HHS Action Plan to Reduce Racial and Ethnic Health Disparities

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A Nation Free of Disparities in Health and Health Care. TABLE OF CONTENTS,Introduction and Background 1,New Opportunities 7. Vision and Purpose 11,Overarching Secretarial Priorities 12. Goal I Transform Health Care 15, Goal II Strengthen the Nation s Health and Human Services Infrastructure. and Workforce 19, Goal III Advance the Health Safety and Well Being of the American People 25. Goal IV Advance Scientific Knowledge and Innovation 29. Goal V Increase Efficiency Transparency and Accountability of HHS Programs 33. Conclusion 35,References 36, Appendix A Provisions of the Affordable Care Act that Address Health Disparities 39.
Appendix B Key Opportunities to Advance Health Disparity Reduction at HHS 42. Appendix C Key Disparity Measures 44,Appendix D Acronyms 45. A Nation Free of Disparities in Health and Health Care 1. INTrODuCTION AND BACkgrOuND,Introduction and Background. Medical advances and new technologies have provided people in. America with the potential for longer healthier lives more than ever It is time to refocus reinforce. before However persistent and well documented health disparities and repeat the message that. exist between different racial and ethnic populations and health equity. health disparities exist and that, remains elusive Health disparities differences in health outcomes. that are closely linked with social economic and environmental health equity benefits everyone. disadvantage are often driven by the social conditions in which Kathleen G Sebelius Secretary. individuals live learn work and play This document provides a brief. Health Human Services, overview of racial and ethnic health disparities and unveils a Department. of Health and Human Services HHS Action Plan to Reduce Racial and. Ethnic Health Disparities HHS Disparities Action Plan. The HHS Disparities Action Plan complements the 2011 National Stakeholder Strategy for Achieving. Health Equity a product of the National Partnership for Action NPA Stakeholder Strategy The NPA. Stakeholder Strategy reflects the commitment of thousands of individuals across the country in almost. every sector It resulted from a public private collaboration that solicited broad community input with the. assistance of state and local government and Federal agencies The NPA Stakeholder Strategy proposes. a comprehensive community driven approach to reduce health disparities in the U S and achieve health. equity through collaboration and synergy Now this first ever HHS Disparities Action Plan and the NPA. Stakeholder Strategy can be used together to coordinate action that will effectively address racial and. ethnic health disparities across the country Furthermore the HHS Disparities Action Plan builds on national. health disparities goals and objectives recently unveiled in Healthy People 2020 and leverages key. provisions of the Affordable Care Act and other cutting edge HHS initiatives. With the HHS Disparities Action Plan the Department commits to continuously assessing the impact of. all policies and programs on racial and ethnic health disparities Furthermore the Department can now. promote integrated approaches evidence based programs and best practices to reduce these disparities. Together the HHS Disparities Action Plan and the NPA Stakeholder Strategy provide strong and visible. national direction for leadership among public and private partners While the Department respects and. recognizes the critical roles other Federal departments play in reducing health disparities this action plan. focuses on HHS initiatives, 2 A Nation Free of Disparities in Health and Health Care.
INTrODuCTION AND BACkgrOuND,Overview of Racial and Ethnic Health Disparities. The societal burden of health and health care disparities in America manifests itself in multiple and major. ways In one stark example Murray et al show a difference of 33 years between the longest living and. shortest living groups in the U S 5 Another study The Economic Burden of Health Inequalities in the United. States by the Joint Center for Political and Economic Studies concludes that the combined costs of health. inequalities and premature death in the United States were 1 24 trillion between 2003 and 2006 6 Such. health disparities arise from both biologic factors and social factors that affect individuals across their. lifespan Regarding the latter the World Health Organization WHO defines these social determinants. of health as the conditions in which people are born grow live work and age that can contribute to or. detract from the health of individuals and communities 7 Marked difference in social determinants such. as poverty low socioeconomic status SES and lack of access to care exist along racial and ethnic lines. These differences can contribute to poor health outcomes 8. Individuals families and communities that have systematically experienced social and economic. disadvantage face greater obstacles to optimal health Characteristics such as race or ethnicity religion. SES gender age mental health disability sexual orientation or gender identity geographic location or. other characteristics historically linked to exclusion or discrimination are known to influence health status 9. While this HHS Disparities Action Plan focuses primarily on health disparities associated with race and. ethnicity many of the strategies can also apply across a wide array of population dimensions For example. expanding healthcare access data collection and the use of evidence based interventions will contribute to. health equity for vulnerable populations that are defined by income geography disability sexual orientation. or other important characteristics, The Burden of Racial and Ethnic Health Disparities Major Dimensions. The leading health indicators have demonstrated little improvement in disparities over the past decade. according to recent analyses of progress on Healthy People 2010 objectives Significant racial and ethnic. health disparities continue to permeate the major dimensions of health care the health care workforce. population health and data collection and research. Disparities in Health Care The Institute of Medicine s IOM landmark 2002 report Unequal Treatment. Confronting Racial and Ethnic Disparities in Health Care identifies the lack of insurance as a significant. driver of healthcare disparities 11 Lack of insurance more than any other demographic or economic barrier. negatively affects the quality of health care received by minority populations Racial and ethnic minorities. are significantly less likely than the rest of the population to have health insurance 12 They constitute about. one third of the U S population but make up more than half of the 50 million people who are uninsured 13. A Nation Free of Disparities in Health and Health Care 3. INTrODuCTION AND BACkgrOuND, Members of racial and ethnic minority groups are also overrepresented among the 56 million people in. America who have inadequate access to a primary care physician 14 Minority children are also less likely. than non Hispanic White children to have a usual source of care 15. Since 2002 the annual Agency for Healthcare Research and Quality AHRQ National Health Disparities. Reports NHDR have documented the status of healthcare disparities and quality of care received by racial. ethnic and socio economic groups in the United States 16 The NHDR documented that racial and ethnic. minorities often receive poorer quality of care and face more barriers in seeking care including preventive. care acute treatment or chronic disease management than do non Hispanic White patients 17 Minority. groups experience rates of preventable hospitalizations that are in some cases almost double that of. non Hispanic Whites 18 African Americans have higher hospitalization rates from influenza than other. populations 19 African American children are twice as likely to be hospitalized and more than four times as. likely to die from asthma as non Hispanic White children 20. Major efforts to provide quality health care to racial and ethnic populations occur through both long. standing safety net programs such as the Health Resources and Services Administration HRSA funded. Community Health Center Program and new initiatives such as those aimed at increasing meaningful use of. health information technology by primary care providers The Community Health Center Program provides. vulnerable populations access to comprehensive culturally competent quality primary healthcare services. Of the nearly 19 million patients currently served through these HRSA funded community health centers 63. percent are racial and ethnic minorities and 92 percent have incomes below the federal poverty level 21. Disparities in the Nation s Health and Human Services Infrastructure and Workforce The 2004. IOM report In the Nation s Compelling Interest Ensuring Diversity in the Health Care Workforce underscores. the significant differences in the racial and ethnic composition of the healthcare workforce compared to. the U S population 22 More recently the American Association of Medical Colleges reported that in 2008. Hispanics made up approximately 16 percent of the U S population but accounted for less than 6 percent of. all physicians 23 African Americans accounted for a similar proportion of the U S s population but just over 6. percent of physicians24, Racial and ethnic minorities are more likely than non Hispanic Whites to report experiencing poorer quality. patient provider interactions a disparity particularly pronounced among the 24 million adults with limited. English proficiency 25 Diversity in the healthcare workforce is a key element of patient centered care The. ability of the healthcare workforce to address disparities will depend on its future cultural competence. and diversity, In addition to cultural competency and diversity issues shortages of physicians and other health.
professionals in underserved areas significantly affect the health of racial and ethnic minorities HRSA s. 4 A Nation Free of Disparities in Health and Health Care. INTrODuCTION AND BACkgrOuND, National Health Service Corps NHSC invests in the healthcare workforce by placing health professionals. in Health Professional Shortage Areas to care for underserved populations Currently 7 000 NHSC. clinicians provide healthcare services in underserved areas in exchange for loan repayment or scholarships. approximately 33 percent of these clinicians are minorities and half serve in community health centers 26. Disparities in the Health Safety and Well Being of the American People All people should have. the opportunity to reach their full potential for health Yet those who live and work in low socioeconomic. circumstances which disproportionately include racial and ethnic minorities often experience reduced. access to healthy lifestyle options and suffer higher rates of morbidity and mortality as compared to their. higher income counterparts 27 The recently released Centers for Disease Control and Prevention CDC. report Health Disparities and Inequalities demonstrates that African American Hispanic Asian American. and American Indian and Alaska Native populations suffer higher mortality rates than other populations 28. Cardiovascular diseases for example account for the largest proportion of inequality in life expectancy. between African American and non Hispanic Whites Childhood obesity affects racial and ethnic minority. children at much higher rates than non Hispanic Whites driving up rates of associated diabetes 29. Addressing disparities at the population level involves both new and well established efforts For the past. decade the CDC s Racial and Ethnic Approaches to Community Health REACH program has empowered. residents to seek better health helped change local healthcare practices and mobilized communities to. implement evidence based public health programs to reduce health disparities across a broad range of. health conditions More recently as part of the American Recovery and Reinvestment Act ARRA and with. additional funds from the Affordable Care Act the 50 CDC funded Communities Putting Prevention to Work. CPPW programs are supporting statewide and community based policy and environmental changes in. nutrition physical activity and tobacco control directly targeting factors that may harm people s health. These recent efforts join well established programs to provide comprehensive child development services. to economically disadvantaged children and families Specifically the Administration for Children and. Families ACF Head Start program promotes the social and cognitive development of children by providing. educational health nutritional social and other services to enrolled children and families The Head. Start program helps parents make progress toward their educational literacy and employment goals. and engages them in their children s learning Most recent data indicate that racial and ethnic minorities. make up 79 percent of the population served by Head Start making this program a critical vehicle for. addressing the social determinants of health disparities 30 And the National Institutes of Health NIH has. woven innovative pilot projects into the Healthy Start setting as a strategy to address the disproportionate. burden of asthma among minority children and children living in poverty These projects serve as models for. developing healthy learning environments to introduce health and asthma self management skills to children. While this HHS Disparities Action Plan focuses primarily on health disparities associated with race and ethnicity many of the strategies can also apply across a wide array of population dimensions For example expanding healthcare access data collection and the use of evidence based interventions will contribute to health equity for vulnerable populations that are deined by income

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