April 25, 2023

Announcing the UNITE External Listening Sessions Summary Report

UNITE Co-Chairs’ Corner

April Co-Chairs' Corner image: Speech bubble with the words “We hear you” within it

“The only way to correctly predict
the future is to pave it,
Is to brave it.”
― Amanda Gorman, Call Us What We Carry: Poems

NIH is pleased to announce the release of the UNITE External Listening Sessions Executive Summary and Summary Report. These external listening sessions were integral to the U Committee’s ability to perform a broad, systematic evaluation to examine diversity, equity, inclusion (DEI), and structural racism within the biomedical research ecosystem.

This report summarizes the perspectives of 1,295 individuals, representing multiple research community sectors, who participated in 14 listening sessions from December 2020 through February 2021. (See our December 9, 2022, blog with strategies and suggestions for conducting listening sessions.)

Our analysis of the participants’ comments on challenges, opportunities, and proposed solutions resulted in five crosscutting themes:

State of equity in the biomedical sciences: Participants viewed systemic inequities as vast across the biomedical research ecosystem. A primary perception is that biases in the grant review process, both at the individual and institutional level, result in a lower likelihood of funding. Micro- and macroaggressions were cited as everyday experiences for racial and ethnic minority trainees and scientists. In addition, the disproportionate impact of emerging issues, such as the COVID-19 pandemic, revealed structural inequities across the health care and biomedical research ecosystems.
- Selected NIH actions that address equity in the biomedical sciences:
  
  Bias awareness in peer review training for scientific review officers, reviewers, and Committee Cochairs
  
  Expectations for recipient institutions to have policies and practices in place that foster an environment free from harassment, including discrimination
Challenges in career pathways and workforce: Participants across listening sessions acknowledged that challenges for people from racial and ethnic minority groups begin with primary education and extend throughout secondary education and into professional careers. For example, inadequate exposure to science, technology, engineering, and math (STEM) beginning in grades K-12 may lead to limited career pathways in the biomedical sciences.
Participants noted the lack of diversity and representation in academic and scientific institutions as a self-perpetuating barrier to career advancement for individuals from underrepresented groups because of insufficient access to role models and mentorship opportunities. Participants also described the burdensome and uncompensated “minority tax” or expectation for individuals from racial and ethnic minority groups to participate in DEI-related activities at the expense of other career opportunities.
- Selected 2023 NIH actions that address career pathways and workforce:
  
  NIH Science Education Partnership Award (SEPA), PAR-23-137, is an R25 program that supports projects that generate resources to increase career opportunities for individuals from diverse backgrounds, including those from groups underrepresented in biomedical research, as well as outreach to these groups in the K–12 STEM community.
  
  Research With Activities Related to Diversity (ReWARD), PAR-23-122, is an R01 program that focuses on the health-related research of scientists making a significant contribution to DEIA and who have no current NIH research project grant funding.
Practices and policies as barriers to equity: A commonly stated perception is that NIH funding structures inherently disadvantage underrepresented minority scientists and Minority Serving Institutions (MSIs). Participant comments covered the lifecycle of the grant funding process.
Specifically, participants noted that the complexity of the NIH grant application process created disadvantages for lower-resourced institutions. They noted that a lack of diversity on peer review panels, perceived inadequacies of MSIs, and the devaluation of health disparities research all contributed to bias in review and funding decisions. Participants also expressed concern that NIH grant mechanisms exclude infrastructure and capacity-building resources, further exacerbating funding inequities.
- Selected 2023 NIH actions that promote equity in grant funding:
  
  Request for Information (RFI) on Proposed Simplified Review Framework for NIH Research Project Grant Applications, NOT-OD-23-034, solicited public input on a proposed revised framework for evaluating and scoring peer review criteria for NIH research project grant applications.
  
  Broadening the reviewer pool to diversify peer review groups.
  
  Instrumentation Grant Program for Resource-Limited Institutions, PAR-23-138, is an S10 program that aims to enhance research capacity and educational opportunities at resource-limited institutions by providing funds to purchase modern, scientific instrumentation.
  
  STrengthening Research Opportunities for NIH Grants (STRONG), PAR-23-144, aims to support research capacity needs assessments by eligible Resource-Limited Institutions (RLIs). The program will also support the recipient institutions to use the results of the assessments to develop action plans for how to meet the identified needs.
Challenges in health disparities research: Another common sentiment is the need for increased funding for health disparities research that serves community needs. Participants raised concerns that NIH-supported health disparities research is often acontextual—studying and addressing health disparities without truly embedding in and engaging with the communities—and often includes culturally incompetent communication and community engagement tactics.
Participants highlighted the importance of community-based participatory research and early and continuous engagement of community collaborators and equitable compensation. They also discussed the perceived harmful impacts of data aggregation in research, including obscuring important differences within populations.
- Selected NIH actions to enhance health disparities research:
  
  The Fiscal Year 2023 Community Partnerships to Advance Science for Society (ComPASS) initiative is a 10-year, $400 million Common Fund effort to increase funding for health disparities research.
  
  Addressing the Impact of Structural Racism and Discrimination on Minority Health and Health Disparities, PAR-23-112, is an R01 program to support intervention research that addresses structural racism and discrimination in order to improve minority health or reduce health disparities.
  
  Community Level Interventions to Improve Minority Health and Reduce Health Disparities, RFA-MD-23-004, is an R01 program to support research to develop and test community-level interventions to improve minority health and reduce health disparities.
Challenges in addressing health care equity and health outcomes: Participants agreed that health care/medical professionals often lack cultural awareness of the diverse populations they serve, including their reasons for distrusting health care systems.
Furthermore, racial and ethnic minorities are underrepresented on medical teams. Additional challenges noted are a lack of patient advocacy and limited access to appointments due to lack of Wi-Fi, a phone, or transportation. These issues and more can negatively impact patient outcomes. Participants proposed that solutions must include cultural understanding, respect, patient advocacy, and diverse representation in health care.
- Selected 2023 NIH action to address health care equity and health outcomes:
  
  Pilot Interventions to Integrate Social Care and Medical Care to Improve Health Equity, RFA-DK-22-038, is an R01 program to support pilot and feasibility trials to test interventions that involve screening for and addressing adverse social determinants of health.

NIH is grateful for the perspectives shared.

We invite you to explore this external listening sessions report and encourage you to sign up for UNITE updates. As illustrated in the selected activities above, NIH is taking steps to address the issues raised in this report.

We are listening and we hear you.