ADDRESSING HEALTH CARE DISPARITIES: PROMISING PRACTICES IN MARYLAND

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ADDRESSING HEALTH CARE DISPARITIESPROMISING
PRACTICES IN MARYLAND

• POSTER SESSION 4117.0
• AMERICAN PUBLIC HEALTH ASSOCIATION
• 132ND ANNUAL MEETING
• WASHINGTON, D.C. NOVEMBER 6-10, 2004

BY DELEGATE SHIRLEY NATHAN-PULLIAM MARYLAND
GENERAL ASSEMBLY AND DR. CARLESSIA A.
HUSSEIN MARYLAND 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 Americans 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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Historic Perspective (continued)

• 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 Secretarys 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

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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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Marylands Population
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Marylands Health Disparities

• Marylands 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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Marylands History

• 1987 Now is the Time Action Agenda for
  Improving Black and Minority Health Maryland
  Governors 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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Marylands 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
• Governors 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 District
• 309 Lowe House Office Building
• Annapolis, Maryland 21401-1991
• 410-841-3350
• Carlessia A. Hussein, R.N., Dr. P.H.
• Director, Minority Health Health Disparities
• Maryland Department of Health Mental Hygiene
• 201 West Preston Street, Room 500
• Baltimore, Maryland 21201
• 410-767-7117
• www.mdhealthdisparities.org