Health Equity Matters
A quarterly e-newsletter in which the Centers for Disease Control and Prevention's (CDC) Office of Minority Health and Health Equity (OMHHE) shares news, perspectives and progress in the science and practice of health equity.
In This Newsletter
Spring 2013 ~ Vol.2, #2
Welcome to Health Equity Matters, an electronic newsletter intended to promote awareness of minority health and health equity issues that affect our work at CDC and in the broader public health community, support the achievement of our goal to eliminate health disparities, and foster ongoing communication and collaboration.
This year, I was honored to be invited to the 34th Annual Minority Health Conference at the University of North Carolina (UNC) Gillings School of Public Health to deliver the Victor J. Schoenbach Health Disparities Keynote Lecture. The Minority Health Conference at UNC has the distinction of being the largest and longest-running student-led health conference in the nation. Co-chaired by two amazing young women - Chassidy Hanley and Adrienne Gill-, the theme of the 2013 conference was “Constructing the Foundation for Health Equity.” The “Millennial generation” of public health workers, researchers, and scholars is entering the workforce at a time when the urgency of addressing the root causes of health inequities is clear while the path to health equity is still being paved.
In this issue of Health Equity Matters, we highlight some of CDC’s efforts to prepare the incoming workforce, as well as national initiatives intending to enhance cultural and linguistic competence. In addition to the regular features included in Health Equity Matters, don’t miss the guest commentary provided by Dr. Lynda Anderson, Director of CDC’s Healthy Aging program, and a brief overview of the new Cochrane Public Health Group report - Community Coalition-Driven Interventions to Reduce Health Disparities – A Systematic Review.
We hope you will enjoy this issue! Special thanks to all of our colleagues across CDC who provide the content for Health Equity Matters!
We welcome your comments, and encourage you to continue to circulate the newsletter among your colleagues and friends.
Leandris C. Liburd, PhD, MPH, MA
Associate Director for Minority Health and Health Equity, CDC/ATSDR
Office of Minority Health & Health Equity (OMHHE)
News You Can Use!
Welcome to our new students!Please join OMHHE in welcoming the 2013 CDC Undergraduate Public Health Scholars Program (CUPS) interns and the Dr. James A. Ferguson Emerging Infectious Diseases fellows. Through the leadership, recruitment and mentoring of our grantees – Columbia University, Kennedy Krieger Institute, Morehouse College, and the University of Michigan –192 undergraduate students will be participating in the 2013 CUPS program from May 29 through August 2, 2013.
The program is intended to expose students interested in minority health to the field of public health research and practice and increase the quality of public health services nationally by providing interns with hands-on, project-oriented assignments. It is expected that this exposure to public health programs will heighten interns’ awareness of and interest in public health careers. Thirty-two CUPS interns from Morehouse College will be on-site at several CDC locations.
Of the 11 graduate students participating in the eight-week Dr. James A. Ferguson Emerging Infectious Diseases Fellowship this summer, six students have been assigned to CDC in Atlanta and six to Kennedy Krieger Institute and other affiliated public health organizations in Baltimore, MD.
The Ferguson fellowship program is a professional development program that provides hands-on experience for graduate students in medical, dental, veterinary, pharmacy, and public health master’s-level graduate programs. This fellowship program is supported through collaboration with The Division of Preparedness and Emerging Infections (DPEI) in the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). The 2013 Ferguson Fellowship cohort will be busy at work until July 26, 2013.
For more information, visit OMHHE's Sponsored Internship & Fellowship Opportunities
First Millennial Health Leaders SummitMore than 50 graduate and medical students selected through nominations by 14 schools of public health and medical schools across the country convened at the inaugural CDC/King Center Millennial Health Leaders Summit on April 4-5, 2013. Students were selected based on their outstanding achievements and promise as future leaders in addressing health disparities across the nation.
“Our goal with the Millennial Health Leaders Summit is for the CDC to be able to convene, in close collaboration with the Martin Luther King, Jr. Center for Non-Violent Social Change and our academic partners, Brown University and Harvard University, the next generation of leaders who will be able to take on the task of eliminating health disparities in the 21st century,” said Dr. Leandris Liburd.
Dr. Ileana Arias, Principal Deputy Director of the CDC and ATSDR, was the keynote speaker at the inauguration. The students had an opportunity to engage in discussions and interactive workshops given by health disparities researchers and policymakers within CDC. The workshops included topics, such as social media, health disparities and health literacy; community-based health equity programs; social determinants of health; “vulnerable populations”; and violence as a public health issue. The closing plenary was given by Asim Jani, MD MPH FACP AAHIVE, Chief, CDC Preventive Medicine Residency and Fellowship, who called on the Millennial Health Leaders to consider the implications of their work in health disparities at the intersection of public health and health care.
On the second day, the Millennial Health Leaders re-convened at the Martin Luther King, Jr. Center for Non-Violent Social Change, at which they were joined by about 60 high school students from the Atlanta area and a number of community leaders. Dr. Bernice King, the CEO of the King Center, gave welcoming remarks and told the participants that their very presence at the King Center with the purpose of discussing solutions to eliminate health disparities has achieved one of the critical goals that her mother, Mrs. Coretta Scott King, had for the King Center as a place for dialogue to solve the pressing problems of our society.
HHS releases enhanced CLAS StandardsHHS has launched the enhanced CLAS Standards, considered a key initiative in the department’s effort to reduce health disparities; the update marks a major milestone in the implementation of the HHS Action Plan to Reduce Racial and Ethnic Health Disparities.
Specifically, the enhanced National Culturally and Linguistically Appropriate Services (CLAS) Standards, developed by the HHS Office of Minority Health, provide a framework to health and health care organizations for the delivery of culturally respectful and linguistically responsive care and services.
By adopting the framework, health and human services professionals will be better able to meet the needs of all individuals at all points of contact, HHS said.
The enhanced standards are a comprehensive update of the 2000 National CLAS Standards and include the expertise of federal and non-federal partners nationwide, to ensure an even stronger platform for health equity.
For additional information, please visit the HHS OMH site, and specifically their Think Cultural Health webpages.
CDC works on a new Language Access Plan (LAP)With the support of representatives from across the agency, OMHHE is coordinating efforts to outline CDC’s Language Access Plan, following the model set out in the HHS 2013 Language Access Plan (HHS LAP) to ensure access to the Department’s programs and activities to people with limited English proficiency (LEP).
Nearly 20 percent of the U.S. population (55 million people) speaks a language other than English at home, 63 percent of hospitals treat LEP patients daily or weekly, and more than 15 languages are frequently encountered by at least 20 percent of hospitals.
In accordance with Executive Order 13166, Improving Access to Services for Persons with limited English proficiency, the HHS LAP establishes the Department’s policy and strategy for serving persons with LEP. The LAP also underscores HHS' commitment to the language access principles, which state that people with LEP should have meaningful access to federally funded programs, activities, services and benefits. The plan further serves as a blueprint for HHS agencies to develop their own agency-specific language access plans.
Community Coalition-Driven Interventions to Reduce Health Disparities – A Systematic ReviewIn March, 2013, CDC's Division of Community Health hosted a presentation on a Cochrane Collaborative Systematic Review titled "Community Coalition-Driven Interventions to Reduce Health Disparities among Racial and Ethnic Minority Populations – A Systematic Review."
This systematic review, which was funded by CDC's Division of Community Health, assessed the effects of community coalition-driven interventions on improving health status in racial and ethnic minority populations. The presenter, Dr. Laurie M. Anderson, Associate Professor in the Department of Epidemiology at the University of Washington, discussed the methods and findings of the review, characteristics of the community coalitions, types of health issues and intervention strategies, effects of coalition-driven interventions on health outcomes, potential risk of bias, and where knowledge gaps existed.
Literature searches were conducted in several electronic databases from January 1990 through September 2012. Searches yielded 27,649 titles and abstracts, from which 545 potentially relevant papers were assessed in full text. After screening full text papers, 59 unique community coalition studies were identified in reports from 156 publications. Most of the studies in the review were conducted in the United States, and the review included several CDC Racial & Ethnic Approaches to Community Health (REACH) sites. Other studies were from the United Kingdom, Canada, and Australia. Conditions targeted included asthma, tobacco use, healthy body weight, cancer screening, alcohol and drug use, and HIV-related risks.
Some large, broad-based, multi-level, and multi-strategy interventions aimed at improving overall health in disadvantaged communities showed no effect. However, many of the programs targeting risk and protective factors and chronic disease prevention did show modest, positive outcomes.
The review procedures are available on the Cochrane Library website (http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009905/abstract).
Tribal Support Website Redesign & Tribal Consultation Policy UpdateCDC's Tribal Support website has been recently redesigned. The enhanced website offers easy-to-find information about tribal activities at CDC/ATSDR, including information about the agency’s Tribal Consultation activities and Tribal Advisory Committee; resources from across the agency and from external partners; and upcoming opportunities for funding and career development. The site also allows visitors to subscribe to receive updates on CDC/ATSDR tribal activities.
The CDC/ATSDR Tribal Consultation Policy was recently revised to ensure consistency with the US Department of Health and Human Services (HHS) Tribal Consultation Policy, with input from HHS, CDC programs, the CDC Tribal Advisory Committee, and other stakeholders. In February, the draft revised policy was sent to leaders of all federally recognized tribes for a review and comment period. Comments were accepted from the public through May 20, 2013.
Evolution of Minority Health in RetrospectiveOpening on Smithsonian magazine’s Museum Day Live, on September 28, 2013. Health is a Human Right examines some historic challenges of the past 120 years in achieving health equity for all in the US. Health is a Human Right is organized and sponsored by the David J. Sencer CDC Museum and OMHHE; and the California Endowment. The exhibit coincides with OMHHE’s 25th anniversary, which will be marked with a series of events for CDC staff to celebrate the agency's achievements in minority health. (September 28, 2013 - January 3, 2014.)
REACH Video and VignettesAn 11-minute video showcasing the impact of community health programs funded through the Racial and Ethnic Approaches to Community Health (REACH) initiative is available online from the CDC Division of Community Health (DCH) website.
"REACH – Improving Lives, Inspiring Hope" features local communities that took action to improve the health of their residents with the goal of reducing racial and ethnic health disparities. The profiles address several chronic health conditions including diabetes, cardiovascular disease, asthma, cancer, and obesity. Separate vignette videos featuring each presenter also are available.
To view the video and the vignettes, go to the DCH website.
New Resources Link Spanish- and Asian-language-Speaking Smokers to Quitting Help
Earlier this year, CDC’s Office on Smoking and Health worked with the National Cancer Institute, the North American Quitline Consortium, and the National Latino Tobacco Control Network to establish a new Spanish-language quitline number. This number is 1-855-DÉJELO-YA (1-855-335-3569), which means “Quit now.” The goal is to provide Spanish-speaking callers with a number that is meaningful and easy to remember.
The new number became operational just before the March 4 launch of CDC’s 2013 Tips From Former Smokers national tobacco education campaign. DÉJELO-YA routes callers to their respective state quitlines so that they can receive tobacco cessation information and services.
Some Spanish-language ads in the Tips campaign are tagged with DÉJELO-YA. In addition, as of April 1, Spanish-language “Click-to-Call” banner ads began appearing on mobile phones. People who click on the ads are connected to 1-855-DÉJELO-YA.
CDC has also worked with experts at the University of California at San Diego, which operates the California Smokers’ Helpline, to make quitline counseling for Chinese, Korean, and Vietnamese speakers available nationally for the first time.
In order to promote this new service, CDC has prepared a newspaper advertisement that will appear throughout the 3 months of the current Tips campaign (April, May, and June) in Chinese-, Korean-, and Vietnamese-language newspapers.
The ad—called “Climb Out”—features an Asian man climbing out of an ashtray, representing escape from tobacco addiction. The ad copy encourages smokers to call the quitline for speakers of Asian languages, where they can access a variety of cessation information and services.
CDC’s Tips campaign will run parallel with ads from the California Smokers' Helpline that are also directed at Asian-languages-speaking audiences. Ad placements from both agencies will be coordinated so that these ads do not run during the same weeks.
Health Equity & Aging
Lynda A. Anderson, PhD, Director, Healthy Aging Program
Applied Research & Translation Branch, Division of Population Health,
National Center for Chronic Disease Prevention & Health Promotion (NCCDPHP)
Older people are growing in number faster than any other age group, nationally and internationally. By 2030, older adults will account for roughly 20% of the U.S. population.1 Globally, by 2015, it is expected that there will be more people over age 65 than young adults aged 15 and younger.2
Analysis of aging trends in the U.S. reveals important growth within the older population, with significant increases in racial and ethnic diversity. In 2010, 80% of older adults in U.S. were non-Hispanic whites. By 2030, older non-Hispanic whites will comprise 71%, Hispanics will comprise 11%, blacks nearly 10%, and Asians about 5% of the older adult population.3 Older adults in these groups may experience the effects of health disparities even more appreciably than younger people of their racial or ethnic group.4 Age is important because it serves as a social category affecting social status and treatment as well as a measure for the length of exposure to inequities caused by race, gender and class.5
The Healthy Aging Program serves as the focal point for older adult health at CDC. Working with internal and external partners, the Healthy Aging Program is committed to leading strategic public health efforts to help older adults be healthier in healthier communities, prevent chronic conditions, and end health disparities. Two cross-cutting principles underlie our efforts to promote health equity.
- - We embrace a life-course perspective to understand a person’s “placement” in society (experiences and roles) as well as life stage or age.6 This perspective can help with identifying determinants of health7 and support the development and testing of strategies at specific life stages over the life course. This is a central tenet in the work of the Healthy Aging Research Network, a subset of Prevention Research Centers, who are working with communities to understand the factors associated with healthy aging and help translate community-based programs and environmental approaches into practice through the Healthy Aging Research Network.
- We provide data to help identify key issues for older adults. The State of Aging and Health in America 2013 presents important data on 15 key health indicators for older adults related to health status, health behaviors, preventive care and screening, and injuries. The report, which was released in May 2013, focuses on several health equity issues such as health literacy and health concerns for persons who identify as lesbian, gay, bisexual, and transgender.
1. A Profile of Older Americans: 2011
Administration on Aging (2011), U.S. Department of Health and Human Services.
2. Ageing in the Twenty-First Century: A Celebration and A Challenge
United Nations Population Fund, New York, & HelpAge International, London, (2012).
3. Population Projections
US Census Bureau.
4. The State of Aging and Health in America 2007
CDC & The Merck Company Foundation, Whitehouse Station, NJ, 2007.
5. Wallace SP. Social determinants of health inequities and health care in old age.
In: Prohaska TR, Anderson LA, Binstock RH, editors. Public Health for an Aging Society. Baltimore MD: Johns Hopkins University Press; 2012, p. 99-118.
6. Ory MG, Smith ML, Resnick B.
Changing behavior throughout the life-course: Translating the success of aging research.
Transl Behav Med,(2012):1-4.
7. HHS Action Plan to Reduce Racial and Ethnic Disparities: A Nation Free of Disparities in Health and Health Care.
U.S. Department of Health and Human Services, Washington, D.C.[April 2011].
Selected publications from OMHHE authors:
Dr. Ana Penman-Aguilar, (OMHHE Associate Director for Science) authored a newly published manuscript.
Penman-Aguilar A, Carter M, Snead MC, Kourtis AP.
Socioeconomic Disadvantage as a Social Determinant of Teen Childbearing in the U.S. Public Health Rep. 2013 Mar;128 Suppl 1:5-22. PubMed PMID: 23450881
This paper was published in a special supplement of Public Health Reports focused on Sexual Health. The authors reviewed scientific literature on socioeconomic influences on teen childbearing. All studies included in the review identified at least one statistically significant association relating socioeconomic factors (e.g., neighborhood disadvantage or neighborhood-level income inequality) to teen birth.
The paper suggests directions for future research and practice related to teen childbearing.
Ramal Moonesinghe, PhD, (OMHHE Senior Mathematical Statistician) was an author on a poster presentation at the Behavioral Risk Factor Surveillance System (BRFSS) Conference, March 19, 2013
Man-huei Chang, MPH, Michael T. Molla, PhD, Benedict I. Truman, MD, Heba Athar1, MD, MPH, Ramal Moonesinghe, PhD, Paula W.Yoon, ScD
Life Expectancy for the U.S. Population by Sex, Race/Ethnicity, and Geographic Region: 2007-2009
This Poster presentation showed that healthy life expectancy can be used to monitor trends in the health of populations and identify health inequalities. Healthy life expectancy in the U.S. varied significantly by sex, race, and ethnicity. Healthy life expectancy can be readily understood and used by public health officials, healthcare providers, and policy makers.
CAPT Sonja Hutchins, MD, MPH, DrPH, FACPM, (OMHHE Senior Medical Advisor) authored an abstract for an oral presentation at the Preventive Medicine 2013 Conference in the session "Scientific Abstract Presentations in Population Health" entitled, Relationships Between Community Preventive Health Indicators, Social Determinants of Health and Life Expectancy, 2009 Community Health Status Indicators (CHSI), United States.
Community preventive health indicators (leading modifiable risk behaviors and conditions) for heart disease and stroke vary across counties in the United States and are linearly linked to county-level socioeconomic status (SES) and life expectancy. Lower SES counties have worse community preventive health indicators and shorter life expectancy than higher SES counties.
This presentation suggests that targeting socioeconomically disadvantaged counties with intensive preventive interventions may reduce county-level risks for cardiovascular disease.
Conversations in Equity
Our blog Conversations in Equity shares and exchanges perspectives and progress in the science and practice of health equity.
See the latest post and add your comments today!
Health Equity Champion
Exclusion, marginalization, and discrimination against population groups perceived as “different” from the majority of Americans minimize their personhood and human rights, and undermine our ability to achieve health equity for all. The discourse of equity requires that we renegotiate how opportunities for health and wellbeing are structured educationally, politically, and socially. We are pleased to honor Dr. Timothy Shriver as Health Equity Champion for his efforts to promote a policy and culture that understands, supports, and integrates people with disabilities in the workings of all aspects of our society.
We salute Dr. Shriver and congratulate him on being a champion for the cause of health equity!
--Leandris C. Liburd
Tim Shriver is a social leader, educator, activist, film producer, and business entrepreneur. He is the Chairman & CEO of Special Olympics , serving more than 4 million Special Olympics athletes and their families in 180 countries. He has helped transform Special Olympics into a movement that focuses on acceptance, inclusion, and respect for all individuals with intellectual disabilities.
“The Special Olympics movement is proud to be a catalyst for change, not just for people with disabilities but for all of us,” Dr. Shriver said. “We continually see great transformations in our athletes – increased confidence, enhanced social skills, better job skills, and improved health and wellbeing. But, ultimately, it isn’t our athletes who need to change. It’s us. We need to alter society’s attitudes and actions and allow people with intellectual disabilities to be their best. And a change in health care is the change we need.”
Health is one area where Special Olympics has worked to bring about this change. Over the last 15 years, the organization’s Healthy Athletes™ program has grown from a handful of healthcare professionals providing screenings at one event, to the world’s largest public health initiative specifically for people with intellectual disabilities. The program has a presence in 122 countries, and has provided more than 1.3 million health screenings. Launched by pioneers Dr. Steven Perlman and Dr. Paul Berman, it has since engaged more than 120,000 health professionals worldwide, and supplied health services, products, and referrals free to its athletes.
The impact of this work is felt well beyond the athletic fields. Data collected has made scientific research possible and convinced policy-makers across the globe to make changes to improve access to health care. Partnerships with the US Centers for Disease Control and Prevention, corporations, and nonprofit organizations have allowed the program to offer life-altering interventions like prescription eyewear, dental care, and hearing aids – interventions that would otherwise be unobtainable. Thousands of health professionals have been among the most deeply affected participants --53% report life changing attitude shifts and significant changes in their practices.
The problems, however, remain staggering. In 1995 when Special Olympics first offered health screenings, the results showed dramatic health problems among the athletes – 35% had untreated dental decay, 23% failed a basic visual acuity test, and 15% needed to be immediately referred to the Emergency Room for care. Sadly, these conditions remain for most people with intellectual disabilities around the world. “I was shocked and disgusted then and I remain shocked and disgusted now,” Dr. Shriver said. “One of our volunteers explained it to me, ‘Doctors often don’t want to see these patients, and when they do, it isn’t real care, it’s a ‘quick and dirty’ - a rushed look and a nudge out the door.’ I know we can do better than that; we must do better than that.”
- 19th National Health Equity Research Webcast
Early Childhood Development: Investing in Our Children and Our Future
(formerly known as the Annual Summer Public Health Research Institute & Videoconference on Minority Health)
June 4, 2013, 1:30pm -4:00pm, EDT
- CHAAMP –Conference on History of African Americans in the Medical Professions
June 14-16, 2013
- The People’s Scientific Conference to Promote Health and Eliminate Health Disparities
June 14-15, 2013
- Implementing Equity in Health in All Policies & Health Impact Assessments:
From Concept to Action
Hosts: PolicyLink and NACCHO
Presented by Shireen Malekafzali, Associate Director, PolicyLink (facilitator)
June 19, 2013, Wednesday, 12:30pm - 2:00pm EDT
Pre-Register at https://cc.readytalk.com/cc/s/registrations/new?cid=fd5iuvhgs6et
- 8th Summer Institute on Migration and Global Health
June 24-28, 2013
Berkeley and Oakland, California
- 38th Annual National Association of Hispanic Nurses® Conference
August 6-9, 2013
New Orleans, Louisiana
- Seventh Annual National Conference on Health Communication, Marketing, & Media
August 20-22, 2013
For more announcements, see the Minority Health Announcements Page
QuickStats: Infant Mortality Rates,* by Race and Hispanic Ethnicity of Mother — United States, 2000, 2005, and 2009
From 2000-2005, infant mortality rates did not change significantly in the United States, but in the following 4 years, from 2005-2009, most US racial & ethnic population groups saw a significant decrease, American Indian/Alaska Native populations, however, actually saw an increase in infant mortality rates during this time period.
For more information on CDC activities, see the CDC SUID & SIDS topic web page and the CDC Feature on SIDS.
Data Source: CDC, MMWR Weekly, February 8, 2013 / 62(05);90.
Progress in Increasing Breastfeeding and Reducing Racial/Ethnic Differences — United States, 2000–2008 Births
Among infants born in the United States in 2008, 74.6% began breastfeeding, 44.4% breastfed for 6 months, and 23.4% for 12 months.
Yet, there are racial and ethnic differences in breastfeeding initiation (starting) and duration (continuing) rates.
For more information, see the CDC Breastfeeding web page.
- CDC's latest Winnable Battles Newsletter
- CDC’s updated Sortable Stats 2.0
- New Resources for Hispanic/Latino & American Indian/Alaska Native Populations
National Diabetes Education Program (NDEP)
- New Social Determinants of Health Topic Area webpage
Healthy People 2020
- Spotlight on Health Webinar focusing on the social determinants of health
Healthy People 2020
- Office of Minority Health Resource Center (OMHRC)
HHS Office of Minority Health (OMH)
- Environmental Justice Strategy & Implementation Plan
- Health Care Expenditures Among Asian American Subgroups
- Anti-Bullying Training Toolkit
U.S. Department of Education (DOE)
- Health Equity Monitor of WHO Global Health Observatory
World Health Organization (WHO)
- Transportation Policy Guides
Association of State & Territorial Health Officials (ASTHO)
- IOM Report: Select Populations and Health Disparities
Institute of Medicine (IOM)
- MCH Library Resource Guides about Racial and Ethnic Health Disparities
The Maternal & Child Health Library at Georgetown University (MCH)
Who was the Asian American scientist who developed methods of testing infants for exposure to drugs or alcohol during pregnancy?
Dr. Har Gobind Khorana, Biochemist Dr. Enrique Ostrea Dr. David Ho, Researcher
One of Healthy People 2020's Goals is to reduce health disparities among Americans. True or False?
Who coined the term "environmental racism"?
Dr. Benjamin Chavis Rep. James E. Clyburn (D-SC) Naomi Davis, Environmentalist
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