1. HealthiestState.org 2006 Health Disparities Package Craig McLaughlin, Executive Director Washington State Board of Health January 25, 2007

2. HealthiestState.org Thanks The Honorable Rosa Franklin Washington State Senate Don Sloma, Policy Director Washington Health Foundation

3. HealthiestState.org Demographics

4. HealthiestState.org Trends Total population 8.5 million by 2030 Asian/Pacific Islanders: 132% Hispanics: 150% Two or more races: 160% Whites: 34.5% Blacks: 60% American Indian/Alaskan Native: 50%

5. HealthiestState.org Trends

6. HealthiestState.org Disparities The infant mortality rate for American Indians and African Americans is more than double the rate for Caucasians. African Americans are more than three times as likely as Caucasians to die from HIV/AIDS, while Hispanics are more than 1.5 times more likely to die from the virus. The rate of tuberculosis for Asians is more than 15 times greater than it is for Caucasians. African Americans are more than three times as likely to die from diabetes as Caucasians; the death rate for American Indians/Alaska Natives is 2.5 times higher and for Hispanics it is 1.5 times higher. (Finkbonner et al. 2001)

7. HealthiestState.org The Package The Legislative Package: Four bills; implement recommendations of Legislatures Joint Select Committee on Health Disparities; $0.6 million for implementation. The bills: Biennial surveys of licensed health professionals to determine many of their characteristics, including their race and ethnicity (SB 6193); Multi-cultural training in health professional education curricula and in continuing education for health professionals (SB 6194); Add Native American to the State Board of Health (SB 6196); and Create Governors Interagency Coordinating Council on Health Disparities, to plan for the elimination of health disparities and to conduct health impact reviews (SB 6197)

8. HealthiestState.org Timeline Prior to 2000 National and state study, discussion and goal setting within health and public health. Healthy People 2010 establishes eliminating health disparities as a national public health goal. Senator Franklin is increasingly concerned about income-based health disparities. Senator Franklin begins building knowledge, relationships and respect as a health policy leader in the state legislature. 2000200120022003200420052006 Natl & State Study Healthy People 2010 Health disparities is a priority state health policy concern Program cuts Health disparities legislative study committee Joint comm. examines HD issues Recommen- dations Cross cultural hlth summit Draft legislation submitted Entire package (five bills) signed

9. HealthiestState.org Concerns build in Washington State communities of color about dwindling access to medical care. Concerns build among providers about nursing shortage and lack of health care workforce diversity. State Board of Health identifies HD as a priority state health policy concern; focuses on health care workforce diversity and the education pipeline. Senator Franklin rises to a state Senate leadership position; continues to gain respect as a health policy leader in the legislature and among communities of color. Health provider groups, health advocacy groups (eg. Wa. Health Foundation, Nursing and Medical Association and others) begin placing HD among their policy priorities. 2000 - 2002 2000200120022003200420052006 Natl & State Study Healthy People 2010 Health disparities is a priority state health policy concern Program cuts Health disparities legislative study committee Joint comm. examines HD issues Recommen- dations Cross cultural hlth summit Draft legislation submitted Entire package (five bills) signed

10. HealthiestState.org State revenue downturn results in major Medicaid and other medical care program cuts; communities of color, health provider groups and others mobilize in opposition. Senator Franklin proposes a legislative HD study committee; original intended scope was income based health disparities and access to health care. There is difficulty gaining adequate legislative support. An unforeseen and unfortunate incident in the legislature creates a political need to demonstrate state policy level concern for racial and ethnic minorities. Senator Franklin seizes the opportunity to secure establishment of an HD legislative study committee. 2002 - 2004 2000200120022003200420052006 Natl & State Study Healthy People 2010 Health disparities is a priority state health policy concern Program cuts Health disparities legislative study committee Joint comm. examines HD issues Recommen- dations Cross cultural hlth summit Draft legislation submitted Entire package (five bills) signed

11. HealthiestState.org Contact Craig McLaughlin Washington State Board of Health craig.mclaughlin@doh.wa.gov (360) 236-4106 craig.mclaughlin@doh.wa.gov

12. HealthiestState.org Senator Franklin and State Rep. Dawn Morrell lead the joint committee in a comprehensive, bipartisan examination of HD issues, including social determinants, health disparities and care disparities. After broad and deep public testimony, carefully drawn, limited recommendations lead to consensus among legislative study committee members. Joint committee members approve the report unanimously. 2004 - 2005 2000200120022003200420052006 Natl & State Study Healthy People 2010 Health disparities is a priority state health policy concern Program cuts Health disparities legislative study committee Joint comm. examines HD issues Recommen- dations Cross cultural hlth summit Draft legislation submitted Entire package (five bills) signed

13. HealthiestState.org State Commissions on Minority Affairs partner with major state health agencies, Washington Health Foundation, Human Links Foundation, and other community groups to convene a cross cultural health summit on diversity and health disparities. Governor Gregoires office, legislators and other political leaders participate. The event is well attended by members of communities of color. Widespread community collaboration begins toward legislative session. Senator Franklin, Rep. Morrell and key community group members hold meetings with Governor Gregoire, her staff and key legislative leaders explaining the joint committee recommendations, securing support for the concepts. 2005 2000200120022003200420052006 Natl & State Study Healthy People 2010 Health disparities is a priority state health policy concern Program cuts Health disparities legislative study committee Joint comm. examines HD issues Recommen- dations Cross cultural hlth summit Draft legislation submitted Entire package (five bills) signed

14. HealthiestState.org Informal discussions are held with state agencies to identify issues and concerns regarding implementation issues, preliminary resource requirements and acceptability of joint committee recommendations. House and Senate Health Committees receive formal briefings on the joint committee report and its recommendations. DecemberWashington Health Foundation drafts legislation to implement the joint committee recommendations and submits it to Senator Franklin and Rep. Morrell for their consideration. 2005 (contd) 2000200120022003200420052006 Natl & State Study Healthy People 2010 Health disparities is a priority state health policy concern Program cuts Health disparities legislative study committee Joint comm. examines HD issues Recommen- dations Cross cultural hlth summit Draft legislation submitted Entire package (five bills) signed

15. HealthiestState.org JanuaryFive companion bills are introduced in both the House (by Rep. Morrell) and Senate (by Senator Franklin) containing virtually all the language in the WHF draft. Bills are heard in the House and Senate. The Senate package is amended slightly and moves through policy and budget committees, and then through the Senate with few objections or concerns. Higher education and health provider concerns about education requirements are settled. Funds are earmarked for implementation in the Senate budget. 2006 2000200120022003200420052006 Natl & State Study Healthy People 2010 Health disparities is a priority state health policy concern Program cuts Health disparities legislative study committee Joint comm. examines HD issues Recommen- dations Cross cultural hlth summit Draft legislation submitted Entire package (five bills) signed

16. HealthiestState.org 2006 (contd) FebruarySenate bills heard in the House. Cost and implementation concerns surface and are resolved favorably as community groups (foundations, labor, nurses, other health providers, and community coalitions of color) and established community leaders make clear the importance of the package. MarchThe package reaches Governor Gregoires desk. Another round of implementation concerns surfaces. Governor Gregoire, hearing once again about the importance of the legislative package to communities of color and health leaders, signs the entire package. AprilImplementation begins! 2000200120022003200420052006 Natl & State Study Healthy People 2010 Health disparities is a priority state health policy concern Program cuts Health disparities legislative study committee Joint comm. examines HD issues Recommen- dations Cross cultural hlth summit Draft legislation submitted Entire package (five bills) signed