Achievements in Closing the Health Gap
Today’s U.S. Department of Health and Human Services is carrying out many activities to promote both the letter and the spirit of the Civil Rights Act. We acknowledge and extend our appreciation to these HHS grantees which exemplify the Department’s wide-ranging efforts to close the health care gap.
Center for Minority Health (CMH) at the Graduate School of Public Health, University of Pittsburgh, is a Center of EXcellence in Partnerships for Community Outreach, Research on Health Disparities, and Training (Project EXPORT) of the NIH National Center on Minority Health and Health Disparities (NCMHD). The mission of CMH is to eliminate racial and ethnic health disparities by establishing trusting community partnerships that increase participation of minorities in biomedical and public health research. CMH has collaborated with the HHS Office for Civil Rights (OCR) to co-sponsor annual National Minority Health Leadership Summits for the past four years. Other federal agencies, including the HHS National Cancer Institute, the HHS Office for Disease Prevention and Health Promotion, and the Veterans Administration, as well as local government and community groups have also joined as partners in the Summits. The series of four annual Health Summits held thus far focus attention on recruiting and retaining minorities in health research, disseminating research findings to minority communities, and addressing issues of trust. The 2003 annual summit theme was "The Impact of Discrimination," and in 2004, the theme was "The Role of Health Communication." Papers from both summits are published in themed issues of the American Journal of Public Health.1
Excellence Centers to Eliminate Ethnic/Racial Disparities (EXCEED) Blood Pressure Initiative at the Medical University of South Carolina was started in 1999 to improve blood pressure control overall and reduce ethnic disparities by providing primary care doctors with a practical way to regularly track their patients who have high blood pressure. Tracking allows the physicians to quickly adjust treatment to help keep blood pressure in a healthy range, thereby preventing deadly consequences such as diabetes, stroke, and heart attack. Today, with over 300 enrolled primary care providers from over 80 clinical sites and a registry of over 80,000 patients, the Initiative has reduced disparities in blood pressure care and management. The Initiative uses a computerized database to track the care received from primary care physicians, providing the physicians with free auditing and feedback. Preliminary findings indicate that blood pressure control of patients whose providers participated in this program improved over seven percent in the first year. The program has been recognized by HHS as a National Best Practice Model and is funded by the HHS Agency for Healthcare Research and Quality (AHRQ) and the NIH National Center on Minority Health and Health Disparities (NCMHD).2
Laguna Pueblo Community Health Representatives (CHR) bridge the gap between American Indians/Alaska Natives and health resources by integrating medical knowledge and local community knowledge in this unique, tribally-contracted health paraprofessional program which utilizes specially-trained indigenous community members. CHR programs nationwide provide quality health care outreach, health promotion, and disease prevention services designed to meet tribal community needs. The exemplary CHR initiatives of the Laguna Pueblo site in New Mexico include the Community Care Station – a health team that travels to worksites, offices, and villages to provide free health screenings for cholesterol, blood glucose, blood pressure, and height/weight; a public transportation program called the Shaa'srka' Transit that provides on average 900 rides per quarter to remotely-located residents to enable them to access health services; emergency preparedness mobilization; and in collaboration with the National Heart, Lung and Blood Institute, a comprehensive, culturally appropriate, ten-session course on heart health education entitled "Honoring the Gift of Heart Health." The CHR Program receives support from the HHS Indian Health Service.3
Latin American Cancer Research Coalition (LACRC), a cancer prevention program that serves the greater Washington, D.C. area, grew out of an innovative program, the Cancer Preventorium, started in 1994. LACRC has changed the point of contact with the health care system for thousands of Latinos in the metropolitan area. Using culturally appropriate social marketing approaches to promote health and prevent cancer, diabetes, hypertension and heart disease, this program has now persuaded more than 8,000 Latinos, 85 percent of them without symptoms, to seek medical education and screening before symptoms of prevalent diseases begin to emerge. The concept of using culturally appropriate social marketing approaches to bring health messages to targeted groups has the potential to modify the current disease centered health care paradigm toward health promotion and disease prevention. The LACRC is part of the Special Populations Networks (SPN) program of the National Cancer Institute of HHS.4
People's Health Center, Inc. (PHC) has 18 medical and dental providers to address the most critical health issues in the St. Louis community with emphasis on eliminating chronic disease disparities through the effective expansion of PHC’s diabetes, cardiovascular, asthma, and cancer collaborative. Cancer screening access is a significant problem in St. Louis. According to the Missouri Department of Health and Senior Services, cancer is the second leading cause of death in St. Louis and clearly presents an important opportunity for prevention. Cancer occurs more frequently among uninsured, Medicaid-eligible, and underinsured minority residents of the City of St. Louis, than in any other population in the State. Chronic disease management is reflected in PHC’s health care plan with resources allocated to promote the integration of cancer prevention education, screening, assessment and treatment with the chronic disease collaborative care (CDCC) model to reach evidencebased guideline goals. PHC receives funding from the HHS Health Resources and Services Administration.5
Vietnamese Reach for Health Initiative Coalition (VRHI) promotes awareness of cervical and breast cancer among the 100,000 Vietnamese- Americans living in Santa Clara County, California. The Coalition has successfully addressed barriers to Pap testing in the Vietnamese community, including lack of culturally and linguistically-appropriate services that are financially and logistically accessible. VRHI utilizes Vietnamese-language media, lay health worker outreach, a low-cost Pap clinic, a patient navigator, and mailed reminders to encourage regular Pap tests. The program has made a significant impact. For example, 47 percent of women who never had a Pap test obtained one after meeting with lay health workers. VRHI helped to establish a low-cost Pap clinic and worked with the State of California to enroll 12 new providers for Pap tests for low-income women. VRHI receives funding from the HHS Centers for Disease Control and Prevention.6
1Representative: Dr. Stephen B. Thomas, Director, Center for Minority Health, Graduate School of Public Health, University of Pittsburgh
2Representative: Dr. Brent Egan, Project Leader, Hypertension Section, Division of General Internal Medicine, Medical University of South Carolina
3Representative: Mr. Roderick Ariwite, Chief Operating Officer, Laguna Pueblo
4Representative: Dr. Elmer Huerta, Director, Cancer Preventorium, Washington Cancer Institute at Washington Hospital Center
5Representative: Ms. Betty Jean Kerr, Chief Executive Officer, People’s Health Centers, Inc.
6Representative: Ms. Thoa Nguyen, Project Director, Vietnamese Community Health Promotion Project – University of California, San Francisco
Last revised: July 22, 2004