CDE Appendix 1 Literature Review - Central East Local Health ...

The Culture, Diversity and Equity Project: Literature Review
They further describe the aims and objectives of US policies and initiatives to tackle healthcare disparities as falling
into three categories:
1. To raise awareness among various stakeholders;
2. To eliminate disparities; and
3. To improve cultural competency.
Examples of notable US policies, legislative acts, and interventions in these three areas are explored below.
1. To raise awareness among various stakeholders
Examples of policies and legislative acts drawn up with this aim in mind include:
• The Minority Health and Health Disparities Research and Education Act of 2000 (P.L. 106-525), which
was signed into law on November 22, 2000. The Act created a National Center on Minority Health and
Health Disparities at the National Institutes of Health (NIH). Activities and functions of the Center include
to fund research programs on health disparities and minority health; support training of members of health
disparity populations as researchers; and provide education loan relief for health professionals who commit
themselves to perform health disparities research. The Center also coordinates all NIH research efforts in this
area. The Act also authorizes the Agency for Healthcare Research and Quality (AHRQ) to conduct and support
activities and research to measure health disparities and to identify causes and remedies. Finally, it authorizes
the Health Resources and Services Administration (HRSA) to support research and demonstration projects to
train health care professionals on reducing health care disparities (see Beal 2004).
• The commissioning of the federal Agency for Health Research and Quality (AHRQ) to draw up what
became the National Healthcare Disparities Report (NHDR) by Congress in 1999, which addresses lowincome
groups, minority populations, women, children, the elderly, and those with special health needs (AHRQ
2002, 2003). The preliminary measure set for NHDR was published in 2002, and the final draft was published
in December 2003 (AHRQ, 2003). This report, since published annually, monitors trends in health care
disparities, measures progress toward their elimination, and raises awareness of racial, ethnic, socioeconomic,
and geographic disparities in health care so as to help guide health policymakers in designing strategies to
eliminate them (Swift, 2002; Exworthy et al., 2006).
• The Institute of Medicine’s (IOM) landmark (2002) report commissioned by US Congress, entitled Unequal
Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Documenting extensive research
evidence relating to health-care disparities between racial/ethnic populations, this report is seen as a landmark in
US policy, insofar as it convinced many agencies to introduce policies addressing healthcare disparities (for
more on content and impact of report, see Smedley et al., 2008; Smedley, 2002). 'I don't think the Bush admin
was very interested in disparities until it was forced on them by that [IOM] report’, a Federal agency
interviewee is quoted as stating, underlining the impact of this report (cited in Exworthy & Washington, 2006).
The report found that “even among the better-controlled studies, the vast majority indicated that minorities are
less likely than whites to receive needed services, including clinically necessary procedures” (Smedley, 2002).
2. To ‘eliminate’ disparities
Examples of U.S. policies and legislative acts drawn up with this aim in mind include:
• ‘Healthy People 2010’, a nationwide public health plan and federal policy, was launched in January 2000 by
the Department of Health and Human Services (DHHS). Its two overarching goals are “to eliminate health
disparities among specific segments of the population” and “to increase quality and years of health life”. These
goals inform the policy’s 467 objectives which, organized into 28 public health focus areas, are designed to
serve as a framework for improving the health of all people in the United States over the course of the first
decade of the 21st century. A selected set of 10 objectives – including physical activity, overweight and obesity,
tobacco use, substance abuse, responsible sexual behaviour, mental health, injury and violence, environmental
quality, immunization, and access to health care - known as the Leading Health Indicators, were created to
monitor progress on these goals and objectives (see section 4.3D below). The Health People 2010 Policy is
theoretically informed by the following model:
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