In 1985, the U.S. Department of Health and Human Services (HHS) released the Secretary Task Force Report on Black and Minority Health (Heckler Report). The report documented the pervasive gaps in health experienced by racial and ethnic minorities in the United States. The report described these gaps as “an affront both to our ideals and to the ongoing genius of American medicine.”
Since the release of the Heckler Report 30 years ago, the nation has made slow but steady progress in closing the gaps in access to care and quality of care experienced by racial and ethnic minorities. At the federal and state levels, offices of minority health were created to develop policies and programs to improve the health of racial and ethnic populations. Minority health research focusing on differences in health status, risk factors for disease and injury, access to and use of health care services, and quality of care began to gain momentum. Terms such as health disparities, health inequality and health equity became part of the public health lexicon. In 2000, “eliminating health disparities” was adopted as one of the overarching goals of Healthy People, the nation’s public health agenda.
Today, life expectancy gaps between blacks and whites have narrowed. Cancer disparities are improving for all minority groups. Teen birth rates have dropped for all groups. Childhood immunization disparities are also closing. Real gains in improving Asian American health and reducing disparities in access to care have also been achieved. For example, health status data for Asian Americans is now available for 188 (37%) Healthy People 2010 population-based objectives. About two-thirds of these 188 objectives have been met or were moving toward their targets.
However, much work remains to be done. Awareness of health disparities is still low among the general public. The list of diseases and health related concerns that have significant disparities is long. Thirty years of research and action have highlighted the powerful link between social factors and health. The underlying factors that affect disparities – now described as the social determinants of health – are complex and overlapping. Where people live and work, jobs, education, discrimination, and the health system’s responses are stronger influences on health and health outcomes than access to care or the process of care. Locally and nationally, Asian Americans continue to experience disparities in areas such as tuberculosis, hepatitis B, HIV testing, and cancer screening.
In 2011, HHS launched the National Partnership for Action (NPA) to End Health Disparities and the National Stakeholder Strategy for Achieving Health Equity. The NPA seeks to increase awareness of health disparities, strengthen leadership for action, improve health and health care outcomes for underserved populations, ensure the linguistic and cultural competency and diversity of the healthcare workforce, and enhance data availability and utilization. Using a “bottom up” approach, ten Regional Health Equity Councils (RHEC) with representation from business, health, education, housing, academia, foundations, and other sectors have been formed to develop collaborative strategies that advance the NPA goals.
The Health Center has long recognized the need to work in partnerships within and beyond the health sector to address service, policy and systems level changes. We currently participate in many partnerships, such as the Region II RHEC, NYC Hepatitis B Coalition, and NYU Langone Medical Center Community Service Plan. We have learned that a high degree of community ownership and participation is essential for sustained success in population level health outcomes.
Written by Regina F. Lee, J.D.
Regina F. Lee is the chief development officer at the Charles B. Wang Community Health Center. She received her JD from the New York University Law School. She has been involved with the Health Center since its founding in 1971. She is also a member of the Regional Health Equity Council, Region II.