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Sequestration and Its Effect on Programs Aimed at Advancing a Diverse U. S. Health Workforce

By Ronny B. Lancaster


After Congressional leaders were unable to reach a budget compromise on March 1st, our country entered a period of previously agreed-upon automatic budget cuts we call sequestration.

Under this automatic spending reduction plan, government expenditures will be reduced by $85 billion this fiscal year. Much of that will come at the expense of agencies such as the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA), Medicare, and the Department of Education.

On March 6th, the House Appropriations Committee passed an “omnibus” bill that would provide funding (at the post-sequestration level) for all federal agencies for the reminder of the fiscal year. To avoid a government shutdown, some measure must pass both Chambers, and be signed by the President, before the current continuing resolution (CR) expires on March 27th. There are discussions about restoring some of the cuts caused by sequestration, but it is unclear whether the omnibus funding bill will be a vehicle for that effort. And, the President is actively reaching out to Congressional Republicans in an effort to find consensus on short term spending and gauge interest in a possible “big deal” involving the elimination of tax loopholes in exchange for significant changes in entitlement programs.

With respect to national public health programs and our biomedical research portfolio, the Nation has entered a new era of reduced government spending. With lower expenditures, the budgets of agencies, which form the spine of our public health system such as NIH, FDA, and the CDC, are under significant scrutiny.

In the interest of advancing the health of our Nation, it is essential to protect the budgets of these agencies, and the important programs they administer, such as the Title VII (health professions training programs) administered by the HRSA. This single program quite effectively helps to ensure a diverse U. S. health workforce.

Ensuring a racially diverse workforce is important for many reasons. Perhaps chief among them is the fact that African Americans, Hispanic Americans and low-income citizens die prematurely, and manifest excess morbidity. These groups, on average, have one and one-half to two and one-half the incidence of stroke, diabetes, cancer, heart disease and infant mortality of the general population. Having a workforce that more closely mirrors these communities is an effective means of addressing these concerns. And the need for a more diverse health workforce will become more pronounced, as racial minorities make up a greater percentage of the U. S. populations in the coming years.

Currently at NIH, there is an effort to improve diversity among scientists who successfully compete for grants and awards. In late 2012, the Advisory Committee to the Director at NIH met and put forth the report of the Biomedical Workforce Implementation Team. This report was in response to the recent study funded by NIH that notes that African Americans and other minorities continue to receive far fewer R01 grants, as they have for the past several decades.

To double the number of minority researchers, NIH proposes:

  • a $53 million injection of funding over four years to create 600 new minority PhD’s. Institutions will receive significant scholarship monies to encourage students along this path;
  • creating a national mentoring network to promote young minority researchers; and,
  • appointing a chief diversity officer to oversee internal issues.

Nobel laureate and current NIH director Dr. Francis Collins recently testified before a House Appropriations Subcommittee that despite shrinking budgets, this proposal would continue to receive support of his office.

In spite of sequestration, existing successful programs such as Title VII and promising new initiatives such as those supported by NIH are essential if we are to achieve a more diverse health workforce. In the singular focus of achieving budget reductions, the value of such initiatives can be missed, to the detriment of our country. To preserve these and other essential programs, it is imperative that we educate our elected officials in Washington about why these and other initiatives are vital to our Nation’s health, and importantly, why they must continue to be funded.

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