The Strategic Framework Preface Introduction Background on the Framework The Strategic Framework Next Steps Conclusions References Complete Framework (print version)
In this section...Introduction The Challenge Role and Responsibilities

I. Introduction

The Challenge. - The United States is a diverse nation. According to 2000 Census data (U.S. Census Bureau, 2000), the population of the United States grew by 13 percent over the last decade, and has increased in diversity at an even greater rate. Racial and ethnic minorities are among the fastest growing of all communities in the country, and today comprise approximately 34 percent of the total U.S. population (U.S. Census Bureau, 2006a, 2). It is projected that, by 2030, 40 percent of the population will be non-White (U.S. Census Bureau, 2004) .

Data on health status point to the fact that there is significant evidence of poor health outcomes among racial/ethnic minority populations with respect to premature death and preventable disease. These poor health outcomes for racial/ethnic minorities are reflected in the pervasiveness of health disparities (Note: This paper will often use the term "health disparities" to refer to the more precise, but longer term, "disparities in health care and health status.") that exist. For example:

• The prevalence of high blood pressure–a major risk factor for coronary heart disease, stroke, kidney disease and heart failure - is nearly 40 percent greater in African Americans than in Whites (an estimated 6.4 million African Americans have hypertension); and cardiovascular and renal disease damage are more frequent and severe (HHS, 2000a, G-2). In addition, African Americans continue to experience a higher rate of stroke, have more severe strokes and continue to be twice as likely to die from a stroke as White Americans (HHS, 2000a, G-11).
  
• Racial and ethnic minority groups, especially the elderly, are disproportionately affected by diabetes. On average, African Americans are 2.1 times as likely as Whites to have diabetes (NCHS, 2006a, Table 55). African Americans with diabetes are also more likely than Whites to experience complications of diabetes, such as amputations of lower extremities (CDC, 2006a) and end-stage renal disease (CDC, 2006b). On average, American Indians/Alaska Natives are 2.3 times as likely as non-Hispanic Whites of similar age to have diabetes (Barnes et al, 2005). Hispanics are 1.7 times as likely to have diabetes as Whites (Lethbridge-Cejku et al, 2006), with Mexican Americans–the largest Hispanic subgroup – more than twice as likely (NCHS, 2006a, Table 55).
  
• African Americans are 21 percent more likely to die from all types of cancer than Whites, adjusting for age (NCHS, 2006a, Table 29). African American men are more than 50 percent likelier to die from prostate cancer than are Whites (Ries et al, 2006, Tables I-23 and I-24). In addition, while breast cancer is diagnosed 10 percent less frequently in African American women than in White women (Ries et al, 2006, Tables I-20 and I-21), African American women are 36 percent more likely to die from the disease (Ries et al, 2006, Tables I-23 and I-24). In other minority communities, cancer also takes a disproportionate toll. Among Hispanics, women are 2.2 times more likely to be diagnosed with cervical cancer than non-Hispanic White women (NCHS, 2006b, Table 53). Asian/Pacific Islander women are 2.7 times as likely to fall ill from stomach cancer as non-Hispanic White women (NCHS, 2006b, Table 53), and Asian American men suffer from stomach cancer 93 percent more often than do non-Hispanic White men (Ries et al, 2006, Tables I-20 and I-21).
  
• Mexican American and African American mothers are more than 2.5 times as likely as non-Hispanic White mothers to begin prenatal care in the third trimester, or not receive prenatal care at all (NCHS, 2006b, Table 7).
  
• Among adults ages 18 to 64, nearly half of Hispanics (49 percent) and more than one of four African Americans (28 percent) were uninsured during 2006, compared with 21 percent of Whites and 18 percent of Asian Americans ((Beal et al, 2007). African Americans and Hispanics also experience differential access to a regular doctor or source of care, with approximately 43 percent of Hispanics and 21 percent of African Americans reporting that they do not have a regular doctor or source of care, compared with 15 percent of Whites and 16 percent of Asian Americans (Beal et al, 2007).

These health issues have been key public health concerns at the Federal level since the 1985 Secretary's Task Force Report on Black and Minority Health (HHS, 1985) under then Secretary of Health and Human Services Margaret Heckler. However, data demonstrate that these disparities remain formidable challenges today. Reports of progress on the "reducing health disparities" goal of Healthy People 2000 (HHS, 1990) showed that, in many respects, racial/ethnic minority populations have remained in relatively poor health, and continue to be underserved by the health care system. In many cases, the health gaps identified in the 1985 Task Force Report have grown (NCHS, 2001, 8). The need to address racial and ethnic minority health status and health disparities was reinforced in the two overarching goals of Healthy People 2010: to increase the quality and years of healthy life for all U.S. populations, and to eliminate health disparities, including those that affect racial and ethnic minorities (HHS, 2000a). The challenge for the U.S. is to adequately address poor racial/ethnic minority health status and persistent racial/ethnic health disparities at a time of rapidly increasing racial and ethnic diversity. Successfully meeting this challenge will promote the continued strength and vitality of the Nation.

OMH's Role and Responsibilities. - The Office of Minority Health (OMH) resides within the Office of Public Health and Science (OPHS), in the Office of the Secretary of the U.S. Department of Health and Human Services (HHS). Its creation was one of the most significant outcomes of the 1985 Task Force Report (HHS, 1985). OMH is a key player in the Federal effort to improve racial/ethnic minority health and to reduce and, ultimately, eliminate racial/ethnic disparities in health care and health status. The OMH mission is "to improve the health of racial and ethnic minority populations through the development of health policies and programs that will help eliminate disparities". (Note: Racial and ethnic minorities encompassed in OMH’s mission include Black or African Americans, Asians, Native Hawaiians or Other Pacific Islanders, American Indians and Alaska Natives and Hispanics.) This mission statement points to the two key action areas–policies and programs–through which OMH serves as the focal point within HHS for efforts to improve racial/ethnic minority health and eliminate racial/ethnic health disparities.

While OMH is the focal point within HHS for racial/ethnic minority health and health disparities efforts, it is not the only Federal agency involved in efforts to address racial/ethnic minority health and health disparities. Within HHS, a number of agencies and operating divisions engage in extensive activities to improve racial/ethnic minority health and reduce racial/ethnic health disparities. They fund a range of racial/ethnic minority health- and health disparities-related efforts, including health services to underserved (often racial/ethnic minority) communities, community-based health education and health communication campaigns and programs, biomedical, behavioral and social science research and health services and community-based prevention research. Such efforts also extend outside of HHS to other public- and private-sector organizations that have a stake in improving the health of racial/ethnic minorities and addressing racial and ethnic health disparities. In spite of these efforts, there is still much room for improvement.