Understanding the Biological Mechanisms Underlying the Health Consequences of Racism, Marginalization, and Discrimination

Event Details

Purpose

To convene people from diverse populations living with or at risk for diabetes and digestive and kidney diseases and conditions, as well as researchers and clinicians from across disciplines, to understand the state of the science and identify opportunities for considering common biological pathways underlying the consequences of racism, marginalization, and discrimination across population groups and disease areas. The focus on interdisciplinary research is intended to foster the cross-pollination of ideas and shared learning, as well as to promote consideration of intersectionality across marginalized identities and the multidimensional research framework.

Background

The marginalization of groups based on socially constructed categories of race, ethnicity, sexual orientation, gender, and other identities produces biological consequences that contribute to health disparities in a variety of diseases and conditions, including many under the purview of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). For example, substantial racial and ethnic disparities exist in obesity, diabetes, and end-stage kidney disease. Racism, marginalization, and discrimination (RMD) is embedded into the structure of American society, which increases exposure to adverse social determinants of health—or social risks—for marginalized populations. These social risks are known to affect health outcomes by constraining or modifying health-related behaviors (e.g., diet, physical activity, smoking). However, experiences with RMD—as well as exposure to social risk—may also directly alter biology by triggering stress pathways and modifying biological homeostasis.

Meeting Objectives

Research questions to be addressed in the workshop include:

• What are the direct biological mechanisms and pathways underlying the relationship between RMD, social risks, and NIDDK diseases/conditions? How do these biological mechanisms interact with social and behavioral drivers of disease? 
• Specific biological mechanisms, pathways, and systems of potential interest for this workshop include, but are not limited to, weathering, stress, allostatic load, hypothalamic-pituitary-adrenal axis, developmental programming, epigenetics, microbiome, immune function, inflammation, neuroendocrine status, endocrine disruption, and telomere shortening, among others.  
• How do these biological mechanisms/pathways differ or overlap across the various population groups that experience RMD? How do these mechanisms combine for populations crossing multiple intersecting, marginalized identities (e.g., class, sex, gender, race)? How can we use an intersectionality lens to examine risk and protective factors? 
• How do these biological mechanisms/pathways differ or overlap in the context of structural versus interpersonal forms of RMD, as well as between RMD and associated social risks? 
• What biopsychosocial factors confer resilience to disease despite exposure to structural and interpersonal RMD, and what are the biological mechanisms through which this resilience occurs? 
• How do we identify biological marker(s) to describe the experience of RMD? 
• Does RMD contribute to the population-level differences in markers of key biological functions (e.g., differences in serum creatinine observed between Black and non-Black people in the United States)?
• What tools (e.g., measures, assessments, assays, wearables, apps) do we need to employ or develop to assess the impact that RMD may have on biology and health outcomes? 

Co-Sponsors/Organizing Committee

NIA, NHLBI, NICHD, NIDCR, NIMHD, NINDS, NINR, OBSSR, ODP, ONR, ORWH, SGMRO, All of Us Research Program

Registration Deadline

April 16, 2024

Agenda

Day 1—April 17, 2024

10:00 a.m. – 10:15 a.m.

Opening Remarks
Griffin Rodgers, M.D., M.A.C.P., National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

10:15 a.m. – 11:00 a.m.

Synthesizing the Findings, Projecting the Future for Biomechanistic Research on Discrimination, Racism, and Health-Related Outcomes
Keith Norris, M.D., Ph.D., University of California, Los Angeles

11:00 a.m. – 11:40 a.m.

Patient and Community Panel
Moderators: Sheena Martenies, Ph.D., University of Illinois and Glenda Roberts, Director of External Relations & Patient Engagement, Center for Dialysis Innovation, University of Washington

Speakers:
Phyllis Harris, Executive Director, The LGBT Community Center of Greater Cleveland
Bobby Howard, Director, Multicultural Donation Education Program, LifeLink of Georgia
Claudia Camacho, University of Colorado, Anschutz Medical Campus

11:40 a.m. – 12:10 p.m.

Lunch Break

12:10 p.m. – 12:55 p.m.

Epidemiology of Racism, Marginalization, and Discrimination in NIDDK Diseases
Moderator: Nicole VanKim, Ph.D. University of Massachusetts

12:10 p.m. – 12:20 p.m.

Discriminatory stressors in African-American women: Implications for cardio metabolic disease and Systemic Lupus Erythematosus
Tené Lewis, Ph.D., M.A., Emory University

12:20 p.m. – 12:30 p.m.

Kidney Disease in SGM Populations
Mitchell R. Lunn, M.D., M.A.S., FACP, FASN, Stanford University

12:30 p.m. – 12:40 p.m.

Structural Racism and Diabetes Outcomes
Leonard E. Egede, M.D., M.S., Medical College of Wisconsin

12:40 p.m. – 12:55 p.m.

Panel Discussion

12:55 p.m. – 2:30 p.m.

Telomeres and Epigenetic Related Mechanisms
Moderator: Ludmila Pawlikowska, Ph.D., NIDDK

12:55 p.m. – 1:10 p.m.

Social stressors and epigenetic aging among Hispanic/Latino adults
Shakira Suglia, Sc.D., Emory University

1:10 p.m. – 1:25 p.m.

The Role of DNA Methylation in the Connections between Early Life Stress, Protective Factors, and Health Disparities in Early Markers of Chronic Disease
Sylvie Mrug, Ph.D., M.S., M.A., The University of Alabama at Birmingham

1:25 p.m. – 1:40 p.m.

Primate Model Studies on Social Environment Impacts on Gene Expression
Noah Snyder-Mackler, Ph.D., Arizona State University

1:40 p.m. – 1:55 p.m.

The Potential Role of Racism, Marginalization, and Discrimination in Systemic Dysfunction and Biological Aging
Idan Shalev, Ph.D., Penn State University

1:55 p.m. – 2:30 p.m.

Panel Discussion

2:30 p.m. – 3:35 p.m.

Prenatal and Fetal Mechanisms
Moderator: Tracy Bale, Ph.D., University of Colorado, Anschutz Medical Campus

2:30 p.m. – 2:45 p.m.

Epigenetic Mechanisms of Prenatal Social Environmental Stressors and Offspring Health
Chantel Martin, Ph.D., M.S.P.H., The University of North Carolina at Chapel Hill

2:45 p.m. – 3:00 p.m.

Fetal Origins of Health Disparities: Transgenerational Consequences of Racism
Nana Matoba, M.D., M.P.H., University of California, San Diego

3:00 p.m. – 3:25 p.m.

Panel Discussion

3:25 p.m. – 3:35 p.m.

Break

3:35 p.m. – 4:45 p.m.

Stress, Allostatic Load, and Inflammation-Related Mechanisms
Moderator: Debra MacKenzie, Ph.D., University of New Mexico

3:35 p.m. – 3:50 p.m.

Discrimination as a Stressor Influencing Brain-Gut Microbiome Alterations; Evidence from Obesity
Arpana Gupta, Ph.D., University of California, Los Angeles

3:50 p.m. – 4:05 p.m.

Discrimination Exposure and Inflammation
Adolfo G. Cuevas, Ph.D., New York University

4:05 p.m. – 4:20 p.m.

Inflammatory Mechanisms Linking Discrimination and Health
Carrington Merritt, The University of North Carolina at Chapel Hill

4:20 p.m. – 4:45 p.m.

Panel Discussion

4:45 p.m.

Day 1 Closing Comments and Adjournment
Gregory G. Germino, M.D., NIDDK

5:00 p.m.

Adjournment

Day 2—April 18, 2024

8:45 a.m. – 10:00 a.m.

Poster Session (in-person only)

10:00 a.m. – 10:10 a.m.

Opening Day 2

10:10 a.m. – 11:25 a.m.

Plenary Panel
Moderator: Karen Parker, Ph.D., M.S.W., Sexual & Gender Minority Research Office, National Institutes of Health

10:10 a.m. – 10:25 a.m.

Contextualizing Race, Racism, and Social-Psycho-Biological Pathways to Health: A historical lens
Amani Nuru-Jeter, Ph.D., M.P.H., University of California, Berkeley

10:25 a.m. – 10:40 a.m.

Racism as a Social-environmental Toxin That Shapes the Inequitable Population-level Distribution of Disease
David Chae, Sc.D., M.A., Tulane School of Public Health and Tropical Medicine

10:40 a.m. – 10:55 a.m.

A social safety perspective on intersectional health disparities
Lisa Diamond, Ph.D., The University of Utah

10:55 a.m. – 11:25 a.m.

Panel Discussion

11:25 a.m. – 12:25 p.m.

Biobehavioral Mechanisms
Moderator: William (Bill) Elmwood, Ph.D., National Institute of Dental and Craniofacial Research

11:25 a.m. – 11:40 a.m.

Neural Mechanisms Linking Social Inequality to Health
Gabriella Alvarez, Ph.D., University of Pittsburgh

11:40 a.m. – 11:55 p.m.

Using a Health Equity Approach to Investigate the Role of Diet and Sex Differences in Cardiometabolic Risk Factors
Ana F. Diallo, Ph.D., MPH, BA, Virginia Commonwealth University

11:55 p.m. – 12:25 p.m.

Panel Discussion

12:25 p.m. – 12:30 p.m.

Breakout Group Charge

12:30 p.m. – 1:15 p.m.

Lunch Break

1:15 p.m. – 2:45 p.m.

Breakout Groups

• Modeling fundamental aspects of RMD through experimental science: What aspects of RMD can we model using animals? Via human studies? Other approaches? What are the limitations/what aspects can we not model via these approaches?
• Addressing measurement/analytical challenges: How do we understand the potential additive or multiplicative effects of RMD in people with multiple intersecting and marginalized social identities? How do we account for the tension between the societal-level nature of RMD versus the individual-level nature of biological processes? How do measures of RMD vary over time/do past measures adequately apply today?
• Pathways to interventions: How can we leverage findings from this research to improve the lives of people who experience RMD?
• Intergenerational and/or transgenerational and life course implications: How might RMD accumulate over the life course and pass from parents to children?
• Building and nurturing a future workforce to address the biological consequences of RMD: Who needs to be at the table to effectively conduct this research? How do we attract those groups to this space? What skills need to be developed/enhanced?

2:45 p.m. – 3:50 p.m.

Breakout Group Report Backs and Discussion

3:50 p.m. – 4:00 p.m.

Closing Comments

4:00 p.m.

Adjournment

Abstracts

Poster Session

Attendees are invited to submit abstracts for posters to be presented on the morning of the second day (April 18, 2024). Abstracts should address new science relevant to understanding biological pathways underlying the health consequences of racism, marginalization, and discrimination in the context of one or more NIDDK diseases. Abstracts from students, trainees, and early stage investigators are particularly encouraged. All abstracts must be submitted via email to Allison Hurst (ahurst@scgcorp.com) of The Scientific Consulting Group, Inc., by March 22, 2024, at 5:00 p.m. EST. Abstract submissions should be in MS Word format and be no longer than 250 words (not including name and affiliation).