Kima Taylor, MD, MPH

Kima Taylor, MD, MPH

2002-2003

Director of Population Health, ICmed, LLC, Baltimore, MD;  Managing Principal, Anka Consulting, LLC, Baltimore, MD

A board-certified pediatrician, Dr. Taylor is currently serving as Director of the National Drug Addiction Treatment and Harm Reduction Program for Open Society Foundations, working to increase access to treatment services for the uninsured and underinsured. The work seeks to engage advocates in the work of reframing addiction as a chronic disease not a criminal justice issue and decrease the inequities in access to and outcomes of community substance use services in an effort to improve health and wellness.  From January 2006-2007 , she served as the Deputy Commissioner for the Baltimore City Health Department. From January 2004-2005, she served as the Legislative Assistant in health and social policy for Senator Paul Sarbanes (D-MD). Dr. Taylor has worked for the American Medical Student Association in various capacities, most recently creating cultural competency and ethnogeriatric curricula guidelines for medical and dental schools. From 1998 to 2002, Dr. Taylor cared for uninsured and underinsured patients at a community health center in Washington, D.C. and created a city-wide coalition to advance literacy in pediatric primary care. She worked with other community organizations to empower youth such that they will realize their abilities, grasp opportunities, and improve the world at large.

Dr. Taylor is a graduate of Brown University School of Medicine and the Georgetown University residency program in pediatrics. In 2002, Dr. Taylor received an M.P.H. degree from the Harvard School of Public Health as a CFHU Fellow; her research focused on exploring state legislative remedies for racial and ethnic health disparities. Dr. Taylor is also a proud mother of two children who seeks to ensure her own well-being by continuing the fight for work-life balance.

2004

Using State Legislation to Remedy Racial and Ethnic Health Disparities

Background:

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.

Methods:

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.

Conclusions:

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.

Faculty Preceptors:

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