Taking Bold Actions “Unity: Achieving Health Equity” June 22, 2012

1. NOBEL-Women’s Conference Women State Legislators Taking Bold Actions “Unity: Achieving Health Equity”June 22, 2012 Carlessia A. Hussein, RN, DrPH Director Office of Minority Health and Health Disparities Maryland Department of Health and Mental Hygiene

2. Office of Minority Health and Health Disparities (MHHD) Established in 2004, Health General Article Sect. 20-1001-1007 Purpose: Be an advocate for the improvement of minority health Structure: Located in Office of and reports to the MD Secretary of Health Minority: African Americans, Asians, Hispanic/Latinos, Native Americans

3. Health Disparities - Health Equity • In Nation • Care Quality & Access are Suboptimal • Especially for Minority & the Low income • Quality is Improving – Disparities is Not • Disparities - Race, Ethnicity, SES Present • In Maryland • Maryland is the 6th most diverse state • Some progress reducing mortality disparities • Large/costly healthcare-use disparities remain

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5. Disease and Risk Factor Disparities in Maryland End-stage Kidney Disease. Vs. Whites, new case rate is: 3.0 times higher for Blacks and American Indians 1.3 times higher for Asians and Hispanics Diabetes. Vs. Non Hispanic Whites, % with dx of diabetes is: 2.0 times higher for Blacks High Blood Pressure. Vs. Non-Hispanic Whites, % with a dx of high blood pressure is: 1.5 times higher for Blacks Obesity. Vs. Non-Hispanic Whites, % with obesity is 1.5 times higher for Blacks

6. Preventable Hospital Admissionshttp://www.dhmh.maryland.gov/mhqcc/Documents/Health-Disparities-Workgroup-Report-1-12-2012.pdf • Black vs. White disparities in admissions for conditions where good outpatient care should prevent most admissions (Ambulatory Care Sensitive Conditions or ACSCs): • Asthma: 2 to 3 times higher depending on age • 49% to 67% of Black admissions are excess due to disparity • Diabetes: 2.4 to 4.6 times higher depending on type • 57% to 78% of Black admissions are excess due to disparity • Hypertension: 4.5 times higher for Blacks • 78% of Black admissions are excess due to disparity

7. Cost of Disparities • A recent report* found that nationally, health disparities among racial and ethnic minorities accounted for: • $ 229 billion in direct medical costs for the four-year period 2003 to 2006. • Maryland’s share of this cost of disparities is estimated to be between $1 billion and $2 billion per year. • Analysis of the hospital cost of excess hospital admissions for Blacks in Maryland (compared to White admission rates) has revealed about $ 0.5 billion of excess cost. • * Joint Center for Political and Economic Studies, entitled The Economic Burden of Health Inequalities in the United States (available at • http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf)

8. Health Equity Model Data Collection, Analysis & Reporting Outreach & Inclusion of Minority Persons Cultural, Linguistic & Health Literacy Workforce Diversity Attention to Social Determinants of Health

9. Innovative legislative Policies • MD Office of Minority Health & Health Disparities Act 2004 • MD Health Benefit Exchange Act 2012 • Hepatitis B & C Public Awareness Act • Cultural Competency & Health Literacy • Strengthen Cultural Competency Training • MD Health Improvement & Disparities Reduction Act 2012

10. Health Equity 2012 • Implement MD Health Improvement and Disparities Reduction Act of 2012 • Health Enterprise Zones • Reduce Disparities – Collect R/E Data • Hospitals Tract Disparities Reduction • Provider Increase Cultural Competency • Academic Institutions Report Cultural Courses • Standards developed for Analysis of R/E Data hez@dhmh.state.md.us http://dhmh.maryland.gov/healthenterprisezones

11. MHIDR Act 2012 • HEZ: geographic area with disparitries • Eligible: local health department or CBO • Criteria: comprehensive plan for disparities - support from key local stakeholders - plan for long term funding - integrate with Health Improvement Plans - supporting funds from private sector

12. MHIDR Act of 2012 • Funding and Incentives - Loan assistance repayment - Income tax Credits - Grants for medical or dental equipment - Grants for capital or leasehold - Priority for Patient Centered Medical - Priority funds - electronic health records

13. Progress in Disparity Elimination • Between 2000 and 2009 the gaps between the Black and White age-adjusted death rates (Black rate minus White rate) were reduced as follows: • For All-cause Mortality, the gap was reduced by 39% • For Cancer Mortality, the gap was reduced by 63% • For Heart Disease Mortality, the gap was reduced by 6% • For Stroke Mortality, the gap was reduced by 43% • For Diabetes Mortality, the gap was reduced by 46% • For HIV/AIDS Mortality, the gap was reduced by 46%

14. From Unity to Equity • Working Together as One – The Team • Outreach and Inclusion and Transparency • Managing For Excellence – Data, Science, Plan • ENGAGING and Marriage to consummate • NEVER Say No to Goals and Values

15. Contact Information Office of Minority Health and Health Disparities Maryland Department of Health and Mental Hygiene201 West Preston Street, Room 500 Baltimore, Maryland 21201Website: www.dhmh.maryland.gov/mhhd Health Disparities Plan: http://dhmh.maryland.gov/hd/pdf/2010/Maryland_Health_Disparities_Plan_of_Action_6.10.10.pdf Phone: 410-767-7117Fax: 410-333-5100Email: healthdisparities@dhmh.state.md.us