Dissecting the Causes of Health Disparities: Michele Evans

Michele Evans Delivers the Anita Roberts Lecture

BY JANETTE NORRINGTON, OD

“As a daughter of the South Bronx who lived and worked there before coming to NIH, I had an indelible recollection of the broken promises, the false promises that never ameliorated poor health,” said Senior Investigator Michele K. Evans during her Anita Roberts Lecture held on November 1, 2021. “I knew I had to become a physician to improve health in communities like this.”

When Evans began her NIH career in 1986 as a medical oncology fellow and clinical associate in the National Cancer Institute (on the Bethesda, Maryland, campus), she was studying DNA repair in cancer-prone heritable syndromes associated with DNA damage hypersensitivity and deficient DNA repair. In 1992, she transferred to the National Institute on Aging (NIA) on the Baltimore campus and saw the poverty in the surrounding neighborhoods. “As I came to work every day in Baltimore, the scene was very much the same as I had experienced as a child,” she said.

She soon redirected her research to focus on the risk factors and causes of health disparities among minority Americans and those of low socioeconomic status (SES). Now she’s NIA’s deputy scientific director and chief of its Health Disparities Research Section.

Multidisciplinary approach

Socially disadvantaged groups of people—such as racial or ethnic minorities, sex and gender minorities, socioeconomic disadvantaged populations, and those living in underserved rural areas—may lack access to good health care. They are often exposed to conditions and environments that place them at higher risk of poor health outcomes, chronic disease, mental disorders, and premature mortality. Evans and other health-disparities researchers are trying to identify and understand the causes of adverse health outcomes in disadvantaged groups and to develop effective interventions to reduce and eliminate health disparities.

Health disparities are associated with biological and behavioral risk factors (such as poor diet, obesity, smoking, excess alcohol consumption, and physical inactivity). But social determinants of health (SDOH) play a role, too: These include education, economic stability, structural racism, occupational opportunities, neighborhood factors, social and community support, and access to good health care. Evans uses an interdisciplinary approach to dissect the interactions of all these factors and their relationship to disproportionate rates of age-related disease and disability in socially marginalized groups.

In the early 1990s, there were no intramural investigators conducting community-based health disparities research, said Evans. In 2004, she and Alan B. Zonderman, an NIA senior investigator, established the Healthy Aging in Neighborhoods of Diversity across the Life Span Study (HANDLS) to explore the interaction of race and SES on the development of age-associated health disparities among African Americans and whites who reside in Baltimore. HANDLS is a multidisciplinary, community-based, longitudinal, epidemiological study with a lab-based section that allows researchers to examine some of the molecular drivers of health disparities and how SDOH manifest into poor health.

Using HANDLS data, Evans and Zonderman conducted the first study that examined the associations between diabetes and cognitive performance as a function of both race and poverty status. They found that African Americans with diabetes who were living below the poverty level may have an increased risk of cognitive deficit at a younger age. “Improving health literacy, doctor-patient communication, and multidisciplinary medical care for impoverished individuals may reduce differences,” the authors concluded in the paper describing the findings (Psychosom Med 77:643–652, 2015).

In another study, they found that living in poverty is a large risk factor for chronic kidney disease in African Americans (Am J Kidney Dis 55:992–1000, 2010). Evans, working with her colleagues, has also found that poverty and discrimination may be drivers in accelerated aging and adverse health outcomes and may operate through many biological pathways such as telomere length, brain matter volume, and oxidative stress. She believes that interventions and implementation science (the study of methods that facilitate the use of evidence-based practices and research) are the future of health-disparities research.

Mentor and role model

Like Anita Roberts, for whom the lecture series is named, Evans is an accomplished scientist and an exceptional mentor. As the training director for NIA’s intramural program, she is helping to prepare the next generation of scientists and encouraging them to become who they want to be in science and research.

“I think sometimes people are not confident and don’t believe in their own competencies,” she said. “You as the mentor have to help them not only to build the competencies that they need to succeed in science, but you also have to build their confidence.”

She also serves as a role model and advises early-career female scientists to recognize the struggles in science and try to not personalize them. Her secrets: dedication, perseverance, and toughness.

“I tend not to back down; I tend to push forward,” she said. “You have to be willing to do that and you have to be willing to take the mischaracterizations of being called aggressive and angry that come as part of speaking your mind and telling your truth… You have to have a stiff back and very thick skin.”

The “Anita B. Roberts Lecture Series: Distinguished Women Scientists at NIH” honors Roberts’ research contributions. Roberts, who spent 30 years at NCI before her untimely death in 2006 from gastric cancer, was known for her groundbreaking work on transforming growth factor–beta, for being a wonderful mentor, and for her ability to balance family and work life. To watch a videocast of Evans’ lecture, “The Science of Health Disparities: The Social Determinants of Health Meet the NIH Mission,” held on November 1, 2021, go to https://videocast.nih.gov/watch=41534.

Janette Norrington, a postdoc in the Office of Intramural Training and Education, is interested in pursuing a career in science communication. In her spare time, Janette likes to read, spend time with family, cook, and write fiction.