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ADDRESSING HEALTH CARE DISPARITIES:PROMISING PRACTICES IN MARYLAND

POSTER SESSION 4117.0

AMERICAN PUBLIC HEALTH ASSOCIATION

132ND ANNUAL MEETING

WASHINGTON, D.C. – NOVEMBER 6-10, 2004

BYDELEGATE SHIRLEY NATHAN-PULLIAM

MARYLAND GENERAL ASSEMBLYAND

DR. CARLESSIA A. HUSSEINMARYLAND STATE DEPARTMENT OF HEALTH

& MENTAL HYGIENE

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Delegate Shirley Nathan-Pulliam “Maryland is facing a health care crisis

within the racial and ethnic community. We the legislators will send a message to Marylanders that they can play a critical role in their health status.”

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Historic Perspective 1895 – Booker T. Washington at Atlanta Exposition Meeting:

discussed deficiencies in Negro health care 1899 – W.E.B. Dubois “The Philadelphia Negro: A Social Study”: a

sociological study of Negroes including health 1903 – W.E.B. Dubois “Souls of Black Folk”: discussed declining health

of Negroes post slavery 1968 –“Kerner Commission Report”: speaks of gains in Black

American’s social welfare, however health inequalities remain severe and troubling

1976 – National Medical Association: met in Washington, D.C. and discussed access, morbidity and mortality disparities between Blacks and Whites

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1980 – Black Congress on Health Law and Economics: met in Dallas, Texas and discussed strategies for bridging health care gaps between Blacks and Whites

1985 – Report of the HHS Secretary’s Task Force on Black and Minority Health (Heckler-Malone): identified the continuing existence of health disparities

1999 – IOM Report: “Unequal Burden of Cancer”, Alfred Haynes & Brian Smedley, Editors: cancer as experienced by ethnic minorities and medically underserved

Historic Perspective (continued)

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Historic Perspective (continued) 2002 – IOM Report: Confronting Racial

and Ethnic Disparities in Health Care: Brian Smedley, Adrienne Stith, Alan Nelson, Editors: race and ethnicity remain as significant predictors of health care quality

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Maryland’s Population

Race

White 3,618,687 66.3% 3,396,256 62.2% 222,431 4.1%

Non-white 1,839,450 33.7% 1,805,371 33.1% 34,079 0.6%

Black 1,564,150 28.7%Asian / Pac Isle 254,983 4.7%

American Indian 20,317 0.4%

MD total 5,458,137 100.0% 5,201,627 95.3% 256,510 4.7%

All percents are percentage of the total Maryland population.

Non-hispanicAll Ethnicities Hispanic

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Maryland’s Health Disparities Maryland’s minority populations experience

many health disparities. For example: Asthma: African-Americans have a death rate

per million of 31.4 compared to 11.7 for Whites Diabetes: African-Americans have a death rate

per 100,000 of 52 compared to 25 for Whites, excess = 27 / 100,000

Heart Disease and Stroke: African-Americans have a death rate per 100,000 of 349 compared to 284 for Whites, excess = 65 / 100,000

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Maryland’s History 1987 – Now is the Time: Action Agenda for

Improving Black and Minority Health: Maryland Governor’s Commission: dismayed at the extent of minority health disparities

1993 – Health Maryland 2000 – Volume 1: report listed the major contributors to death

1994 – Office of Minority Health: established within the Office of Community Relations (not in statute)

1996 – Health Maryland 2000 – Volume 2: report listed death trends and disparities

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Maryland’s History (continued) 1999 – Healthy Maryland 2010 Project: began

a statewide planning effort to develop action plans

2001 – Maryland Health Improvement Plan: published statewide plan of recommendations; each local county published its own plan

2002 – Healthy Maryland Chartbook: published book of health data for state showing trends and continuing disparities

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Legislative Actions in Maryland Elected by the people to the Maryland General

Assembly Working as a health care professional Collaborating with community advocates Partnering with health care leaders Educating colleagues in the General Assembly Keeping the “Minority Agenda” on the Table Maryland Black Caucus Legislative Week:

Chaired Health Committee

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Legislative Actions in Maryland Holding legislative hearings on minority health

problems: mental health, child health, prisoner health, disease prevention, HIV/AIDS, Hepatitis C

Submitting bills to committees: drafting minority health bills with input and lobbying from key advocacy groups

Educating the Media: interpreting impact on the health of minorities for bills under discussion

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Legislative Bills Passed 2002 Senate Bill 451: authorized the Maryland

Health Care Foundation to support programs to reduce health care disparities and coordinate groups

2003 House Bill 883: the Health Services Disparities Prevention Act: the Department of Health will take actions to reduce disparities Cultural competency among providers Offer courses and staff training Develop a plan to reduce disparities

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Legislative Bills Passed (continued)

2003 House Bill 883: The Health Services Disparities Prevention Act (continued) Identify successful prevention programs Promote health literacy and cultural sensitivity Develop methods for measurement of

disparities Involve major stakeholders across state

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Legislative Bills Passed (continued)

2004 House Bill 86/Senate Bill 177: Office of Minority Health and Health Disparities (MHHD) established in Office of Health Secretary MHHD develop plan to reduce health care

services disparities for minorities in state MHHD collect and analyze data MHHD increase racial and ethnic minorities

among health professionals Develop strategic plan for public services

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Legislative Bills Passed (continued) 2004 House Bill 86/Senate Bill 177: Office of

MHHD (continued) MHHD review existing laws to ensure that they

facilitate adequate care to Blacks and other minorities

MHHD work with health professional schools to include courses on health disparities

MHHD work with all advocacy groups to reduce health care disparities

Provide grants to community-based organizations and HBCUs with programs to reduce disparities

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Working Together 2004 Legislative Session: faced major funding

challenges; could not fund many new programs Advocacy Groups: worked with legislators to increase

awareness and obtain votes on the bills Key Health Leadership: visited legislative chairs and

major vote carriers to garner support Governor’s Office: educated the Administration

regarding the impact of health disparities on the growing Medicaid budget and health costs system-wide

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Praying and Horse Trading Key Health Leaders: provided written

commitments to assist the state with in-kind support to implement the bill

Health Secretary: made commitment to locate resources within Department, in spite of budget cuts

Bill Sponsors and Health Secretary: agreed to support bill without funding because of importance of obtaining a legislative mandate in the state

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Closing Comment“Over 100 Years of discussion and studies

on disparities in health care, the window of opportunity is now open again with the IOM and other Reports. We cannot let it close without making a significant difference in reducing health disparities in Maryland.”

Delegate Shirley Nathan-Pulliam, RN, BSN, M.A.S.

Maryland State Representative

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Closing Comment“The Health Goals of this nation are:

To Increase Quality & Years of Healthy Life To Eliminate Health Disparities

A systematic, focused and measured approach to reducing health disparities can lead to reduced human suffering, decline in cost of health services and healthier communities.

Quality Health Care = Absence of Disparities

Absence of Disparities = Quality of Health Care for all Marylanders”

Carlessia A. Hussein, R.N., Dr. P.H.

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Contacts in Maryland Delegate Shirley Nathan-Pulliam

10th Legislative District309 Lowe House Office BuildingAnnapolis, Maryland 21401-1991410-841-3350

Carlessia A. Hussein, R.N., Dr. P.H.Director, Minority Health & Health DisparitiesMaryland Department of Health & Mental Hygiene201 West Preston Street, Room 500Baltimore, Maryland 21201410-767-7117

www.mdhealthdisparities.org