1. 1 RACIAL AND ETHNIC HEALTH DISPARITIES and the HHS Office for Civil Rights U.S. Department of Health & Human Services

2. 2 Overview What are health disparities? What is the role of discrimination in health disparities? What can the HHS Office for Civil Rights do to reduce health disparities?

3. 3 What are “Racial and Ethnic Health Disparities”? Differences in rates of diseases Differences in health outcomes affecting the health status of certain racial or ethnic groups

4. 4 Differences in rates of disease Blacks and American Indians have diabetes at higher rates than Whites EXAMPLES of Health Disparities

5. 5 Differences in outcomes of disease Compared to Whites, a higher percentage of Black and Native American babies die in the first year of life

6. 6 Differences in outcomes of disease Black women die of cervical cancer at twice the rate of White women EXAMPLES of Health Disparities

7. 7 What are “Racial and Ethnic Health Disparities”? Differences in health care access and medical treatment

8. 8 Differences in access/treatment In one study -- Minority nursing home patients were less likely than White patients to receive medicine for their pain EXAMPLES

9. 9 Differences in access/treatment Racial minorities are less likely than Whites to receive certain cardiac diagnostic procedures EXAMPLES

10. 10 HHS: Addressing Health Disparities GOALS: Increase Quality and Years of Healthy Life Eliminate Health Disparities www.healthypeople.gov OCR webpage links to over 20 HHS health disparities initiatives: http://www.hhs.gov/ocr/healthdisparities.html

11. 11 HHS Secretary’s 500-Day Plan Commitment To Transforming Health Care In the next 500 days, Secretary Mike Leavitt will concentrate on, in the area of health disparities: “Supporting community-based approaches to closing the healthcare gap, particularly among racial and ethnic minority populations, including American Indians and Alaska Natives.” http://www.hhs.gov/500DayPlan/500dayplan.html

12. 12 HHS Initiatives to Address Health Disparities Closing the Health Gap Initiative and “Take A Loved One to the Doctor” Day National Center on Minority Health and Health Disparities (NIH) HHS Health Disparities Council Other HHS health disparities centers and grant programs at NCI, AHRQ, HRSA, CMS

13. 13 HHS Promising Practices Partnerships with community and faith-based organizations and with universities, e.g.: U. Pitt. Center for Minority Health Medical University of South Carolina Laguna Pueblo Community Health Representatives Latin American Cancer Research Coalition People’s Health Center Vietnamese Reach for Health Initiative Coalition

14. 14 OCR’s Role HHS-OCR’s responsibility: to enforce Title VI of the Civil Rights Act of 1964 -- as it applies to health care providers who receive federal funds or other assistance from HHS

15. 15 Tuskegee experiment Segregation of medical facilities and health care providers LEGACY: DISTRUST AND RELUCTANCE TO SEEK CARE A Short History of Discrimination in Health Care

16. 16 Protects persons of every race, color or national origin from unlawful discrimination – Race: e.g., Black, White, Asian – Color: skin color, regardless of race – National Origin: ancestry or ethnicity, can include language proficiency Title VI of the Civil Rights Act of 1964

17. 17 Unlawful Discrimination Title VI Recipients of Federal financial assistance may not on the basis of race, color, or national origin: deny an individual a service, aid, or other benefit provide a benefit which is different or provided in a different manner subject an individual to segregation or separate treatment

18. 18 Under Title VI, HHS recipients may not: – restrict an individual in the enjoyment of benefits, privileges – treat an individual differently in determining eligibility – deny a person an opportunity to participate on a planning or advisory board Unlawful Discrimination (continued)

19. 19 Recipients include: Hospitals, nursing homes, home health agencies, managed care organizations Health research programs Physicians, dentists, hospital social workers, Other providers who receive Federal financial assistance from HHS Who is Covered by Title VI?

20. 20 What causes differences in health status? Discrimination vs. Other Factors Contributing to Disparities

21. 21 Occupation insufficient education Heredity Lifestyle choices Geographic barriers Environment Low income Reluctance to seek treatment Inadequate insurance DISCRIMINATION Generally, these are not unlawful discrimination under the enforcement jurisdiction of OCR

22. 22 OCR’s Responsibility: Excluding a person, denying them benefits, or otherwise discriminating against them because of their race or some other prohibited reason DISCRIMINATION

23. 23 May be Intentional, or Unintentional DISCRIMINATION

24. 24 Are there neutral reasons for the disparity? e.g., this group of patients doesn’t go to the doctor because they lack transportation or child care? or Did the medical provider treat this group of patients differently because of their race, color, or ethnicity? Identifying Discrimination

25. 25 Blacks wait longer to seek medical attention Blacks less likely than Whites to receive certain procedures and treatments Red Flags for Discrimination Excluding a person, denying them benefits, or otherwise discriminating against them because of their race, color, or national origin

26. 26 FACT: In one study, doctors rated Black patients as less intelligent, less educated, more likely to abuse drugs and alcohol, less apt to comply with medical advice, and more likely to lack social support… … even after their income, education, and personality characteristics were taken into account.

27. 27 Discrimination? Beliefs or attitudes alone are not discriminatory. BUT IF beliefs can be shown to affect the way people are treated, the treatment may be discriminatory.

28. 28 FACT: Among Medicare recipients in managed care health plans, Blacks were less likely to receive: Breast cancer screenings Eye exams when diabetic Medicine after a heart attack Follow-up after hospitalization for mental illness Flu shots

29. 29 Discrimination? Doctors/HMOs seem to be treating patients differently on the basis of race … … more investigation would be needed.

30. 30 Asthmatic African-Americans in one health maintenance organization (“HMO”) were less likely than Whites to see specialists and to use inhalers, and were more likely to be hospitalized Blacks with diabetes are less likely to get proper medical care than White diabetics Discrimination? Possibly.

31. 31 What To Do If…. You believe you or someone else has been discriminated against by a health care provider….. You are a health care provider and want help in improving access to your services by racial and ethnic minorities….

32. 32 Contact OCR We can help!

33. 33 What Can OCR Do? Complaint Investigations Compliance Reviews Voluntary Compliance Technical Assistance

34. 34 Provide information on racial and ethnic health disparities to recipients and other providers upon request Refer recipients to quality resources Review recipient policies and make suggestions Make presentations to organizations What Else Can OCR Do? Technical Assistance

35. 35 FOR MORE INFORMATION  policy guidance  fact sheets  complaint forms  regional office contact information Available on OCR’s website: www.hhs.gov/ocr