The Massachusetts Medical
Society is in strong support of H.622/S.641, identical bills to establish an
Office of Health Equity in the Executive Office of Health and Human Services to
coordinate state efforts to eliminate racial and ethnic health
disparities. This legislation would also
incorporate the Health Disparities Council as an on-going advisory body to the
Office of Health Equity and would mandate a number of important initiatives
that would help the Office to achieve its goal. We thank Rep. Jeffrey Sanchez
and Sen. Jason Lewis for their leadership on this issue.
The Society’s House of
Delegates has a long-standing Policy: “That the Massachusetts Medical Society
support the elimination of racial and ethnic disparities in health care as an
issue of high priority.” The Society has
been active on the state level on this issue since 2004, as a member of the State
Commission on the Elimination of Racial and Ethnic Health Disparities, and on
the federal level as a participant in the national Commission to End Health
Care Disparities, led by the American Medical Association, the National Medical
Association and the National Hispanic Medical Association. The recommendations
embodied in these bills are consistent with the final reports of those bodies
and would go a long way towards the reduction and eventual elimination of racial
and ethnic health disparities
It has long been clear from
the medical literature that racial and ethnic minorities in the United States
are at greater risk of death and disease from a variety of illnesses, and that
they often do not receive the same quality of health care as do other patients.
These disparities continue and include access
to appropriate cancer diagnostic
tests and treatment; screening, diagnostic, and therapeutic interventions for
heart disease and stroke; diabetes care; clinical procedures for
cerebrovascular disease; HIV care; renal transplantation; asthma care; and, a
range of other preventive and specialty health services such as: maternal and
child health care, immunizations, mental health, rehabilitative services,
long-term care, and pain management.
Massachusetts prides itself
on providing health insurance to a greater percentage of the population than
any other state. However, access to insurance coverage has not solved
the problem of access to quality health care for racially and ethnically
diverse populations in Massachusetts. There are non-coverage factors that
also relate to health disparities. Commonly identified factors include cultural
differences in understandings of the causes of illness, language barriers,
individual bias, lack of patient trust in the health care system, lack of
health literacy and poor communications by all parties. Studies show that these
issues continue. In the February 2011 issue of the Journal of the American Medical Association, researchers found that
among elderly Medicare recipients, black patients were more likely to be
readmitted after hospitalization for 3 common conditions, a gap that was
related to both race and to the site where care was received. Specifically,
elderly black Medicare patients had higher odds of 30-day readmission than
white patients for acute myocardial infarction, congestive heart failure, and
pneumonia. These disparities were related to race itself as well as to the site
where care was provided: black patients had a 13% higher odds of readmission
than white patients, while patients discharged from minority-serving hospitals
had a 23% higher odds of readmission than patients discharged from
non–minority-serving hospitals.
A particularly longstanding
concern to the MMS has been the need to create a more diverse healthcare
workforce. The Society has long been committed to expanding educational
opportunities for racial and ethnic populations in medicine and in the
biomedical sciences. While the
recruitment and retention of physicians in Massachusetts has increasingly
become a major workforce problem, the recruitment of physicians who come from
diverse racial and ethnic backgrounds is of particular concern. The lack of diversity extends throughout most
levels of the professional healthcare workforce.
In order to help increase the
diversity in the healthcare workforce, the MMS continues to participate in the
AMA’s Doctors Back to School program. This program sends minority physicians
and medical students into the community as a way to introduce children to
professional role models. Doctors Back to School aims to inspire students of
all ages, especially those from underrepresented racial and ethnic groups, to
pursue careers in medicine.
The Society also hosts
programs such as “Reality Medicine.” This program allows medical students,
residents, fellows and young physicians to talk with experienced physicians
about issues of interest to them, including career choices, the clinical
practice environment, the business of medicine, community advocacy, and keys to
success
According
to HHS’ Action Plan to Reduce Racial and
Ethnic Health Disparities, racial and ethnic minorities are more likely
than non-Hispanic whites to report experiencing poorer quality patient-provider
interactions, a disparity particularly pronounced among the 24 million adults
with limited English proficiency. Diversity
in the healthcare workforce is a key element of patient-centered care. The
ability of the healthcare workforce to address disparities will depend on its
future cultural competence and diversity.
Under the legislation before
you, the Office of Health Equity would empower all future Secretaries of the
Executive Office of Health and Human Services to work with their counterparts
in the executive branch – including the Secretary of Education, the Secretary
of Labor and Workforce Development, and the heads of the many quasi-public
economic development agencies in the state – to develop the training and
education programs necessary to prepare for the multi-cultural healthcare
workforce we need as part of our efforts to reduce and eliminate
disparities.
Supporting the bills will
also be in keeping with the national efforts by HHS and its Action Plan to Reduce Racial and Ethnic
Health Disparities. This action plan is aimed at reducing the health
disparities that affect people in the United States. The report includes five
goals to eliminate disparities:
- Transform
Health
- Strengthen the
Nation’s Health and Human Services Infrastructure and Workforce
- Advance the
Health, Safety, and Well-Being of the American People
- Advance
Scientific Knowledge and Innovation
- Increase
Efficiency, Transparency, and Accountability of HHS Programs
S.600, An Act to promote
health equity, sponsored by Sen. Barrett is consistent with principles of the
MMS policy and is also supported by the MMS.
The MMS urges the Committee
on Health Care Financing to act favorably on these important bills.
