Policies on Health Equity and Disparity in America

By Jude Luke, Center for Closing the Health Gap

Efforts to tackle the issues of health equity and disparity in America are primarily
categorized into three levels of legislation: national, state, and local. Unsurprisingly, the most
progress in health equity/disparity occurs at the local level, followed by the state, while the
federal level demonstrates only a few initiatives aimed at addressing equity/disparity. In this
brief, the various past efforts of political entities through all three levels of legislation will be
examined and discussed.

Federal Level

At the federal level, only two major bills with a holistic approach to disparity
predominate, both regarding the same act. The Health Equity and Accountability Act of 2014
and of 2016 both collaborated to implement ideas to address equity and end disparity. Amongst
the provisions in the act are efforts to improve data collection to further understand and identify
areas of disparity; implementation of cultural and linguistic standards in health care;
stipulations aimed at increasing the diversity of the healthcare workforce (especially important
with regards to mental health); enhancement of access to health insurance and care;
establishment of standards to improve mental health care; institution of refined standards of
care for incarcerated individuals; advancements in research regarding diseases that
disproportionately affects minorities; implementation of protocols to wield health information
technologies to better address disparities in health; addressing community health and
promoting preventative contraceptive efforts and sexual education; and implementation of broad
statements to mitigate discrimination in federal health care programs and research. Both of
these bills’ holistic approach to healthcare disparity establish standards with long-reaching
implications for the country, especially minority communities affected by disparity.

https://www.congress.gov/bill/114th-congress/house-bill/5475/related-bills
https://www.congress.gov/bill/113th-congress/house-bill/5294
http://familiesusa.org/blog/2016/08/federal-health-equity-bill-offers-model-states

State Level

Of the 55 state policies regarding health disparities proposed in 2016, only 14 passed.
Among the states with passing legislation are California, Florida, Ohio, Rhode Island, and
Minnesota.
In California, Bill SCR131 established the month of May as Mental Health Awareness
Month in order to enhance public recognition of mental health. Included in the provision is
increased awareness about the stark disparities in mental health care like access to care and
quality of care.
In Florida, Bill HB941 revised the Office of Minority Health in the Department of Health
to be the Office of Minority Health and Health Equity. Additionally, the bill implements a health
equity officer who evaluates grant proposals for effectiveness of funds regarding health equity.
 In Ohio, Bill SB332 addresses cultural competency standards. Specifically, the bill
requires Ohio state health care provider boards to adopt rules relating to cultural competency and
consider race/gender disparities in medical treatment decisions.
In Rhode Island, Bill HB8121 declares April as Community Health Workers Month,
recognizes community health workers, and promotes the idea that diversity in the healthcare
workforce is an integral part of reducing health care disparities. Additionally, in Rhode Island,
Bill SB2919 declares April to be Health Disparity Month, further highlighting the issue.
In Minnesota, Bills HF2749 and SF2356 are primarily related to state finance, but
ordinances in the bill are specifically devoted to addressing disparate communities. The
provisions establish a healthy food access program which increases availability and access to
inexpensive, nutritious, and culturally sensitive foods for low-moderate income, underserved
communities. Fresh fruits and vegetables are included in the program. Additionally, the bill
establishes an advisory committee responsible for procuring a report each year on the status of
the food access program, as well as any potential improvements. With the few states which
passed meaningful policies, it is hopeful that in the upcoming years, more comprehensive
legislation can be passed which can more specifically address disparity at the state-level.

http://www.ncsl.org/research/health/2016-health-disparities-legislation.aspx

Local Level

At the local level, there have been numerous efforts to address disparity. For brevity sake,
three major ones will be highlighted. These efforts take place in San Francisco, Boston, and King
County (Seattle), Washington.
In San Francisco, the Bay Area Regional Health Inequities Initiative (BARHII) is a
coalition of the Bay Area public health departments, officers, and staff focused on upstream
efforts to address health disparities. BARHII became an organization in 2002 and has rapidly
grown since its inception. BARHII’s growing influence has been apparent in its briefs regarding
a variety of policies, both local and federal. The organization works hand-in-hand with other
public health departments and local government to promote strategies for the benefit of public
health and pass legislation targeting disparities/equity.
In Boston, and across the nation, Black and Hispanic children are disproportionately
hospitalized with asthma complications than white children. As a result, Boston Children’s
Hospital established the Community Asthma Initiative (CAI). The CAI functions as a team of
nurses and diverse, bilingual community health workers who implement case management
and home visits with the goal of reducing childhood asthma disparity. Case management
includes meeting with landlords to enforce housing code regarding pests and mold, assistance in
obtaining benefits like food stamps, and utilizing inspectional services to assist with smoking
cessation and legal services. Home visits through CAI primarily included asthma education,
home environment assessment and filter installment, pest management, and education regarding
‘green cleaning’ methods. Data collected from the project demonstrate that CAI decreased the
number of, predominantly Black and Hispanic, children with hospital admissions relating to
asthma and decreased emergency asthma visits. Additionally, data demonstrated that CAI
participants had significantly less hospitalizations compared to a control group. CAI’s model
has since been replicated in other cities and its success has been seen, while also accounting for
cultural, linguistic, and systemic variations.
 In King County, Washington, “deep and persistent” inequalities by race and location have
continued to expand. In order to counter this expansion, the Equity and Social Justice (ESJ)
Office was established in 2015 and ESJ has consistently been incorporated into the County’s
work and policies. The ESJ primarily works upstream, similar to BARHII, through community
partnerships with the goal of address racial justice, including in healthcare. Unique about ESJ is
its approach to tackle the underlying causes of inequality through its focus on racism and
racial justice. This includes anti-racism training, addressing historic oppression, and more
contemporary issues. Moving forward, the ESJ is committed to a pro-equity agenda in a variety
of societal areas, including health care. ESJ functions primarily through community engagement,
with a goal of mobilizing communities to feel empowered and make decisions which will best
benefit disparate communities.

https://www.cdc.gov/mmwr/volumes/65/su/su6501a4.htm?s_cid=su6501a4_w
http:/barhii.org/
https://www.kingcounty.gov/elected/executive/equity-social-justice.aspx