Health
Disparities
A Report on the Maryland
Statewide Conference on Health Disparities “Closing the Health
Care Divide: Eliminating Disparities for Racial and Ethnic Minority
Communities”
By Kathleen M. White, PhD, RN
On June 8 of this year, I had the great opportunity
to represent the Maryland Nurses Association at the
Maryland Statewide Conference on Health Disparities
called “Closing the Health Care Divide: Eliminating
Disparities for Racial and Ethnic Minority Communities”
sponsored by the Department of Health and Mental Hygiene
(DHMH). The purpose of the conference was to heighten
the awareness across Maryland’s health system
regarding the problems of minority health disparities
and the need to develop a more focused approach to eliminate
disparities in Maryland. The invitational, yet open,
conference brought together several hundred interested
people from across the state representing private and
public interests, Maryland communities, local and state
government, the health care networks, payers, providers
and patients.
The conference, held at University of Maryland Baltimore
County (UMBC), started with a welcome by Dr. Freeman
Hrabowski, President of UMBC who applauded the conference
and the work to be done. A distinguished group of speakers
including Dr. Nelson Sabatini, Secretary of the DHMH;
Dr. Donald Wilson, Vice President of Medical Affairs
and Dean, University of Maryland School of Medicine;
The Honorable Shirley Nathan-Pulliam, Maryland House
of Delegates; and Dr. Carlessia Hussein, Director of
Maryland Health and Health Disparities and Cigarette
Restitution Fund Program, filled the first part of the
morning. They were followed by a panel of experts from
academia, government and private industry who discussed
“Why States Must Address Health Disparities.”
Four afternoon concurrent sessions dealt with Health
Professional Education, Identifying Funding Strategies,
Measuring Disparities, and Access to Quality Services.
These breakout sessions included facilitated presentation
and group discussion.
It was very interesting to learn about the history
of the state initiative In 2003, the Maryland General
Assembly passed HB 883, the Health Care Services Disparities
Prevention Act of 2003 with the specified purpose of
authorizing institutions of higher education in the
State to include courses in the curriculum or offer
special seminars on health care services disparities
of specified minority populations seminars that prepare
health professionals to eliminate health disparities
in all health settings and requiring the Department
of Health and Mental Hygiene, in consultation with the
Maryland Healthcare Foundation, to develop and implement
a plan to reduce health care disparities based on race,
gender, ethnicity and poverty; the Department shall
involve statewide groups and partners. It mandated a
plan that addresses available funding, identifies gaps
in service, reduces duplication and fragmentation and
identifies outcome measures to reduce disparities. In
2004, House Bill 86 entitled Maryland Office of Minority
Health and Health Disparities, established the new Maryland
Office of Minority Health and Health Disparities in
the DHMH and requires the Director of the Office to
report to the Secretary of Health and Mental Hygiene.
This legislation was sponsored by Delegate Shirley Nathan-Pulliam.
The opportunity to hear this information and discuss
the issues with interested participants greatly increased
the value of the day. However, for me, as a practicing
nurse and educator, the many and varied resources that
were presented to the audience were: PRICELESS! I will
attempt to give you some of them.
The website for the Maryland DHMH Office of Minority
Health and Health Disparities is found at http://www.mdhealthdisparities.org.
The purpose of this initiative is to focus awareness
on health disparities in Maryland and across the country.
This coordinated state effort is reflected in the vision
and mission statements found on the fact sheet link
on the website. The Vision
of the Maryland DHMH is a state in which health care
services are organized and delivered in a manner designed
to eliminate health disparities among its ethnic and
racial populations, thereby leading the way to a Healthy
Maryland in the New Millennium. The Mission
is to promote the health of all Maryland citizens, with
a Health Disparities Initiative that will focus the
Department’s resources on eliminating health disparities,
partner with statewide organizations in developing policies
and implementing programs and monitor and report the
progress to elected officials and the public. The target
ethnic/racial groups shall include African Americans,
Hispanic/Latino Americans, Asian Americans and Native
Americans. The website map includes a fact sheet about
the office, frequently asked questions; what’s
new with health disparities; the history of the office;
links to state and national health disparities data
programs and reports; racial and ethnic resources; funding
opportunities; and a calendar of events. This is an
invaluable website and I encourage all of you to look
at it and navigate the resources.
Several of the interesting resources that the website
provides as links are worth bringing to your attention.
The first is the National Health Care Disparities Report
Executive Summary published by the Agency for Health
Care Research and Quality (AHRQ) in 2003. Congress mandated
that the AHRQ to produce an annual report on health
care disparities in the United States (Public Law 106-129).
The National Healthcare Disparities Report (NHDR) is
the first annual report intended to give a summary of
disparities in the United States using a broad set of
performance measures that will be used to monitor the
Nation’s progress toward improved health care
quality for all Americans.
The second interesting link on the website is the CDC
Behavioral Risk Factor Surveillance System also with
a link on the Maryland page under reports and Materials
where you can search for state, year and category of
risk factor surveillance. For example, if you are interested
in women’s health, you would choose that as the
category of risk factor surveillance and the following
questions would appear:
Another risk factor category is health care access,
by choosing that category of risk factor surveillance,
the following questions appear:
The risk factor surveillance categories include: activity
limitation, alcohol consumption, asthma, cardiovascular
disease, cholesterol awareness, colorectal screening,
demographics, diabetes, exercise, firearms, health care
access, health care utilization, health status, HIV/AIDS,
hypertension awareness, immunization, injury control,
nutrition, oral health, risk factors and calculated
variables, smokeless tobacco, tobacco use, weight control
and women’s health.
The last website link is a report by the Institute
of Medicine from 2002 that you may already be familiar
with. It is, however, worth mentioning as it is seminal
work on this topic. In the report, “Unequal Treatment:
Confronting Racial and Ethnic Disparities in Health
Care” a panel of experts document the evidence
and explore how persons of color experience the health
care environment, how disparities in treatment arise
and look specifically at aspects of clinical encounter
that may contribute to such disparities. If you are
not familiar with the report, it also offers recommendations
for improvements in medical care financing, allocation
of care, availability of language translation, community-based
care, and suggests the potential of cross-cultural education
to improve provider–patient communication. Dr.
Martha Hill, Dean of the Johns Hopkins University School
of Nursing, was the Co-Vice Chairperson of this Institute
of Medicine work group.
I encourage you to go to this website to get the latest
information available on health disparities. The information
can help you to be aware of health disparities that
touch every race, ethnicity, older and younger age groups,
and us as women. The disparities result in differences
in access to primary care services, in diagnosis and
treatment options and in referrals made. Nelson Sabatini,
Secretary of DHMH, said “There is more than enough
evidence that health disparities exist. All one has
to do is to look at the differences between African
Americans and Caucasians in infant and maternal mortality
rates. The gap between African Americans and Caucasians
is even more staggering when looking at HIV data. It
is time to stop talking and move forward to eliminate
health disparities gaps in Maryland.” As nurses
we have a responsibility to our patients to be a part
of reducing health disparities and improving the health
of all Americans.
Kathleen M. White, PhD, RN, is Associate Professor
and Director for the Faculty Practice at the Johns Hopkins
University School of Nursing. She is also the immediate
past president of MNA District 2 and continues to serve
on the District 2 Board of Directors.
Reprinted from The Maryland Nurse, issue 3, volume
6, August, September, October 2004. p21.
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