Due to the Healthy People 2010, many new initiatives are aimed at decreasing racial and ethnic health disparities. The varying initiatives beg the realization that disparities are multi-causal and their solutions will have to come from all areas of our society. The federal government through its many health-related sections NIH, HRSA, CMS, OMH, has started tackling the diversity problem, by creating ideas and funding streams for health care and community organizations. Hospitals and insurance companies have started data collection and other programs to address disparities. Medical schools are using cultural competency to eradicate disparities. However, there has not been as much study about how states are tackling differences. An initial task force led by John McDonough, an ex-legislator from Massachusetts, began to research the possibilities of using state governance as a means to address disparities. From those initial papers, my working group was tasked with finding ways to use state legislation to address racial and ethnic health differences.
State laws have often been used to protect people's rights, but rarely have they entered the disparity arena. However, state laws may be the first place to start. Racial and ethnic health disparity causes and effects differ depending on a patient's location. These differences make it hard for the U.S. Congress and Senate to pass legislation to address specific disparities. The states, however, are in a better position to affect individuals. With proper data collection they can assess the needs of their population and their own infrastructure. States are in a better position to empower, via funding and other support, local community organizations that have already successfully begun to find solutions. Furthermore states can negotiate with larger health care institutions to ensure uniformity, and quality in larger health care settings such as Medicaid contracts, hospitals, health professional schools.
The Legislative Briefs are uniformly designed to demonstrate the racial and ethnic health disparities that exist, delineate successful “best practices” legislation, and discuss how state policy could shape the future. My five program areas included Workforce Diversity, Oral Health, Infant Mortality, Injury Prevention, and Cultural Competency. I did extensive literature and database searches to create the briefs. I obtained background by searching state legislative, federal and state government, school and community organization databases and many more. I also conducted literature searches, but the briefs were really augmented by speaking to key contacts with background in the area. Key contacts provided framing and insight to what can and cannot be implemented legislatively. They also provided further places to look for information.
I developed about 20 legislative briefs of the five working groups. In working together we realize that there has not been a lot of state-initiated legislation dealing with racial and ethnic health disparities. Many states seem to lack individual data that could allow them to begin addressing disparities within their own communities. Without data, states can see racial and ethnic health disparities as a national problem, but not their problem. Thus, step one across the board is to begin collecting data including race and ethnicity. Secondly, when states do begin to address racial and ethnic health disparities, as in California, they are having difficulties getting bills passed or signed into law. This is due to lack of funding, lack of political will, and lack of lobbying from larger institutions among other reasons. With more outcome research, and program evaluation, we may have an easier time expanding the knowledge base and creating political will. States may be less reluctant to spend money, if we are able to show actual program successes. Programs must include evaluative research and states/grantees must be willing to fund the evaluation component.
John McDonough, Dr.P.H., Schneider Institute for Health Policy, Brandeis University
Brian Gibbs, PhD, Division of Public Health Practice, Harvard School of Public Health