Health disparities (avoidable differences in health status) are inequitably distributed in Connecticut communities of color. Black/African-American and Hispanic/Latino populations in particular are disproportionately affected by health problems and encounter health care systems not culturally and linguistically responsive to their needs.
Racial and ethnic health disparities have been extensively documented in Connecticut and nationally, and present a complex challenge for health care and public health systems, and society at large.
CT Health has made a long-term commitment to promoting health equity by eliminating racial and ethnic health disparities.
Between 2000-2007, CT Health’s funding strategy was multifaceted, emphasizing community-driven health promotion and multicultural health programs. CT Health’s current strategic plan spans 2007-2017.
While the strategic plan retains the foundation’s commitment to eliminating disparities, the strategy has shifted from supporting programs to a systems-change approach, with two specific objectives. Objective 1: CT Health will invest in creating public will to decrease racial and ethnic health disparities in access and treatment.
Objective 2: CT Health will invest in improving the quality of systems that enhance patient-provider interactions to promote more equitable treatment and outcomes.
Creating public will to eliminate racial and ethnic health disparities
A critical mass is needed in Connecticut to elevate health disparities as a priority social issue that can be improved.
Public will may be defined as the expression of public sentiment or opinion through efforts to educate, inform or influence a segment of the public about an issue to have them support or oppose actions at the programmatic, systemic or policy level.
Building public will takes time and perseverance. It starts with raising awareness, but must go further to engage people in action. To improve the issue, the public must exert internal and external pressure on public and private systems to be more responsive to health disparities and affected communities. It is expected that public demands will be met with public actions that will improve conditions for equitable health.
Examples of strategies that can create public will include:
Developing influential champions from all sectors, especially champions of color
Developing messages and messengers that resonate with different segments of the public
Grassroots (community-driven) and grasstop (influence by leaders) engagement
Coordinating and unifying efforts to reduce disparities at local, state and national levels
Civic participation
Advocacy
Generating public policy solutions
Financing and resources dedicated to disparities elimination
Raising health disparities in the public debate
Local level action
Engaging new partners and allies
Developing and implementing a community agenda
Improving the quality of systems that enhance the patient-provider interaction
Understanding and addressing health care disparities demands that people examine:
How patients are treated
Systemic forces that affect health outcomes
The Institute of Medicine report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, concluded that racial and ethnic minorities tend to receive less communicative and less participatory care that is more susceptible to unconscious bias than whites, even when insurance status, income, age and severity of conditions are comparable.
Additionally, the Institute of Medicine’s Crossing the Quality Chasm report concluded that one of the key ways to improve quality of care is to provide care that is respectful of and responsive to patient preferences, needs and values, and ensures that these factors guide all clinical decisions.
Meanwhile, studies show that health disparities are influenced by where racial and ethnic minorities receive care (e.g., Hasnain-Wynia et al., 2007; Bach et., Al 2004). These studies document quality disparities between health care systems, institutions and providers that disproportionately care for patients of color.
CT Health’s approach is thus to invest in improving the patient-provider interaction where large populations of color receive services. Examples of areas in which systems changes could enhance the patient-provider interaction include:
Quality improvement
Health information technology
The medical home
Data
Organizational policies and procedures
Public policy
Health care payers/funding streams
Accountability mechanisms
Provider education
Patient/family-centered care
Patient/consumer advocacy
Patient/consumer empowerment
Intra- and inter-institutional linkages and coordination
Organizational cultural and linguistic competence
Standards of care, evidence-based medicine
Models that facilitate more effective patient-provider communication and trust
References: Bach, P.B., Pham, H.H., Schrag, D., Tate, R.C. & Hargraves, J.L. (2004). Primary Care Physicians who Treat Blacks and Whites. The New England Journal of Medicine, 351, 575-584.
Committee on Quality Health Care in America, Institute of Medicine. (2001). Crossing The Quality Chasm: A New Health System For The 21st Century. Washington DC: National Academies Press.
Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. (2002). Unequal Treatment, Confronting Racial and Ethnic Disparities in Health Care. Washington DC: National Academies Press.
Hasnain-Wynia, R., Baker, D.W., Nerenz, D., Feinglass, J., Beal, A.C., Landrum, M.B., Behal, R., & Weissman, J.S. (2007). Disparities in health care are driven by where minority patients seek care: Examination of the hospital quality alliance measures. Archives of Internal Medicine, 176, 1233-1239.
Links:
Policy Panel Report (Pathways to Equal Health: Eliminating Racial & Ethnic Health Disparities)
For more information about racial and ethnic health disparities, contact senior program officer Elizabeth Krause (860) 224-2200, Elizabeth@cthealth.org
Racial and Ethnic Health Disparities (2007 Annual Report: New Haven organization takes family-centered approach to preventing diabetes among at-risk Latina women)
