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STRATEGIES TO REDUCE HEALTH DISPARITIES Various strategies are being employed to reduce health disparities. Models and interventions include: 1) large-scale federally-funded interventions designed to reduce the impact of health disparities on chronic diseases, 2) strategies to improve access to services and 3) community-based and community-driven disparity initiatives. Articles in this section explore the evidence surrounding the efficacy of these types of models. Emphasis is also placed on the importance of tracking and monitoring changes in health status resulting from these interventions. Cooper LA, Hill MN, Powe NR. Designing and evaluating interventions to eliminate racial and ethnic disparities in health care. Journal of General Internal Medicine [serial online]. June 2002;17(6):477-486. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1495065. Accessed May 19,2007. This article presents a modified version of the Institute of Medicine’s model of access to health services to eliminate health care disparities. This new model incorporates the features of other access models and highlights barriers and mediating factors important to include in interventions (e.g., community partnerships, multifaceted and intense approaches, culturally and linguistically appropriate methods). The authors also recommend that interventions to eliminate health disparities be considered within the broader context of improving quality of care. The Centers for Disease Control and Prevention. REACH 2010 page. Available at: http://www.cdc.gov/reach/about.htm. Accessed May 18, 2007. Racial and Ethnic Approaches to Community Health (REACH) is a federal initiative intended to eliminate racial and ethnic disparities in health by the year 2010 in the following six priority areas: infant mortality, breast and cervical cancer, cardiovascular diseases, diabetes, HIV/AIDS and child and adult immunizations. REACH supports community coalitions in designing, implementing and evaluating community-driven strategies to eliminate health disparities in communities, health care settings, schools and work sites around the United States. To date, REACH communities have shown an increase in mammography, Pap test, cholesterol and HgA1c screenings. National Committee on Vital and Health Statistics (NCVHS). Eliminating health disparities: strengthening data on race, ethnicity and primary language in the United States. Washington, DC: NCVHS; 2005. Available at: http://www.ncvhs.hhs.gov/051107rpt.pdf. Accessed May 18, 2007. This report is a summary of the NCVHS findings and recommended strategies for the U.S. Department of Health and Human Services and its partners to address the collection of data on race, ethnicity and primary language. Two key recommendations are presented: 1) enhance the quality, reliability and completeness of data collection and data integration and 2) increase and strengthen the capacity of health statistics infrastructure to analyze, report and disseminate data on the various ethnic, racial and linguistic subpopulations in the U.S. and its territories. Physicians for Human Rights. The right to equal treatment: an action plan to end racial and ethnic disparities in clinical diagnosis and treatment in the United States. Boston, MA: Physicians for Human Rights; 2003. Available at: http://physiciansforhumanrights.org/library/documents/reports/report-rightequaltreat-2003.PDF. Accessed May 19, 2007. After examining the evidence on racial and ethnic disparities in medical care, Physicians for Human Rights invokes a civil and human rights perspective and emphasizes the role the federal government needs to play in systematically identifying and monitoring disparities in the quality of health services in the United States. This report extends the conclusions of the Institute of Medicine’s Unequal Treatment and gives 24 detailed policy recommendations and 11 research recommendations for a sustained advocacy campaign to reduce and eliminate racial and ethnic disparities in health care. Siegel B, Berliner H, Adams A, Wasongarz D. Addressing health disparities in community settings: an analysis for best practices in community-based approaches to ending disparities in health care. Princeton, NJ: Robert Wood Johnson Foundation; 2003. Available at: http://www.rwjf.org/files/research/UrgentMatters-disparitiesfin.pdf. Accessed May 18, 2007. This report describes and analyzes the following best practices that have emerged through community-based disparity initiatives: 1) mobilizing and managing a continuum of resources and services for clients, 2) one-on-one outreach that facilitates health education and navigation of the health system and 3) embracing multiple strategies for cultural competency. The authors point out that good evaluation is lacking; that community models are developed in response to local idiosyncrasies and that small community-based disparity initiatives are unlikely to have a large impact on the health of minority populations or solve greater issues of poverty, racism and lack of health insurance for millions of Americans. U.S. Department of Health and Human Services. Healthy People 2010. Washington, DC: Office of Disease Prevention and Health Promotion; 2000. Available at: http://www.healthypeople.gov/Document/pdf/uih/2010uih.pdf. December 17, 2005. |
