Office for Civil Rights

Winston A. Wilkinson
Featured Speaker

Foxwoods Conference Center
39 Norwich Westerly Road,
Mashantucket, CT

Civil Rights and Healthcare Disparities: Impacting Access and Quality of Care

Good afternoon and thank you Peter for that kind introduction.

It's a pleasure to be here today to speak at the 5^th New England Regional Minority Health Conference to discuss the compelling issue of healthcare disparities.

OCR has been regularly involved in these conferences, and my predecessor, Tom Perez, gave a keynote address at this conference back in 1999 in Providence, Rhode Island.

I would like to commend the hosts for bringing us together for this important conference, including:

• the New England Regional Minority Health Committee;
• the State of Connecticut Department of Public Health;
• the Mashantucket Pequot Tribal Nation; and
• All the others who worked to bring this event to fruition.

It's inspiring to see such a high level of commitment to this issue from our state, local, and tribal leaders.

And with you, Dr. Graham, I'm glad to share this panel as we move forward to eliminate disparities in healthcare.

We are here today because we recognize that healthcare disparities still exist in our country, and we are all committed to working together to eliminate them.

It's a complex problem, but one which Dr. Graham and I join with leadership throughout the Department of Health and Human Services in our united commitment to carry out Secretary Leavitt's goal to eliminate inequalities in healthcare, including those caused by discrimination.

Like many of you, I personally experienced the sting of discrimination first hand. I was raised in a poor, segregated community in Prince George's County, Maryland.

Growing up, we depended on local nurses and midwives for all of our medical needs from broken bones to heart conditions because no hospital in the county would treat us.

When my siblings and I were born, we had to be delivered in our home by mid-wives and our parents had to just hope that no complications arose.

But not having access to hospitals was a common occurrence for us back then, and some just called it a sign of the times.

Fortunately times have changed, and there are now a number of efforts nationwide focused on eliminating barriers that prevent equal access to healthcare.

But unfortunately, we still have a long way to go to achieve a level playing field.

Everyone here today is aware of the well-documented racial and ethnic disparities in health. So instead of reciting the statistics, I'll just give you a snapshot of where we are today.

The 2006 National Healthcare Quality Report, compiled by the Department's Agency for Healthcare Research and Quality (AHRQ), found that overall quality of care for all Americans improved, especially where focused efforts were made to improve care.

However, AHRQ's 2006 National Healthcare Disparities Report found that disparities related to race, ethnicity, and socioeconomic status still pervade the American healthcare system.

So, even though overall disparities in quality and access are narrowing,

• African Americans are still dying from prostate cancer in disproportionate numbers;
• Tribal communities in the New England region continue to face diabetes in unprecedented numbers; and
• Hispanics are still disproportionately experiencing disabling health conditions such as obesity.

Discrimination sometimes plays a role in these disparities, and that's where OCR comes into play.

We're rooting out and eliminating healthcare disparities by ensuring that access to quality healthcare and social services is neither hindered nor denied because of unlawful discrimination.

Discrimination often appears in different and more covert forms than it did when I was growing up. For example, today's discrimination could entail:

• Physicians prescribing different or less effective treatment to minority patients;
• Hospitals failing to provide medical information to non-English speaking patients; or
• Home health care agencies failing to provide nurses in neighborhoods with high minority population.

And regardless of whether the discrimination is covert or overt, OCR works to alleviate all forms of health disparities through vigorous enforcement of civil rights.

There are three prongs to our strategy:

1) Enforcement; 2) Education; and 3) Collaboration.

Enforcement
So let me start with enforcement.

OCR monitors entities that receive Federal funds from HHS to ensure they are complying with all Federal anti-discrimination statutes, regulations and rules. We do this by investigating discrimination complaints and conducting compliance and pre-grant reviews.

The laws enforced by OCR protect individuals from discrimination based on their race, color, national origin, age, disability, sex, and religion.

We have investigators in our 10 regional offices who investigate complaints of alleged discrimination. If violations of the laws are found, my agency can cause federal funds to be withdrawn from recipients if they fail to remedy their discriminatory practices or policies that result in unequal access.

For example, in one case we investigated, an Asian-American man, who was unable to communicate in English, was admitted to a hospital to have his colon removed. During his 7 day stay, he was not once provided an interpreter. Shortly after the surgery, he began to hemorrhage. Because he had no way of communicating this to the doctors, the hospital had no idea of his potentially life-threatening situation.

Luckily the patient survived and, as a result of OCR's involvement, the hospital agreed to take steps to ensure meaningful access to its services by non-English speaking patients to prevent events like this from occurring again.

We also investigated a complaint against a State Department of Children and Families which was responsible for administering essential social services. In that case it was alleged that eligible Hispanic applicants were being subjected to discriminatory treatment, such as:

• Being denied for services if their household included persons who were unwilling or unable to provide Social Security Numbers ("SSNs") or other documentation proving citizenship or immigration status;
• Being asked unnecessary questions about the citizenship status of non-applicant household members; and
• Enduring threats to be reported to the INS.

These threats were creating barriers to children receiving social services essential for their health and well-being.

As a result of OCR's intervention, the agency entered into a written and signed agreement with OCR ensuring that everyone, regardless of national origin, can access public benefits for which they are eligible without facing discrimination and intimidation.

But although OCR is an enforcement agency, we've found that outreach to providers and community groups is an effective way to impact health disparities caused by policies or practices that have the effect of delaying or denying treatment to people in need.

Education
This leads me to the second prong of OCR's strategy to eliminate Health Disparities --- Education.

OCR recognizes that, as our nation becomes more diverse, the challenge of providing equal access to quality care becomes more difficult.

Therefore, OCR provides training and technical assistance where necessary to help providers meet their legal obligations and help individuals to seek remedies for discriminatory treatment or practices.

OCR largely achieves this through coordinated efforts of its headquarters and regional staff.

Our regional staff provides direct technical assistance to healthcare and social service providers, and the headquarters staff provides subject matter expertise in support of the regions.

For example, I convened a new Leadership Group on Health Disparities in OCR. One action item includes forming relationships with local medical institutions to help aspiring physicians appreciate their legal responsibilities for ensuring that all patients have meaningful access to quality care.

HHS' - National Heart, Lung and Blood Institute has been identified as a potential partner in achieving this objective. The Institute has funded 18 medical schools to develop curriculum for medical students on "cultural competency."

OCR is now working with the collaborative to ensure that compliance with civil rights laws is incorporated into this curriculum.

For another education project, OCR is working with the American Hospital Association (AHA) to raise awareness of hospitals' legal obligations to provide meaningful access to limited English Proficient (LEP) persons and ensure effective communication with deaf and hard-of-hearing persons.

OCR's regional offices nationwide are collaborating with state hospital associations and member hospitals to identify and promote best practices for communicating effectively with persons who are LEP or deaf or hard of hearing.

As I demonstrated in my earlier example about a hospital not providing a patient with an interpreter, equal access to healthcare, patient safety, and quality healthcare are directly dependent on effective communication. All providers should be adequately educated on how to achieve this.

But it is equally important to educate patients through outreach to make sure they are aware of their civil rights in order for them to know how to protect themselves.

Peter Chan, our Region I Regional Manager who graciously introduced me, has been phenomenal in achieving this by reaching out to the local New England community. Due to his efforts, OCR has served a key role in events such as:

• The National Alliance of Vietnamese and American Service Agencies' National Conference, where we discussed disparities, access, LEP issues;
• The "Bringing It Home - Mobilizing and Creating Change Conference," where we addressed disparities and discrimination against individuals with HIV/AIDS; and
• The 2006 Tribal Indian Consultation in Washington, DC, which, among other things, addressed health issues related to diabetes and obesity, and access to culturally competent care.

OCR staff has also appeared as guest speakers on several Hispanic radio programs in the local area.

Our employees are committed to outreach, and each year we reach thousands of individuals nationwide through our efforts.

Collaboration
So let me now talk about the third and final prong of OCR's strategy to eliminate Health Disparities --- Collaboration.

OCR is reducing disparities by eliminating discrimination through building relationships and collaborating with others that share our vision.

Building relationships and collaborative efforts is a powerful tool in eliminating disparities because it allows different groups to cohesively address this multifaceted problem from several different points of view.

Peter has led our local efforts in fostering relationships with grassroots organizations as well as New England government agencies.

When I first came to OCR just over a year ago, Peter and I traveled around New England to meet with local health and social service leaders.

We met with groups like the Massachusetts Immigrant and Refugee Coalition and the Office of New Bostonians.

We also met with the Office of Minority Health in New England, and while I'm at the podium, I'd like to thank Rear Admiral John Milner, the Regional Health Administrator, and Janet Scott-Harris, the Region I OMH Consultant, for hosting and facilitating the meeting.

I walked away from those gatherings with a better understanding of the disparities and healthcare access issues in the region, and of the sense of urgency to eliminate them. I also left with an idea of how OCR could better allocate its resources in the region.

And with this in mind, we sought out new collaboration opportunities to address some of the identified issues.

For example,

• We are collaborating with the Hospital Association of Rhode Island for our Hospital Association Effective Communication Outreach project;
• We are serving on the Federal Special Emphasis Program Coalition to help raise cultural awareness; and
• We helped organize the 2006 American Indian Alaska Native Heritage Month Celebration.

In addition, OCR will be partnering with HHS' Office of Minority Health for the upcoming Celebra Spring Kickoff in Boston in June.

OCR's Region I staff has been great in getting involved in the local community, but there's a lot more to be done, and this is where we need your help.

My hope is that you tell us what we can do to support your efforts to reach out to and serve at risk communities.

If your ideas address factors that fall into the domain of another HHS agency, my staff will help connect you with the appropriate agency office. So I encourage you all to share your ideas with me and members of my staff.

Conclusion
So in closing, I'd like to say that we can most efficiently achieve our common goal of eliminating disparities, especially those caused by discrimination, by vigorously enforcing the civil rights laws, by informing the public, and by working together.

My staff at OCR is committed to this, and we have the support of the entire department of Health and Human Services.

HHS is supported by a budget that accounts for almost one-out-of-four Federal dollars.

Combined, these resources drive the Nation's efforts to protect the health of all Americans and provide essential human services to those in need.

And narrowing disparities in access to quality healthcare is a top priority for me, Secretary Leavitt and everyone in HHS.

I praise your efforts, and I commend each of you for participating in this very important conference.

I look forward to building more bridges and establishing more partnerships with you to accomplish our important task.

I thank you for this opportunity to address you today.

Last revised: April 12, 2007

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