Institute Talk: A Conversation with Carl V. Hill on the NIA and Health Disparity Research

Carl V. Hill is director of the Office of Special Populations at the National Institute on Aging, which leads the federal government in conducting and supporting research on aging and the health and well-being of older people. Hill recently visited the UMass Boston campus, where he was the featured speaker at the first annual Gerontology Institute Fellows Dinner. Earlier that day, Hill talked with Institute Director Len Fishman about his career, how he promotes funding for health disparity research and current priorities for the institute’s $3.1 billion research budget. The following is an edited version of their conversation.

Len Fishman: How did you first become interested in a career in public health and health disparity research in particular?

Carl V. Hill: I was in the first class of the Masters of Public Health program at the Morehouse School of Medicine. The founder of that program was Dr. Bill Jenkins, who passed away this year. He was one of the first whistle-blowers on the Tuskegee Syphilis Study. He was also a mentor to many African-Americans in public health and he started this program that allowed many of us to have a start. Later, I had a chance to study for my PhD at the University of Michigan. I worked with people like Woody Neighbors and James S. Jackson, who both worked on the Survey of American Life. They also worked on the Survey on Black Americans, the first data collection on the lives and health of African-Americans in this country.

LF: Later you went to the National Institute of Child Health and Human Development, and eventually moved to the National Institute on Aging. What brought you across the age spectrum to NIA?

CVH: When I was at Child Health, the NIA was really interested in getting its Office of Special Populations back up and running. They had a director who retired and no one had been at that post for quite some time. My training and expertise was about disparities from a life-course perspective.

LF: What’s the role of the Office of Special Populations within NIA?

CVH: I get a chance to work in many ways as a maverick across the four main divisions of NIA –Aging Biology, Neuroscience, Behavioral and Social Research, and Geriatrics and Clinical Gerontology. We have to stimulate diversity and participation. So we think about how we can engage with Hispanic-serving institutions, historically Black colleges and universities (HBCUs) or smaller institutions where we don’t fund many investigators. How can we get our divisions to be involved in engaging a diverse set of investigators?

LF: So how did you set out to do that when you arrived at NIA?

CVH: Integrating health disparities within the NIA mission meant that all of its divisions had to be on board. One approach that worked well was a framework we developed, engaging staff from each main NIA division to identify the important factors behind health disparities. Once we got that buy-in from the staff, we were able to use this framework to get investigators around the country interested in disparities.

LF: That framework comprises four determinants of health disparities in aging: environmental, sociocultural, behavioral, and biological. Using the framework, NIA has awarded over $100,000,000 since 2015 to support research in these areas. I know it’s relatively early to ask, but what have we learned so far?

CVH: We learned that health disparities research is applicable to the priorities for each division at NIA and that our program staff would get behind this push to focus on health disparity research. That was a question, whether my small office would be the only champion for this framework. But there was an overwhelming positive reception.

LF: So part of your job is to mainstream this issue everywhere?

CVH: Right. I don’t think our framework tool is groundbreaking in its highlighting of the determinants of health disparities. But it was pivotal in our effort to get people on board. Using this tool, we’ve been able to have the divisions use their set-aside funds. A small office like mine may have a meager budget to fund a couple of health disparities projects, but the divisions can use their allotments for this. Once we developed the framework where NIA staff had a chance to voice their opinions about what was important for disparities — once we all agreed on something that could represent our entire institute  — our divisions really looked forward to stimulating funding opportunities and supporting disparities research.

LF: What are the priorities at NIA these days?

CVH: The same as they’ve been but we have a really specific focus on stimulating research that addresses Alzheimer’s disease. [Hill discussed NIA’s dramatic funding increase targeting Alzheimer’s research at the Gerontology Institute Fellows Dinner]. But aging research is broad, so one focus is neuroscience, not only pertaining to Alzheimer’s, but also covering other dementias and the range of outcomes; behavioral and social research is also priority for the NIA, as is aging biology. Along with that is training. We want to be sure young investigators are able to compete and receive mentor training from NIA.

LF: Are you and your colleagues discouraged by recently pharmacological setbacks in the development of a treatment for Alzheimer’s disease?

CVH: No. There’s been this real race for a cure. But we’ve got to expand our viewpoint and understand there are social, environmental and behavioral determinants that are so important for understanding Alzheimer’s.

LF: So it’s not just a pill.

CVF: It’s not just a pill, and being discouraged is not the word. We have additional work to do.

LF: On the subject of Alzheimer’s research, there’s evidence African-Americans are twice as likely to have the disease, and Latinos  are 1.5 times more likely than Caucasians. How is your office trying to make sure that aspect of the disease is being examined?

CVH: We’ve partnered with our division of neuroscience. Before we even had a firm understanding about the disparity, we knew there needed to be a focus on diverse populations. We had a funding opportunity announcement on disparities in Alzheimer’s disease way back in 2015 and we’ve supported 15 or 20 projects. We want to stimulate research not just exploring proteins and amyloids in the brain but also upstream factors – where you live and how that affects culture, metabolic outcomes and cardiovascular outcomes that have been linked to brain health. Also, we’re focused on diverse participation, recruiting and retaining populations into this research.

LF: The NIH and NIA can seem foreboding from the outside, especially to young researchers. Any thoughts that might help them develop a comfort level dealing with these agencies?

CH: I understand that engaging the NIH can seem quite daunting. But the program staff and offices at all the institutes have a real appreciation for engaging emerging researchers. Program officers are evaluated on how well they provide customer service to new investigators and those with questions. It’s tied to their job performance, but it’s also just how we work. I wouldn’t submit anything to NIH without first having a couple of program officers look at the drafts, the specific aims, and to give researchers some feedback.

LF: How can that help?

CVH: Sometimes it’s not that a research idea isn’t good. It just isn’t relevant to a particular institution. The best program officers will take a one-page draft of specific aims and shop it around to other program officers as well. We want to see people have success when engaging with NIH, that’s the most important piece for us.

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