Strategies to Reduce Health Disparities

Assisting Communities

Presenters: Tuei Doong, M.H.A., Deputy Director, Office of Minority Health, Office of the Secretary, U.S. Department of Health and Human Services, Rockville, MD Cheryl A. Boyce, M.S., Executive Director, Ohio Commission on Minority Health, Columbus, OH Jill A. Hunsaker, M.P.H., Director, Colorado Turning Point Initiative, Colorado Department of Public Health and Environment, Denver, CO

Government entities interested in reducing disparities must first make a conscious policy decision to do so. This translates into asking the question, "How will this affect racial/ethnic minorities?" when considering implementation of any new program or policy. Once this decision has been made, various strategies (covered in this document) can be applied simultaneously:

Develop education, communications, and social marketing campaigns to inform decisionmakers, stakeholders, and the general public. Education campaigns begin with documenting problems and laying out a clear case for addressing disparities.

Measure and monitor levels of disparity. This involves overcoming challenges. Little data are available at State and local levels, especially on smaller groups. Misunderstandings still exist regarding the legality of collecting these data.

Test interventions through demonstrations. For example, the 24 REACH 2010 demonstrations (funded by the Federal Centers for Disease Control and Prevention) are required to create coalitions that will use local strategies to determine the root causes of the health disparities and then mobilize community resources to develop effective and sustainable programs.

Build partnerships among such groups as the civil rights community, national and local foundations, and volunteer and professional organizations.

Build and strengthen infrastructure through multiple strategies, among them:

• Increase minority representation in the health and human services fields.
• Improve access for persons with limited English proficiency.
• Create culturally and linguistically appropriate services.

Establish State minority health entities (SMHEs) that can engage in a wide range of education, communications, and social marketing activities, among them:

• Collect data, advocate and promote the need for more health data.
• Test interventions through support of small grant projects.
• Work with various partners.
• Provide training in cultural competency.
• Engage in activities to increase the numbers of racial/ethnic minorities in the health professions.

The Ohio Commission on Minority Health, an autonomous State agency, was created in 1987. Its 18-member board includes the directors of the Departments of Mental Retardation and Developmental Disabilities, Mental Health, Human Services, Public Instruction, and Health. The Commission was the result of public hearings throughout the State.

The Commission manages grants for programs targeted to specific populations. Grants have cultural—rather than racial—norms. All grantee projects are evaluated; grantees have 24 months to produce positive outcomes. Most of the successful projects are then incorporated into other State systems. Grant programs include:

• Demonstrations both in general systems capacity and for specific diseases/conditions.
• Systemic Lupus Erythematosus.
• Minority Health Month.
• Smoking Cessation.
• Health Priorities Trust Fund.
• Covering Ohio Kids (Robert Wood Johnson).
• HIV/AIDS Infrastructure Grant (Office of Minority Health, U.S. Public Health Service).

Keys to success for Ohio's efforts include:

• Involving indigenous leaders who are known, trusted, and respected. These leaders may be formal heads of organizations or informal leaders of their neighborhoods.
• Developing a base of support to ensure sustainability. The Commission's database now includes 10,000 names. These people give the Commission grass-roots, political power.
• Establishing relationships that foster trust, respect, and integrity.
• Developing a clear, focused, shared vision. Discover what stakeholders have in common. For example, focus first on getting money into the system. After the money has been obtained, stakeholders can make decisions about how best to use it.
• Developing a diverse funding base. Consider grants, contracts, leveraging and bartering experiences, and product development.
• Institutionalizing efforts. Early in the process, create a plan to sustain the approaches developed by the community.
• Building community-centered approaches. There is something for everyone to do. People respond to things that are bigger than themselves.
• Requiring tangible evidence that demonstrations are working. Do not limit your focus to service delivery. Develop/fund projects with high visibility, as well as those that build capacity among individuals, communities, and systems.

In Colorado, in lieu of an office of minority health, the Department of Public Health is building the capacity of a nonprofit leadership entity—the Colorado Minority Health Forum—to take the lead in coordinating a statewide disparities effort involving many partners. The Forum is supported by the Colorado Turning Point Initiative, a collaborative of close to 300 diverse partners with the Colorado Department of Public Health and Environment as the lead agency.

Colorado Minority Health Forum is a group of 150 minority health professionals and other health professionals who care about minority health issues. Its goals include:

• Increasing the diversity of the public health and health care workforce, especially within leadership positions.
• Supporting the leadership development of minority health professionals.
• Ensuring that services are provided in a culturally competent manner.
• Promoting innovative outreach strategies and service-delivery models.
• Ensuring minority participation on boards, committees, and coalitions.
• Working toward an increase in insurance coverage and greater access to quality health care services.

Through the Turning Point Initiative, the Robert Wood Johnson Foundation provides 2 years of funding for each of 21 States to create a health-improvement plan, then 4 years of funding to implement one piece of the plan. Colorado Turning Point partners unanimously chose to reduce health disparities in response to their assessment of disparities. The Colorado Turning Point Initiative will build the leadership capacity of the Colorado Minority Health Forum by:

• Providing administrative support and coordinating work groups and chapters around the State.
• Writing grants to obtain staff.
• Maintaining an active member database and reaching out to new members.
• Sending out the weekly E-mail newsletter to all members.
• Providing a yearly conference on health disparities.
• Providing scholarships for minority health professionals to attend leadership development training.

The collaborative's partners pool resources to complete major projects (e.g., assessment, training, reports). Successes of the collaborative include:

• Asthma Mapping Project.
• Motor Vehicle Fatality Assessment (focusing on rural Hispanic communities).
• Training on workforce diversity.
• Sending 20 partners to cultural competency training.
• Sending 10 minority health professionals to 1 year of leadership training at the Regional Institute for Health and Environment (in the fall).
• Training rural health professionals in health assessment (in the summer).

Additional Resources

Jones CP. Levels of racism: A theoretic framework and a gardener's tale. Am J Pub Health 2000;90(8):1212-15.

Office of Minority Health, Office of the Public Health and Science, U.S. Department of Health and Human Services. Executive summary: Assessment of state minority health infrastructure and capacity to address issues of health disparity. Rockville (MD): The Offices; 2000 Sep.

Office of Minority Health, U.S. Department of Health and Human Services. National leadership summit for eliminating racial and ethnic disparities in health: creating partnerships for healthy communities. Bethesda (MD): The Office; 2001.

Ross H. Closing the gap. Washington (DC): U.S. Department of Health and Human Services, Office of Public Health and Science, Office of Minority Health Resource Center; 2000 Oct.

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