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Effective Interventions for Reducing Racial and Ethnic Disparities in Health

Policy Date: 1/1/2000
Policy Number: 20005

The American Public Health Association,
Knowing that many ethnic* minorities in the United States suffer substantially and disproportionately from adverse health conditions and inadequate access to quality health care services as described in detail in “Healthy People 2010”;1 and
Recognizing that over the years in the United States there have been efforts in the United States to reduce ethnic disparities in health through national health policy (e.g., “Healthy People 2000”);2 and
Understanding that some of these efforts to reduce ethnic disparities in health outcome may have also successfully improved the nation’s health during the 20th century as evidenced by overall reductions in deaths from coronary heart disease and stroke, an increase in the number of healthy mothers and babies (e.g., in 1997 an alltime low infant mortality rate of 7.2 deaths per 1,000 live births), and elimination or near elimination of a number of vaccine-preventable diseases of childhood (e.g., in 1996, 90% of young children were vaccinated with most critical vac-cines);1,3-6 and
Further understanding that the 20th century has also given rise to other great public health achievements, including improved motorvehicle safety, safer workplaces, control of infectious dis-eases, safer and healthier foods, fluoridation of drinking water, and recognition of tobacco use as a health hazard;3,7-13 and
Realizing that these 20th century achievements resulted from efforts to reach all Americans through a variety of policies that focused on legislation, regulation, research, and education; a voluntary change in personal lifestyles; and pop-ulation wide policies and programs that also targeted high-risk groups, including racial/ethnic minority populations;3-13 and
Recognizing that the public health community needs to understand and replicate interventions that have already demonstrated success in reducing or eliminating ethnic disparities in health; and
Further recognizing that lessons learned from 20th century achievements, particularly childhood immunizations, suggest that the following eight activities, especially if taken together as a strategy, would be effective in eliminating certain disparities in health: setting a national priority, adopting not only long-term goals but interim goals (e.g., annual or biennial), providing of sufficient funding for effective programs that is tied to accountability, regularly monitoring and evaluating progress toward goals at all levels of government and the community, providing financial incentives for achievement of goals, engaging the community by forming community partnership and encouraging participation, expanding access to quality health care services, and optimizing health care services through performance moni-toring, evaluation, and feedback;1,3-22 and
Understanding that, while the overall health of Americans improved during the 20th century, persistent and often increasing disparities in the burden of illness and death have been experienced by ethnic minorities, particularly by African Americans (e.g., hypertension, infant mortality, adult immunizations;)1 and
Recognizing that the persistent problem of ethnic disparities in health led to President Clin-ton’s announcement in 1998 of a goal to eliminate health disparities in six areas as part of his Initiative on Race and that elimination of disparities in health has become a national health goal for the 21st century (Healthy People 2010) and a priority issue for the American Public Health Association;1,23 and
Realizing that the previously mentioned eight activities, taken together as a strategy, have demonstrated success in addressing some ethnic disparities and can be applied to the six areas that President Clinton has targeted for elimination of disparities (infant mortality, cancer screening and management, diabetes, cardiovascular disease, HIV infection and AIDS, and immunization), and all other national health objectives of 2010 in which ethnic minorities have a 25% or more difference in outcome;1 and
Recognizing that the sum of four hundred million dollars was initially appropriated to the initiative for prevention, outreach, and education in the six priority areas; and
Further recognizing that the action plan of the Department of Health and Human Services (DHHS) includes providing leadership in research, expanding and improving programs to purchase or deliver quality health care services, reducing poverty and providing children with healthy envi-ronments, and expanding prevention efforts;24 and
Realizing that a first step of the action plan of the DHHS is to review existing programs to identify and implement strategies that work, our support in promoting effective interventions is time-ly; therefore, APHA
1. Reaffirms the recent joint announcement of APHA and DHHS as partners in a national campaign to eliminate racial and ethnic health disparities;
2. Supports the action plan of the DHHS for eliminating ethnic disparities in health, particularly activities to identify existing inter-ventions/ programs effective in eliminating health disparities and the communitybased demonstration projects that are identifying new strategies by expanding our knowledge of intervenable risk factors for eliminating disparities (i.e., REACH 2010 projects);
3. Urges the DHHS and Congress to ensure that the current plan for targeting specific priority areas for elimination be continued, particularly in future administrations, and to expand funding to fully implement effective interventions for first eliminating disparities in the six priority areas, and then to the focus areas specified in Healthy People 2010 in which ethnic minorities experience a 25% or more difference in health outcome;
4. Urges the DHHS to provide a summary of effective strategies for eliminating health disparities to the public;
5. Urges the public health community to promote effective strategies through presenta-tion, publication, and implementation; and
6. Urges the convening of a meeting to identify what works, how to translate the interventions into to effective programs, and what are the remaining underlying reasons for health disparities.
* Ethnic means racial and ethnic as described in the action plan of the DHHS titled Racial and Ethnic Disparities in Health, February 1998.

References

  1. Healthy People 2010 (Conference Edition in Two Volumes). Washington, DC: US Department of Health and Human Services; January 2000.
  2. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Full report commentary. Washington, DC: U.S. Department of Health and Human Services, 1991. DHHS publication (PHS) 91-50212.
  3. Centers for Disease Control and Prevention. Ten great public health achievements—United States, 1900-1999. MMWR. 1999;48: 241-243.
  4. Centers for Disease Control and Preven-tion. Achievements in public health, 1900-1999. Decline in deaths from heart disease and stroke. MMWR. 1999;48:649-656.
  5. Centers for Disease Control and Preven-tion. Achievements in public health, 1900-1999. Healthier mothers and babies. MMWR. 1999; 48:849-858.
  6. Centers for Disease Control and Prevention. Achievements in public health, 1900-1999. Impact of vaccines universally recommended for children—achievements—United States, 1900 1999. MMWR. 1999;48: 243-248.
  7. Centers for Disease Control and Preven-tion. Achievements in public health, 1900-1999. Motor vehicle safety: A 20th century public health achievement. MMWR. 1999; 48:369-374.
  8. Centers for Disease Control and Preven-tion. Vaccination coverage by race/ethnicity and proverty level among children aged 19-35 months—United States, 1997. MMWR 1998;47: 956-959.
  9. Centers for Disease Control and Prevention. January-December 1998: vaccination coverage by race/ethnicity. http//www.cdc.gov/nip .coverage
  10. Bernier R, Orenstein W, Hutchins S, et al. Do vaccines reach those who most need them? In: Vaccination and World Health. West Sussex, England: John Wiley & Sons Ltd., 1994.
  11. Centers for Disease Control and Preven-tion. Achievements in public health, 1900-1999. Improvements in workplace safety—United States, 1900-1999. MMWR. 1999;48: 461-469.
  12. Centers for Disease Control and Preven-tion. Achievements in public health, 1900-1999. Control of infectious diseases. MMWR. 1999;48: 621-629.
  13. Centers for Disease Control and Prevention. Achievements in public health, 1900-1999. Safer and healthier foods. MMWR. 1999; 48:905-913.
  14. Centers for Disease Control and Preven-tion. Achievements in public health, 1900-1999. Fluoridation of drinking water to prevent dental caries. MMWR. 1999;48:933-940.
  15. Centers for Disease Control and Preven-tion. Achievements in public health, 1900-1999. Tobacco Use—United States, 1900-1999. MMWR. 1999;48:986-993.
  16. Centers for Disease Control and Preven-tion. Achievements in public health, 1900-1999. Family Planning. MMWR. 1999;48: 1073-1080.
  17. Orenstein W. Overview of immunization. In 32nd National Immunization Conference Proceedings. Atlanta, GA: Centers for Disease Control and Prevention, 1998. 1-9.
  18. Centers for Disease Control and Preven-tion. Status report on the childhood immunization initiative: National, state, and urban area vaccination coverage levels among children 19-35 months—United States, 1996. MMWR. 1997; 46:657-664.
  19. Centers for Disease Control and Preven-tion. Status report on the childhood immunization initiative: Reported cases of selected vaccine-preventable diseases—United States, 1996. MMWR. 1997;46:665-670.
  20. Institute of Medicine. Improving Health in a Community: A Role for Performance Moni -toring. Washington, DC: National Academy Press, 1997.
  21. Dever GE. Improving Outcomes in Public Health Practice: Strategies and Methods. Gaith-ersburg, MD: Aspen Publishers, 1997.
  22. Fairbrother G, Hanson KL, Freidman S, et al. The impact of physician bonuses, enhanced fees, and feedback on childhood immunization rates. Am J Public Health. 1999; 89:171-175.
  23. Lasker RD. Medicine and Public Health: The Power of Collaboration. New York, NY: New York Academy of Medicine, 1997.
  24. Task Force on Community Preventive Ser-vices. Recommendations regarding interventions to improve vaccination coverage in children, ado-lescents, and adults. Am J Prev Med. 2000;18 (1S):92-96.
  25. National Immunization Program. Assessment feedback, incentives, and exchange (AFIX). http://www.cdc.gov/nip/afix.
  26. American Public Health Association. Programs, projects, and practices. http://www. apha.org/ppp
  27. Department of Health and Human Ser-vices. Race and health. http://www.raceand health.hhs.gov.

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