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Update on the Action Plan to Reduce Racial and Ethnic Health Disparities

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Update on the Action Plan to Reduce Racial and Ethnic Health Disparities U.S. Department of Health and Human Services Office of the Secretary PROGRESS REPORT TO CONGRESS HHS Office of Minority Health 2020 Update on the Action Plan to Reduce Racial and Ethnic Health Disparities FY 2020 1 Acronyms AIM Alliance for Innovation on Maternal Health ARHQ Agency for Healthcare Research and Quality CDC Centers for Disease Control and Prevention CHIP Children’s Health Insurance Program CLAS Culturally and Linguistically Appropriate Services CMS Centers for Medicare & Medicaid Services FDA Food and Drug Administration FQHC Federally Qualified Health Center HRSA Health Resources and Services Administration HHS U.S. Department of Health and Human Services IHS Indian Health Service MMRC Maternal Mortality Review Committee NIH National Institutes of Health OCR Office for Civil Rights OMH HHS Office of Minority Health RHC Rural Health Clinic SAMHSA Substance Abuse and Mental Health Services Administration Summary Included in the Manager’s Agreement to H.R. 1865, which became Public Law 116-94, the Further Consolidated Appropriations Act, 2020, was a request for an update of the Action Plan to Reduce Racial and Ethnic Health Disparities (page 119): Within 180 days of enactment of this Act, HHS shall submit to the Committees an update of the Action Plan to Reduce Racial and Ethnic Health Disparities. The update should include barriers to full implementation and proposed remedies. The report should include the extent that HHS programs collect, report, and analyze health disparities data based on race, ethnicity, disability, and other characteristics for the population HHS programs serve. The updated report shall include specific efforts to improve birth outcomes for African-American women and children, including how to address implicit bias in healthcare delivery and the health impacts of trauma associated with racism. (Page 119, Managers Agreement) The following report is an update on the HHS Action Plan to Reduce Racial and Ethnic Health Disparities. 2 PROGRESS REPORT Overview In 2011, the U.S. Department of Health and Human Services (HHS) published the Action Plan to Reduce Racial and Ethnic Health Disparities, (Disparities Action Plan) to strategically align HHS efforts to reduce and eliminate disparities in health and health care. The five primary goals of the Action Plan are listed below. I. Transform Health Care II. Strengthen the Nation’s Health and Human Services Infrastructure and Workforce III. Advance the Health, Safety and Well-Being of the American People IV. Advance Scientific Knowledge and Innovation V. Increase the Efficiency, Transparency and Accountability of HHS Programs The Disparities Action Plan featured select HHS programs and milestones to reinforce an integrated, data-driven approach for addressing health disparities and improving the access, use and outcomes of HHS initiatives. In 2015, HHS provided a progress report on the Disparities Action Plan to provide illustrative examples of important work to reduce health disparities. The goals for the Disparities Action Plan continue to be relevant as HHS increases the impact of policies and programs to reduce health disparities in the context of emerging policies and conditions. This progress report highlights the implementation of the Disparities Action Plan elements in FY 2019 and FY 2020, with particular attention to the following three HHS priority areas. A. The Opioid Crisis B. Maternal and Infant Health C. COVID-19 Response and Recovery A. The Opioid Crisis The opioid crisis is a nationwide public health challenge, and opioid misuse and opioid overdose mortality continues to affect racial and ethnic minority populations. Data from the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that non-Hispanic Native Hawaiians and other Pacific Islanders have the highest rates of opioid misuse among those aged 18 and over.1 According to the Centers for Disease Control and Prevention (CDC), from 2017 to 2018, small decreases occurred in all overdose deaths and 1 SAMHSA Center for Behavioral Health Statistics and Quality. (2019). 2018 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville, MD. Table 1.60B, accessed from: https://www.samhsa.gov/data/nsduh/reports-detailed- tables-2018-NSDUH 3 in deaths involving all opioids, prescription opioids, and heroin. However, deaths involving synthetic opioids continued to increase in 2018 and accounted for two-thirds of opioid-involved deaths. Data show that from 2017 to 2018, Hispanics experienced the largest relative increases (27%) in synthetic opioid-involved overdose deaths compared to other racial/ethnic groups.2 Non-Hispanic Asians/Pacific Islanders experienced the second largest increase (25%).3 Non-Hispanic Whites experienced the lowest relative increase (5.9%).4 Despite growing opioid misuse and overdose mortality issues, treatment utilization remains lower among racial and ethnic minority populations. The CDC also noted that increases in deaths among racial and ethnic minorities indicates the need for culturally tailored interventions that address social determinants of health and structural- level factors. B. Maternal and Infant Health According to the CDC, the maternal mortality rate in the United States for 2018 was 17.4 maternal deaths per 100,000 live births. CDC data show that racial/ethnic disparities in pregnancy-related mortality5 and severe maternal morbidity are striking. During 2011-2016, the pregnancy-related mortality6 ratios were: • 42.4 deaths per 100,000 live births for non-Hispanic Black women. • 30.4 deaths per 100,000 live births for non-Hispanic American Indian/Alaska Native (AI/AN) women. • 14.1 deaths per 100,000 live births for non-Hispanic Asian/Pacific Islander women. • 13.0 deaths per 100,000 live births for non-Hispanic white women. • 11.3 deaths per 100,000 live births for Hispanic women. Severe maternal morbidity7 rates are higher among racial and ethnic minority women compared to non-Hispanic white women. In 2017, the rate of severe maternal morbidity was 93% higher among Black/African American women when compared to white women.8 This variability in 2 https://www.cdc.gov/mmwr/volumes/69/wr/mm6911a4.htm 3 https://www.cdc.gov/mmwr/volumes/69/wr/mm6911a4.htm 4 https://www.cdc.gov/mmwr/volumes/69/wr/mm6911a4.htm 5 According to the CDC, Maternal Mortality is defined as “the death of a woman while pregnant or within 42 days of termination of pregnancy,” but excludes those from accidental/incidental causes. Source: https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2020/202001_MMR.htm 6 According to the CDC, a Pregnancy Related Death is defined as “A pregnancy-related death is defined as the death of a woman while pregnant or within 1 year of the end of a pregnancy –regardless of the outcome, duration or site of the pregnancy–from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.” Source: https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality- surveillance-system.htm#how 7 Severe Maternal Morbidity includes unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman's health. SOURCE: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html#anchor_how 8 Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases (SID), 41 States and the District of Columbia, 2017 (from all states with reliable race reporting data in 2017 except Minnesota, Montana, North Dakota, Nebraska, Utah, and West Virginia) www.hcup- 4 the risk of severe complications of pregnancy and pregnancy related deaths by race/ethnicity indicates that more can be done to understand and reduce pregnancy-related deaths. In the last two years, HHS has given added priority to improving maternal health outcomes in the United States. In 2019, HHS established a department-wide workgroup to coordinate and enhance the Department’s work in this area, including addressing racial and ethnic disparities in maternal mortality and severe morbidity. C. COVID-19 Response and Recovery Data suggests that racial and ethnic minority populations bear a disproportionate burden of illness and death from COVID-19. As of August 18, 2020, Black/African American individuals accounted for 19.8% of confirmed cases (with known race/ethnicity) despite making up 13.4% of the U.S. population. Hispanic individuals accounted for 31.1% of confirmed cases but represent 18.5% of the U.S. population.9,10 Data from some states and localities have suggested higher rates of deaths for racial and ethnic minority individuals than for white individuals. Among AI/AN populations, the Navajo Nation (located in Arizona, Utah and New Mexico) and the White Mountain Apache Tribe (located in Arizona) has been particularly affected. The Navajo Nation individuals accounted for over four times more deaths compared to the state of Arizona’s COVID-19 death rate (267 vs. 63 per 100,000 population).11,12 The White Mountain Apache Tribe individuals accounted for close to four times more deaths compared to the state of Arizona’s COVID-19 death rate (245 vs. 63 per 100,000 population).6,13 Racial and ethnic minorities are at greater risk for exposure to and adverse outcomes from COVID-19 due to social determinants of health and living and working conditions. A greater prevalence of underlying health conditions also put racial and ethnic minorities
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