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Health Affairs Forum on Disparities on Health and Health Care

Howard K. Koh, M.D., M.P.H.
Assistant Secretary for Health
U.S. Department of Health and Human Services

October 6, 2011
Health Affairs Forum on “Disparities on Health and Health Care”
Washington, DC

Remarks as prepared for delivery 


Of all the forms of inequality, injustice in health is the most shocking and the most inhumane.”

Time and time again, we have repeated these powerful words of Dr. Martin Luther King — as our own “call to action” for achieving health equity for all.

In thinking about some of the challenges we face in achieving this goal — including how long it can take to arrive at lasting solutions — we can remind ourselves of another one of Dr. King’s oft-quoted sayings: “The arc of the moral universe is long, but it bends towards justice."

In other words, our actions matter.

I truly believe that a society that works together — can create a society in which every person has the opportunity to reach his or her full potential for health.

A society in which we can celebrate a health system that delivers prevention early, consistently, and effectively, instead of a system that delivers medical treatment too late.

But hoping for change and progress is not enough to transform our health system to one that reduces health disparities.

To be successful, we need an overarching framework to connect our individual steps and efforts, to guide our cooperation, and to leverage our knowledge and experience, so we can combine efforts with those — government leaders, community groups, employers, health professionals and others — who are fighting for health equity.
That’s why, in April of this year, HHS released two strategic action plans aimed at reducing health disparities among racial and ethnic minorities.

The “HHS Action Plan to Reduce Health Disparities” outlines specific goals and actions our Department, in partnership with other federal agencies, will take to reduce disparities.

HHS also released the “National Stakeholder Strategy for Achieving Health Equity,” a common set of goals and objectives for public and private sector initiatives and partnerships to help racial and ethnic minorities and other underserved groups reach their full health potential.

Today, I want to share more details about both of these important action plans. Together, with the unprecedented opportunities available in the new Affordable Care Act, we have perhaps the greatest opportunity within decades to significantly improve health and health care for all, including the most vulnerable among us.

It is time for all of us, especially in a society that is becoming more richly diverse —to renew our efforts to refocus, reinforce, and repeat the message that health disparities still exist and that health equity benefits everyone.

We will not rest until we have achieved a nation free of health disparities, and until we have created better systems for prevention and care.

From a national and global point of view, we are facing major threats to our environment and our health, including persistent, pervasive and well-documented health disparities that have, for years, affected racial and ethnic minorities, the poor, and other at-risk populations.

In 1985, HHS released the Report of the Secretary's Task Force on Black and Minority Health, more widely known as the “Heckler Report.” It was the first comprehensive accounting of the health disparities affecting racial and ethnic minorities in the U.S.

Its opening pages highlighted the national paradox of “phenomenal scientific achievement” and “steady improvement in overall health status,” which, it pointed out, existed alongside “persistent, significant health inequities” for minority Americans.

Over the last 25-plus years, we have responded with federal, state and local action — through many diverse health care initiatives — to improve the direct care of underserved populations, and to reduce the incidence of chronic diseases, especially among our minority populations.

But we know we must do more, much, much more, to address illnesses such as cancer, heart disease, hepatitis, tobacco addiction, HIV, obesity, substance abuse and other conditions, which are exacerbated by health inequities, struggling health systems and poverty.

Many would appropriately view these challenges as giant obstacles. Many would even turn away to leave the hard work of improving our communities and society to others.

At times like this, when there is so much work yet to be done, I think of the words of my wonderful friend, the late Rev. William Sloane Coffin. He said: "Giant obstacles are brilliant opportunities, brilliantly disguised as giant obstacles."

And, at HHS, in our new disparities plans, we are choosing to view these obstacles as opportunities — to find effective new approaches to prevention.

President Obama and HHS have made eliminating health disparities a top priority for this Administration.

Despite significant improvements in health and health services throughout the nation since the release of the Heckler Report, health disparities continue to exist. So we clearly require new approaches and new partnerships to help close the health gap in the United States.

At HHS, we recognized that a formal, national strategy for reducing racial and ethnic health disparities — would be the most effective way to provide the visible national direction needed to achieve our goals.

So after considerable community input and support across all sectors — HHS unveiled, last April — its first-ever Action Plan to Reduce Racial and Ethnic Health Disparities.

The plan is focused on improving the health status of vulnerable populations across the lifespan.

It will assess the impact of all HHS policies and programs on health disparities, promote integrated approaches among HHS agencies, and drive the implementation of evidence-based programs and best practices.

The Action Plan not only responds to advice offered by our national stakeholders, but it also leverages new and unprecedented opportunities in the Affordable Care Act that are expected to benefit diverse communities.

It employs 12 strategies and 30+ actions to achieve its five major goals:

Within the framework of the HHS Action Plan, the five overall goals for reducing disparities and associated action steps include:

  • Transforming Health Care: Action steps include expanding insurance coverage, increasing access to care through development of new service delivery sites and introducing quality initiatives such as increased utilization of medical homes.
  • Strengthening the Nation’s Health and Human Services Workforce: Action steps include a new pipeline program for recruiting undergraduates from underserved communities for public health and biomedical sciences careers, expanding and improving health care interpreting and translation, and supporting more training of community health workers, such as promotoras.
  • Advancing the Health, Safety and Well-Being of the American People: Action steps include implementing the CDC’s new Community Transformation Grants, and additional targeted efforts to achieve improvements in cardiovascular disease, childhood obesity, tobacco-related diseases, maternal and child health, flu and asthma.
  • Advancing Scientific Knowledge and Innovation: Action steps include implementing a new health data collection and analysis strategy authorized by the Affordable Care Act, and increasing patient-centered outcomes research.
  • Increasing the Efficiency, Transparency and Accountability of HHS Programs: Actions steps include ensuring that assessments of policies and programs on health disparities will become part of all HHS decision-making.   Evaluations will measure progress toward reducing health disparities.  

HHS also released the “National Stakeholder Strategy for Achieving Health Equity,” a common set of goals and objectives for public and private sector initiatives and partnerships to help racial and ethnic minorities and other underserved groups reach their full health potential.

The heart of the Strategy resides in the 20 strategies for action to end health disparities that were developed by a national, collaborative process.

  • Each of these strategies is linked to one of the five NPA goals of:
    • Awareness;
    • Leadership;
    • Health System and Life Experience (improving health and healthcare outcomes for racial, ethnic, and underserved populations);
    • Cultural and Linguistic Competency; and
    • Data, Research, and Evaluation.

Together, these important goals and strategies comprise a menu of resources that change-oriented stakeholders in any organization can use in a very practical way to devise the specific actions that are compatible with their missions, needs, skills and resources.

Both plans are available online at:

Through integrated approaches, and in partnership with communities, the Action Plan and Stakeholder Strategy move the country closer toward the vision of a nation free of health disparities.

So, in summary, these are very exciting times for health and health care in our nation, and for prevention.

In challenging times, our efforts are even more necessary — and as a matter of social justice, we need to be guided by the mantra that health equity benefits everyone.

We also need to renew our commitment to communicate about the power of prevention in the most effective ways.

Because, when prevention works, everyone benefits.

Thank you for your commitment, now and in the future, to building a healthier nation — and a better future for all.