EDITORIAL Partnership, Research, and Leadership to Advance Health Equity and Eliminate Health Disparities
Scientific and technological advances have had profound effects on the quality and longevity of human life. Yet, despite these advances, disparities in health outcomes persist for many Americans, as evidenced by alarming rates of disease incidence, morbidity, and mortality1. For decades, there have been numerous efforts to understand the root causes of health and health care disparities and to ultimately eliminate them. To address this complex problem, federal agencies, including the Department of Health and Human Services (HHS) and the Department of Veterans Affairs, have fostered a coordinated action in response to this prevailing issue and have provided leadership for advancing health equity.
REDUCING RACIAL AND ETHNIC HEALTH DISPARITIES In 2011, after substantial community input, HHS launched the most comprehensive federal commitment yet to reducing racial and ethnic health disparities—the HHS Action Plan to Reduce Racial and Ethnic Health Disparities.2 Representing an important milestone and framework to achieve health equity, the HHS Disparities Action Plan is guided by the vision of a “nation free of disparities in health and health care” and charges all HHS operating and staff divisions to heighten the impact of HHS policies and programs to reduce health disparities. It includes five goals: 1. transform health care;
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2. strengthen the nation’s health and human services infrastructure and workforce; 3. advance the health, safety, and well-being of the American people; 4. advance scientific knowledge and innovation; and 5. increase the efficiency, transparency, and accountability of HHS programs. Embedded in the missions of the Office of Minority Health (OMH) and the National Institute on Minority Health and Health Disparities (NIMHD), the pursuit of the vision set forth by the HHS Disparities Action Plan offers the opportunity to promote three key shared principles: partnership, research, and leadership.
PARTNERSHIP The goal of eliminating health disparities cannot be accomplished by a single sector or entity. Furthermore, it is recognized that the causes of health disparities are complex and multifactorial and stem from not only the health care sector but also the social determinants of health (i.e., the conditions in which people are born, grow, live, work, and age). Sustainable partnerships among government agencies, as well as public---private partnerships exemplify the importance of collaborative engagement needed to accomplish this goal. A key example of such a partnership is the National Partnership for Action to End Health Disparities (NPA).3 Responding to the call from nearly 2000 leaders at the 2006 National Leadership Summit for
Eliminating Health Disparities for cross-cutting, multilevel, and systems-oriented approaches for tackling health disparities, OMH launched the NPA. The NPA was established to mobilize a nationwide, comprehensive, community driven, and sustained approach to combating health disparities and to move the nation toward achieving health equity. The mission of the NPA is to increase the effectiveness of programs that target the elimination of health disparities through the coordination of partners, leaders, and stakeholders committed to action. The National Stakeholder Strategy for Achieving Health Equity,3 a key product of the NPA built upon the input of thousands of individuals and organizations across the country, provides a common set of goals and strategies that public and private sector leaders can use to strengthen their initiatives to reduce health disparities, anchored by five goals: 1. awareness, 2. leadership, 3. health system and life experience, 4. cultural and linguistic competency, and 5. data, research, and evaluation. Demonstrating the significance of multisectorial partnership and engagement, the NPA has four key implementation components: 1. Federal Interagency Health Equity Team—an interagency federal team comprising 12 federal agencies that identifies opportunities for federal collaboration on efforts relevant
American Journal of Public Health | Supplement 4, 2014, Vol 104, No. S4
EDITORIAL
to the NPA and provides guidance for national, regional, state, tribal, and local efforts that address health equity2; 2. Regional Health Equity Councils—10 nonfederal regional coalitions across the country that drive action around common issues and leverage resources to combat health disparities; 3. State Offices of Minority Health—State and Territorial Offices of Minority Health lead states’ and territories’ efforts in updating health disparity or health equity plans so that they align with the NPA and develop strategic partnerships; and 4. National Partners—national entities that support the NPA by advancing the NPA goals within their organization’s mission and operations and through leveraging strategic partnerships.
RESEARCH In recognition of the need for increased scientific collaboration to eliminate health disparities, the Federal Collaboration on Health Disparities Research (FCHDR),4 cochaired by the NIMHD and OMH, was convened to explore innovative and improved crosssectorial solutions to address health disparities through research. As chartered, the purpose of FCHDR is to engage a wide range of federal institutions to identify, support, and coordinate research priorities for cross-agency partnerships to hasten the elimination of health disparities. Federal partners, including the Department of Veterans Affairs, participate in FCHDR by exploring needs and opportunities for pooling scientific expertise and resources to conduct, translate, and develop
the evidence base for policy, practice, and dissemination of research. Each participating agency displays a responsibility to contribute to the whole of government, in those areas in which it has recognized capability and experience. To support its purpose, FCHDR outlined the following objectives: 1. explore the complexity of addressing the broad biological and nonbiological determinants of health; 2. develop the evidence base, through enhanced partnerships on research, capacitybuilding, outreach, and training; 3. identify new or improved solutions (e.g., new and innovative breakthrough strategies); 4. support and disseminate research to infuse and enhance services in key public health areas; 5. support research that informs existing regulatory reviews and practices that address health disparities; and 6. identify priorities for crossagency partnerships. Achievement of these objectives is within our reach as we use bestpractice guidelines and technologies to support effective communication, coordination, and collaboration. Led by the NIMHD, the 2012 Eliminating Health Disparities Summit showcased its investment and contribution to health disparities research and the continued integration of science, practice, and policy, including actions on the social determinants of health, community engagement, broad partnerships, capacity-building, and media outreach.
LEADERSHIP Together with OMH and NIMHD, the individual offices of minority health that were established
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by the Affordable Care Act in six HHS agencies—the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, the Food and Drug Administration, the Health Resources and Services Administration, and the Substance Abuse and Mental Health Services Administration—strengthen the minority health infrastructure across HHS agencies and drive leadership and coordination for eliminating health disparities. Recognizing the need for such departmental infrastructure and coordination on health disparities, the Department of Veterans Affairs likewise established an Office of Health Equity to champion efforts across the Veterans Health Administration to address health disparities. As our nation moves forward tackling health and social inequalities, it becomes our responsibility as leaders to engage in addressing the challenging questions that inform public policies and to develop the right interventions that improve the health of all Americans.
CONCLUSIONS What have we learned and where do we go from here? In 1985, HHS released the Report of the Secretary’s Task Force on Black and Minority Health.5 It represented the first comprehensive US government accounting of the health disparities affecting racial and ethnic minorities in the United States. Today, with the implementation of the HHS Disparities Action Plan, the nation has since responded with initiatives aimed at addressing these disparities. However, disparities are still a reality, and we offer the primary notion that partnership, research, and leadership are critical and fundamental to eliminate health
disparities and advance health equity. We recognize that solutions emerge from a large and expanding network of partners committed to a collective vision—a vision of the 21st century that sets us on a path toward “a nation free of health and health care disparities.” j J. Nadine Gracia, MD, MSCE John Ruffin, PhD
About the Authors J. Nadine Gracia is with the Office of Minority Health, US Department of Health and Human Services, Rockville, MD. John Ruffin was with the National Institute on Minority Health and Health Disparities, National Institutes of Health, US Department of Health and Human Services, Rockville. Correspondence should be sent to J. Nadine Gracia, MD, MSCE, 1101 Wootton Parkway, Suite 600. Rockville, MD 20852 (e-mail: [email protected]). Reprints can be ordered at http://www.ajph. org by clicking the “Reprints” link. This article was accepted July 2, 2014. doi:10.2105/AJPH.2014.302201
Contributors J. N. Gracia developed the concept, framed the discussion, and completed the writing of the editorial. J. Ruffin provided significant insights and substantial comments in drafting the editorial.
References 1. Centers for Disease Control and Prevention. Conclusion and future directions: CDC Health Disparities and Inequalities Report—United States, 2013. MMWR Surveill Summ. 2013;62(suppl 3): 184---186. 2. Department of Health and Human Services. HHS Action Plan to Reduce Racial and Ethnic Disparities: A Nation Free of Disparities in Health and Health Care. Washington, DC: Department of Health and Human Services; 2011. 3. National Partnership for Action to End Health Disparities. National Stakeholder Strategy for Achieving Health Equity. Rockville, MD: Department of Health and Human Services, Office of Minority Health; 2011. 4. Rashid JR, Spengler R, Wagner R, et al. Eliminating health disparities through transdisciplinary research, crossagency collaboration, and public participation. Am J Public Health. 2009;99(11):1955---1961. 5. Report of the Secretary’s Task Force on Black and Minority Health. Washington, DC: Department of Health and Human Services; 1985.
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Scientific and technological advances have had profound effects on the quality and longevity of human life. Yet, despite these advances, disparities in health outcomes persist for many Americans, as evidenced by alarming rates of disease incidence, morbidity, and mortality1. For decades, there have been numerous efforts to understand the root causes of health and health care disparities and to ultimately eliminate them. To address this complex problem, federal agencies, including the Department of Health and Human Services (HHS) and the Department of Veterans Affairs, have fostered a coordinated action in response to this prevailing issue and have provided leadership for advancing health equity.
REDUCING RACIAL AND ETHNIC HEALTH DISPARITIES In 2011, after substantial community input, HHS launched the most comprehensive federal commitment yet to reducing racial and ethnic health disparities—the HHS Action Plan to Reduce Racial and Ethnic Health Disparities.2 Representing an important milestone and framework to achieve health equity, the HHS Disparities Action Plan is guided by the vision of a “nation free of disparities in health and health care” and charges all HHS operating and staff divisions to heighten the impact of HHS policies and programs to reduce health disparities. It includes five goals: 1. transform health care;
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2. strengthen the nation’s health and human services infrastructure and workforce; 3. advance the health, safety, and well-being of the American people; 4. advance scientific knowledge and innovation; and 5. increase the efficiency, transparency, and accountability of HHS programs. Embedded in the missions of the Office of Minority Health (OMH) and the National Institute on Minority Health and Health Disparities (NIMHD), the pursuit of the vision set forth by the HHS Disparities Action Plan offers the opportunity to promote three key shared principles: partnership, research, and leadership.
PARTNERSHIP The goal of eliminating health disparities cannot be accomplished by a single sector or entity. Furthermore, it is recognized that the causes of health disparities are complex and multifactorial and stem from not only the health care sector but also the social determinants of health (i.e., the conditions in which people are born, grow, live, work, and age). Sustainable partnerships among government agencies, as well as public---private partnerships exemplify the importance of collaborative engagement needed to accomplish this goal. A key example of such a partnership is the National Partnership for Action to End Health Disparities (NPA).3 Responding to the call from nearly 2000 leaders at the 2006 National Leadership Summit for
Eliminating Health Disparities for cross-cutting, multilevel, and systems-oriented approaches for tackling health disparities, OMH launched the NPA. The NPA was established to mobilize a nationwide, comprehensive, community driven, and sustained approach to combating health disparities and to move the nation toward achieving health equity. The mission of the NPA is to increase the effectiveness of programs that target the elimination of health disparities through the coordination of partners, leaders, and stakeholders committed to action. The National Stakeholder Strategy for Achieving Health Equity,3 a key product of the NPA built upon the input of thousands of individuals and organizations across the country, provides a common set of goals and strategies that public and private sector leaders can use to strengthen their initiatives to reduce health disparities, anchored by five goals: 1. awareness, 2. leadership, 3. health system and life experience, 4. cultural and linguistic competency, and 5. data, research, and evaluation. Demonstrating the significance of multisectorial partnership and engagement, the NPA has four key implementation components: 1. Federal Interagency Health Equity Team—an interagency federal team comprising 12 federal agencies that identifies opportunities for federal collaboration on efforts relevant
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to the NPA and provides guidance for national, regional, state, tribal, and local efforts that address health equity2; 2. Regional Health Equity Councils—10 nonfederal regional coalitions across the country that drive action around common issues and leverage resources to combat health disparities; 3. State Offices of Minority Health—State and Territorial Offices of Minority Health lead states’ and territories’ efforts in updating health disparity or health equity plans so that they align with the NPA and develop strategic partnerships; and 4. National Partners—national entities that support the NPA by advancing the NPA goals within their organization’s mission and operations and through leveraging strategic partnerships.
RESEARCH In recognition of the need for increased scientific collaboration to eliminate health disparities, the Federal Collaboration on Health Disparities Research (FCHDR),4 cochaired by the NIMHD and OMH, was convened to explore innovative and improved crosssectorial solutions to address health disparities through research. As chartered, the purpose of FCHDR is to engage a wide range of federal institutions to identify, support, and coordinate research priorities for cross-agency partnerships to hasten the elimination of health disparities. Federal partners, including the Department of Veterans Affairs, participate in FCHDR by exploring needs and opportunities for pooling scientific expertise and resources to conduct, translate, and develop
the evidence base for policy, practice, and dissemination of research. Each participating agency displays a responsibility to contribute to the whole of government, in those areas in which it has recognized capability and experience. To support its purpose, FCHDR outlined the following objectives: 1. explore the complexity of addressing the broad biological and nonbiological determinants of health; 2. develop the evidence base, through enhanced partnerships on research, capacitybuilding, outreach, and training; 3. identify new or improved solutions (e.g., new and innovative breakthrough strategies); 4. support and disseminate research to infuse and enhance services in key public health areas; 5. support research that informs existing regulatory reviews and practices that address health disparities; and 6. identify priorities for crossagency partnerships. Achievement of these objectives is within our reach as we use bestpractice guidelines and technologies to support effective communication, coordination, and collaboration. Led by the NIMHD, the 2012 Eliminating Health Disparities Summit showcased its investment and contribution to health disparities research and the continued integration of science, practice, and policy, including actions on the social determinants of health, community engagement, broad partnerships, capacity-building, and media outreach.
LEADERSHIP Together with OMH and NIMHD, the individual offices of minority health that were established
Supplement 4, 2014, Vol 104, No. S4 | American Journal of Public Health
by the Affordable Care Act in six HHS agencies—the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, the Food and Drug Administration, the Health Resources and Services Administration, and the Substance Abuse and Mental Health Services Administration—strengthen the minority health infrastructure across HHS agencies and drive leadership and coordination for eliminating health disparities. Recognizing the need for such departmental infrastructure and coordination on health disparities, the Department of Veterans Affairs likewise established an Office of Health Equity to champion efforts across the Veterans Health Administration to address health disparities. As our nation moves forward tackling health and social inequalities, it becomes our responsibility as leaders to engage in addressing the challenging questions that inform public policies and to develop the right interventions that improve the health of all Americans.
CONCLUSIONS What have we learned and where do we go from here? In 1985, HHS released the Report of the Secretary’s Task Force on Black and Minority Health.5 It represented the first comprehensive US government accounting of the health disparities affecting racial and ethnic minorities in the United States. Today, with the implementation of the HHS Disparities Action Plan, the nation has since responded with initiatives aimed at addressing these disparities. However, disparities are still a reality, and we offer the primary notion that partnership, research, and leadership are critical and fundamental to eliminate health
disparities and advance health equity. We recognize that solutions emerge from a large and expanding network of partners committed to a collective vision—a vision of the 21st century that sets us on a path toward “a nation free of health and health care disparities.” j J. Nadine Gracia, MD, MSCE John Ruffin, PhD
About the Authors J. Nadine Gracia is with the Office of Minority Health, US Department of Health and Human Services, Rockville, MD. John Ruffin was with the National Institute on Minority Health and Health Disparities, National Institutes of Health, US Department of Health and Human Services, Rockville. Correspondence should be sent to J. Nadine Gracia, MD, MSCE, 1101 Wootton Parkway, Suite 600. Rockville, MD 20852 (e-mail: [email protected]). Reprints can be ordered at http://www.ajph. org by clicking the “Reprints” link. This article was accepted July 2, 2014. doi:10.2105/AJPH.2014.302201
Contributors J. N. Gracia developed the concept, framed the discussion, and completed the writing of the editorial. J. Ruffin provided significant insights and substantial comments in drafting the editorial.
References 1. Centers for Disease Control and Prevention. Conclusion and future directions: CDC Health Disparities and Inequalities Report—United States, 2013. MMWR Surveill Summ. 2013;62(suppl 3): 184---186. 2. Department of Health and Human Services. HHS Action Plan to Reduce Racial and Ethnic Disparities: A Nation Free of Disparities in Health and Health Care. Washington, DC: Department of Health and Human Services; 2011. 3. National Partnership for Action to End Health Disparities. National Stakeholder Strategy for Achieving Health Equity. Rockville, MD: Department of Health and Human Services, Office of Minority Health; 2011. 4. Rashid JR, Spengler R, Wagner R, et al. Eliminating health disparities through transdisciplinary research, crossagency collaboration, and public participation. Am J Public Health. 2009;99(11):1955---1961. 5. Report of the Secretary’s Task Force on Black and Minority Health. Washington, DC: Department of Health and Human Services; 1985.
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