Expanding NIH’s Definition of Socio-Economic Disadvantaged to be More Inclusive and Diversify the Workforce


An extensive literature demonstrates that socioeconomic status is one of the strongest predictors of health, on par with typical risk markers like smoking, physical inactivity, hypertension, and diabetes.  An intriguing graphic shows life expectancy according to stops on the London subway system – as described in a news story, “if you travel eastbound between Lancaster Gate and Mile End – 20 minutes on the Central line – life expectancy decreases by 12 years.”  This association of strong links between socioeconomic status and health is remarkably reproducible – including on subway maps of the Washington DC area and in a study of Northeastern Ohio patients undergoing stress testing at the Cleveland Clinic.

This same pattern – low socioeconomic status and poor outcome – applies to educational outcomes: if anything, the differences are even more striking.  A study of 2002 high-school sophomores found that 10 years later, in 2012, 60% of those from a high socioeconomic status received a bachelor’s degree compared to only 29% of those from a middle socioeconomic status and 14% of those from a low socioeconomic status.  These differences are enormous – coming from a high socioeconomic status background doubles to quadruples the likelihood of receiving a bachelor’s degree.  Furthermore, among students who do attend college, lower socioeconomic status predicts a much lower likelihood of choosing a “STEM” major.  Even among those students who make it all the way to securing a position as a full-time professor, low socioeconomic status background continues to present barriers to success

NIH recognizes it needs to encourage and enable careers of biomedical scientists with disadvantaged backgrounds. In a 2018, Guide Notice (NOT-OD-18-210) describing our interest in diversity, we stated that “NIH encourages institutions to diversify their student and faculty populations to enhance the participation of individuals from groups that are underrepresented in the biomedical, clinical, behavioral and social sciences (NOT-OD-18-210), such as:

Individuals from racial and ethnic groups that have been shown by the National Science Foundation to be underrepresented in health-related sciences on a national basis…

Individuals with disabilities …, and individuals from disadvantaged backgrounds …”

Despite our calling out “individuals from disadvantaged backgrounds,” less than 1% of investigators on diversity supplement applications in FY2018 came in under the disadvantaged background category, category C (see Figure 1).

Figure 1 shows FY 2018 success rates for NIH diversity supplement applicants. Hispanic=70% awarded of 466 applications, African American=62% awarded of 454 applications, American Indian/Alaska Native=76% awarded of 37 applications, Native Hawaiian/Pacific Islander=53% of fewer than 11 applications, individuals with disabilities=74% awarded of 34 applications, disadvantaged=1% of fewer than 11 applications, other=23% awarded of 98 applications.

Why so few?  We suspect that a critical reason is our definition of a disadvantaged background.  Looking at NOT-OD-18-210 in detail, we offer two criteria for defining a disadvantaged background:

  1. Individuals who come from a family with an annual income below established low-income thresholds
  2. Individuals who come from an educational environment such as that found in certain rural or inner-city environments that has demonstrably and directly inhibited the individual from obtaining the knowledge, skills, and abilities necessary to develop and participate in a research career.

On careful inspection, that first item is extraordinarily narrow – the annual threshold for a family of 4 is only $25,750.  For the United States, that’s severe poverty and represents an overly strict threshold.  In fact, most US government programs typically use a threshold that are twice the values listed.

The second bullet has the opposite problem – it might be broad and inclusive but is nearly impossible to evaluate.  What does “certain rural or inner-city environments” mean? 

Given these difficulties, NIH has considered a different approach to defining scientists from disadvantaged backgrounds (which we announce in the NIH Guide NOT-OD-20-031). We reviewed a wide variety of criteria, looking for those that are relatively easy to self-evaluate and that capture a large proportion of affected people. Now, through this Guide Notice which supersedes current diversity language in existing funding opportunities, we will consider scientists to have come from a disadvantaged background if they meet at least two of the following criteria.   

  1. Were or currently are homeless, as defined by the McKinney-Vento Homeless Assistance Act
  2. Were or currently are in the foster care system, as defined by the Administration for Children and Families;
  3. Were eligible for the Federal Free and Reduced Lunch Program for two or more years;
  4. Have/had no parents or legal guardians who completed a bachelor’s degree (see the U.S. Department of Education);
  5. Were or currently are eligible for Federal Pell grants;
  6. Received support from the Special Supplemental Nutrition Program for Women, Infants and Children as a parent or child;
  7. Grew up in one of the following areas: a) a U.S. rural area, as designated by the Health Resources and Services Administration Rural Health Grants Eligibility Analyzer, or b) a Centers for Medicare and Medicaid Services-designated Low-Income and Health Professional Shortage Areas  (qualifying zip codes are included in the file). Only one of the two possibilities in #7 can be used as a criterion for the disadvantaged background

This revised definition should better capture many scientists with a disadvantaged background, and be relatively easy to assess, ensuring we continue enhancing the diversity of the biomedical research workforce.

We encourage scientists with a disadvantaged background to apply to our diversity programs.  We look forward to seeing your applications!

Update (2/19/20): Want more on NIH’s interest in diversity, supplement programs, and the revised definition? Listen to this NIH All About Grants podcast with Dr. Jon Lorsch, Director of the National Institute of General Medical Sciences (MP3 / Transcript).


  1. I am heartened by this revision of the definition of this socioeconomic disadvantage in the diversity definition, especially the inclusion of foster care involvement in the criteria.

    Previously socioeconomic disadvantage as an eligible category had only been routinely accepted for high school and college students. Will it be accepted for graduate students now?

    1. It is not limited to high school and undergraduate students anymore. We did not put a career-stage limit on it because there are data indicating that a disadvantaged background can have long-term effects on career attainment.

      1. I agree that this is a really wonderful change in NIH policy on diversity. I can personally attest to the affects of low socio-economic status on a life-long career. I really wish these avenues were open just a few short years ago because it would have really helped me. You state that “We did not put a career-stage limit on it…” I am now at the point where I am past the post-doc stage, but was unable to obtain an independent faculty position, so I am currently working as a staff-scientist. This is a somewhat “dead-end” position in terms of ever being able to run my own lab, so my question is are there funding opportunities under the newly expanded inclusion and diversity criteria that I could still apply for to help me get back on an academic track?

  2. Interesting. One important question – do the two below requirements cover people who were in poverty outside the U.S. (and so WOULD have been eligible if they were in the U.S. as children)? Those of us who are now U.S. citizens but were outside the U.S. as children were not eligible (because we were not in the U.S. as kids), but were equally disadvantaged.

    – Were eligible for the Federal Free and Reduced Lunch Program for two or more years;
    – Were or currently are eligible for Federal Pell grants;

    It is very difficult to meet this if you lived as a child outside the U.S. – at least 3 of the requirements (the other is the U.S. Foster Care system) seems to need you to have been here as a kid (no matter what your citizenship is now).

    Can you clarify what ‘eligibility’ means here?

    1. The Guide notice provides examples of categories of populations that can enhance diversity. Even though the notice provides US based metrics for the term disadvantaged, these are just examples of groups that would be considered in this category. Those from other types of disadvantaged backgrounds are encouraged to explain how they further the goals of the diversity program. (Note that because the cost of living, etc. varies so greatly from country to country, using U.S. low-income measures to determine low SES in another country would not make sense.)

  3. This is a great change.

    I’d like to point out a second factor that seriously reduces the number of low SES academics – the complete impossibility of combining a career with having a baby without significant family support.

    There is no possible way of paying for rent (median rents of over 2K/month in my city of Seattle) and daycare (1.6K a month) on a postdoctoral salary. I personally have provided support to 3 talented students who have essentially had the choice of either not continuing with their pregnancy or not continuing with their careers. Many students face this very personal choice without ever discussing it with their PI.

    1. The list is of funding announcements not specific grants and only the sponsor of the funding announcement is listed. The NEI is signed on to many of these announcements and does award grants in these areas. The NEI has a strong record of supporting diversity in vision research. Thank you for you interest.

  4. I applaud you for your thoughtful efforts to revise and broaden the definition in this way. In my perception, it’s an important step in the right direction toward greater inclusivity. Kudos to you, NIH Extramural Programs Staff!

  5. Given limited resources, allocation of funds should be prioritized for projects with the possibility of creating a paradigm shift or for investigators who are likely to “make a little dent in the universe.” Is there any data at this point that the NIH diversity programs accomplish either of these goals ?

    1. The data that these groups are not represented on the playing field is proof we aren’t exploring all avenues that can “make a little dent in the universe”. We need all human beings represented in Science if we are going to evolve into a more civilized and advanced species.

    2. The better question might be “Is there any data that the NIH can predict which projects have ‘the possibility of creating a paradigm shift’ or which investigators who are likely to ‘make a little dent in the universe’?” The process is effective at identifying persistence and paperwork-ability. Every change will have winners and losers, but when one of the measures of success is previous funding, that first grant can be all the difference for someone from a disadvantaged background.
      I’m somewhat biased, though, because I meet 5 of the 7 criteria above, and I just got my first fellowship this year on my fourth attempt.

  6. How about some RFAs that target populations with low SES in diseases that impact them (regardless of race, sex, etc.) from a mechanistic, biological perspective. Has never seemed to be a priority or emphasis area compared with other disparity types.

  7. Thank you for this outreach, the recognition of the significance of reaching the socio-economically disadvantaged and what I hope will be increased funding to institutions that have had this mission for decades and that have experience and success with this population. Hopefully this initiative will help to balance the “rich get richer” system that I have seen prevail, especially in research funding (federal and private), private donations, and…where I see the greatest socio-economic disadvantage: medical school acceptances and a prohibitively expensive application process. I hope too that the successes of state and regional high ed institutions in reaching the socio-economically disadvantaged will be increasingly recognized and funded.

  8. Many years ago, I tried to receive an R01 supplement to support a disadvantaged African American female doctoral student. The NIH program officer was so denigrating because I had not discussed the proposal with him initially and turned down the supplement. Nevertheless, I re-submitted the supplement incorporating his revisions and was turned down again. That sort of attitude prevented me from submitting the supplement a third time. If NIH wants to encourage diversity, train your program officers better to work with the PIs to submit successful supplements, re-write the supplement notices so that the requirements for a successful supplement are clear, and train your program officers to be more responsive to questions.

  9. Will our Olympic committees also be allowing those with disadvantaged upbringings to compete in Tokyo this summer? Would be nice to see some short people on the basketball team and some of our taller citizens competing in equestrian events.

  10. This should hugely broaden the qualifying demographic!

    Out of curiosity, I checked to see if at least two of the criteria would apply to me (27 years past PhD in physics, co-investigator on NIH grant applications within the past decade). Sure enough, criteria 4,5, and 7 apply! I always considered myself as middle class growing up, but I followed the link “Rural Health Grants Eligibility Analyzer” to see that the address I grew up in applies. Each of my parents had two years of college (i.e., no bachelors degree), which was all my dad needed back in the late 1950’s (plus passing the civil service exam) to garner what would now require at least a BS, and his later managerial position would now require an MS, presumably. Thirdly I qualified for Pell grants (or whatever they were called circa 1980) for my undergraduate years.

    The main interest is my observation of plenty-smart high school classmates who did not even go to college, or attended inexpensive/unchallenging colleges (with corresponding lifetime outcomes). Our public schools were pretty good (noting that that best students succeeded just fine at demanding colleges and universities, and in STEM fields) but I think the parents and milieu can be a huge impediment; and incomes are all pretty low still today in those small rural towns. Indeed I expect that the MAJORITY of students in my high school back then, and quite likely in the corresponding one today, qualify under #4,5, and 7.

    I repeat, a hugely broadened demographic.

  11. I agree with Jim (see above). I feel that there are thousands of scientists who can still be included in the disadvantaged/minorities list but are not even considered as disadvantaged. Some examples, not being educated in the US but being employed in the US after their PhD, coming from diverse racial/ethnic backgrounds, plus being a woman, plus not being able to submit their own grants within 10 years of completion of their PhD because they were stuck in labs of difficult scientists who exploited them on the basis of their visa situation….the list is endless..Question is: Is there hope for people like this to ever become successful?

  12. Is there a time restriction on any of the requirements? Would they need to be met before turning 18, for example? Or before completing graduate school?
    Thank you!

    1. To build off LC’s question – if a student were born into a qualified* ZIP code identified, but later moved to another ZIP code, would they still be eligible? Is there a set amount of years to qualify as “growing up” in that ZIP code?

      * Centers for Medicare and Medicaid Services-designated Low-Income and Health Professional Shortage Areas,

      1. For the location of where someone grew up, it is up to the respondent to decide whether they had lived in the place long enough and at the right ages to consider that they grew up there and if they were influenced by living there when they were under 18. Presumably, if someone lived in a low income community from the ages of zero to one and then moved to an affluent community, the criteria of living in a low income or rural area would not apply.

  13. The NIH Diversity programs do not support disadvantaged backgrounds for most of the applications. One example is the “Small Grants for New Investigators to Promote Diversity in Health-Related Research (R21)” (PAR-13-074) is to ‘Promote Diversity’ but has a line that reads “For the purposes of this program, the disadvantaged background category (C1 and C2) is not applicable.” (C1 and C2 sections written below) Therefore, it does not actually support disadvantaged backgrounds. Maybe this should be allowed if you want to include ‘Diversity.’

    C. Individuals from disadvantaged backgrounds, defined as:

    1. Individuals who come from a family with an annual income below established low-income thresholds. These thresholds are based on family size, published by the U.S. Bureau of the Census; adjusted annually for changes in the Consumer Price Index; and adjusted by the Secretary for use in all health professions programs. The Secretary periodically publishes these income levels at http://aspe.hhs.gov/poverty/index.cfm.

    2. Individuals who come from an educational environment such as that found in certain rural or inner-city environments that has demonstrably and directly inhibited the individual from obtaining the knowledge, skills, and abilities necessary to develop and participate in a research career.

  14. It is gratifying to see NIH recognizing that factors other than race and ethnicity can render someone disadvantaged, and actually taking steps to do help these individuals. I grew up poor, was smart and fast enough to avoid the bad kids in the neighborhood, and eventually make it to a private college on full scholarship, then med school, a faculty position, and NIH funding. But not everyone can be so fortunate. President Obama, before his first term, was in position to make history when he suggested consideration of socioeconomic status independent of race as a factor to be considered in diversity. Unfortunately, this never made it past an interview on a news show, but thank you NIH for recognizing this important issue.

  15. This is great news!

    I don’t mean to derail the topic, but as one of only 25 people awarded a diversity supplement on the basis of disability in FY2018, the application process needs some changes to be more welcoming to people with disabilities. One of the review criteria evaluates the candidate eligibility statement (which is written and signed by the PI/mentor). Specifically, the review considers “The strength of the description of how this particular appointment will promote diversity “. It’s hard to come up with a “strong” description without providing some details about the actual disability. I am fortunate that my mentor is someone who I felt comfortable disclosing this information to, but others I definitely would not have been as comfortable and probably would not have applied for the supplement. This is very unlike the process for getting ADA accommodations, where all details other than the specific accommodations requested are not revealed to faculty. Remember most people with disabilities have invisible disabilities and many of us are very hesitant in (or are at least careful about) revealing this information out of very legitimate concern that we may be seen as less productive scientists and face other forms of discrimination.

  16. Regarding # 7 – “Grew up in” is a very broad term and while many people may spend much of their lives in one place, others, such a military dependents, do not. Is there a specific number of years one should be in a certain zipcode to consider that they “grew up there?” I meet other criteria, but I am curious, because I am often asked where I am from or where I grew up and the answer is “all over” since my dad was in the Army. I suppose this can also be addressed in the diversity statement.

  17. I would add, as someone who meets all of those matrices, that it isn’t just about recruitment, but also retention. For students and even beyond, the cultural differences between those who have lifelong support for academic achievement and everything that comes with it, and those who don’t, can be incredibly limiting.

  18. I would like to see the inclusion of previous incarceration as a consideration for disadvantaged. The number of prison post-secondary education classes and degrees is increasing and some of these students are struggling financially to finish undergraduate degrees in order to continue in PhD programs. The financial challenge is significant and likely prevents students from doing the research needed to prepare for graduate admission. Please consider adding this category.

  19. I think it is great that NIH has seen the light of day, albeit you are 3/4 of a century late in discovering this.
    The entire academic community and NIH has been prejudiced against people who grow up in poor homes, regardless of race. I am white and my father never went to school, not even first grade. My mother went to sixth grade. To get into a Ph.D. program I had to take these stupid tests such as the Miller Analogies Test which has ridiculous questions about alcoholic beverages in Copenhagen vs. Paris vs. London vs. Amsterdam. How would someone, regardless of her/his aptitude in Math or vocabulary know this and why is the relevant to critical thinking? These ridiculous tests (Miller Analogies Test) are so biased against poor people. Despite being deprived of travel or haute culture growing up, I managed to get a high enough score on this stupid test to gain entrance to MENSA.
    This does not contradict my thoughts about discrimination against poor people in the Scientific communities.
    The same is true in Academe. People who are raised by Doctors, Lawyers and Professors have a huge advantage in navigating the system. They know how to be two-faced, how to
    say one thing and mean another, how to suck up to people in power, etc. What you see is not what you get in people who have higher incomes. This is part of doing business.
    Oh, yet another contradiction. I own five houses, all have views and two are waterfront.
    SO, I guess I learned how to play the game.

  20. Hello, Thank you for taking this initiative. I think it’s very important to expand the definition of socio-economical disadvantage. I am currently faculty wanted to apply for RO1 grant. I do come from socio-economic background and in hight school and college and the points below apply to me
    1. Were eligible for the Federal Free and Reduced Lunch Program for two or more years;
    2. Have no parents who completed a bachelor’s degree (see the U.S. Department of Education);
    3. Were eligible for Federal Pell grants;

    How do I apply for RO1 and indicate that I come from socio-economic disadvantaged background? Are there specific grants designed for us or do we just apply through the regular process?

    thanks so much

  21. I was born in a village in China. I belong to a “minority religion” that is discriminated against there. My dad did get a college degree but because of religious discrimination could not find a good job and had to sell used clothes on the street. We depended on the generosity of others to get by. I worked extremely hard in high school to get a full academic scholarship to Harvard, PhD from Stanford, and am now a scientist at an Ivy League Research institution. I don’t qualify as racial “minority” by Federal Standards, and never had to be on Federal assistance programs, only because I pulled myself up from my bootstraps. What about people like me? Don’t I get any sort of break?

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