During the month of April — Minority Health Month — the Obama administration took significant steps to build momentum for efforts to eliminate racial and ethnic health inequities. But with this momentum the stakes have become higher than ever, just as fiscal and political pressures mount that could undermine progress.
Health inequities span from the cradle to the grave, in the form of higher rates of infant mortality, chronic disease, disability and premature death among many racial and ethnic minority groups. A large volume of research demonstrates that these inequities persist even after socioeconomic factors — such as income and education levels — are considered. For example, African American mothers with a college degree experience infant mortality at rates higher than white mothers who have less than a high school education.
Many affected populations also face barriers to health care services, which further increases risks born by segregation and poverty concentration. These circumstances include poor geographic access to full-service grocery stores; higher rates of exposure to fast food; environmental degradation; crime and violence; and the stresses associated with these examples, as well as many others.
The Affordable Care Act, signed into law by President Barack Obama just over a year ago, is an important first step toward eliminating these inequities. Every credible analysis shows that this measure will improve access to health care and stimulate public health strategies to keep communities healthy, which have the greatest potential to reduce health inequities. It will expand access to health insurance, improve the distribution of health care resources in underserved communities and stimulate federal research on health inequities — among many other provisions that help ensure that all Americans have an opportunity to live healthy lives.
But the law is only one element of what must be a multi-faceted solution. Success will require public-private partnerships, a reality that received a big shot in the arm when the Obama administration released, for the first time in federal government history, a national strategy — the National Stakeholder Strategy for Achieving Health Equity — to eliminate health inequities.
At the same time, the Department of Health and Human Services released an Action Plan to Reduce Health Disparities, that coordinates the department’s goals and actions to reduce health inequities. This plan is aligned with the national strategy to expand its impact.
Their release was particularly significant given that the month’s dominant health policy news story was the House Republican plan to slash Medicaid and other federal health programs, many of which disproportionately help racial and ethnic minorities.
The administration’s national strategy, which was released by the HHS Office of Minority Health, outlines a common set of goals for public and private sector initiatives to achieve health equity. It is a product of the National Partnership for Action, and incorporates ideas generated from thousands of individuals and organizations across the country to transform health care and expand health care access; improve the diversity and distribution of the health care workforce; expand the cultural and linguistic competence of health care systems; and improve neighborhood conditions that shape health, among many other objectives.
The HHS action plan outlines strategies and actions to reduce health disparities in five overarching areas, including health care; the health and human services workforce; prevention; scientific knowledge and innovation; and HHS programs. This plan was developed in response to the stakeholder strategy and is intended to amplify its impact.
Some might argue that such an agenda and coordinated federal effort is late in coming, given the fact that over 25 years ago the release of a major report on health disparities among racial and ethnic groups — the so-called Heckler Report, after President Ronald Reagan’s HHS Secretary Margaret Heckler — first called federal attention to the problem of the health gap.
Others will argue that there is no time like the present to take significant steps to eliminate health inequities. If they are correct, April 2011 may prove to be a pivotal month.
Brian D. Smedley, Ph.D., is vice president and director of the Joint Center for Political and Economic Studies Health Policy Institute.