HOW FAR HAVE WE COME IN
REDUCING HEALTH DISPARITIES?

Progress Since 2000

Workshop Summary

Karen M. Anderson, Rapporteur

Roundtable on the Promotion of Health Equity
and the Elimination of Health Disparities

Board on Population Health and Public Health Practice

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu



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HOW FAR HAVE WE COME IN REDUCING HEALTH DISPARITIES? Progress Since 2000 Workshop Summary Karen M. Anderson, Rapporteur Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities Board on Population Health and Public Health Practice

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Govern- ing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineer- ing, and the Institute of Medicine. This study was supported by contracts between the National Academy of Sciences and the Centers for Disease Control and Prevention; Aetna Inc.; Merck & Co., Inc.; Sanofi Aventis; and Kaiser Permanente. The views presented in this publication do not necessarily reflect the view of the organizations or agencies that provided sup- port for this project. International Standard Book Number-13: 978-0-309-25530-1 International Standard Book Number-10: 0-309-25530-9 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2012 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2012. How far have we come in reducing health disparities?: Progress since 2000: Workshop summary. Washington, DC: The National Academies Press.

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“Knowing is not enough; we must apply. Willing is not enough; we must do.” — Goethe Advising the Nation. Improving Health.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad- emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Insti- tute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sci- ences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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MEMBERS OF THE PLANNING COMMITTEE1 CARA V. JAMES (Chair), Henry J. Kaiser Family Foundation JEFFREY LEVI, Trust for America’s Health MILDRED THOMPSON, PolicyLink PATTIE TUCKER, Centers for Disease Control and Prevention WILLIAM VEGA, University of Southern California SID VOORAKKARA, The California Endowment WINSTON WONG, Kaiser Permanente 1 Institute of Medicine planning committees are solely responsible for organizing the work- shop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution. v

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MEMBERS OF THE ROUNDTABLE ON THE PROMOTION OF HEALTH EQUITY AND THE ELIMINATION OF HEALTH DISPARITIES1 WILLIAM VEGA (Chair), University of Southern California MILDRED THOMPSON (Co-Chair), PolicyLink PATRICIA BAKER, The Connecticut Health Foundation KAREN BARCH, Sanofi-Aventis ANNE C. BEAL, Aetna Foundation AMERICA BRACHO, Latino Health Access FRANCIS D. CHESLEY, Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services (Ex Officio) JAMILA DAVISON, Emory University ALLAN GOLDBERG, Merck & Co., Inc. GARTH N. GRAHAM, Office of Minority Health, U.S. Department of Health and Human Services TOM GRANATIR, Humana, Inc. CARA V. JAMES, Henry J. Kaiser Family Foundation JENNIE R. JOE, University of Arizona JAMES R. KIMMEY, Missouri Foundation for Health ANNE C. KUBISCH, The Aspen Institute JEFFREY LEVI, Trust for America’s Health JOHN LEWIN, American College of Cardiology NEWELL McELWEE, Merck & Co., Inc. GARY D. NELSON, Healthcare Georgia Foundation ELENA O. NIGHTINGALE, Institute of Medicine SAMUEL NUSSBAUM, WellPoint, Inc. DAVID P. PRYOR, Aetna, Inc. STEVE M. PU, Missouri Foundation for Health AMELIE G. RAMIREZ, University of Texas Health Science Center at San Antonio KYU RHEE, Health Resources and Services Administration, U.S. Department of Health and Human Services SAMUEL SO, Stanford University PATTIE TUCKER, Centers for Disease Control and Prevention SID VOORAKKARA, The California Endowment VICTORIA WICKS, Sanofi-Aventis WINSTON F. WONG, Kaiser Permanente TERRI D. WRIGHT, W.K. Kellogg Foundation 1 Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteur and the Institute of Medicine. vii

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IOM Project Staff KAREN M. ANDERSON, Senior Program Officer ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice ALEJANDRA MARTIN, Research Assistant ANDRES GAVIRIA, Senior Program Assistant DORIS ROMERO, Financial Officer HOPE HARE, Administrative Assistant DANQING ZHU, Intern viii

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Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this report: Magda Barini-Garcia, Office of Health Equity, Health Resources and Services Administration James Kimmey, Saint Louis University Jamila Rashid, Office of Minority Health, Department of Health and Human Services Melissa A. Simon, Northwestern University Although the reviewers listed above provided many constructive com- ments and suggestions, they did not see the final draft of the report before its release. The review of this report was overseen by Carmen R. Green, University of Michigan Medical School. Appointed by the Institute of Medicine, she was responsible for making certain that an independent examination of this report was carried out in accordance with institu- tional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the author and the institution. ix

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Contents 1 INTRODUCTION 1 Scope of the Workshop, 2 Workshop Agenda, 3 Key Themes, 4 References, 5 2 WHAT PROGRESS IN REDUCING HEALTH DISPARITIES HAS BEEN MADE?: A HISTORICAL PERSPECTIVE 7 Building Stronger Communities for Better Health: Moving from Science to Policy and Practice, 8 Where Do Health Disparities Stand Today?, 13 Magnitude and Consequences of Health Disparities, 23 Discussion, 27 References, 29 3 HEALTHY PEOPLE 2010: HOW FAR HAVE WE COME IN REDUCING HEALTH DISPARITIES? 31 Healthy People, 31 HHS and Efforts to Reduce Disparities, 38 HHS and Health Care Reform, 39 HHS and Prevention, 39 References, 40 xi

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xii CONTENTS 4 FEDERAL PERSPECTIVES ON REDUCING HEALTH DISPARITIES 43 John Ruffin, 43 Carolyn Clancy, 47 Discussion, 52 References, 52 5 PROMISING PRACTICES IN ADDRESSING SOCIAL DETERMINANTS: OBESITY PREVENTION 53 The President’s Task Force on Childhood Obesity, 53 Reducing Childhood Obesity: A Strategy to Address Health Disparities, 58 The California Endowment’s Building Healthy Communities Initiative, 63 Discussion, 67 References, 68 6 WHAT DO WE STILL NEED TO LEARN ABOUT REDUCING HEALTH DISPARITIES? 69 Paula Braveman, 69 Anne Beal, 75 Dennis Andrulis, 78 Discussion, 83 References, 84 7 LEGISLATIVE ACTIONS TO REDUCE HEALTH DISPARITIES 85 The Senate Perspective, 85 The House of Representatives Perspective, 89 Discussion, 90 APPENDIXES A WORKSHOP AGENDA 93 B SPEAKER BIOGRAPHICAL SKETCHES 97