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

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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 development of methods to reduce them.22 In strategies for eliminating local barriers to addressing these and other well-recognized health. As one example, section 4201 is intended deficiencies, the Healthy People 2020 initiative to encourage community infrastructures and proposes the elimination of health disparities as programs to promote health in schools, work- one of its four overarching national goals,23,24 places, and neighborhoods. with progress to be monitored by HHS over Furthermore, section 5307 provides a strong the upcoming decade. foundation for the Action Plan with respect to improving both the diversity of the health care

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Exhibit 1

National Stakeholder Strategy For Achieving Health Equity: Goals And Strategic Areas Goal Strategic area 1. Awareness: increase awareness of the significance of health 1. Health care agenda disparities, their impact on the nation, and the actions necessary 2. Partnerships to improve health outcomes for racial, ethnic, and underserved 3. Media populations 4. Communication 2. Leadership: strengthen and broaden leadership for addressing 5. Capacity building health disparities at all levels 6. Funding and research priorities 7. Youth 3. Health system and life experience: improve health and health 8. Access to care care outcomes for racial, ethnic, and underserved populations 9. Children 10. Older adults 11. Health communication 12. Education 13. Social and economic conditions 4. Cultural and linguistic competency: improve cultural and 14. Workforce linguistic competency and diversity of the health-related 15. Diversity workforce 16. Ethics, standards, and financing for interpreting and translation services 5. Data, research, and evaluation: improve data availability; 17. Data coordination, use, and diffusion of research and evaluation 18. Community-based research and action; outcomes community-originated intervention strategies 19. Coordination of research 20. Knowledge transfer

SOURCE National Stakeholder Strategy for Achieving Health Equity (Note 13 in text).

workforce and its competency in treating pa- mary language (section 4302) and for strength- tients from different cultural and linguistic back- ening HHS’s administrative capacity to address grounds. And the act lays the groundwork for minority health (section 10334).12 advancing data collection through the reporting Key Strategic Planning Initiatives In addi- of health information by race, ethnicity, and pri- tion to Healthy People 2020,24 recent national

Exhibit 2

HHS Action Plan To Reduce Racial And Ethnic Health Disparities: Goals And Related Strategies Goal Strategy 1. Transform health care 1a. Reduce disparities in health insurance coverage and access to care 1b. Reduce disparities in access to primary care services and care coordination 1c. Reduce disparities in the quality of health care 2. Strengthen the nation’s health and human services 2a. Increase ability of all health professions and health care system to identify and address infrastructure and workforce racial and ethnic health disparities 2b. Promote use of community health workers and promotores 2c. Increase diversity of health care and public health workforces 3. Advance the health, safety, and well-being of the 3a. Reduce disparities in population health by increasing availability and effectiveness of American people community-based programs and policies 3b. Conduct and evaluate pilot tests of health disparity impact assessments of selected proposed national policies and programs 4. Advance scientific knowledge and innovation 4a. Implement a multifaceted health disparities data collection strategy across HHS 4b. Conduct and support research to inform disparities-reduction initiatives 5. Increase the efficiency, transparency, and 5a. Streamline grant administration for health disparities funding accountability of HHS programs 5b. Monitor and evaluate implementation of the HHS Action Plan at the goal, strategy, and action levels

SOURCE HHS Action Plan to Reduce Racial and Ethnic Health Disparities (Note 11 in text). NOTES HHS is Department of Health and Human Services. Promotores are trusted local people who serve as community health workers.

1824 Health Affairs October 2011 30:10 Downloaded from content.healthaffairs.org by Health Affairs on October 31, 2011 at UNC LAW LIBRARY efficiently than before. Implementation of the The Affordable Care Act also establishes the Community Health Center Fund. The fund will Affordable Care Act invest $11 billion over five years in ongoing op- erations at federally qualified community health should narrow centers; the expansion of preventive and primary disparities in health health care services; major construction and ren- ovation projects at existing sites; and the crea- insurance coverage. tion of new health centers in medically under- served areas. Of note, low-income racial and ethnic minorities account for nearly two-thirds of the people now served by the health centers, which are funded by the Health Resources and Services Administration. commitments to improve health and thereby Strengthen The Workforce And Infra- decrease disparities abound. They include the structure Steps to advance the goal of strength- 2010 Let’s Move! initiative launched by First ening the workforce and infrastructure include Lady Michelle Obama, which proposes to solve, increasing and diversifying the workforce and within a generation, the challenge of childhood improving communication and translation obesity that disproportionately affects minor- services. For example, the Affordable Care Act ities.27 Other recent initiatives in HHS catalyze provides $1.5 billion over five years to expand prevention efforts5 in areas such as tobacco the National Health Service Corps. Currently, control, HIV/AIDS, vaccines, health literacy, 7,000 clinicians in the corps are working in environmental justice, and chronic viral underserved areas in exchange for loan repay- hepatitis.28–33 ments or scholarships. Approximately half of them deliver care in health centers, and about one-third of them are minorities. With the addi- Priorities, Goals, And Strategies tional funding, the corps will expand capacity in To create the Action Plan, Secretary Kathleen primary care, long-term care, and dentistry. To Sebelius charged the HHS Working Group for improve health services delivery for underserved the Action Plan to Reduce Racial and Ethnic Dis- populations, the Health Resources and Services parities with the responsibility of producing a Administration will also recruit professionals vision of a nation free of disparities in health from historically black colleges and universities and health care. Beginning in fiscal year 2011, for enrollment. the working group combined efforts across the At the same time, through demonstration department’s twelve agencies to promote the five projects, the Administration for Children and major goals, listed above, with examples of pro- Families is encouraging recipients of Temporary posed actions described in further detail below Assistance for Needy Families (which provides (Exhibit 2).11 assistance to needy families to help pay for food, Transform Health Care Implementation of clothing, housing, and other basic needs) to re- the Affordable Care Act should narrow dispar- ceive training and enter health care professions. ities in health insurance coverage and access Similarly, the Office of Minority Health, the and improve primary care services, care co- Centers for Medicare and Medicaid Services, and ordination, and health care quality. In 2014, other entities within HHS will use a national for example, Medicaid coverage will expand to advisory group to help upgrade the National cover individuals with incomes under 133 per- Standards for Culturally and Linguistically Ap- cent of the federal poverty level. Additionally, tax propriate Services in Health Care.34 First released credits will help families and individuals with in 2000, these standards set benchmarks for incomes below 400 percent of the poverty level serving diverse populations. The department purchase affordable coverage in the new state will also expand translation services, in part by insurance exchanges. promoting the interpreting profession as an es- These efforts will improve access to care for sential component of the health care workforce minority communities, building on the recent and establishing an online national registry of coverage advances for youth provided by the certified interpreters for health care facilities Children’s Health Insurance Program Reautho- and providers. The Action Plan also calls for pro- rization Act of 2009. Streamlined enrollment grams to train health care interpreters and to procedures will speed determinations of eligibil- promote credentialing examinations, where ity, connecting qualified individuals to health appropriate. insurance and human service programs more The Centers for Medicare and Medicaid

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Services also plans to include grants for better web-based software and other technologies to All HHS agencies have help people who have limited English language proficiency enroll in Medicaid and the Children’s begun upgrading their Health Insurance Program. Improve Americans’ Health, Safety, And strategic plans, Well-Being The previously noted key strategic communications, planning initiatives reinforce the Affordable Care Act’s major focus on prevention.35 Of note, programs, and the act establishes a Prevention and Public Health Fund, with $15 billion over ten years regulations. planned for prevention initiatives that should particularly help the underserved. In addition, the Maternal, Infant, and Early Childhood Home Visiting Program12 addresses the diverse needs of underserved minority women and families with limited social support networks. Through this Administration, Health Resources and Services effort, improvements in prenatal, maternal, Administration, Substance Abuse and Mental newborn, and child health and development; pa- Health Services Administration, and Centers renting skills; school readiness; and family eco- for Medicare and Medicaid Services. These nomic self-sufficiency could lead to reductions in changes, along with the elevation of the former outcomes such as domestic violence and paren- National Center for Minority Health and Health tal substance abuse. Disparities at the National Institutes of Health to Complementing this effort, the Substance a full-fledged institute, should help integrate ef- Abuse and Mental Health Services Adminis- forts across the entire department. tration will train health care professionals to All HHS agencies have begun upgrading their deliver evidence-based behavioral health inter- strategic plans, communications, programs, and ventions for trauma and trauma-related dis- regulations to implement the Action Plan. Using orders affecting minority populations. The key performance measures for each of the five agency will provide technical assistance through goals, the agencies will track health disparities its National Network to Eliminate Disparities in outcomes across domains. Behavioral Health. Consider, for example, the goal of expanding Advance Scientific Knowledge And Inno- the number of insured Americans through vation Section 4302 of the Affordable Care Medicaid, the Children’s Health Insurance Act serves as a major driver for improving the Program, Medicare, the health insurance ex- availability and quality of data on racial and eth- changes, and other forms of insurance.11 At the nic minority populations.12 Specifically, this sec- goal level—transforming health care—HHS will tion requires the HHS secretary to adopt new monitor key indicators across the domains of standards for data collected by race, ethnicity, insurance coverage, access to primary care, sex, primary language, and disability status. It and quality of care (Exhibit 2). At the strategy also requires that these standards be met by all level—reducing disparities in health insurance federally funded population health surveys. By coverage and access to care—the department will ensuring the collection and reporting of more track the number of uninsured racial and ethnic detailed and uniform demographic data than minorities under age sixty-five. And at the action ever before, the standards should lead to im- level, the department will monitor the number of proved identification of health disparities and racial and ethnic minorities in the Children’s the creation of better interventions to ad- Health Insurance Program and Medicaid via dress them. its streamlined eligibility programs and, after Increase HHS’s Efficiency, Transparency, 2014, through the Medicaid expansions and in- And Accountability HHS will heighten co- surance exchanges. A detailed appendix in the ordination to maximize the overall impact of Action Plan describes these and other the strategies in the Action Plan, track progress measures.11 in achieving its goals, and streamline grant administration for health disparities funding. Section 10334 of the Affordable Care Act12 re- Early Steps For Implementation quires the creation of new offices of minority Implementation of the Action Plan is well under health in six agencies in HHS: the Agency for way. For example, the Health Resources and Healthcare Research and Quality, Centers for Services Administration recently awarded Disease Control and Prevention, Food and Drug sixty-seven New Access Point grants—totaling

1826 Health Affairs October 2011 30:10 Downloaded from content.healthaffairs.org by Health Affairs on October 31, 2011 at UNC LAW LIBRARY Additionally, the National Cancer Institute’s The Action Plan Community Networks Program continues to support community-based participatory re- addresses deeply search to increase cancer awareness, prevention, and control in underserved populations. rooted disparities that Implementing the Action Plan will not be easy. It addresses deeply rooted disparities that have have defied major defied major efforts toward progress for many efforts toward years. Furthermore, despite the major infusion of new funds from the Affordable Care Act, the progress for years. budget climate remains uncertain. In assuming implementation responsibilities, HHS’s Health Disparities Council will seek strong co- ordination with the National Partnership for Ac- tion as well as other federal, state, and commu- nity partners. $28 million—that not only expand existing fed- erally qualified community health centers but also support new sites. Conclusion To help diversify the health workforce, HHS The first HHS Action Plan to Reduce Racial and recently announced a National Steering Commit- Ethnic Health Disparities11 holds much promise tee for promotores—trusted local people who for the nation. Responding to community input, serve as community health workers—and has be- it offers a comprehensive commitment to gun developing a national training curriculum. addressing disparities related to insurance cov- Additionally, the Centers for Disease Control and erage, quality of care, workforce diversity, pop- Prevention recently announced its $103 million ulation health, and data collection. By taking Community Transformation Grants program, advantage of a new climate for change and of whereby grants to state and local organizations opportunities such as the Affordable Care Act can help communities implement projects and other initiatives, the country can move proven to reduce diabetes, heart disease, and closer to becoming a nation free of health and other chronic conditions. health care disparities. ▪

Theauthorsaregratefultothe members of the Department of Health and Human Services’ Working Group on Racial and Ethnic Health Disparities for their commitment and dedication, which resulted in this report. They acknowledge the special efforts of Rosie Henson, Rochelle Rollins, Dora Hughes, Rima Cohen, Regan Crump, Jim Scanlon, and Julie Piotrowski.

NOTES

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The role of home-visitation pro- Center; 2007 Mar [cited 2011 Internet]. Washington (DC): Office grams in improving health outcomes Aug 31]. Available from: http:// of the First Lady; [cited 2011 Aug 31]. for children and families. Pediatrics. www.graham-center.org/online/ Available from: http://www 1998;101(3):486–9. graham/home/publications/ .letsmove.gov 10 Census Bureau [Internet]. Washing- monographs-books/2007/ 28 Department of Health and Human ton (DC): Census Bureau. Press re- rgcmo-access-denied.html Services. Ending the tobacco epi- lease, An older and more diverse 19 Health Resources and Services demic: a tobacco control strategic nation by midcentury; 2008 Aug 14 Administration. Bureau of Clinician action plan for the U.S. Department [cited 2011 Aug 31]. Available from: Recruitment and Services manage- of Health and Human Services [In- http://www.census.gov/newsroom/ ment information system [Internet]. ternet]. Washington (DC): HHS; releases/archives/population/ Rockville (MD): HRSA; [cited 2011 2010 Nov 10 [cited 2011 Aug 31]. cb08-123.html Aug 31]. Available from: https:// Available from: http://www.hhs 11 Department of Health and Human nis.hrsa.gov/Public/NSP/Help_ .gov/ash/initiatives/tobacco/ Services. HHS action plan to reduce UserAccount.html tobaccostrategicplan2010.pdf racial and ethnic health disparities 20 Institute of Medicine. In the nation’s 29 Office of National AIDS Policy. Na- [Internet]. Washington (DC): HHS; compelling interest: ensuring diver- tional HIV/AIDS strategy [Internet]. 2011 [cited 2011 Aug 31]. Available sity in the health care workforce. Washington (DC): The Office; [cited from: http://www.minorityhealth Washington (DC): National Acad- 2011 Aug 31]. Available from: .hhs.gov/npa/templates/content emies Press; 2004. http://www.whitehouse.gov/ .aspx?lvl=1&lvlid=33&ID=285 21 Collins KS, Hughes DL, Doty MM, administration/eop/onap/nhas 12 HealthCare.gov. 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About Healthy 33 Department of Health and Human editors. Unequal treatment: con- People [Internet]. Washington (DC): Services. Combating the silent epi- fronting racial and ethnic disparities Department of Health and Human demic of viral hepatitis: action plan in health care. Washington (DC): Services; [updated 2011 Jun 22; cited for the prevention, care, and treat- National Academies Press; 2003. 2011 Aug 19]. Available from: http:// ment of viral hepatitis [Internet]. 16 Agency for Healthcare Research and www.healthypeople.gov/2020/ Washington (DC): HHS; [cited 2011 Quality. 2010 national healthcare about/default.aspx Aug 31]. Available from: http:// quality and disparities reports [In- 25 National Partnership for Action to www.hhs.gov/ash/initiatives/ ternet]. Rockville (MD): AHRQ; End Health Disparities [home page hepatitis/ [cited 2011 Aug 31]. Available on the Internet]. Rockville (MD): 34 Department of Health and Human from: http://www.ahrq.gov/qual/ Department of Health and Human Services, Office of Minority Health. qrdr10.htm Services; [cited 2011 Aug 31]. Avail- National standards for culturally and 17 Centers for Disease Control and able from: http://www.minority- linguistically appropriate services in Prevention. CDC health disparities health.hhs.gov/npa health care: final report [Internet]. and inequalities report—United 26 Graham GN. Quality of care and Washington (DC): HHS; 2001 Mar States, 2011. MMWR. 2011; health disparities: the evolving role [cited 2011 Aug 31]. Available from: 60(Supp):1–114. of the government. In: Williams R, http://www.omhrc.gov/assets/pdf/ 18 National Association of Community editor. Eliminating healthcare dis- checked/finalreport.pdf Health Centers, Robert Graham parities in America: beyond the IOM 35 Koh HK, Sebelius KG. Promoting Center. Access denied: a look at report. Totowa (NJ): Humana Press, prevention through the Affordable America’s medically disenfranchised 2007. p. 337–49. Care Act. N Engl J Med. 2010; [Internet]. Washington (DC): The 27 LetsMove.gov [home page on the 363(14):1296–9.

1828 Health Affairs October 2011 30:10 Downloaded from content.healthaffairs.org by Health Affairs on October 31, 2011 at UNC LAW LIBRARY ABOUT THE AUTHORS: HOWARD K. KOH, GARTH GRAHAM & SHERRY A. GLIED

health in Massachusetts. He has which sought to identify the published more than 200 scholarly behavioral underpinnings of heart articles on such topics as problems among young African disparities, cancer control, American men. Howard K. Koh is the assistant melanoma and skin cancer, tobacco Graham is on the faculty of secretary for health control, public health Harvard Medical School and has at the Department preparedness, health promotion, authored numerous scientific of Health and disease prevention, and public articles on cardiovascular disease, Human Services health leadership. HIV/AIDS, and community (HHS). Koh received his medical degree medicine. He earned his medical In this month’s Health Affairs, from the degree at the Yale School of Howard Koh and coauthors from and a master of public health Medicine, where he graduated cum the Department of Health and degree from University. He laude, and his master of public Human Services (HHS) report on is board certified in internal health degree from the Yale School the 2011 HHS Action Plan to medicine, hematology, medical of Epidemiology and Public Health. Reduce Racial and Ethnic Health , and dermatology. He Disparities, which they describe as traces his concern about health the most comprehensive federal disparities not just to his early effort to realize “the vision of a days as a physician treating inner- nation free of disparities in health city patients at Massachusetts and health care.” They enumerate GeneralHospitalandBostonCity and expand on the plan’smajor Hospital, but also to his experience Sherry A. Glied is goals, which include helping members of his extended the assistant — implementation of provisions of family immigrants from South secretary for — planning and the Affordable Care Act along with Korea navigate the US health care evaluation at HHS. other key initiatives. system. Koh is the assistant secretary for Sherry Glied is the assistant health at HHS. In that position, he secretary for planning and oversees fourteen public health evaluation at HHS. Previously, she offices, including the Office of the headed the Department of Health Surgeon General and the Public Policy and Management at Health Service Commissioned Columbia University’sMailman Corps; ten regional health offices Garth Graham is School of Public Health. She is on across the country; and ten the deputy leave from that position as she presidential and secretarial assistant secretary serves at HHS. In 1992 and 1993 for minority health advisory committees. He also she was senior economist for at HHS. oversees numerous health care and labor market policy interdisciplinary programs Garth Graham is the deputy on the President’s Council of dedicated to disease prevention, assistant secretary for minority Economic Advisers, under health promotion, bioethics, health at HHS, where he oversees Presidents George H.W. Bush and research integrity, human research federal health policies that address . She is a member of protections, women’sandminority the concerns of racial and ethnic the Institute of Medicine. Her main health, and the reduction of health minorities and strives to ensure research interests are health policy disparities. that federal, state, and local health reform and mental health care Before his current appointment, programs meet the needs of the policy. Koh was a professor and the disadvantaged. He was previously a Glied received her master’s associate dean for public health White House Fellow and special degree in economics from the practice at the Harvard School of assistant to the HHS secretary. He University of Toronto and her Public Health. From 1997 to 2003 also founded the Boston Men’s doctorate in economics from he was commissioner of public Cardiovascular Health Project, Harvard University.

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