he represents NHLBI in ODSS funding opportunities that focus on the ethical application of AI/ML in biomedical and behavioral sciences. Asif Rizwan is also a member of the NIH Transformative Health Disparities Research Working Group.
Comment
Chronic Stress
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Identifying the Collaborations
I'm curious which disciplines the panelists believe should be integrated into our modeling paradigms more (sociologists, psychologists, public health officials, etc.)?
Affordable Health Technology
Are there specific science initiatives in more affordable healthcare technology (e.g., smart watches, remote blood pressure measurements) for addressing health disparities? If so, could you comment on what you view as the most important factors that should be considered in developing these new technologies (price vs accuracy vs accessibility)?
You can apply through our…
- You can apply through our parent R01 and other similar programs.
- SBIR RFA: Innovation for healthy living: https://grants.nih.gov/grants/guide/rfa-files/RFA-MD-23-003.html
great opportunity
Thanks for this great session - super helpful
use of Geographical information systems (GIS)
Using GIS the zip code is too large of a "block" census blocks are used typically and the concept of "scale" is important here..
one recent finding (unpublished) is that proximity to health care (centers, etc) is a key determinant of health..thoughts on this?
Yes, access to healthcare is…
Yes, access to healthcare is an important factor.
Scale of study
Many of the factors considered in SDOH seem to be at the population level. Are there efforts to understand the molecular to cellular scale impacts of SDOH?
How to bridge SDoH and biochemical MSM
Are there existing project examples of bridging individual/community health with molecular/cellular/tissue level analysis? If not, what kinds of uses do you imagine for extending biochemical mechanistic models to SDoH?
This is a great question,…
This is a great question, that we hope to explore more in the breakout session. Our third speaker will also speak to how community factors impact the molecular/cellular levels biologically - which could serve to guide MSM efforts.
infrastructure talk - fantastic!
GIS could help here identify areas that are most vulnerable -- but who can/will fund the structural changes that are needed?
NIH supported research…
NIH supported research abstracts can be found here: https://reporter.nih.gov/
Relevant NIEHS Workshops
In 1921 and 2022, NIEHS held two workshops relevant to this issue (the environmental aspects) with inspiring example of community involved research. See these links for the presentations, potential collabotors, etc.
https://bit.ly/2XJJiwy
https://www.niehs.nih.gov/news/events/pastmtg/2022/eheworkshop2022/
Post Katrina comment
the city KNEW that the levees were weak yet they did not do anything about it. who and how can accountability happen?
Funding Opportunities
•PAR-22-230: NINR Areas of Emphasis for Research to Optimize Health and Advance Health Equity (R01 Clinical Trial Optional)
•PAR-23-112: Addressing the Impact of Structural Racism and Discrimination on Minority Health and Health Disparities (R01 - Clinical Trial Optional)
•RFA-MD-23-004: Community Level Interventions to Improve Minority Health and Reduce Health Disparities (R01 - Clinical Trial Optional)
•PAR-23-170: Interventions to expand cancer screening and preventive services to ADVANCE health in populations that experience health disparities (R01, Clinical Trial Required)
•RFA-HG-23-017: Investigator-Initiated Research in Genomics and Health Equity (R01 Clinical Trial Optional)
•RFA-AG-24-036: Measuring Financial Hardship Among People and Families Living with AD/ADRD (R01 Clinical Trial Not Allowed)
septic systems
as the systems age lead can leak in and lead to many bad problems as well as failed systems. who/how can create a regular check system?
ComPASS
- Social determinants of health encompass the conditions in which people are born, live, work, and age, and they significantly influence health outcomes and risks.
- Addressing health disparities and promoting health equity extends beyond traditional healthcare settings and requires interventions at multiple levels.
- Structural interventions aim to modify social, economic, political, and physical environments that contribute to health disparities, offering the greatest opportunity to advance health equity.
- Examples of structural interventions include criminal justice system policy changes, universal basic income programs, broadband internet expansion, and community revitalization projects.
- Meaningful community engagement principles include trust, bi-directional communication, inclusivity, cultural centeredness, equitable financing, shared governance, ongoing collaboration, and co-creation.
- Community Partnerships to Advance Science for Society (ComPASS) is a program supported by the NIH Common Fund, focusing on health equity and leveraging structural interventions through multi-sectoral partnerships.
- The goals of ComPASS are to implement community-led health equity structural interventions, reduce health disparities, and develop a research model for community-led structural intervention research.
- Community-Led Health Equity Structural Interventions (CHESIs) are aimed at intervening upon structural factors that perpetuate health disparities and are developed, implemented, and assessed in collaboration with research partners.
- Health Equity Research Hubs provide localized support, training, and capacity building for sustainable community engagement and research for assigned CHESI projects.
- The Coordination Center/National Health Equity Research Assembly (HERA) leads program management, coordination, data collection, infrastructure creation, and long-term support across research projects and Hubs in ComPASS.
The Role of the Built Environment (Dr. Reilly)
- The built environment significantly impacts individuals and communities, leading to disruptions in lives, forced migration, major health effects, lack of medication and medical care access, mental health implications, and unreliable essential services like power and water.
- Historically marginalized groups face higher exposure to climate hazards and have experienced underinvestment in infrastructure, resulting in reduced capacity to adapt to environmental challenges.
- Research question: How do hurricanes' frequency and intensity affect median rent and housing affordability over time?
- Policy: Local, state, and federal policies should explicitly protect and support renters in the face of climate-related disasters.
- Socioeconomic inequality contributes to more severe impacts from hurricanes, such as power outages, and spatial variations in socioeconomic inequality are associated with differences in recovery speeds. Comprehensive data analysis and understanding are needed to address these issues effectively.
MSM tools to address health disparities
How can MSM tools help address health disparities? Can they make them worse?
Healthcare access versus feasibility
Could the speakers comment on what they observe in disparities of healthcare access (e.g., having insurance and/or a hospital) versus healthcare feasibility (e.g., single parent working two jobs who can't make a checkup or regular treatment)?
Opinion: Limiting factor in digital twins
A comment/call to action for our community: we typically ignore socioeconomic effects on health/physiology, though this will be a major determinant in making an "inclusive digital twin" versus a "privileged digital twin."
Very Exciting (and depressing!) talk on BC
in the study where you found TNBC had an increase due to redlined areas, was this true for low-socioeconomic whites as well as black communities?
Injustice in our genes ( Dr. Miller-Kleinhenz)
- Health equity is the goal of ensuring fair and just opportunities for individuals to achieve their highest level of health.
- Structural racism, which encompasses public policies, institutional practices, social forces, and ideologies, perpetuates inequities among races and has a significant impact on health outcomes.
- Redlining, the systematic denial of various services or goods based on place, has led to disinvestment in certain areas and neighborhoods, affecting housing, education, work environments, healthcare, nutrition, green space, physical activity, residential segregation, financial stress, and temperature.
- Contemporary redlining is associated with adverse health outcomes, such as increased breast cancer mortality and higher rates of triple-negative breast cancer diagnosis, highlighting the biological consequences of structural inequities.
- Epigenome studies have shown associations between redlining and DNA methylation in breast cancer, implicating molecular mechanisms in racial disparities.
Modeling beyond population of interest
When developing solutions for specific uses, it makes sense that we might want to build a solution for the current population of interest. What if the population of interest is not generally representative of every individual that may be impacted by a solution? What happens if that population of interest changes in the future (5, 10, 20 years from now)? Should models being developed look to expand beyond the perceived population of interest to try and mitigate potential biases in the future?
Pictures
In regards to multi-temporal scales, where can we make progress in understanding the effects of chronic stress (e.g., racial inequitites, environmental stresses) on physiological processes (e.g., autonomic nervous system, inflammation)? How should we address this rather daunting topic?