Health Equity Matters

• State of Health Equity at CDC Forum

  More than 200 CDC staff attended the State of Health Equity at CDC Forum on September 27, 2012. The Forum represents an agency-wide effort to focus our broad health equity work into key areas for action, including 1) monitoring trends in health equity, 2) examining key elements of effective health equity programs, 3) organizational infrastructure that supports health equity work, and 4) national policies that both support and drive this work. As it is crucial to examine our efforts, our progress, and existing gaps, CDC staff from multiple disciplines gathered to discuss where CDC should focus its efforts to achieve health equity goals. Discussions during the Forum focused on what is known, what requires further research, and what partnerships will be necessary to achieve health equity. A launching point for future action, the Forum has begun to set up a process for establishing consensus across the agency in these four areas.
  
  
  

• New NCHHSTP's Associate Director for Health Equity

  OMHHE welcomes Wayne A. Duffus, MD, PhD, new Associate Director for Health Equity with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP).
  
  Dr. Duffus joined NCHHSTP on August 29, 2012. Previously, Dr. Duffus served for 8 years as the Medical Director of the STD/HIV Division and the AIDS Drug Assistance Program Pharmacy in the South Carolina Department of Health and Environmental Control (SCDHEC), and was an infectious disease physician at the SCDHEC STD clinic for 10 years. In addition, Dr. Duffus most recently served as a Clinical Associate Professor in the Infectious Diseases Division at the University of South Carolina (USC) School of Medicine and had patient care responsibilities in the Ryan White clinic. He was also an Adjunct Associate Professor in the USC Arnold School of Public Health. He brings a vast amount of clinical, academic, and public health experience and knowledge to the Office of the Director, NCHHSTP and to the position of Associate Director for Health Equity.
  
  

• New Health Equity Award at CDC/ATSDR

  OMHHE congratulates the recipient of the first CDC/ATSDR Health Equity Award, Hamid S. Jafari, MD. This award recognizes “outstanding efforts in achieving health equity through the identification, reduction, or elimination of infectious or chronic disease health disparities through programs, research and surveillance”. Nominated by the Center for Global Health “for leadership in eliminating poliovirus transmission and increasing health equity among children in India,” Dr. Jafari led the National Polio Surveillance Project in India from June 2007 to March 2012.
  
  

• CDC’s Office of Diversity Management and Equal Employment Opportunity (ODMEEO) hosts Dr. Jane Delgado as keynote speaker for the 2012 Hispanic Heritage Month celebration

  Jane Delgado, PhD, MS, President and CEO of the National Alliance for Hispanic Health, shared an overview of Hispanic health and the value of partnerships with a CDC audience on October 11, 2012 as part of CDC’s Hispanic Heritage Month celebration. Dr. Delgado, who serves on several national boards (including the Kresge Foundation and the Northern Virginia Health Foundation) and is regularly sought out by the media as a commentator, has won numerous awards including being named in 1998 and 2002 by Hispanic Business, and in 2007 by People En Español as among the 100 most influential Hispanics. Dr. Delgado’s presentation highlighted the importance of various factors on the health of Hispanics, such as economics, cultural factors, an aging population, and environmental and workforce issues. The event also included an announcement that CDC/ATSDR’s Latino/Hispanic Health Work Group, sponsored by CDC Chief of Staff Carmen Villar, will soon be an official CDC scientific workgroup.
  
  

Health Equity and Motor Vehicle Injury Prevention

Linda C. Degutis, DrPH, Director,
National Center for Injury Prevention & Control (NCIPC)

Motor vehicle crashes are a leading cause of death for people in the United States. The problem is widespread—more than 35,000 people were killed in motor vehicle crashes in 2010. Yet, research shows that racial and ethnic minorities are disproportionately affected, making motor vehicle injury prevention an important health equity issue.

In 2010, American Indian/Alaska Native (AI/AN) males had a motor vehicle-related death rate about 2 to 5 times higher than rates of males of other races/ethnicities; black males had the second-highest death rate, followed by whites, Hispanics, and Asian/Pacific Islanders (A/PIs). Among females, the AI/AN motor vehicle-related death rate was about 2 to 4 times higher than rates of females of other races/ethnicities; white females had the second-highest death rate, followed by blacks, Hispanics, and A/PIs.

Motor vehicle crashes—and related injuries and deaths—are preventable. There are many proven strategies that can be used, including primary seat belt laws (which allow police to stop a vehicle solely for a seat belt violation), age-appropriate child safety seat and booster seat use laws, focused child restraint distribution plus education programs, ignition interlock devices (which disable a vehicle’s ignition if alcohol is detected in the driver’s breath), sobriety checkpoints, minimum legal drinking age laws, and 0.08 g/dL blood alcohol concentration laws.

In order to help reduce disparities in motor vehicle-related injuries, interventions should be tailored to the unique cultures of different racial/ethnic groups.

One successful example can be found in the Injury Center’s efforts to address the disparities in motor vehicle-related death and injury among AI/AN. The Injury Center funded four American Indian tribes from 2004-2009 to move science to action by tailoring, implementing, and evaluating evidence-based interventions to reduce motor vehicle-related injury and death in their communities. Each tribe developed a program that was tailored to their unique cultural needs. As a result, these pilot programs were successful at increasing seat belt use, increasing child safety seat use, and decreasing alcohol-impaired driving. Building on these successes, the Injury Center has doubled the size of this program and is currently funding eight American Indian tribes to adapt and implement evidence-based interventions to reduce motor vehicle-related injury and death in their communities.

We’re making progress, but more needs to be done to increase use of evidence-based strategies to reduce disparities and keep everyone safe on the road.

Native American Road Safety Success Story

American Indians/Alaska Natives (AI/AN) have the highest motor vehicle-related death rates of all racial and ethnic groups, with rates one-and-a-half to three times greater than rates for all other Americans. To address this disparity, CDC’s National Center for Injury Prevention and Control (NCIPC) started the Tribal Motor Vehicle Injury Prevention Program (TMVIPP) to provide funding to AI/AN tribes to reduce motor vehicle-related injuries and deaths among members of their communities.

TMVIPP sites implement effective evidence-based interventions informed by The Guide to Community Preventive Services, a systematic review of community-based interventions. An overriding intent of this program is to assist tribes in developing evidence-based effective strategies in programs, which take into consideration the unique cultures of Native Americans.

CDC’s NCIPC funded four pilot Tribal Motor Vehicle Injury Prevention programs in FY 2004-2009. The programs were successful at increasing seat belt use, increasing child safety seat use, and decreasing alcohol-impaired driving. For example, in Wisconsin, the Ho-Chunk Nation Division of Health created a culturally tailored motor vehicle injury prevention program (MVIPP) to improve road safety and reduce injuries and deaths among tribal members. Teaching the Ho-Chunk Nation motor vehicle safety skills is a challenge because it is not a land-based reservation, and tribal members occupy lands scattered across 14 different Wisconsin counties—making program implementation difficult. The Ho-Chunk Nation also does not have its own police department.

To overcome these challenges, the Ho-Chunk Nation MVIPP worked closely with area police departments and also raised awareness through a comprehensive media campaign. By delivering culturally appropriate motor vehicle safety messages in both English and the local Ho-Chunk dialect, the MVIPP connected with an essential element of tribal identity, “People of the Big Voice.” At health fairs and powwows, tribal members used story-telling and reenactment of car crashes to show how motor vehicle crashes have affected their community. Billboards and public service announcements on the radio spread safe driving messages. The Ho-Chunk Nation MVIPP also conducted “Safe Native American Passengers” training to help law enforcement build skills and increase enforcement of child safety seat use laws. The Ho-Chunk program also engaged regional county police departments in seat belt use campaigns and increased enforcement of seat belt laws.

As a result of these MVIPP activities, from 2005 to 2009 the Ho-Chunk Nation drivers’ use of seat belts increased from 50% to 69%; passenger seat belt use grew even more, from 33% to 63%. Another measure of success is the increased use of child safety seats which grew from 26% to 76%. Working with other organizations, the Ho-Chunk Nation Division of Health MVPIP distributed more than 1,300 car seats, at an average rate of about 250 per year.

Because each of the 562 U.S. tribal communities is unique, CDC seeks to gain further knowledge related to tribal motor vehicle injury prevention through expansion of these programs to tribal communities of varying social, political, and cultural environments. For FY 2010 through FY 2014, eight tribes have been selected to receive funding to implement and evaluate effective evidence-based motor vehicle safety strategies. CDC will collect lessons learned from these programs to create a best practices document for all tribes.

More information can be found at Native American Road Safety.

CDC/ATSDR Tribal Support Unit in Action

CDC/ATSDR Tribal Support serves as the principal contact for all tribal-related public health activities and advisor to and main liaison with policy-level officials. The unit is responsible for implementing and ensuring agency-wide adherence to CDC/ATSDR and HHS Tribal Consultation policies, and strengthening partnerships across HHS, as well as numerous programmatic activities including issues tracking, technical assistance and providing funding through cooperative agreements.

CDC recognizes our special obligations to and unique relationship with American Indian populations, is committed to working with federally recognized tribes on a government-to-government basis, and strongly supports and respects tribal sovereignty.

One example of this commitment is evidenced by the CDC/ATSDR Tribal Advisory Committee (TAC), which is comprised of elected tribal leaders and serves as an advisory committee to CDC/ATSDR providing input, guidance, and advice on policies, guidelines, and programmatic issues affecting the health of Indian tribes.

By engaging in open, continuous, and meaningful consultations, CDC/ATSDR and its TAC work to eliminate health disparities, ensure that access to public health services is maximized, advance or enhance the social, physical, and economic status of Indians, and attain health equity for all Indian people and communities.

Delight Satter, Associate Director for Tribal Support, is achieving the goals of the Tribal Support Unit through such tribal consultations. The CDC/ATSDR Tribal Advisory Committee recently (TAC) convened in Uncasville, Connecticut for the summer TAC meeting and 9th Biannual CDC/ATSDR Tribal Consultation Session. Hosted by the Mohegan Tribe, the meetings included presentations from CDC representatives as well as official consultation activities and site visits to both the Mashantucket Pequot and Mohegan Tribes. Satter also represented CDC at the HHS Secretary’s Tribal Advisory Committee meeting in Washington, DC. Tribal Support also convened an inaugural meeting for all CDC/ATSDR staff whose official duties include working with tribes and Native-serving organizations – marking the first time all tribal project officers and program consultants came together to network and share information and resources.

In its efforts to focus on relationship and capacity building, Tribal Support is also partnering with the Association of State and Territorial Health Officials (ASTHO) on a “Knowing Tribal Health” guidance document and developing a TAC issues tracking tool to ensure follow-up on items raised by TAC members. This tool will help to solidify the relationship between tribes and CDC/ATSDR by ensuring accountability and prioritizing those issues most important to American Indian/Alaska Native populations.

Selected publications from OMHHE authors:

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Penman-Aguilar A, Whiteman MK, Cox S, Posner SF, Meikle SF, Kourtis AP, Jamieson DJ.
Complications of Common Gynecologic Surgeries among HIV-Infected Women in the United States
Infect Dis Obstet Gynecol. 2012;2012:610876. Epub 2012 May 17.
PMID: 22675242

The paper raises issues of access to care among HIV-infected women. “Our finding that the frequency of infectious and other surgical complications among hospitalizations of HIV-infected women did not decrease following widespread implementation of Highly Active Antiretroviral Therapy (HAART) suggests that women’s access to and adherence to treatment for HIV disease could be improved. Strategies for improving access and adherence to HAART should be developed, evaluated, and prioritized,” stated the authors.

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Bouye, K., Moonesinghe, R., Murphy, F.
Defining Community Boundaries and Conducting Community Assessments : Community Engagement Organization and Development (CEOD) Methods and Practices
in Community Engagement, Organization, and Development for Public Health Practice (New York: 2013).

The chapter briefly explores several concepts, models, and methods to assess community needs and resources. These methods will assist public health practitioners, communities and partners in planning and designing community health-related programs.

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Moonesinghe, R., Fleming, E.,Truman, B., Hogben, M.,Dean, H.
Linear and Non-Linear Associations of Gonorrhea Diagnosis Rates with Social Determinants of Health
Int J Environ Res Public Health. 2012 September;9(9):3149-3165.

This study analyzed the association between gonorrhea diagnosis rates and social determinants of health using surveillance data from the National Notifiable Sexually Transmitted Disease Surveillance and American Community Survey.

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Barnes PA, Curtis AB, Hall-Downey L, Moonesinghe R.
A multistate examination of partnership activity among local public health systems using the National Public Health Performance Standards
J Public Health Manag Pract. 2012 Sep-Oct;18(5):E14-23.
PMID: 22836543

This study examined whether partnership-related measures in the second version of the National Public Health Performance Standards are useful in evaluating level of activity as well as identifying latent constructs that exist among local public health systems.

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Hutchins S, Davids B, Jones C, Hood J.
Relationship of county-level social determinants of health and life expectancy,
2009 Community Health Status Indicators (CHSI), United States
Paper presented at the 140th Annual Meeting of the American Public Health Association (APHA),
San Francisco, CA, Oct. 27-31, 2012.

This presentation focused on county-level educational, poverty and racial indicators, which were moderately to strongly associated with life expectancy. Counties with the longest life expectancy should be examined further to identify their policies and resources for education, the economy, social relationships, the physical environment and health care that explain their better health.

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Hutchins S
Reduction of Childhood Immunization Disparities:
Effective Science, Policy and Practice
Paper presented at the 140th Annual Meeting of the American Public Health Association (APHA),
San Francisco, CA, Oct. 27-31, 2012.

This case study highlighted the success of national childhood vaccination strategies in reducing, and in some situations, eliminating, vaccination disparities between minority and non-minority children, and called for examination of these strategies by health professionals and policy makers who are devising programs to meet the Healthy People 2020 objectives for the elimination of health disparities and achievement of health equity.

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Bouye K.
Strategies for Improving Health Disparities among Disadvantaged Populations
Paper presented at the 140th Annual Meeting of the American Public Health Association (APHA),
San Francisco, CA, Oct. 27-31, 2012.

The presentation described current efforts of CDC’s Office of Minority Health and Health Equity (OMHHE) to prepare a publication summarizing the most effective and comprehensive CDC-funded programs for addressing health disparities. The publication, developed in response to the CDC Health Disparities & Inequalities Report - United States, 2011, will serve as a catalyst for health policy development and individual- and community-level improvements in health.

Our blog Conversations in Equity shares and exchanges perspectives and progress in the science and practice of health equity.

See the latest post and add your comments today!

The under-representation of African Americans, Hispanics, American Indians, and certain segments of the nation’s Asian/Pacific Islander population in the public health and health care workforce is well documented. According to the Sullivan Commission on Diversity in the Healthcare Workforce, “The lack of minority health professionals is compounding the nation’s persistent racial and ethnic health disparities. From cancer, heart disease, and HIV/AIDS to diabetes and mental health, African Americans, Hispanic Americans, and American Indians tend to receive less and lower quality health care than whites, resulting in higher mortality rates.”

A more diverse health workforce will strengthen cultural competence, improve language access to persons who speak a language other than English at home, and reduce healthcare disparities.(See November’s blog post – (“Wanted: A Workforce to End Health Disparities.")

Our Health Equity Champion for this edition, Dr. Fernando Sanchez Mendoza, has demonstrated that increasing the presence of Hispanic/Latino students in schools of medicine and schools of public health is achievable, and contributes to improved health outcomes among patients and at the community level. We salute Dr. Mendoza for the dedication of his life’s work to improving Hispanic health.

--Leandris C. Liburd

Dr. Fernando Sanchez Mendoza is Professor and Chief of the Division of General Pediatrics at the Lucile Packard Children’s Hospital at Stanford.

Dr. Mendoza received his medical degree from Stanford University, and after a pediatric residency at Stanford University Hospital, he obtained a Master's of Public Health from Harvard University, and returned to Stanford as a Robert Wood Johnson Academic General Pediatric Fellow. As a faculty member of the Stanford Medical School Faculty since 1981, and as Assistant/Associate Dean of Minority Advising and Programs since 1983, Dr. Mendoza has demonstrated leadership in helping to develop the future workforce in health and health care.

“I would like to thank the CDC’s Office of Minority Health and Health Equity Director, Dr. Leandris Liburd, for the honor of being named a “Health Equity Champion,” states Dr. Mendoza. “I have been fortunate to have a career where I can help influence the development of the next generation of health care providers. Our nation, with its growing diversity, more than ever needs to diversify its health care workforce. The future of health care, with a focus on patient-centered care, will require this in order to achieve cost-efficient, high quality, and culturally sensitive care. Thus, we as a nation have a challenge to improve the pipeline of the human capital from our minority communities into the health professions. This can only be done if we keep our focus on this goal and invest the necessary resources to accomplish it."

Dr. Mendoza’s research interests have focused on the health disparities of poor children, particularly U.S. Hispanic children, and his more recent work focuses on immigrant children’s health. He is on the executive board of the Hispanic Serving Health Professions Schools (HSHPS), a consortium of medical and public health schools focused on improving the health of the Hispanic community by improving the health careers pipeline for Hispanic students, and increasing the number of Hispanic faculty in medical and public health schools.

OMHHE honors Dr. Mendoza for his significant contributions to public health, to populations experiencing health disparities, and to the future of the public health workforce.

• 1st Annual Navajo Nation HIV Prevention Conference
  November 28-29, 2012
  Gallup Inn-Gallup, New Mexico
  
• National Hispanic Medical Association's 17th Annual Conference
  Abstracts submission deadline: November 30, 2012
  April 25-28, 2013
  Washington, DC
  
• 13th Reasearch Centers in Minority Institutions (RCMI) International Symposium on Health Disparities
  December 10-13, 2012
  San Juan, Puerto Rico
  
• Barbara Jordan Health Policy Scholars Program
  This is an 11-week program that brings rising college seniors and recent college graduates to Washington, D.C., where they are placed in congressional offices to learn about health policy issues, with a focus on issues affecting racial and ethnic minority and underserved communities.
  Application deadline: December 14, 2012
  
• 2012 Summit on the Science of Eliminating Health Disparities
  December 17-19, 2012
  National Harbor, Maryland
  
• Postdoctoral Fellowship website The Division of HIV/AIDS Prevention (DHAP) in Communities of Color Postdoctoral Fellowship seeks four doctoral-level researchers (e.g., behavioral scientists, epidemiologists, social scientists, evaluators, educators, economists, anthropologists, or MDs with research training and/or experience) for the 2013-2015 cycle.
  Application Deadline: December 31, 2012
  
• The Gates Millennium Scholars (GMS) Program
  This program provides outstanding African American, American Indian/Alaska Native, Asian Pacific Islander American, and Hispanic American students with an opportunity to complete an undergraduate college education in any discipline area of interest.
  Application Deadline: January 16, 2013
  
• Partnering with Tribal Nations The Association of State and Territorial Health Officials (ASTHO) released its Tribal Health Primer, which explores the role of state health officials in establishing partnerships with tribal nations and provides tips on how to work successfully with American Indian/Alaska Native tribes and tribal organizations.
  
  

For more announcements, see the Minority Health Announcements Page

Health Care Disparities Affecting Men and Women at the State Level

“Nationally, 13.2% of men ages 18 to 64 reported they did not visit a doctor in the prior year due to cost.

On average, 21.8% of Hispanic, 20.7% of American Indian and Alaska Native men, and 18.2% of black men reported cost as a barrier to care.

This was about twice the rate of Asian American, Native Hawaiian and other Pacific Islander men (10.9%), and white men (10.3%).”

From the Kaiser Family Foundation (KKF) report,
Putting Men's Health Care Disparities on the Map: Examining Racial and Ethnic Disparities at the State Level (2012),
Data source: Behavioral Risk Factor Surveillance System(BRFSS), 2006-2008.



“Nationally, 17.5% of women ages 18—64 reported they did not visit a doctor in the prior year due to cost.

On average, 27.4% of Latina, 25.7% of American Indian and Alaska Native women, and 21.9% of Black women reported this problem.

By comparison, 12.1% Asian American, Native Hawaiian and Other Pacific Islander and 14.7% of White women reported cost as a barrier to care.”

From KKF’s companion report,
Putting Women's Health Care Disparities on the Map: Examining Racial and Ethnic Disparities at the State Level (2009),
Data source: Behavioral Risk Factor Surveillance System (BRFSS), 2006-2008.

Chart.

OMHHE prepares to celebrate its 25th anniversary!

We will share highlights of its history in upcoming issues of Health Equity Matters.
Stay tuned.