Health Disparities Report Shows It Is Possible to Reduce the Gaps

By Jennifer Larson, contributor

April 30, 2014 - Despite progress in recent years, health disparities associated with certain characteristics such as race, ethnicity, income and geography remain a very real and pervasive problem.

The 2013 CDC Health Disparities and Inequalities Report noted that great progress has been made over the past 50 years, allowing more people to live longer, healthier, more productive lives. “However, this upward trend is neither as rapid as it should be--we lag behind dozens of other nations--nor is it uniformly experienced by people in the United States,” wrote the report’s authors. In fact, they added, “life expectancy and other key health outcomes vary greatly by race, sex, socioeconomic status, and geographic location.”

All the more reason, experts say, to continue with the efforts to address the disparities.

The CDC recently published a supplement as part of its Morbidity and Mortality Weekly Report series focused on successful evidence-based interventions that are reducing some of those gaps. The report describes five successful projects that employ six key components: innovation, technical package, performance management, partnerships, communication and political commitment.

The five projects highlighted include:

•  The Vaccines for Children (VFC) Program, which launched in 1993 to eliminate the cost of vaccines as a barrier to vaccination for young children;
•  The Healthy Love intervention, an interactive workshop designed to prevent HIV/SDT infection in heterosexual non-Hispanic black women, involving service provider organizations in the community;
•  Many Men, Many Voices (EMV), a program using small group interaction and education in an effort to decrease sexual risk behaviors and increase protective behaviors in black men who have sex with other men, in an effort to prevent HIV/STD transmission;
•  A program aimed at reducing motor vehicle accidents among four Native American tribal communities, which tend to have higher death rates than other races/ethnicities;
•  An intervention designed to reduce smoking rates and increase the quit rate among Vietnamese and Cambodian communities, as Southeast Asian men tend to have some of the highest smoking rates in the United States.

The projects were chosen because they have successfully addressed and reduced certain disparities--and because they offer potential to other communities, said researcher Karen Bouye, PhD, MPH, MS.

“They are promising practices, and that’s because these interventions offer roadmaps for other communities,” said Bouye, senior advisor for research and health scientist at the CDC’s Office of Minority Health and Health Disparities.

Evidence matters…but so do other factors

When planning an intervention aimed at closing a gap, what matters most?

Evidence-based interventions are essential, said Lawrence Schell, PhD, but there must be a balance struck between the time it takes to develop and test them and the time it takes to implement them and help people.

Additionally, Schell, who is the director of the Center for the Elimination of Minority Health Disparities at the University of Albany, SUNY, thinks that successful interventions require input during the design process from the people in the community who are actually being targeted by the effort.  Investigators may have good theories, but theories can only go so far.

“In order for something to work well on the ground, the people on the ground have to have some input on the construction of the intervention,” he said.

Renaisa Anthony, MD, deputy director of the University of Nebraska Medical Center’s Center for Reducing Health Disparities, agreed. She also noted that there must be room for innovation.  Even if a community or population has many things in common with similar communities, there may be subtle nuances that can have an impact on what works and what doesn’t.

“All communities are a little bit different,” said Anthony, adding that even successful approaches that worked 10 years ago may need updating or changing.

That’s definitely possible with the CDC-led interventions highlighted, Bouye said, adding that a successful intervention should include input and feedback from the targeted communities, like those chosen for the new report.

For example, the American Indian/Alaska Native tribal communities each chose evidence-based road safety interventions from the Guide to Community Preventive Services and developed a specific set of strategies to implement them. And the program that worked to reduce smoking rates among Southeast Asian men involved community health workers to implement the interventions.

Efforts must continue

Experts in the field of health disparities note that the unresolved gaps in care are costly--on many fronts.  The National Conference of State Legislatures has cited a 2009 study from the Joint Center for Political and Economic studies that estimated $230 billion in direct medical care expenditures could have been saved between 2003 and 2006 alone by eliminating health disparities for minorities.

“We can continue to ignore that there are some things in the social environment, the physical environment, our working environment, the way that our country is organized that, for some reason, certain groups end up disenfranchised and have different outcomes,” said Anthony. “If we continue to ignore that, what we [will pay] is going to be astronomical.”

Added Schell, “We waste a tremendous amount of human resource and talent.”

Many of the problems that have led to the disparities are a result of a larger underlying problem: poverty. Many of these disparities are well-entrenched and multi-generational, said Schell. But saying that the problem is too big to be solved is not the way to go, he emphasized.

“Any alleviation is a big improvement,” Schell said.

The CDC-led interventions show that health disparities can be successfully reduced, and it’s important to keep making progress, said Bouye.

“It can be done,” she said.


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