Battling Health Disparities in Aging Research and Care

Dr. Carl Hill joins the podcast to discuss research taking place around the country that works to improve health care and access for elders in diverse racial, ethnic and socioeconomic groups. Guest: Carl Hill, PhD, MPH, Director, Office of Special Populations, National Institute on Aging

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Dr Carl Hill
Dr. Carl V. Hill

Show Notes

Two journal articles are relevant to and were mentioned in Dr. Hill's podcast interview. They are both available for free on the NIH-supported PubMed Commons.

"Life Course Approaches to the Causes of Health Disparities"

"The National Institute on Aging Health Disparities Research Framework"


Nathaniel Chin: I'm Dr. Nathaniel Chin, and you're listening to Dementia Matters, a podcast about Alzheimer's disease. Dementia Matters is a production of the Wisconsin Alzheimer's Disease Research Center. Our goal is to educate listeners on the latest news in Alzheimer's disease research and caregiver strategies. Thanks for joining us.

Nathaniel Chin: Today's guest on dementia matters is Dr. Carl Hill, the director of the Office of Special Populations at the National Institutes on Aging. Dr. Hill leads the Institute on Aging efforts in health disparities research related to aging. Dr. Hill, welcome to Dementia Matters.

Carl Hill: Thank you for having me here, Dr. Chin. It's an honor.

Nathaniel Chin: To begin with, can you give us an overview of the nation's health disparities challenges in the aging population?

Carl Hill: Yeah, thanks for that, Dr. Chin. There are quite a few challenges related to access to any healthcare or access to quality care for minority elders. There are certainly gaps in life expectancy -- while all people are living longer, not everyone is living to the same ages. So it's very important to understand what important factors determine those disparities. And then, quite frankly, we see disparities related to Alzheimer's disease where African Americans are twice as likely to develop this dementia. So, very important challenges for our researchers to solve.

Nathaniel Chin: And good research you guys are doing. And so if you could give us a couple of examples of the type of research the NIH is supporting to help address health disparities.

Carl Hill: We have a really active National Institute on Minority Health and Health Disparities that really gives the NIH guidance on important areas for health disparities research, so they define the priority populations for this research. And then at the NIA we really focus in on some important levels of analysis for thinking about disparities research that occur in the environment, that may be socio-cultural and behavioral, and how all of that links to important aging biology outcomes. So really important work. And I think maybe third is, considering that there may be distinct pathways to aging-related diseases for priority health disparities groups. So really some encouraging rigorous research that's being supported.

Nathaniel Chin: And it's a broad range of research. It isn't just one type. I mean you're talking about a lot of different things when you talk about your goals.

Carl Hill: Yes, absolutely. Absolutely. And I think this is important for team science and including researchers that represent various disciplines and an interdisciplinary approach for rigorous health disparities research related to aging.

Nathaniel Chin: Because it's not just the biology, it's also the socioeconomic, the cultural, the health behaviors that you just spoke about.

Carl Hill: Absolutely. We like to think of health behavior as a nexus that links into behavior, but that behavior is also shaped by cultural factors and also the factors in the macro environment that might place people in certain neighborhoods or in certain employment sectors that influence behavior and biology.

Nathaniel Chin: Now, can you give us a couple of examples of some interesting results that have stemmed from the research that you guys have supported in the health disparities work?

Carl Hill: I'm really encouraged by the work of Dr. Jen Manly at Columbia who is, you know, really taking a look at different pathways to Alzheimer's disease and exploring that for African Americans and Latinos that may be more related to vascular and metabolic processes. So that's really intriguing to think that the intervention and understanding of Alzheimer's disease may have a totally different pathway for these populations.

Nathaniel Chin: Well, because you also mentioned in the lecture earlier today that Alzheimer's disease affects certain groups of people differently. African Americans are two times more likely to develop Alzheimer's disease, that Latinos are about one and a half times more likely.

Carl Hill: That's right. That's right. So I think that's a really good example, Dr. Chin, for exploring the socio-cultural factors and also the environmental factors that could be in play here. And I'm thinking about health promotion, which link into, you know, healthy eating or more physical activity, so that individuals from these groups can protect their brain health.

Nathaniel Chin: And one of the important things that I think you mentioned earlier to me was that genetics doesn't seem to be the driving force in these differences.

Carl Hill: Well, we don't know just yet. So I think we are really encouraged by our support of these research projects that we've been able to stimulate through the development of our health disparities framework. So more to come and stay tuned, but I think what we do know is that there are additional factors in other levels of analysis that are important for these populations.

Nathaniel Chin: And could you comment on the study that was done in socioeconomic status?

Carl Hill: Yeah. So important findings from Dr. [Zeki] Al Hazzouri at the University of Miami who took a look at groupings of individuals in various socioeconomic status groups and social mobility. And it was really interesting finding that those who were lower socioeconomic status, but high social mobility had the lowest probability of staying dementia free. So that says something about, you know, higher for coping and the health implications that need to be explained a bit further.

Nathaniel Chin: Yeah. That really shines a light on it. It's not just the socioeconomic status; there's something else there.

Carl Hill: Yeah. There's other work from Jamal and colleagues that show an interesting relationship with years of education and heart disease death rates when comparing whites and blacks, where, as you would imagine, years of education has a protective effect for whites. But the black-white ratio actually increases for blacks with the number of years of education. So clearly there's more to these relationships, and we're really excited about the investigators that we're supporting to figure this out.

Nathaniel Chin: So then how does the research turn into change at the local level and in people's lives?

Carl Hill: Ideally, you know, we're able to organize the findings and communicate those to important stakeholders, whether that'd be Congress or our partners over at other agencies like the Centers for Disease Control and Prevention. And they're able to take that and turn that into some intervention or turn it into some public health or health protecting program that's translated to state health departments and local health departments. And that's how some of this information and the results that are really important reach communities and individuals and their families.

Nathaniel Chin: Because it seems to me at first we have to identify the disparities themselves, the differences. And then from that we have to understand them. And ideally from that then we transform them into policy and program changes that we can help the people we study.

Carl Hill: Absolutely. But that process takes time. I'll tell you, in science, building consensus takes takes time. But you know, with support from a number of partners ... I have to think about Alzheimer's disease and the Alzheimer's Association, we are able to build a cadre of researchers that are really exploring disparities at multiple levels of analysis. And that can give us some results that we can begin to organize and hopefully translate in the future.

Nathaniel Chin: So then really, a part of that is making sure the science is the best that it can be. And so I use that as my lead into ... you did publish a really important article on the integration of life course approaches into health disparities research. And so if you could, please explain what is the life course approach and what will it help the research community understand about health disparities and aging?

Carl Hill: Yes, absolutely. I was on a team. The National Institute on Minority Health and Health Disparities at NIH is currently undertaking a visioning process for next steps and strategic directions for health disparities research. And one of their really important topics is the life course approach. So realizing that factors that occur over the course of people's lives impacts their health along the way and as they become older adults. So that realization I think is really important because it begins to connect and get researchers out of silos and understand that maternal health, child health is related to health in middle ages and certainly related to health at older ages. And that it gives us a chance to collaborate and really stimulate the field for rigorous health disparities research.

Nathaniel Chin: And it's a nice framework that really views and respects the human being as having multiple things going at the same time, that we're not just static, that we're dynamic, and the things that have happened to us years ago can actually impact us today.

Carl Hill: Absolutely. And I think that informs the research, right? So it's really important that we are able to provide resources and training on innovative methods for being able to tease out how those factors that might occur in adolescence or middle age effect aging, when a person is 65 years or older. So in theory, even the multilevel health disparities research, it's grounded in sociological theory and it sounds great, but we've got to make sure that we're able to have innovative methods for testing these important hypotheses and answering these research questions.

Nathaniel Chin: You know, I'd like to end by asking, are there ways that our listeners can get involved in their communities or their own families to help this research and the medical community reduce health disparities?

Carl Hill: Absolutely. So diversity in biomedical sciences is very important -- that diversity in participation and also in perspective. So people can get involved by being aware of research studies that are currently underway in their communities, and if they're able to participate or they know a family member or someone in their neighborhood that may be eligible, by sharing that information. But also by being a voice, a champion for health disparities research and knowing what types of studies are occurring in the area and engaging with people like you so that they can be aware of the opportunities to participate or support health disparities research that is taking place here at the University of Wisconsin.

Nathaniel Chin: Well, with that, Dr. Hill, thank you so much for what you're doing at the NIA and for being here on our podcast, Dementia Matters, today.

Carl Hill: Dr. Chin, I'm a big fan and it's just a privilege to be here for Dementia Matters. Thank you.

Nathaniel Chin: Dementia Matters is brought to you by the Wisconsin Alzheimer's Disease Research Center. The Wisconsin Alzheimer's Disease Research Center combines academic, clinical and research expertise from the University of Wisconsin School of Medicine and Public Health and the Geriatric Research, Education and Clinical Center of the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin. It receives funding from private, university, state and national sources, including a grant from the National Institutes of Health for Alzheimer's Disease Centers.

Nathaniel Chin: This episode was produced by Rebecca Wasieleski and edited by Bashir Aden. Our musical jingle is “Cases to Rest” by Blue Dot Sessions. Check out our website at You can also follow us on Twitter and Facebook. If you have any questions or comments, email us at Thanks for listening.