SCOPE OF THE WORKSHOP

On April 8, 2010, the IOM's Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities sponsored a public workshop to focus on what, if any, progress has been made to address health disparities. The workshop had three major objectives: first, to assess the progress that has been made; second, to consider the scope and effectiveness of efforts to address the social determinants of health disparities; and third, to determine what still needs to be elucidated about efforts to address social determinants and reduce health disparities.

The workshop, Ten Years Later: How Far Have We Come in Reducing Health Disparities?, was organized to further advance the dialogue about health disparities by facilitation of a discussion of the topic among stakeholders, including members of the community, academia, the health care community, and business; policy makers; and philanthropic organizations. The goal of the meeting was to consider the progress—or lack thereof—that has been made over the past decade to reduce health disparities. The workshop also highlighted federal, state, and local efforts to reduce health disparities.

WORKSHOP AGENDA

Following introductory comments by Roundtable chair William Vega, a panel of three experts addressed the question of what progress to reduce health disparities has been made. Brian Smedley of the Joint Center for Political and Economic Studies, David Williams of Harvard University, and Steven Woolf of Virginia Commonwealth University shared their thoughts from a historical perspective.

This panel presentation was followed by remarks from the assistant secretary for health of the U.S. Department of Health and Human Services, Howard Koh. A panel titled Federal Perspectives on Reducing Health Disparities featured presentations by John Ruffin of the National Center on Minority Health and Health Disparities (NCMHD)² of NIH and Carolyn Clancy from the Agency for Healthcare Research and Quality.

Presentations focusing specifically on the topic of disparities in childhood obesity were then given by Roundtable member Mildred Thompson, who discussed the obesity program of the Robert Wood Johnson Foundation Center to Prevent Childhood Obesity, Susan Sher of the President's Task Force on Childhood Obesity, and Mary Lou Fulton of The California Endowment's Building Healthy Communities program in California.

A distinguished panel of presenters addressed the question, What do we still need to learn about reducing health disparities? Dennis Andrulis, Roundtable member Anne C. Beal, and Paula Braveman shared their thoughts.

The final panel of the day featured presentations by three congressional staff members. Each provided an update on the status of health care reform legislation and its potential to affect health disparities. At the end of each panel, a question-and-answer period was included.

KEY THEMES

Throughout the workshop, individual speakers and workshop participants highlighted several recurring themes:

• Persistence of health disparities. Health disparities are not going away. Many participants agreed that health disparities have persisted over time and across the life course. Furthermore, people of color experience an earlier onset and a greater severity of negative health outcomes.
• The state of the economy. Several participants noted that the current economic downturn has had—and will continue to have—serious effects on health, particularly for low-income families and people of color. Living in poverty is a major risk factor for poor health outcomes. Furthermore, race/ethnicity and income are inextricably intertwined in the United States.
• Race and racism. Despite a general feeling that the United States is in a “postracial” period (e.g., Whitehead, 2009), several participants noted that institutional racism and racial discrimination are very much alive and well. Institutional racism and its effects have well-documented negative effects on health outcomes.
• The importance of place. Many speakers discussed the important role of community environmental factors in influencing health outcomes. Residential segregation continues to be a major problem for people of color living in low-income communities.
• Awareness of health disparities. The need to raise awareness of the existence of health disparities in the United States continues to be important; several speakers commented on the low levels of awareness of health disparities by the general public.
• Health in all policies. Many participants commented that although the integration of large governmental sectors and policies is complex, it is necessary to improve health outcomes for all people. Several major federal efforts to infuse health into the policies of federal agencies other than those directly related to health are under way.
• The role of the community in creating a health disparities agenda. Throughout the day, it was noted that health disparities cannot be addressed without input from the local community level. Additionally, communities themselves are creating their own health initiatives, often funded by the philanthropic sector.
• The promise of the Patient Protection and Affordable Care Act (ACA). There are a number of provisions in the law that promote health equity by increasing access to health care and making health insurance more affordable. Throughout the day, participants described the potential for reducing disparities through the implementation of the ACA.
• Other topics for further research. A number of participants mentioned the challenges involved with measurement of cultural competence, the need to bring interventions to scale, and the critical role that prevention plays.

REFERENCES

• HHS (Department of Health and Human Services). Mental Health: A Report of the Surgeon General. Rockville, MD: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health; 1999.
• HHS. Reducing Tobacco Use: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2000.
• IOM (Institute of Medicine). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001. [PubMed: 25057539]
• IOM. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington, DC: The National Academies Press; 2003. [PubMed: 25032386]
• IOM. State and Local Policy Initiatives to Reduce Health Disparities. Washington, DC: The National Academies Press; 2011.
• Whitehead C. The year of living postracially. New York Times. Nov 4, 2009.