New Sleep Health Disparities Policy Recommendations

Background:

On June 8th, 2020, Project Sleep issued this statement standing firmly in solidarity with our Black community members and unequivocally condemning racism. We also made specific pledges including, “to highlight sleep research focused on race, racism, and sleep and health disparities, as well as advocate for more research in this area.”

In furtherance of this pledge, Project Sleep worked with our health policy experts and the sleep health disparities research community to develop specific relevant policy recommendations.  We will utilize these new recommendations in our fall advocacy efforts, kicking off with our Virtual Advocacy Training on Friday, Sept. 18th, 2020 at 2:00 p.m. ET.

Social Justice and Health Disparities Policy Recommendations

Racial-ethnic minorities are more likely to get insufficient sleep, and are more likely to have sleep disorders. Since sleep plays important roles in cardiovascular function, metabolism, immunity, mental health, and brain function, this sleep disparity creates a situation where racial/ethnic minorities are systematically set up for worse health outcomes. Not only does poor sleep lead to worse outcomes on its own, it interacts with other conditions, worsening the already-important problems associated with heart disease, diabetes, obesity, cancer, depression, and other medical conditions.

The causes of these sleep disparities are complex and involve a combination of socioeconomic, environmental, and other factors. Unfortunately, there is almost no research on targeting sleep disorders diagnosis and treatments for racial/ethnic minorities, and securing funding for sleep disparities research is extremely difficult. Moreover, there are very few researchers from racial/ethnic minority backgrounds doing this research, due in part to many systemic barriers making it difficult to develop academic careers. Some training programs, such as those funded by the National Institutes of Health (NIH), are showing promise.

Policy Recommendations to Advance Social Justice, Improve Equitable Training and Career Development, and Address Sleep Health Disparities:

  • Training and Career Development: Ensure funding for early-career pipeline programs that help individuals of low socio-economic status and underrepresented racial/ethnic minority groups to thrive in the medical and research fields. This can include strengthening existing loan forgiveness programs, bolstering career development and training grants and fellowships (at NIH), and providing infrastructure at the institutional level for developing minority faculty.
  • Community-Led Interventions: Ensure dedicated research funding to develop and implement people-centered, community-led interventions to improve community awareness and treatment of sleep disorders and sleep loss. This could include building and strengthening existing NIH and PCORI initiatives to support Community-Based Participatory Research, Community Engaged Research, Community-Derived Interventions. These would fund projects that include the community as a full partner in research.
  • Education for Healthcare Providers: Provide funding to educate public health and healthcare providers on signs of sleep loss and sleep disorder issues impacting racial minorities and underrepresented groups. Care providers are increasingly aware of the importance of sleep health, but providers often lack training in how to assess and treat sleep disorders.
  • Research Funding: Provide meaningful research funding to better understand and address health disparities for minorities.
  • School Start Times: Ensure research funding to study how school start times impact low socio-economic and minority communities. Ample evidence shows that delaying high school start times is a public health priority, and this can disproportionately impact minority-serving schools, undercutting academic success, mental health, and other outcomes in these communities.

Your Voice Matters

Advocate with Project Sleep this fall to ensure that these recommendations are adopted and implemented. To get started, RSVP for our Virtual Advocacy Webinar on Sept. 18th at 2:00 p.m. ET. If you cannot attend the live webinar but want to get involved, RSVP anyway to receive the recording. We will help all those who sign up to reach out to their Members of Congress this fall.

Want to Learn More? Read the Research!

Recent publications highlighting key items of interest in sleep and health disparities (this quick list is not comprehensive):

Sleep, Health, and Society

By: Michael Grandner

  • Summary: Insufficient sleep and sleep disorders are highly prevalent in the population and are associated with significant morbidity and mortality. Adverse outcomes of insufficient sleep and/or sleep disorders are weight gain and obesity, cardiovascular disease, diabetes, accidents and injuries, stress, pain, neurocognitive dysfunction, psychiatric symptoms, and mortality. Exposure to sleep difficulties varies by age, sex, race/ethnicity, and socioeconomic status; significant sleep health disparities exist in the population and are driven by social, environmental, and structural factors. Societal influences, such as globalization, technology, and public policy, also affect sleep at a population level.

Sleep Disparity, Race/Ethnicity, and Socioeconomic Position

By: Michael Grandner, Natasha Williams, Kristen Knutson, Dorothy Roberts, Girardin Jean-Louis

  • Summary: Race/ethnicity and socioeconomic position play a role in the experience of sleep in the community. Racial/ethnic minorities and the socioeconomically disadvantaged may be systematically more likely to experience sleep patterns that are associated with adverse health outcomes. It is possible that disparities in sleep represent a pathway by which larger disparities in health emerge. This review (1) contextualizes the concept of race/ethnicity in biomedical research, (2) summarizes previous studies that describe patterns of sleep attainment across race/ethnicity groups, (3) discusses several pathways by which race/ethnicity may be associated with sleep, (4) introduces the potential role of socioeconomic position in the patterning of sleep, and (5) proposes future research directions to address this issue.

A Workshop Report on the Causes and Consequences of Sleep Health Disparities

By: Chandra Jackson, Jenelle Walker, Marishka Brown, Rina Das, and Nancy Jones

  • Summary: Sleep deficiencies, which include insufficient or long sleep duration, poor sleep quality, and irregular timing of sleep, are disproportionately distributed among populations that experience health disparities in the United States. Sleep deficiencies are associated with a wide range of suboptimal health outcomes, high-risk health behaviors, and poorer overall functioning and well-being. This report focuses on sleep health disparities, which is a term defined as differences in one or more dimensions of sleep health on a consistent basis that adversely affect designated disadvantaged populations. Sleep Health Disparities appear to share many of the same determinants and causal pathways observed for health outcomes with well-known disparities. There also appears to be common behavioral and biological mechanisms that connect sleep with poorer health outcomes, suggesting a link between sleep and other health disparities observed within these designated populations. In 2018, the National Institute on Minority Health and Health Disparities, the National Heart, Lung, and Blood Institute, and the Office of Behavioral and Social Sciences Research convened a workshop with experts in sleep, circadian rhythms, and health disparities to identify research gaps, challenges, and opportunities to better understand and advance research to address Sleep Health Disparities. The major strategy to address these is to promote integration between health disparity causal pathways and sleep and circadian-related mechanisms in research approaches and study designs. Additional strategies include developing a comprehensive, integrative conceptual model, building transdisciplinary training and research infrastructure, and designing as well as testing multilevel, multifactorial interventions to address Sleep Health Disparities.

Thank You

Special thanks to Dr. Michael Grandner for rallying the sleep health disparities research community together to inform this process. Thank you to our entire community for your support and positive feedback. We will keep you updated as we continue to make progress on our longterm commitments to equality, diversity and inclusion.

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