The U.S. Department Health and Human Services (HHS) has launched programs that attack health disparities directly. HHS has launched programs that engage racial and ethnic minority communities in the fight against specific diseases and conditions that have a major impact. HHS has worked to ensure that programs that are not minority-specific, but which serve large numbers of Americans, are systematically looking for opportunities to prevent, screen, diagnose, refer for follow-up care, and treat health conditions that have a disproportionate and adverse impact on minority populations.
SELECTED HHS MINORITY HEALTH INITIATIVES AND PROGRAM
Initiatives and Programs Addressing Multiple Issues
HHS Council on Health Disparities: In February 2004, Secretary Thompson created the HHS Council on Health Disparities to coordinate and unify HHS actions on disparity issues. The Council will ensure that HHS contracts, conferences, grants, and initiatives are aligned with the goal of enhancing and expanding the Department's role in reducing health disparities, including striving for racial and ethnic parity in the health professions.
Consolidated Health Center Program: Community health centers deliver preventive and primary care to patients regardless of their ability to pay. The Consolidated Health Center Program is a national network of more than 3,800 clinics comprised of community health centers, migrant health centers, health care for the homeless centers and public housing primary care centers. These centers served about 12.5 million people in 2003.
Closing the Health Gap/Take A Loved One to the Doctor Day: Launched in November 2001, this educational campaign is designed to help make good health an important issue among racial and ethnic minority populations who are affected by serious diseases and health conditions at far greater rates than other Americans. "Take A Loved One to the Doctor Day," the third Tuesday of each September, has become a key element of the campaign. The focus of the day is to encourage individuals to take charge of their health by visiting a health professional (doctor, nurse, dentist, nurse practitioner, or other health provider), making an appointment for a visit, attending a health event in the community, or helping a friend, neighbor, or family member do the same.
Health Disparity Collaboratives: This multi-year health initiative was developed to specifically improve the health status of underserved populations. When a gap exists between what is known to be effective health care and what is actually done in clinical practice the Collaboratives seek to close the gap by assuring that patients receive evidence-based care and encourages them to be active participants in their own care. To date, more than 300 community health centers have participated in Collaboratives to delay or decrease complications of diabetes. Forty health centers are currently participating in the IHI Breakthrough Series devoted to asthma and depression. For further information, visit http://bphc.hrsa.gov/quality/Collaboratives.htm.
Racial and Ethnic Approaches to Community Health (REACH 2010): Launched in 1999, REACH 2010 is designed to eliminate heath disparities in the following six priority areas: cardiovascular disease, immunizations, breast and cervical cancer screening and management, diabetes, HIV/AIDS, and infant mortality. REACH 2010 supports community coalitions in designing, implementing, and evaluating community-driven strategies to eliminate health disparities. For more information on the initiative, visit http://www.cdc.gov/reach2010.
Medicare Modernization Act: On December 8, 2003, President Bush signed into law the Medicare Prescription Drug, Improvement and Modernization Act (MMA) of 2003. This landmark legislation provides seniors and people living with disabilities with a prescription drug benefit, more choices and better benefits under Medicare, the most significant improvement to senior health care in nearly 40 years.
State Children's Health Insurance Program (SCHIP): SCHIP gives each state permission to offer health insurance to children, up to age 19, who are not already insured.. SCHIP is a state administered program and each state sets its own guidelines regarding eligibility and services
African American 9 A Day Campaign: Spearheaded by the National Cancer Institute (NCI), the African American 9 A Day national campaign is designed to encourage African American men to eat 9 servings of fruits and vegetables a day. African American men are among the most seriously affected by diet-related chronic diseases, and have the lowest overall consumption of fruits and vegetables. For more information on the campaign, visit http://www.9aday.cancer.gov.
National Breast & Cervical Cancer Early Detection Program (NBCCEDP): NBCCEDP provides breast and cervical cancer screening, diagnosis, and treatment to low income, medically underserved, and uninsured women (emphasizing recruitment of minority women) through states, tribes and territories. To date, the program has provided more than 3.5 million screening tests for breast and cervical cancer to nearly 1.5 million low-income women. For more information on the program, visit http://www.cdc.gov/cancer/nbccedp.
Screen for Life: Screen for Life is a national colorectal cancer action campaign designed to inform all AmericansCwith special emphasis on African Americans, Hispanics, and people with Medicare coverageCabout the benefits of colorectal cancer screening for all adults aged 50 or over. For more information, visit http://www.cdc.gov/cancer/screenforlife.
Trans-HHS Cancer Health Disparities Progress Review Group: HHS established The Trans-HHS Cancer Health Disparities Progress Review Group (PRG) in 2003 to bring together the Nation's leading researchers, health practitioners and advocates as well as cancer survivors, to look at eliminating health disparities from cancer. For more information on the PRG, visit http://www.hhs.gov/chdprg/pdf/chdprg.pdf.
Diabetes Detection Initiative: Finding the Undiagnosed (DDI): Launched in 2003, DDI is a community-based initiative designed to increase blood testing for individuals who are at high-risk for diabetes and to increase diagnosis for those with unrecognized diabetes. About 5.2 million of the total 18.2 million persons with diabetes in the United States have undiagnosed or unrecognized diabetes. For more information on DDI, visit http://www.ndep.nih.gov/ddi/.
National Diabetes Education Program (NDEP): The NDEP is taking the lead on delivering the type 2 diabetes prevention message to high risk audiences. The campaign focuses on empowering people at high risk to make modest lifestyle changes that can prevent or delay the onset of type 2 diabetes. For more information, visit http://www.ndep.nih.gov/.
President Bush's fiscal year 2005 budget request includes a six percent increase in the HIV/AIDS in Minority Communities Fund. This request is for $53 million to support innovative approaches to HIV/AIDS prevention and treatment in minority communities. The following selected HIV/AIDS programs build on the department's core mission to protect and improve the health of vulnerable populations:
Health Resources and Services Administration (HRSA): HRSA oversees the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act B federal legislation that addresses the unmet health needs of persons living with HIV disease by funding primary health care and support services. Ryan White helps provide services primarily to racial and ethnic minorities through local community health centers. For more information, visit http://hab.hrsa.gov/.
Centers for Disease Control and Prevention (CDC): The newly established Office of Health Disparities seeks to improve the health of populations disproportionately affected by HIV infection and other sexually transmitted diseases, tuberculosis, and other related diseases and conditions, and to ultimately reduce health disparities.
CDC will fund three new projects in FY 2004: (1) The HIV Prevention Survey for Historically Black Colleges and Universities (HBCUs), (2) Demonstration Projects for Implementation of Rapid HIV Testing in HBCUs and Alternative Venues and Populations, and (3) CDC's Prevention Response to the North Carolina HIV Infection Outbreak. The first project will assess the availability of HIV prevention and testing services and the willingness to offer routine HIV testing on each campus. The survey will focus on the following five areas: HIV and STD knowledge, prevalence of high risk behaviors, attitudes toward HIV prevention, HIV testing and HIV care willingness, and risk perception. The second project seeks to introduce rapid HIV testing programs to serve attendees of HBCUs and Hispanic Serving Institutions, develop and evaluate new models for providing rapid and conventional HIV testing into clinical venues that have not offered routine HIV screening in the past in high risk communities, and introduce rapid HIV testing in clinical and non-clinical settings that serve Native Americans, migrant worker populations, and pre- or post-operative transgendered persons. The third project provides funding to support trained peer volunteers to adapt community level HIV prevention interventions.
In April 2003, CDC announced a new initiative, "Advancing HIV Prevention (AHP): New Strategies for a Changing Epidemic," aimed at reducing the number of new HIV infections that occur each year in the Unites States. In 2002, racial and ethnic minorities represented 68% of all reported HIV/AIDS cases. The AHP initiative expands on current HIV prevention strategies and models other approaches that have proven effective in preventing infectious diseases. The initiative has four key strategies: making HIV testing a routine part of medical care, implementing new models for diagnosing HIV infections outside medical settings, preventing new infections by working with persons diagnosed with HIV and their partners, and further decreasing perinatal HIV transmission.
CDC is working with health departments and community-based organizations (CBOs) to ensure they have the skills and resources to incorporate rapid HIV testing. CDC has conducted 20 regional rapid HIV test training sessions for health departments and CBOs that plan to conduct rapid HIV testing. Additional test kits have been purchased by CDC and distributed to 50 sites around the country.
Infant Mortality Campaign: Scheduled to be launched in 2004, an initiative is being added to address the disparities in rates of infant mortality among racial and ethnic minorities. The national campaign "It's a Family Affair" was developed to reduce African American and American Indian and Alaska Native infant deaths from Sudden Infant Death Syndrome. The initiative will encompass strategies to reduce African American infant deaths from low birth weight.
Racial and Ethnic Adult Disparities in Immunization Initiative (READII): Launched in 2002, READII is a three-year demonstration project developed to close the gap in adult influenza and pneumococcal vaccination coverage for African Americans and Hispanics age 65 and older. For more information on the initiative, visit http://www.cdc.gov/nip/specint/readii/.
Minority Health Research
National Institutes of Health (NIH): The National Institutes of Health is federal focal point for medical and behavioral research for the nation. HHS is continuing to expand its medical research concerning racial and ethnic minorities. Sample research programs at the NIH include:
National Center on Minority Health and Health Disparities (NCMHD): NCMHD leads, coordinates, supports and assesses the NIH research effort to reduce and ultimately eliminate health disparities as they affect racial and ethnic communities and medically underserved individuals. In late 2003, NCMHD awarded $65.1 million to support the advancement of health disparities research and the elimination of health disparities among racial and ethnic minority and medically underserved communities. For more information on NCMHD, visit http://ncmhd.nih.gov/.
Center to Reduce Cancer Health Disparities: NIH's National Cancer Institute (NCI) opened the Center to Reduce Cancer Health Disparities in 2001 to address the unequal burden of cancer. The center's mission is to advance understanding of the causes of health disparities, and develop and integrate effective interventions to reduce or eliminate those disparities. For more information, visit http://crchd.cancer.gov.
Centers for Population Health and Health Disparities: In 2003, Secretary Thompson announced the creation of eight Centers for Population Health and Health Disparities, designed to support research to understand and reduce differences in health outcomes, access and care. The eight centers will form a network of research teams to explore the complexity of health disparities, following a community-based research approach. Studies will focus on obesity, cardiovascular disease, breast cancer, prostate cancer, cervical cancer, mental health, gene-environment interactions, psychosocial stress, and other factors. Investigators will follow a community-based research approach with populations including low-income Whites, African Americans, Hispanics, and the elderly. For more information, visit http://www.nih.gov.
National Heart, Lung, and Blood Institute: NIH's National Health Lung and Blood Institute (NHLBI) partners with African American communities through Enhanced Dissemination and Utilization Centers to implement education and intervention programs to cut the rates of CVD risk factors and to promote healthy lifestyles. NHLBI is also conducting the Jackson Heart StudyCthe first large-scale cardiovascular disease study among African Americans to examine the factors that influence the diseases development in this population. For more information, visit http://www.nhlbi.nih.gov/.
National Institute of Environmental Health Sciences (NIEHS): NIEHS has been a leader in the area of understanding how poverty, environmental pollution, and health interrelate. The NIEHS has developed a number of projects and grant programs designed to define the health disparities issue and to arm policy makers with the necessary information to reduce these disparities. For further information on these and other environmental health programs of the NIEHS, visit http://www.niehs.nih.gov/
Other HHS Agency Activities
Indian Health Service (IHS): The goal of IHS is to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and Alaska Native people who are members of federally recognized Tribes. For more information, visit http://www.ihs.gov.
Administration for Children and Families (ACF): ACF's Administration for Native Americans provides direct grants, contracts, and interagency agreements to American Indian programs for social and economic development and governance, training and technical assistance, research, demonstration and evaluation. For more information, visit http://www.acf.dhhs.gov/.
Administration on Aging (AoA): AoA provides funding to Tribes to provide meals and other supportive services for their elderly members and to help their members provide care for their elderly relatives. In addition, the 2000 amendments of the Older Americans Act established the Native American Caregiver Support Program, recognizing the need of Native elders. For more information, visit http://www.aoa.gov/carenetwork/default.htm.
Additional Minority Health Resources
Office of Minority Health Resource Center (OMHRC): The OMHRC serves as a national resource and referral service on minority health. The center collects and distributes information including print and electronic publications for professionals and consumers. OMHRC provides access to minority health experts from across the country and technical and capacity-building assistance for community-based organizations and AIDS service organizations. For more information, call 1-800-444-6472 or visit OMH home page.
MEDLINEplus: NIH's National Library of Medicine (NLM) offers MEDLINEplus, the Spanish-language companion health Web site to NLM's MEDLINE, which provides authoritative, full-text medical resources. The new site is available at http://www.medlineplus.gov/esp.
Office for Civil Rights: The HHS Office for Civil Rights drafted written policy guidance to assist health and social services providers in ensuring that persons with limited English skills can effectively access critical health and social services. For more information, visit http://www.hhs.gov/ocr/lep/.
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