Remarks to a Town Hall Meeting on Eliminating Health Disparities

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by HRSA Administrator Mary K. Wakefield

November 4, 2009
Winston-Salem, N.C..

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Thank you.  I’m delighted to be here today as part of this distinguished panel. 

I’m a nurse, and I’m from the other “North” state – North Dakota.  And as of February of this year, I’m the administrator of the Health Resources and Services Administration.  Like CDC, NIH, and AHRQ, HRSA is an agency of the U.S. Department of Health and Human Services.

I was asked to describe some of what we’re doing to address health disparities.

For those of you who don’t know HRSA, our mission is to improve access to quality health care for the underserved.  HRSA programs support the delivery of health care to some 24 million medically underserved and uninsured people.  It’s an agency that bridges the gap between the federal government and families and communities across the nation.

We engage in a range of activities with our $7 billion annual budget.  For example, we administer the Federal program that cares for people with Hansen’s disease, or leprosy.  We oversee organ, bone marrow and cord blood donation.  We have an entire office that supports the delivery of health care in rural areas, and we run a program that provides low-cost drugs to safety-net providers.

But when it comes to efforts to eliminate disparities in access to care and health outcomes, our largest programs do the heavy lifting: health centers, Ryan White, health professions training, and maternal and child health.  

The largest portion of the individuals whose health care we support – more than 17 million people – are served through our network of 1,100 health center grantees.  These community-based and community-directed grantees provide preventive and primary care to all who enter their doors at more than 7,000 clinics.  Some of the clinics use mobile vans to reach people.

Of those 17 million patients, 60 percent identified themselves are minority Americans.  In 2007:

• 5.4 million patients, or a third of the total, were Latino or Hispanic Americans.
• 3.5 million patients, or 22 percent, were African Americans;
• 4 percent were Asian/Hawaiian/Pacific Islanders; and about 1.5 percent were American Indians/Alaska Natives.

Health centers are a vital health care resource to minority Americans.  When Congress and the President invest to improve these centers, minorities’ access to health care improves.  That’s just what happened when President Obama signed the Recovery Act in February and directed $2 billion to expand and renovate the health center network.  That $2 billion infusion, by the way, is equal to HRSA’s annual budget for the entire health center network, and it gives you an idea of the magnitude of the investment.

For years, health centers have been involved in “health disparities collaboratives,” which bring together teams of health center staff – doctors, dentists, nurses, and social workers – to improve their systems of care by learning about and then implementing better ways to work together, better ways to care for their patients.

Data collection and analysis of patient outcomes are at the core of the collaboratives' work.  By tracking patient outcomes, health centers and HRSA staff are able to identify interventions that improve care for patients suffering from chronic diseases like asthma, cardiovascular disease and diabetes.  Our staff then work with grantees to share best practices in clinical care and strategies to implement them.

Last year the health center program added to its quality efforts by establishing a set of clinical performance measures for several key health conditions and age groups.  For the first time, health centers in 2008 reported on:

• childhood immunization rates;
• entry into prenatal care;
• PAP testing;
• low birthweight;
• control of hypertension; and
• diabetes.

In addition to tracking these core health indicators, health centers also report data by race and ethnicity on low birth weight, diabetes and hypertension to track our progress in eliminating disparities in health outcomes.

Here’s what we’ve learned in preliminary findings from the 2008 data:

• Over the past year, the percent of low birthweight babies delivered by women who received prenatal care at health centers decreased from 7.8 percent to 7.6 percent, which is lower than the most recent national average of 8.3 percent.
• And among patients suffering from hypertension, 62 percent have their blood pressure under control, and more than 30 percent of health centers exceed the Healthy People 2010 goal of 68 percent.  That’s good, but not nearly good enough.

These gains move us in the right direction, but I intend to push ahead forcefully with additional, continuing quality improvements during my term.

The second program important to today’s conversation is HRSA’s Ryan White HIV/AIDS Program.  It’s our largest program by total budget with $2.2 billion, and it also supports direct health care services, in this case for low-income and uninsured people living with HIV.  Ryan White grantees provide clinical care, support services and life-sustaining pharmaceuticals to about 530,000 people annually.

Minority Americans are about 70 percent of patients cared for annually by our Ryan White grantees.  African Americans represent almost half of all clients; Hispanic Americans make up about a fifth of the total.

A few days ago President Obama signed the latest extension of the Ryan White Program, its fourth since the act was created 19 years ago.  At the signing ceremony, he noted that the program “helps communities that are … often least served by our health care system, including minority communities.”

In the Ryan White program, too, we’re involved deeply in quality improvements that will improve the care people receive.  The previous reauthorization of Ryan White made client-level data reporting a requirement for the first time, and that requirement became a mandate for all grantees earlier this year.

Our grantees are in middle stages of this move to client-level data reporting, and we’re already starting to see how the new data can be used to make real program improvements.  Now we can look at service utilization patterns to see how resources are allocated to meet the needs of clients.  We can improve service linkages by checking on how referrals are being made and track how well clients are keeping to their treatment plans.

We’re happy with the progress that is being made in the transition, and we’ll be able to provide fuller reports on performance and patient outcomes going forward.

The health center and Ryan White programs provide services; now let’s turn your attention to some of HRSA’s programs that prepare the health professions workplace.

Many of the programs are structured to boost the participation of disadvantaged and minority individuals in the health professions; others have broader eligibility.  Overall,  more than half of the students enrolled in our health professions programs are minority or disadvantaged Americans.

Why has Congress determined greater minority involvement in the health professions to be a worthy national goal?  Because numerous studies indicate that underserved communities benefit from the service of minority providers, who more frequently choose to practice in these communities than their non-minority counterparts, and who often more intimately understand the needs of residents.

The Recovery Act added a jolt of $200 million into our health professions programs – their funding had been cut or restricted in recent years.  These new funds have already supported the training and education of more than 14,000 students, and additional Recovery Act awards will be made in fiscal year 2010. 

Among the many HRSA health professions programs that benefit disadvantaged and minority students, a few stand out: the Nursing Workforce Diversity Program, the Health Careers Opportunity Program, and the Centers of Excellence program.  In the last academic year, more than 13,000 minority and disadvantaged students across the country benefited from these programs. 

I can’t close without discussing one of the most egregious health disparities between white and black Americans:  the infant mortality rate remains two and a half times higher for black than white babies in the United States. 

HRSA is home to the federal government’s Maternal and Child Health Bureau, one of the nation’s leading public health agencies.  Among its many responsibilities, the Bureau administers the Healthy Start program, whose grantees in 100 high-risk, mostly minority communities are committed to reducing disparities in infant mortality and low birth weight.

We’ve had success near here through a Healthy Start project that serves Bertie, Edgecombe, Greene, Martin, Pitt, Tyrrell, and Washington Counties in North Carolina – counties with stubbornly high infant mortality rates.  

For 2001-2005 (the most recent for data collection), mortality rates for African American infants served by the Healthy Start Baby Love Plus Initiative dropped from 15.2 to 13.7 deaths per 1,000 live births.  The reduction is noteworthy because a comparison area not served by Healthy Start had a 46 percent increase in the disparity between black and white infant mortality rates during this same period.

That’s a quick summary of some of the features of HRSA programs to improve access to quality health care for minority Americans and to educational opportunities in the health professions.  As I indicated, HRSA’s main strategies to reduce disparities rely on funding for direct health care programs that disproportionately serve minority Americans, and on scholarships and loans for minority students and faculty in the health professions.

Thank you.