"Connecticut's Multicultural Health Initiatives - The Beginning"
Comments of Connecticut State Senator Toni Nathaniel Harp
NCSL Health Policy Conference
Charlotte, North Carolina
December 2000
Minority health issues have received attention over the past couple of years from both the states and federal government. Minority health issues are now a national health policy priority, helped in part by former President Clinton's Initiative of Race and the Department of Health and Human Services' campaign for 100 percent access to health care and no health disparities. But significant disparities exist. Infant mortality rates of African American children are over twice the rates of Caucasian children. For people of Hispanic origin, 37 percent are uninsured versus 14 percent of Caucasians, 23 percent of African Americans and 17 percent of American Indians and Alaska Natives. In spite of advances in medical technology and better health status for Americans as a whole, minority racial, ethnic and economic groups still consistently experience disparities in health status and health care.
Connecticut, like many other states, is trying to grapple with this issue. As background, let's go back to 1997 when an ad hoc group of professionals and community activists held the first Dr. Fredrick G. Adams Multicultural/Multiethnic Health Summit in Connecticut. The conference signified a commitment in Connecticut to create a program that would be devoted to multiethnic applied research, education and advocacy. These activities were considered essential to reduce disparities in illness and disease in Connecticut.
Over 350 participants at the Summit identified the need to establish a state commission that would be a bipartisan body charged by the legislature to reduce disparities in health status between communities of color and the state average.
As a first step, the legislature created and funded an Office of Multicultural Health and placed it in the Department of Public Health. The office is responsible for improving the health of all state residents by eliminating differences in disease, disability and death rates among ethnic, racial and cultural populations. The Department of Public Health is encouraged to apply for, accept and spend available federal, state and other funds and enter into contracts to carry out the office's responsibilities. The office may provide grants for culturally appropriate health education demonstration projects and apply for, accept and spend public and private funds for these projects. It may also recommend policies, procedures, activities and resource allocations to improve health among the state's racial, ethnic and cultural populations.
The office must:
- Monitor the health status of African-Americans, Latinos/Hispanics, Native Americans/Alaskan Natives, Asians, Native Hawaiians and other Pacific Islanders
- Compare the results with the health status of non-Hispanic Caucasians/whites
- Assess the effectiveness of state programs in eliminating differences in health status
The office must also assess the health education and resource needs of the ethnic, racial and cultural populations and maintain a directory of and assist in developing and promoting multicultural and multiethnic health resources. The Department of Public Health must submit an annual report on the office's activities to the governor, the General Assembly, the Permanent Commission on the Status of Women, the Latino and Puerto Rican Affairs Commission, the Indian Affairs Council, and the Connecticut African-American Affairs Commission. The office must disseminate its findings statewide through community workshops and other means.
The Office of Multicultural Health produced the 1999 Multicultural Health - Health Status of Minority Groups in Connecticut report, specifying that both regional and national analyses point to striking differences in the health status of racial and ethnic minorities.
Minority residents of Connecticut, as identified by the report, come from more than 100 different countries including the United States and its territories. The report also found that the Department's findings are limited by the lack of data in critical areas termed as "determinants of health status." For example, there is insufficient data regarding behavioral risk factors, occupational risk factors, malnutrition, disability, interpersonal violence, and environmental risk factors such as poor housing and neighborhood safety and pollution.
The U.S. Department of Health and Human Services is concerned that racial and ethnic classifications do not address underlying disparities. This has caused renewed urgency, in Connecticut and across the country, to find more direct measurements of the social and economic factors affecting the health of communities and individuals.
During the June 2000 session of Connecticut's General Assembly, Section 14 of Public Act 00-216 created an Advisory Commission on Multicultural Health. One of the charges of the organization is to more directly measure social and economic factors that affect the health of communities.
The mission of Connecticut's Advisory Commission is the elimination of disparities in health status among the state's cultural and ethnic communities and the overall improvement of the health of state residents. The Commission is mandated to meet quarterly and is responsible for:
- Advising the commissioner of public health and the director of the Office of Multicultural Health on the preparation and implementation of reports and strategic plans and the coordination of issues and policies related to the Office of Multicultural Health
- Advising the commissioner of public health on the development of a multicultural health promotion plan and monitoring the implementation of such plan
- Making recommendations to the commissioner and the joint standing committee of the General Assembly on matters relating to public health and concerning multicultural health issues, policies and programs
It is the intent of this commission to assist the commissioner in exploring the many ideas about what constitutes culturally appropriate health services, including recognition of significant differences with respect to target population, scope and quality of services.
According to its chairperson, the commission will work with the commissioner in a systematic manner to recommend that the proposed national standards be used as guidelines as Connecticut seeks to eliminate disparities and improve quality of life for all.
These proposed standards are written to ensure that:
- Providers understand and implement services that are accessible to and appropriate for diverse populations
- Policymakers draft consistent and comprehensive laws, regulations and contract language accreditation, and that credentialing agencies assess and compare providers who say they provide culturally competent services, and assure quality for diverse populations
- Purchasers of health benefits advocate for the needs of ethnic consumers and leverage responses from insurers and health plans
- Patients understand their right to receive accessible and appropriate health care services and to evaluate whether providers offer them
- Advocates promote quality health care for diverse populations, and assess and monitor care being delivered by providers
- Educators incorporate cultural and linguistic competence into their curricula
There are seven other states that have an office responsible for this activity: Arkansas, Missouri, Illinois, Louisiana, New Jersey, New York and Texas. Ten other states have a commission or advisory group: Arkansas, Illinois, Indiana, Missouri, New Jersey, New York, North Carolina, Ohio, Tennessee and Virginia. Nine states have initiatives to increase minority health professionals: California, Delaware, Florida, Louisiana, Michigan, New York, Minnesota (AHEC), Tennessee (AHEC) and Virginia (AHEC). Eight states have focused on sickle cell anemia programs: California, Colorado, Florida, Illinois, Indiana, Kansas, Louisiana and Massachusetts. Texas has set aside a special fund for health research and education. Florida and Wisconsin provide health service gap grants. There are at least 10 states that provide special programs aimed at addressing a specific population and/or health condition, including Maryland's oral cancer initiative for African American men, Nebraska's Native American Program, and Illinois' immunization outreach program.
All of these initiatives are new. Only 31 states have legislated any programs at all. If our country is to meet the Healthy People 2010 goal to eliminate health disparities, there is much to be done.
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