J. Nadine Gracia, MD, MSCE Deputy Assistant Secretary for Minority Health (Acting)

1. Update from the HHS Health Disparities Council: Aligning SACIM’s Priorities with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities J. Nadine Gracia, MD, MSCEDeputy Assistant Secretary for Minority Health (Acting) Office of Minority Health U.S. Department of Health and Human Services Secretary’s Advisory Committee on Infant Mortality November 15, 2012

2. OUTLINE • Overview of the HHS Action Plan to Reduce Racial and Ethnic Health Disparities • Implementation and Evaluation of the HHS Disparities Action Plan • Synergy between SACIM and the HHS Disparities Action Plan

3. The Office of Minority Health (OMH) OMH Mission OMH Functions • To improve the health of racial and ethnic minority populations through the development of health policies and programs that will help eliminate health disparities.

4. OMH Strategic Priorities FOCUS: Translating core minority health and health disparities programs on the ground into strategic activities and policies.

5. HHS Action Plan to Reduce Racial and Ethnic Health Disparities Vision: “A nation free of disparities in health and health care.”

6. HHS Action Plan to Reduce Racial and Ethnic Health Disparities • Represents the largest federal commitment on disparities reduction and achieving health equity • Leverages provisions from the Affordable Care Act for a coordinated and impactful effort • HHS Health Disparities Council oversees the Disparities Action Plan implementation

7. U. S. Department of Health and Human ServicesHealth Disparities Council Council Chair Howard K. Koh, MD, MPH, Assistant Secretary for Health Council Members • HHS Operating Divisions • Administration for Children and Families (ACF) • Administration for Community Living (ACL) • Agency for Healthcare Research and Quality (AHRQ) • Centers for Disease Control and Prevention (CDC) • Centers for Medicare & Medicaid Services (CMS) • Food and Drug Administration (FDA) • Health Resources and Services Administration (HRSA) • Indian Health Service (IHS) • National Institutes of Health (NIH) • Substance Abuse and Mental Health Services Administration (SAMHSA) • HHS Staff Divisions • Assistant Secretary for Administration (ASA) • Assistant Secretary for Legislation (ASL) • Assistant Secretary for Planning and Evaluation (ASPE) • Assistant Secretary for Preparedness and Response (ASPR) • Assistant Secretary for Public Affairs (ASPA) • Center for Faith-Based and Neighborhood Partnerships (CFBNP) • Intergovernmental and External Affairs (IEA) • National Vaccine Program Office (NVPO) • Office for Civil Rights (OCR) • Office of the General Counsel (OGC) • Office of Health Reform (OHR) • Office of Minority Health (OMH)* • Office of the National Coordinator for Health Information Technology (ONC) *Executive Secretariat 7

8. Office of Minority Health Directors • HHS OMH – J. Nadine Gracia, MD, MSCE, Acting Director, Office of Minority Health • AHRQ – Francis Chesley, Jr., MD, Director, Office of Extramural Research, Education, and Priority Populations • CDC – Leandris Liburd, PhD, MPH, Director, Office of Minority Health and Health Equity • CMS – Cara James, PhD, Director, Office of Minority Health • FDA – Jonca Bull, MD, Director, Office of Minority Health • HRSA – Michelle Allender-Smith, MS, RN, Director, Office of Health Equity • NIH – John Ruffin, PhD, Director, National Institute on Minority Health and Health Disparities • SAMHSA – Larke Huang, PhD, Director, Office of Behavioral Health Equity

9. Goals of the HHS Disparities Action Plan • Transform Health Care • Strengthen the Nation’s Health and Human Services Infrastructure and Workforce • Advance the Health, Safety, and Well-Being of the American People • Advance Scientific Knowledge and Innovation • Increase Efficiency, Transparency, and Accountability of HHS Programs

10. Goal I: Transform Health Care • Strategies: • Reduce disparities in health insurance coverage and access to care. • Reduce disparities in access to primary care services and care coordination. • Reduce disparities in the quality of health care.

11. Goal I: Transform Health Care • Health Resources and Services Administration New Access Point Awards • In June 2012, more than $128 million awarded to 219 health centers to help expand access to care for more than 1.25 million additional patients.

12. Goal I: Transform Health Care • OMH and the Office of the National Coordinator for Health Information Technology Reducing Cancer Among Women of Color App Challenge • Information about preventive and screening services for breast and gynecologic cancers – in different languages and in culturally appropriate contexts; • Communicate with patient health records or provider-sponsored patient portals; • Strengthen communications between a patient’s care team that may be located across a large geographic area; and • Support patient engagement and caregiver support by helping patients and their caregivers keep track of complex care plans with a particular emphasis on connections to community health workers. http://challenge.gov/ONC/402-reducing-cancer-among-women-of-color

13. Goal II: Strengthen the Nation’s Health and Human Services Infrastructure and Workforce • Strategies: • Increase the ability of all health professions and the healthcare system to identify and address racial and ethnic health disparities. • Promote the use of community health workers and Promotoras. • Increase the diversity of the healthcare and public health workforces.

14. Goal II: Strengthen the Nation’s Health and Human Services Infrastructure and Workforce • Office of Minority Health • Enhancement Initiative of the National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS Standards). • Administration for Children and Families Health Profession Opportunity Grants Program • Provides education and training to TANF recipients and other low-income individuals for occupations in the health care field. • Authorized by the Affordable Care Act, ACF has funded 32 HPOG programs throughout the nation. http://www.acf.hhs.gov/programs/ofa/programs/hpog

15. Goal II: Strengthen the Nation’s Health and Human Services Infrastructure and Workforce • HHS Promotores de Salud/Community Health Workers (CHWs) Initiative • CDC National Diabetes Education Program developed the Road to Health toolkit. The toolkit is a diabetes prevention resource for community health workers and other lay workers to use with people at risk for type 2 diabetes.  • National Heart, Lung, and Blood Institute CHW Health Disparities Initiative: funded Strategic Champion Demonstration Projects which will develop, implement, and evaluate innovative approaches to train CHWs and conduct community education using their curricula in African American, American Indian, Filipino, and Latino communities. 

16. Goal III: Advance the Health, Safety, and Well-Being of the American People • Strategies: • Reduce disparities in population health by increasing the availability and effectiveness of community-based programs and policies. • Conduct and evaluate pilot tests of health disparity impact assessments of selected proposed national policies and programs.

17. Goal III: Advance the Health, Safety, and Well-Being of the American People • HRSA/ACF Maternal, Infant and Early Childhood Home Visitation Program • ACF and HRSA provide states guidance and assistance in early learning and development, the prevention and identification of child maltreatment, the improvement of maternal and child health outcomes, and family engagement. • In April 2012, nearly $72 million awarded for states to expand or establish their home visiting program. http://mchb.hrsa.gov/programs/homevisiting/

18. Goal III: Advance the Health, Safety, and Well-Being of the American People • HHS Adult Immunization Task Force Disparities Working Group • Partnership with Walgreens providing vouchers for free flu vaccination for uninsured and underserved individuals. More than 52,000 flu vaccine vouchers redeemed in the 2011-2012 flu season. • Developed the National Influenza Vaccination Disparities Partnership, a national multi-sector campaign spearheaded by local partners committed to promoting the importance of vaccination uptake among underserved populations. • Op-eds, social media, radio interviews, webinars, online educational and outreach materials, and flu vaccination events in minority and underserved communities.

19. Goal IV: Advance Scientific Knowledge and Innovation • Strategies: • Increase the availability and quality of data collected and reported on racial and ethnic minority populations. • Conduct and support research to inform disparities reduction initiatives.

20. Goal IV: Advance Scientific Knowledge and Innovation Section 4302 of the Affordable Care Act: Data Collection and Analysis. • Requires the Secretary of Health and Human Services to establish data collection standards for race, ethnicity, sex, primary language and disability status. • Standards apply to population-based health surveys conducted or sponsored by HHS, in which respondents either self-report information or from a knowledgeable proxy.

21. Goal V: Increase Efficiency, Transparency, and Accountability of HHS Programs • Strategies: • Streamline grant administration for health disparities funding. • Monitor and evaluate implementation of the HHS Disparities Action Plan.

22. HHS Disparities Action Plan Evaluation: Examples of Key Disparities Measures* • Percentage of the U.S. nonelderly population (0-64) with health coverage • Percentage of people who have a specific source of ongoing medical care • Percentage of infants born at low birthweight • Percentage of adults and adolescents who smoke cigarettes *Appendix C of HHS Disparities Action Plan

23. Health System Tracking Project 23

24. Synergy RECOMMENDATIONS FOR A NATIONAL STRATEGY Improve the health of women. Assure safety and high-quality, patient-centered services along the continuum of perinatal care. Redeploy key evidence-based, highly effective preventive interventions to a new generation of consumers and their providers. Reduce racial/ethic and income disparities, influence social determinants, and increase health equity through place-based initiatives in higher risk communities and other investments to reduce poverty. Invest in adequate data, monitoring, and surveillance systems nationwide (national, regional, state, and local levels) to measure access, quality, and outcomes. Optimize the potential of interagency, public-private, and multi-disciplinary collaboration. 24

25. Office of Minority Health U.S. Department of Health and Human Services www.minorityhealth.hhs.gov (800) 444-6472