Eliminating Health Disparities: Challenges and Opportunities Marsha Lillie-Blanton, Dr.P.H. Vice President in Health Policy The Henry J. Kaiser Family Foundation Centers for Disease Control and Prevention 19th National Conference on Chronic Disease March 3, 2005 Atlanta, GA

Health Determinants Social and Environmental Conditions of Life Family History Health Infrastructure of Local Community Health Coverage and Quality of Care Figure 1

Challenges & Opportunities Increasing Awareness and Knowledge Assuring Adequate and Meaningful Insurance Coverage Improving Healthcare Quality Figure 2

Awareness and Knowledge of Health and Health Care Disparities

“How Do You Think the Average African American Compares to the Average White Person in Terms of…?” Aware of the differ- ences INFANT MORTALITY Whites Say Not aware of the differences 45% 54% “just as well off” (39%) “better off” (6%) “don’t know” (9%) African Americans Say say “worse off” Aware of the differ- ences Not aware of the differences say “worse off” 42% 58% Aware of the differ- ences LIFE EXPECTANCY Whites Say Not aware of the differences 43% 57% African Americans Say say ”worse off” Aware of the differ- ences Not aware of the differences say “worse off” 46% 53% say... Figure 3 say... “just as well off” (42%) “better off” (8%) “don’t know” (8%) say... “just as well off” (43%) “better off” (5%) “don’t know” (9%) “just as well off” (36%) “better off” (10%) “don’t know” (7%) SOURCE: Kaiser Family Foundation Survey of Race, Ethnicity and Medical Care: Public Perceptions and Experiences, October 1999 (Conducted July - Sept, Facts: In 1997, black infant mortality was 2 ½ times higher than white (14.2 per 1,000 black infants born versus 6.0 per 1,000 white infants born), and blacks in 1996, on average, lived 6.6 years less than whites.

Heart Disease Death Rates for Adults 25-64, by Income, Race and Gender, NOTE: These data are the most recently available by race and income. SOURCE: Health, United States, 1998, Socioeconomic Status and Health Chartbook, Data Table for Figure 27. White, Non-Latino African American, Non-Latino Deaths per 100,000 person years Figure 4 Under $10, 000Over $15, 000

What More Can Be Done To Increase Awareness/Knowledge Outreach and informational efforts to make the facts known Education and training of health providers through professional associations & credentialing organizations Expand Knowledge Base ( Collection and Reporting of Data by Race& Social Class; Research on Interventions ) Figure 5

Insurance Coverage

People of color are more likely than whites to be uninsured or covered by Medicaid White, Non-Latino million African American, Non-Latino 32.0 million Latino 38.2 million Asian/ Pacific Islander 11.2 million American Indian/ Alaska Native 1.5 million NOTE: “Other Public” includes Medicare and military-related coverage. SOURCE: Kaiser Commission on Medicaid and the Uninsured, Health Insurance Coverage in America: 2003 Data Update, Nonelderly Population 2003 Figure 6 Two Or More Races 3.9 million Uninsured Medicaid and Other Public Private (Employer and Individual)

One-quarter to nearly one-half of nonelderly low- income population groups are uninsured NOTE: Less than 200% of poverty level = $28,256 for family of 3 in SOURCE: Kaiser Commission on Medicaid and the Uninsured, Health Insurance Coverage in America: 2001 Data Update, White, Non-Latino Latino African American, Non-Latino Asian/Pacific Islander American Indian/Alaska Native 200%+ <200% White, Non-Latino Latino African American, Non-Latino Asian/Pacific Islander American Indian/Alaska Native Poverty Level Figure 7

What More Can Be Done To Improve Coverage Simplify Medicaid Enrollment and Eligibility Process Improve Medicaid Retention of Enrollees Develop Private Sector Financial Incentives for Low-Wage Workers Build Public Consensus on Viable Approaches Figure 8

Improving Quality of Health Care

Disparities Exist Among Insured Children: Underuse of Medication Among Medicaid Beneficiaries with Asthma * Difference is statistically significant after adjustment. + Compared to whites ‡ Compared to families in which the parent had graduated from high school, but had no additional education NOTE: Model adjusted for socio-demographic factors, symptom level, and reports of processes of care. The children, ages 2-16, were enrolled in managed care plans located in California, Massachusetts, and Washington state. SOURCE: Finkelstein et al., Figure 9 Odds Ratio of Underuse Given the Characteristic Below ‡ + + Equal Likelihood

Disparities Exist Among Insured Adults: Reperfusion Therapy in Medicare Beneficiaries with Acute MI MenWomen Source: Canto, JG et al. New England Journal Of Medicine April 13; 342(15): Figure 10

What More Can Be Done To Improve Health Care Quality and Reduce Disparities Collect and Report Data on Patterns of Care By Race Research on Interventions Leadership from Professional Societies in Implementing Practice Guidelines CMS Peer Review/Quality Improvement Activities Medicaid Specific Cultural Competence Purchasing Guidelines for MCOs CMS Quality Assurance Requirements for MCOs (42 DFR ) Figure 11

What can you do? Get to know the evidence Engage colleagues in discussions about observed differential practices Support data collection and analysis efforts in your clinical practice settings Review your own practices to ensure that standards of care are followed across groups Encourage 4T’s: talent, technology, trust, tracking Figure 12