1 ADDRESSING HEALTH CARE DISPARITIES: PROMISING PRACTICES IN MARYLAND POSTER SESSION AMERICAN PUBLIC HEALTH ASSOCIATION 132 ND 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

2 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.”

3 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 American’s 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

– 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 Secretary’s 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 Historic Perspective (continued)

– 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

6 Maryland’s Population

7 Maryland’s Health Disparities Maryland’s 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

8 Maryland’s History 1987 – Now is the Time: Action Agenda for Improving Black and Minority Health: Maryland Governor’s 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

9 Maryland’s 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

10 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

11 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

12 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

13 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

14 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

15 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

16 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 Governor’s Office: educated the Administration regarding the impact of health disparities on the growing Medicaid budget and health costs system-wide

17 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

18 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

19 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.

20 Contacts in Maryland Delegate Shirley Nathan-Pulliam 10 th Legislative District 309 Lowe House Office Building Annapolis, Maryland 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