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

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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: 66
The Culture, Diversity and Equity Project: Literature Review Figure 3.2: Healthy People 2010 Theoretical Model Source: Raphael and Bryant, 2006, p.45. Critics argue that while the Healthy People 2010 plan mentions broader determinants of health (as reflected in the above health model), the prioritized indicators and concrete strategies pursued in practice neglect broader determinants of health, being ‘firmly planted in the biomedical and behavioural public health model’ (Raphael & Bryant, 2006). • The ‘Steps to a Healthier US’ is another major US Federal policy aimed at health promotion and disease prevention that was launched in 2003 by the US Department of Health and Human Services. This policy also refers to health disparities, yet like Healthy People 2010, neglects structural factors, placing the emphasis instead on ‘physical fitness, prevention, nutrition and health lifestyles’ (see DHHS, 2003 www. healthierus.gov/steps/index.html; also see Exworthy et al., 2006). • One of the more ambitious avowed aims of the US Federal Bureau of Primary Health Care is‘100% access and 0 disparities’ (Exworthy & Washington, 2006) 3. To improve cultural competency Culturally and Linguistically Appropriate Service (CLAS) Standards: The Office of Minority Health of the US Department of Health and Human Services developed 14 National Standards for Culturally and Linguistically Appropriate Services (CLAS) in healthcare in 2001. The CLAS Standards were developed with several purposes in mind including: • “To correct inequities that currently exist in the provision of health services and to make these services more responsive to the individual needs of all patients/ consumers… especially…the needs of racial, ethnic, and linguistic population groups that experience unequal access to health services”; 67
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Appendix 1: Health Equity Literatur
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The Culture, Diversity and Equity P
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HEALTH EQUITY LITERATURE REVIEW INT
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REFERENCES ACAS [Advisory Conciliat
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