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Nathan Stinson, Jr., Ph.D., M.D., M.P.H.
Deputy Assistant Secretary for Minority Health, Office of Public Health and Science
OMH's Role in Eliminating Racial and Ethnic Disparities in Health
Congressional Black Caucus, the Congressional Hispanic Caucus, and the Congressional Asian Pacific American Caucus
April 12, 2002
Good morning. I am Dr. Nathan Stinson, Deputy Assistant Secretary for Minority Health and director of the Office of Minority Health (OMH). I want to thank the respective chairpersons and members of the Congressional Black Caucus, Congressional Hispanic Caucus, and the Congressional Asian Pacific American Caucus for the invitation to testify at this important special hearing on the Department of Health and Human Services' (HHS) status and progress towards eliminating racial and ethnic health disparities.
It is clear that health disparities are not new occurrences. The 1983 issue of Health, United States, the annual report card on the health status of the American people, documented significant progress in the overall health picture of the Nation, but reinforced the sad fact of the continuing health-related burdens experienced by the racial and ethnic minority populations compared to the U.S. population as a whole. Such health disparities continue to persist:
- Although 55 percent of the reported AIDS cases occurred among African Americans and Hispanics, these two populations groups represent approximately 13 and 12 percent, respectively, of the total U.S. population. Similarly, 15 percent of the U.S. adolescent population is African American, yet 60 percent of the AIDS cases reported in 1999 were among African Americans.
- On average, Hispanic/Latino Americans are almost twice as likely to have diabetes than non-Hispanic whites of similar age. American Indians are at least twice as likely to have diabetes compared to non-Hispanic Whites of similar age.
- Data on the number of Asian and Pacific Islander Americans who have diabetes are limited, but studies show that type 2 diabetes is a growing problem among some groups within this population. For example, the prevalence of type 2 diabetes is two to three times higher among Japanese Americans living in Seattle compared with non-Hispanic Whites and two times higher among Native Hawaiians compared to White residents living in Hawaii.
- African American women -- those with less than, equal to, or greater than 12 years of education -- suffer at least twice the incidence of infant mortality compared to either White or Asian and Pacific Islander women.1
- Between 1980 and 1990, there was almost a 40 percent increase in obesity among adults aged 20 years or elder in the general population.2 Adult (20-74 years) Black, non-Hispanic female have a higher incidence of overweight and obesity compared to White, non-Hispanic females.3
Unfortunately, those communities experiencing disparities are hardest hit. They suffer worse health status and higher episodes of mortality, and this is unacceptable. The real challenge for HHS and the public is not debating whether disparities exist, but in developing and implementing strategies to reduce and eliminate them.
This hearing could not be more timely. As the Deputy Secretary reviewed, there are multiple cross-cutting activities going on within HHS to make progress towards eliminating racial and ethnic health disparities. Further announcements of some of these activities will involve not only HHS, but the state and local governments, private sector, and communities as well.
OMH has taken an advisory and leadership role in the Department's coordinated efforts that relate to disease prevention, health promotion, and improved access to quality health care for the underserved populations. The OMH advises the Assistant Secretary for Health and Surgeon General on public health issues affecting the diverse populations and is key staff for major Departmental initiatives directed towards improving the health of racial and ethnic minorities. The Office of Minority Health does not have direct line of authority -- authorizing legislation requires the PHS agency heads to consult with the Deputy Assistant Secretary of Minority Health to coordinate activities to improve minority health.
OMH's mission is to improve the health of racial and ethnic minority populations through the development of health policies and programs that will help to address health disparities and gaps. This mission is even more important in light of the increasing racial, ethnic, cultural, and linguistic diversity of the U.S. population, the major changes underway in the health care industry, and the challenges of adequately addressing the health care needs of the U.S. while controlling the associated costs.
To work towards the Department's goal, OMH strives to encourage these changes to improve and strengthen the public health infrastructure by advocating for the improvement of communication and information dissemination, policy coordination and development, coalition and partnership building, demonstration programs and program evaluations, and data collection and analysis. OMH assesses the impact of proposed policies, programs, legislation, and changes in the health care delivery system on racial and ethnic minorities' health, coordinates evaluations and reports to Congress for OMH, coordinates efforts to improve the availability and quality of health data for minorities, reviews agency budget requests, and staffs inter-departmental committees.
Communication and Information Dissemination
OMH is an integral part of the Department's voice in spreading the message on how to prevent disease, disability and death through the dissemination of information on racial and ethnic minority health, such as up-to-date facts and resources, scheduled conferences and events and campaign information, to name a few. The goal is to keep these issues on the radar-screen in order to lay the foundation for responsive policy and program action.
- Closing the Health Gap, the new HHS partnership with ABC radio network, was launched early in FY2002. This strategy will reach African American consumers about the health gaps between them and the rest of the population, and to challenge and empower them to make lifestyle behavior changes to help close the gap.
- OMH is engaged in departmental-wide campaigns to promote disease prevention, awareness, and preventive actions in the public. These efforts will depend upon partnerships within HHS and other departments, as well as state and local governmental agencies, and non-governmental and private entities, such as national and community minority organizations and faith-based organizations, to name a few.
- Since its inception in 1987, the Office of Minority Health Resource Center (OMH-RC) has grown to become one of the nation's largest sources of minority health information. The OMH-RC collects, distributes, and facilitates the exchange of information through customized database searches (including funding, media, research, and data information), publications, mailing lists, and referrals. To reach the diverse population, bilingual (Spanish/English) information specialists as well as translated written materials are available.
- OMH has continued to produce high-quality and highly-sought-after publications that appeal to consumers, universities, state offices of minority health, health educators, researchers, and administrators. The OMH-RC develops and distributes two OMH newsletters, each of which has a circulation of more than 40,000.
Closing the Gap is published 10 times per year and covers a different minority health topic each month. It covers both the successful efforts of minority community programs working on health issues, and services/resources available from HHS agencies. OMH has closely collaborated with CMS, AoA, HRSA, CDC, ODPHP, OWH and other agencies to develop a number of special issues focused on key health topics for minority audiences. Recent issues have been on men's health and violence prevention and the upcoming issue is on diabetes.
The second newsletter, HIV Impact, appears four times per year and focuses on information community-based and AIDS-service organizations can use in their work.
- OMH continues to update The Pocket Guide to Minority Health Resources, the single most requested publication originated by OMH. The popular Breast Cancer Resource Guide for Minority Women was also reprinted by OMH. Now in its second edition, the publication contains a wealth of resources for minority women with breast cancer, their families, and health professionals who treat breast cancer.
- Web-sites have become a major source of information to learn about new facts, legislation and conferences, to name a few. In FY 2000, OMH launched its new and improved web site (www.omhrc.gov). Administered by OMH-RC, the site contains information on minority health, including pages on: what's new, programs and initiatives, data and statistics, funding opportunities, conferences, legislative action in Congress, and useful information links. Hits on the website are expected to increase from 1 million in FY 2000 to a projected 3.2 million in FY 2002. This website includes a Departmental Hispanic Agenda for Action web site, building upon the work of the HHS Hispanic Customer Service Pages. OMH coordinates HHS's efforts to implement other selected White House Initiatives, and is developing the Historically Black Colleges and Universities, and Tribal Colleges and Universities sites. OMH also developing a cultural competency web site that contains complete information about the national standards for culturally and linguistically appropriate services (CLAS) in health care.
- OMH-RC launched a website dedicated to the Department's Minority HIV/AIDS Initiative. This web site provided information on current news, funding, technical assistance, prevention and living with HIV/AIDS, and included links to reports, archives, and both federal and non-federal sites. A special page on the 20th anniversary of the first reported cases of AIDS was created in May 2001 and provided a tool kit for local organizations to plan and implement commemorative efforts. This special page received more than 10,000 hits in its first two months of operation.
Under the Minority HIV/AIDS Initiative, the OMH-RC expanded technical assistance to minority community-based organizations (CBOs) and AIDS service organizations (ASOs). This HIV/AIDS technical assistance and services team works to increase awareness of HIV/AIDS among minorities and support organizations that service racial and ethnic minorities. A national technical assistance campaign was conducted in six cities, focusing on organization development and sustainability of CBOs and ASOs. Nearly 750 persons representing 168 organizations participated in skills building workshops. Direct technical assistance site visits to an additional 35 organizations, and telephone and mail consultations with another 40 organizations were provided.
- The OMH-RC also promotes and educates the public on minority health issues by representing OMH at national conferences of professional organizations, hosting workshops and exhibits, working with the other HHS agencies to publicize special health promotion campaigns, and initiating its own media projects that improve the quality and availability of health information to minority communities. In addition, OMH-RC initiates its own media projects that improve the quality and availability of health information to minority communities. In FY 2000, OMH developed and conducted a national print media campaign targeting African Americans to increase HIV/AIDS awareness among this population. The campaign generated inquiries from around the Nation requesting OMH-RC's HIV/AIDS information packets.
Policy Coordination and Development
- Because culture and language are vital factors in how health care services are delivered and received, it is important that health care professionals embrace the principles of cultural and linguistically appropriate care. OMH has initiated a project to develop Cultural Competency Curriculum Modules for family physicians. This is a two-year project and will result in the development of modules to equip family practitioners with the cultural and linguistic competencies that will enable them to better treat the increasing diverse U.S. population.
- As required by the Health Professions Education Partnerships Act of 1998 (P.L. 105-392) OMH provides staffing and resources to HHS's Advisory Committee on Minority Health. This newly formed Advisory Committee will provide recommendations to the Secretary and Department on issues related to minority health and health disparities. The Committee comprises twelve (12) members who are not employees or officers of the Federal Government. The Committee meets four times a year and all sessions are open to the public and announced before hand in the Federal Register.
- The 1990 Disadvantaged Minority Health Improvement Act (P.L. 101-527) and the Health Professions Education Partnerships Act of 1998 (P.L. 105-392), require the OMH to address each of the four racial/ethnic populations identified in the legislation equitably. Prominent activities of the OMH include leading and staffing White House and Department Initiatives aimed at improving the ability of the Federal government and educational institutions to serve racial/ethnic minorities.
- The minority initiatives are designed to strengthen the capacity of minority institutions of higher education and community-based organizations to provide a quality education, develop minority researchers and address the health and human service concerns of racial/ethnic minorities. The minority initiatives' activities have assisted the Department in its efforts to change the way it does business in several key areas, including the elimination of racial and ethnic disparities in health. The Department has institutionalized specific activities aimed at fulfilling the mission of the minority initiatives, including: strengthening partnerships with institutions of higher education; increasing Hispanic employment in the Department; improving customer service, and a mechanism to increase the funding for minority institutions of higher education.
- OMH coordinates activities to support the Hispanic action agenda, inclusive of Executive Order 13230, President's Advisory Commission on Educational Excellence for Hispanic Americans. This is a nine-point agenda which addresses issues of employment, educational opportunities, capacity building, data collection and research, and health. The broad goal of this initiative is to strengthen the Department's efforts to improve service delivery for Hispanic customers and improve their overall well-being.
- OMH has leadership responsibility within the Department for managing, coordinating and monitoring activities required under Executive Order 13256 -- Historically Black Colleges and Universities (HBCUs.) This Executive Order requires all Federal agencies "to strengthen the capacity of HBCUs to provide quality education, and to increase opportunities to participate in and benefit from Federal programs."
In this capacity, OMH provides technical assistance to Department agencies and offices regarding implementation of the Executive Order and to HBCUs regarding program activities in which they might participate.
- Executive Order 13125, Increasing Participation of Asian Americans and Pacific Islanders in Federal Programs, is aimed at improving the quality of life of Asian Americans and Pacific Islanders through increased participation in Federal programs where they may be underserved (e.g., health, human services, housing, education, labor, transportation, and economic and community development). Based on the pioneering work of the HHS's AAPI Action Agenda, this executive order establishes an advisory commission and a White House Initiative on AAPIs. OMH has led the Department in the development of a snapshot of departmental programs, an inventory of departmental efforts targeted to AAPIs, and is in the process of refining HHS's FY2002 agency plan for implementing the executive order.
- The White House Initiative on Tribal Colleges and Universities, pursuant to Executive Order 13021, reaffirms the special relationship of the Federal government to American Indians and Alaska Natives. This special relationship is the government to government relationship based on the U.S. Constitution, treaties, Federal statutes, court decisions, and Executive Branch policies, as well as moral and ethical considerations. The initiative aims to increase the Tribal Colleges' access to Federal opportunities, expand their participation in Federal programs, and raise awareness about the important role TCUs have in Tribal communities. The order also fosters links between TCUs and both private and non-profit organizations.
In this capacity, the OMH provides technical assistance to Department agencies and offices regarding implementation of the Executive Order, and to TCUs regarding program activities in which they may participate.
- Quality Improvement Activities -- In February 2000, OMH/OPHS convened the meeting on Diversity and Communication in Health Care: Addressing Race, Ethnicity, Language and Social Class in Health Care Disparities. The goal was to determine the state-of-the-art for improving provider-patient communication, determine its adequacy to raise effectiveness of health care for racial and ethnic minorities, and develop a work plan to provide needed modifications. The meeting brought together health professions educators, practitioners, patients, and community representatives. More than 80 invited experts in patient provider communication, cultural competency, and health professions education participated in the meeting. A summary report was distributed to participants.
Coalition and Partnership Building
Partnerships with fellow HHS agencies and other Federal departments, representatives from state and local government, community-based organizations, and the public in general is critical in making progress. Making the bridge with the communities and resources allows us not to reinvent the wheel. We are able to know rather than assume what problems they face, what's been done, and what has worked.
- OMH has been crafting and leading the development of HHS's National Leadership Summit on Eliminating Disparities in Health Among Racial and Ethnic Minority Populations. This Summit is scheduled for July 2002 in Washington, D.C. The Summit seeks to draw national attention to the existence of health disparities and to the innovative approaches being implemented at the local, state, and Federal levels to address these disparities. The aim of the Summit is to stimulate replication of programs and to enhance program outcomes. Approximately 2,500 leaders of national, state, and community-based organizations representing all sectors that influence health (e.g., housing, labor, education) will attend. The Summit will emphasize the critical need for all groups and organizations to work together and across all sectors to improve the health of our communities. The Summit is also designed to impart skills to individuals who can then use them as a means to enhance efforts within their own communities.
To ensure that participants leave the Summit with tangible information and resources that can be used in their communities upon their return, OMH is developing a community resources "Tool Box" to serve as a resource for individuals and organizations looking to enhance their programs or to start new programs.
- OMH is also sponsoring, "A National Forum on Health Disparity Issues for American Indians and Alaska Natives: Breaking Down Barriers -- We are all Related," a forum for Tribal leaders, Urban Indian health organizations, health officials, federal and state policymakers, and public/private organizations to jointly work on eliminating barriers that perpetuate health disparities for American Indian/Alaska Natives. This forum is directed to not only identify strategies and foster partnerships among federal, state, local and tribal governments to fulfill their obligations to improve the health status of all American Indians and Alaska Natives, but to also recognize and honor the legal and historic basis for tribal sovereignty, trust responsibility, and government-to-government relationships in these strategies.
- OMH has linked Federal, public and private sector groups, community-based organizations, and individuals to exchange information and coordinate activities on health status and the quality of life of racial and ethnic minority populations. This Minority Health Network focuses on developing a Federal and State infrastructure. Offices of Minority Health have been established in OPHS, NIH, HRSA, CDC and SAMHSA. Minority health coordinators/contacts have been designated in, AoA, ACF, CMS, FDA, AHRQ, and IHS. The Network also includes the 10 OMH Regional Minority Health Consultants and 34 State minority health entities.
The OMH-RC makes available the Resource Persons Network, which consists of a network of health professionals from a wide variety of organizations (e.g., community organizations, academia, research organizations, medical centers) who volunteer to provide technical assistance to community-based organizations and other health professionals active in minority health issues.
- The OMH held a meeting of the State Minority Health Representatives in September 2001. Directors from existing State offices of minority health, and minority health contacts in States (including the District of Columbia, Puerto Rico, and the Virgin Islands) which do not have a formal minority health structure, attended this summit. This summit was designed to: (1) provide state minority health representatives with the information and guidance needed to meet the challenges of emerging health-related issues impacting the states and the communities they serve; and (2) provide a forum for developing strategies and fostering collaborations and partnerships that will address health-related issues in a concerted effort to eliminate health disparities across the nation.
- Under the State Partnership Initiative, the OMH awarded contracts to 12 State minority health entities in FY 2000. In early FY 2000, OMH completed an assessment of State minority health infrastructure and capacity to address health disparities. The study's recommended strategies that, if addressed in their entirety, could lead to substantial improvements in efforts at the state level to address racial and ethnic health disparities. These recommended strategies include: collection, tracking, and dissemination of data; improving inter- and intra-organizational collaborations related to minority health; technical assistance to improve state health infrastructures; and funding for minority health initiatives at the state and local levels. In FY 2001, OMH began to implement a number of the study recommendations, including awards to four State minority health entities and funds to the 10 PHS Regional offices.
Foster research demonstrations, scientific investigations, and evaluations aimed at improving the health of racial and ethnic minorities
To fulfill OMH's role in supporting demonstrations and evaluations to test innovative models, and to increase access to services for persons with limited English proficiency (LEP), OMH supports a number of grant programs and cooperative agreements aimed at developing innovative approaches to eliminate racial and ethnic health disparities. Grant projects include: efforts to improve and expand the capacity for linguistic and cultural competence of health care providers, health promotion and disease risk reduction interventions, community-based HIV/AIDS education and prevention activities, and provision of technical assistance to stimulate and foster the development of effective and durable service delivery capacity for HIV prevention and treatment among organizations which are closely interfaced with minority populations highly impacted by HIV/AIDS.
- As directed by FY 2001 appropriations language, OMH provided one-year funding to 11 organizations to conduct activities initiated by each organization. For example, the Donald R. Watkins Memorial Foundation in Houston, Texas, will enhance care for African American and low income individuals with HIV/AIDS by coordinating services and expanding outreach efforts. The Fresno Community Hospital and Medical Center of California will support diabetes care and outreach for Hispanic Americans and low-income individuals. FY2002 appropriations language also directs the supports of 11 organizations (10 new, one continuation.)
- OMH has continued to support its principal demonstration grant programs: the Bilingual/Bicultural Service Demonstration Program to improve the ability of health care providers and other health care professionals to deliver linguistically and culturally competent health services to limited-English-proficient minority populations; and the Community Programs to Improve Minority Health Grant Program (formerly, the Minority Community Health Coalition Demonstration Program) which supports projects that address socio-cultural barriers and demonstrate effective coordination of integrated community-based screening, outreach, and other enabling services.
- In FY 2001, OMH funded 30 grants under the newly established Health Disparities Grants in Minority Health Program to support local pilot and small-scale projects which address a wide range of health problems and issues related to health disparities in local minority communities.
- In FY 2001, OMH has continued the Programs funded by the Minority HIV/AIDS Initiative, the Technical Assistance/Capacity Development Demonstration Program (TA/CD) for HIV/AIDS-Related Services in Highly Impacted Minority Communities, State and Territorial Minority HIV/AIDS Demonstration Program, and the Minority Community Health Coalition Demonstration Program HIV/AIDS. Continuation support was provided to 37 grantees in FY 2001.
OMH has continued to support and manage umbrella cooperative agreements and standard cooperative agreements. The umbrella cooperative agreements establish broad programmatic frameworks for multiple projects. Cooperative agreements have been used to provide an opportunity for HHS and other federal agencies to collaborate and jointly fund individual projects.
- OMH currently has 27 multi-year cooperative agreements to assist in enhancing and expanding health promotion, disease prevention, health advocacy and health services research opportunities within minority communities. OMH also has a cooperative agreement with Central State University to support a Family and Community Violence Prevention Program at HBCUs and other minority institutions. Twenty-six minority institutions participate, partnering with community organizations to influence the academic and career development of at-risk populations, improve the quality of life for residents of impoverished neighborhoods which surround many campuses, and reduce the potential for violent behavior among youth and their families. A cooperative agreement with Cicatelli Associates, Inc. supports an HIV/AIDS Regional Resource Network Project. This project focuses on improving coordination, comprehensiveness and quality of HIV/AIDS service provision by brining community-based organizations, primarily those providing support services to communities of color, into federal regional planning and networking efforts.
Promote the Collection of Health Data by Racial/Ethnic Categories
Lack of data places policy makers at risk of making inappropriate decisions that reflect a lack of understanding of the mechanisms driving the increased burden of disease and death as well and its impact. The absence of timely, reliable, valid, and appropriate data is often a limiting factor in measuring progress of programs and status of the targeted population.
- Creative efforts have taken place within HHS to meet data challenges. For example, HHS has organized a Data Council that plays a role in a number of areas, particularly in the development of department-wide data collection, to which Assistant Secretaries and Agency Administrator level HHS officials have a direct reporting relationship to the Secretary.
- The OMH co-chairs the HHS Data Council's Working Group on Racial and Ethnic Data, the internal advisory group to the Secretary on minority health data and statistics. Major accomplishments of this Working Group include an inventory of HHS data collection systems which make their data available to the public (www.aspe.hhs.gov/datacncl/datadirectory), a report HHS Plan to Improve the Collection and Use of Racial and Ethnic Data which outlines data gaps and makes recommendations to improve racial and ethnic data across HHS, and an HHS inclusion policy for racial and ethnic data in HHS sponsored and maintained data systems.
- In August 2001, the Data Council's Working Group on Racial and Ethnic Data planned and OMH sponsored two sessions at the American Statistical Association annual meeting to showcase the Department's efforts to further racial and ethnic data policy as well as efforts at the state and local levels. For the session on "Improving Data on Racial/Ethnic Groups," panelists described successful efforts involving the communities studied. For the session on "How to Implement Racial/Ethnic Data Policy," panelists discussed policy issues as well as innovative approaches for improving racial and ethnic data collection, analysis, and dissemination.
- OMH continues to provide technical assistance on racial and ethnic data to HHS, other Federal and state agencies, and non-Federal entities. For example, during FY 00 and FY 01, OMH participated in the Academic Medicine and Managed Care Forum's Subcommittee on Minority Health. The Forum, the largest private sector funding source of health services research, has established health disparities as a priority.
- During FY 2001, significant progress was made to develop and pilot test a uniform information/data set for evaluating and assessing the impacts of OMH-funded activities. OMH is completing the final report and guidelines to implement uniform data collection, reporting, and analysis among OMH-funded programs.
- In FY 2001, OMH's contractor, National Health Law Program, completed an initial review of state laws, regulations, and other written policies regarding the collection, reporting, and use of racial and ethnic data in the health care context among all 50 states and the District of Columbia. The findings will be critical in clarifying state policies on the collection of racial and ethnic data. Preliminary results of this project have found that 46 states do not prohibit health insurers and/or health maintenance organizations from collecting racial and ethnic data on application forms. Only South Carolina requires the collection of such data. Findings have been shared with the National Committee on Vital and Health Statistics, the American Public Health Association, the American Association of Health Plans, the HMO Research Network, The Commonwealth Fund, and several other health professional associations.
- Health, United States, 2001, Table 21 (1996-1998), page 154.
- Testimony by Frank Vinicor (August 13, 2001) before Senate Finance Committee chairman, Max Baucus (D-MT).
- Health, United States, 2001, Table 69 (1988-1994), page 256.
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Last revised: April 30, 2002