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At the Intersection of Health, Health Care and Policy Doi: 10.1377/Hlthaff At the Intersection of Health, Health Care and Policy Cite this article as: Howard K. Koh, Garth Graham and Sherry A. Glied Reducing Racial And Ethnic Disparities: The Action Plan From The Department Of Health And Human Services Health Affairs, 30, no.10 (2011):1822-1829 doi: 10.1377/hlthaff.2011.0673 The online version of this article, along with updated information and services, is available at: http://content.healthaffairs.org/content/30/10/1822.full.html For Reprints, Links & Permissions: http://healthaffairs.org/1340_reprints.php E-mail Alerts : http://content.healthaffairs.org/subscriptions/etoc.dtl To Subscribe: http://content.healthaffairs.org/subscriptions/online.shtml Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © 2011 by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of Health Affairs may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved. Not for commercial use or unauthorized distribution Downloaded from content.healthaffairs.org by Health Affairs on October 31, 2011 at UNC LAW LIBRARY National Priorities By Howard K. Koh, Garth Graham, and Sherry A. Glied doi: 10.1377/hlthaff.2011.0673 HEALTH AFFAIRS 30, NO. 10 (2011): 1822–1829 ©2011 Project HOPE— Reducing Racial And Ethnic The People-to-People Health Foundation, Inc. Disparities: The Action Plan From The Department Of Health And Human Services Howard K. Koh (Howard.Koh@ hhs.gov) is the assistant ABSTRACT The Department of Health and Human Services (HHS) recently secretary for health at the unveiled the most comprehensive federal commitment yet to reducing Department of Health and Human Services (HHS), in racial and ethnic health disparities. The 2011 HHS Action Plan to Reduce Washington, D.C. Racial and Ethnic Health Disparities not only responds to advice Garth Graham is the deputy previously offered by stakeholders around the nation, but it also assistant secretary for minority health at HHS. capitalizes on new and unprecedented opportunities in the Affordable Care Act of 2010 to benefit diverse communities. The Action Plan Sherry A. Glied is the assistant secretary for advances five major goals: transforming health care; strengthening the planning and evaluation at infrastructure and workforce of the nation’s health and human services; HHS. advancing Americans’ health and well-being; promoting scientific knowledge and innovation; and upholding the accountability of HHS for making demonstrable progress. By mobilizing HHS around these goals, the Action Plan moves the country closer to realizing the vision of a nation free of disparities in health and health care. n 1985 the Department of Health and the paradox noted in the Heckler Report and the Human Services (HHS) released the increasing diversity of the nation’s population10 Report of the Secretary’s Task Force on prompted HHS to review and reinvigorate its Black and Minority Health. Sometimes commitment to reducing racial and ethnic health called the Heckler Report, it represented disparities. Ithe first comprehensive US government ac- The department recognized that a broad counting of the health disparities affecting racial federal plan, never attempted previously, could and ethnic minorities in the United States.1 The provide critical and visible national direction. report’s opening pages highlighted the “national Hence, in 2011, after considerable community paradox of phenomenal scientific achievement input and with support across the sectors of and steady improvement in overall health status” the health care system, the department unveiled accompanied by “persistent, significant health the first HHS Action Plan to Reduce Racial and inequities [that] exist for minority Americans.”1 Ethnic Health Disparities.11 The country has since responded with an array The Action Plan represents the first federal of initiatives aimed at improving both direct care strategic disparities plan and the most compre- of underserved populations2 and community- hensive federal commitment in this area to date. based prevention.3–7 States and community It builds not only on the promise of the Afford- groups have also contributed greatly, through able Care Act of 201012 but also on other key both new and well-established programs—such national strategic planning initiatives.13 Further- as the Bronx Racial and Ethnic Approaches to more, the Action Plan presents a unified frame- Community Health (REACH) Coalition, which work for HHS, in collaboration with other has worked to increase local residents’ access federal departments and with communities, to to healthy food.4,8,9 However, the persistence of transform health care, strengthen the infrastruc- 1822 Health Affairs October 2011 30:10 Downloaded from content.healthaffairs.org by Health Affairs on October 31, 2011 at UNC LAW LIBRARY ture and workforce of the nation’s health and A New Climate For Change human services, advance Americans’ health Several developments besides the Action Plan and well-being, promote scientific knowledge helped usher in a new climate to address the and innovation, and uphold the accountability disparities challenge. These include the National of HHS for making demonstrable progress. We Partnership for Action to End Health Dispar- believe that these efforts, summarized in this ities, a grassroots public-private collaboration;25 paper, can move the country closer to the reality the National Stakeholder Strategy for Achieving of a nation free of disparities in health and Health Equity;13 the Affordable Care Act;12 and an health care. array of complementary national strategic plan- ning initiatives. Engaging Stakeholders Seeking public The Need For A Disparities guidance for a revitalized strategy to address Action Plan health disparities, the HHS Office of Minority Persistent and pervasive health disparities Health convened nearly 2,000 stakeholders have affected racial and ethnic minorities, the from around the country at a National Leader- poor, and other at-risk populations for years. ship Summit for Eliminating Racial and Ethnic A health disparity can be defined as a particular Disparities in Health in 2008.25,26 The summit type of health inequality stemming from social, stimulated the subsequent formation of the Na- economic, or environmental disadvantage.13 tional Partnership for Action to End Health Dis- Although disparities can also be viewed through parities, which includes community- and faith- many other lenses—for example, socioeconomic based organizations, businesses, health care and status, sex, age, level of disability, geography, insurance industries, academe, cities and sexual orientation, or gender identity—the counties, states, tribes, and federal agencies.25 Action Plan focuses specifically on race and In community meetings over a two-year ethnicity. Included within the definition of period, the partnership drafted recommenda- health disparities are health care disparities, or tions that culminated in the 2011 National Stake- differences in the amount and quality of health holder Strategy for Achieving Health Equity.13 care that different groups receive. The National Stakeholder Strategy, released to- Health and health care disparities carry major gether with the Action Plan, proposes a common societal consequences.1,14–17 For example, racial set of national goals and objectives for the public and ethnic minorities, who constitute about a and private sectors. The main principles include third of the US population but more than half improving local awareness of health disparities, of the uninsured, have particularly poor access to enhancing local data collection efforts, and em- primary care.18 Large racial and ethnic health phasizing public-private partnerships to im- disparities also permeate the health care work- prove access to care (Exhibit 1). Local groups force, the health of populations, and data collec- can tailor the strategy for their own com- tion and research. Critical shortages of culturally munities. competent health professionals affect the quality TheAffordableCareActThe Affordable of health care for the nation’s minorities, espe- Care Act12 not only enacted comprehensive cially populations with limited English profi- health reform, but it also addressed health dis- ciency.19–21 parities in critical ways. Exhibit 2 lists some of Population health disparities in a wide array of the act’s major provisions in this area. For exam- conditions—including cardiovascular disease, ple, sections 1311 and 2201 are intended to in- cancer, HIV/AIDS, diabetes, viral hepatitis, men- crease both access to and the affordability of care tal health, and oral health—contribute to poorer for underserved populations. Section 3011 is de- health outcomes for racial and ethnic minor- signed to strengthen the health care system to ities.11,13 Moreover, the lack of consistent, widely improve quality of care; section 10503 to expand used standards for collecting and reporting community-level care through health centers health data by racial and ethnic subpopulations and teams; and section 4004 to increase preven- and primary language has complicated the early tion efforts for underserved groups. In addition, identification of health disparities as well as the many provisions focus on community-based
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