Addressing Racial and Ethnic Health Disparities

The Office for Civil Rights (OCR) of the US Department of Health and Human Services (HHS) is pleased to have the opportunity to be part of this publication that addresses an essential, challenging, and achievable goal—the elimination of ethnic and racial health disparities. We are also pleased to continue our partnership with Stephen Thomas and the Centers for Minority Health, University of Pittsburgh, as well as our federal partners, Michael Fine and Said Ibrahim of the Department of Veterans Affairs Center for Health Equity Research and Promotion, working collectively to achieve this goal.

Closing the health care gap by eliminating health disparities is one of Secretary Tommy Thompson’s top priorities. In releasing a recent departmental report on our progress toward eliminating disparities, Secretary Thompson noted, “Our goal is to eliminate disparities in health among all population groups by 2010. While we are making progress, this report shows how far we still have to go.”1 During the 1990s, HHS measured national trends in racial and ethnic specific rates for 17 health statistic indicators. All racial and ethnic groups experienced improvements in rates for 10 of the 17 indicators. At the same time, the report also shows that despite these overall improvements, in some areas the disparities for ethnic and racial minorities remained the same or even increased. Thus, although we have seen notable progress in the overall health of the nation, there are continuing disparities in illness and death experienced by members of certain racial and ethnic groups compared with the US population as a whole.

The demographic changes that are anticipated over the next decade magnify the importance of addressing disparities in health status, which is a primary goal of the secretary’s Healthy People 2010 Initiative. Because groups that are currently experiencing poorer health are expected to grow as a proportion of the total US population, it is clear that the success we achieve together in improving the health of these groups will significantly affect the future health of our entire nation. A national focus on disparities in health status that addresses the bases for disparities, and that works to eradicate any barriers that illegally enhance or maintain disparities in access to health care, is important as major changes occur in the demographics and diversity of our population.

Increasing access to health care, including the elimination of health disparities, is the first of 10 department-wide program objectives established by the secretary. Toward that end, in November 2002 the secretary announced awards of $85 million to support the elimination of health disparities among racial and ethnic minority communities, furthering the strategies discussed during the July 2002 national health disparities summit in Washington, DC. As Thompson said, “AfricanAmericans, Hispanics, Native Americans, Alaska Natives, and Asians and Pacific Islanders suffer an unequal burden of death and disease, despite improvements in the overall health of the general population over the past decade. . . . These awards demonstrate our commitment to making real progress to eliminate health disparities in this country.”2

Specifically, the National Institutes of Health’s National Center on Minority Health and Health Disparities provided $74.5 million distributed among an array of its programs—the Centers of Excellence Program, the Endowment Program, the Research Infrastructure in Minority Institutions Program, and loan repayment programs. In addition, HHS’s Office of Minority Health awarded 65 grants totaling $10.5 million to support community and state-based efforts to eliminate HIV/AIDS and other health disparities in racial and ethnic minority communities. Of this amount, $4.6 million is supported by funding from the Minority AIDS Initiative.

HHS’s OCR works with states, localities, and recipients of federal financial assistance in pursuit of one of the OCR’s core functions—ensuring compliance with Title VI of the Civil Rights Act of 1964, which prohibits discrimination on the basis of race or national origin. Recipients of HHS federal financial assistance must ensure that policies and procedures do not exclude or have the effect of excluding or limiting the participation of beneficiaries in their programs on the basis of race, color, or national origin. In fiscal year (FY) 2002 and FY 2003, the OCR has dedicated and will continue to commit policy and compliance staff resources to address the role that discrimination plays in race and ethnic health disparities. The OCR is a key component of the department’s health disparities initiative, and it presented Congressional testimony in April 2002 on its role in the department’s efforts to eliminate racial and ethnic health disparities. Recent comprehensive studies by the Institute of Medicine, the Commonwealth Fund,3,4 and others have underscored the critical importance of the OCR in eliminating these disparities. The OCR’s role has taken on a heightened significance in light of the Supreme Court’s decision in Alexander v. Sandoval,5 which determined that there is no private right of action for suits by aggrieved parties in disparate impact cases. As such, as delegated by the Department of Justice, the OCR is the sole entity with authority to conduct investigations of alleged violations of the Title VI rights of individuals receiving HHS funded services where policies and practices related to the providers of these services may have a discriminatory disparate impact on minority consumers.

In FY 2004, the OCR will continue to focus on a broad range of Title VI access issues including disparities in access, quality, and availability of health services. The OCR’s efforts will be an integral part of the department’s overall initiative to eliminate health disparities. The OCR’s work also will support other significant departmental efforts to eliminate health disparities, including prevention, organ and tissue donation and transplantation, mental health services, faith-based initiatives, and strengthening families. In FY 2004, the OCR’s racial and ethnic disparities effort will particularly concentrate on educating communities and working with stakeholders to identify and implement community-based comprehensive plans for eliminating race disparities and discrimination in health care access and service provision. The OCR’s efforts should serve as models for bringing diverse stakeholders together—health care providers, academics, and community and faith-based organizations—to address access and quality issues and to increase overall awareness of civil rights laws and their applicability in health care settings. We will also continue to support other efforts, such as the Pittsburgh Summit, which resulted in many of the articles published in this issue of the Journal, to foster dialogue among these stakeholders.

In FY 2003 and continuing into FY 2004, the OCR’s health disparities work will also include, in particular, a focus on the issue of discrimination and disparities in mental health services and care in response to the Surgeon General’s August 2001 report Mental Health: Culture, Race and Ethnicity.6 As set forth in that report, civil rights issues in mental health may include clinician bias, language barriers, and discriminatory access to quality care.

The OCR will also be conducting public education and awareness activities about civil rights issues arising from mental health practices that may erect barriers to access and receipt of quality mental health services. The OCR’s activities in this area will include working to ensure nondiscriminatory access to Medicaid managed care and State Children’s Health Insurance Program mental health benefits, as well as access to programs to provide mental health supportive services to women and children funded under the Temporary Assistance for Needy Families program. These activities will intersect with the OCR’s existing work on Title VI access issues, racial and ethnic health disparities, managed care, and Temporary Assistance for Needy Families as well as support enhanced focus on nondiscrimination in adoption and foster care.

Organ and tissue donation/transplantation is another arena in which the FY 2004 budget will support the OCR’s continued nondiscrimination activities, addressing disparities and differential health outcomes. The OCR will work to inform racial and ethnic minorities of their rights to nondiscriminatory access, as donors or recipients, and we will work with HHS-funded programs to ensure that such programs are operated in a nondiscriminatory manner. Among other means, the OCR will work with community and faith-based organizations, as appropriate, to address social, cultural, and other potential barriers to full participation by racial and ethnic minorities.

Though eliminating racial and health disparities is a significant challenge, we have good reason to expect success: in one generation, with education and commitment, our nation changed from a country of smokers to a place inhospitable to tobacco products. The OCR, and the entire Department of Health and Human Services, are committed to eliminating health disparities. Together with our counterparts in the states and the private sector, we are striving to reach that goal in this generation.