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1
Introduction
Although some attention is paid to the reduction of health disparities
at the national level, information about successful efforts at the state and
local levels is seldom heard. What are the policy levers that have led to suc-
cessful state or local initiatives? To make progress at the national level, it
is important to understand what has worked at other levels of government.
Similarly, successes in other nations might provide important lessons
for the United States. For example, what is going on with health inequali-
ties in England, where there is clear accountability and strong support for
reducing health disparities?
The present workshop, then, was designed to focus on state and local
policy initiatives to improve health disparities. The workshop also included
information about efforts at reducing health disparities in England. There,
health officials carefully look at the data to identify the drivers of health
disparities. Once this has occurred, they then figure out who is responsible
and who has leverage over those issues and then get local agencies to work
together.
This workshop follows four earlier workshops convened by the Round-
table on the Promotion of Health Equity and the Elimination of Health
Disparities. The first, held in St. Louis, Missouri, focused on the interface
between the health care system and the community in which it is based.
The second, held in Atlanta, Georgia, looked at issues of disparities across
the life span, with a particular emphasis on young children. The third,
held in Newport Beach, California, drew on the potential linkages between
health literacy, health disparities, and quality improvement efforts. Finally,
the fourth one, held in Los Angeles, California, investigated the role of
1
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2 POLICY INITIATIVES TO REDUCE HEALTH DISPARITIES
framing in addressing health disparities and the impact that the nation’s
demographic changes are having on health disparities.
The purpose of the Roundtable is to convene various groups of people
and continue to have a dialogue. As a Roundtable is not a formal Insti-
tute of Medicine committee, the members do not make recommendations.
Workshops serve as a way to present and disseminate ideas to a broader
audience of people, including policy makers, government agency staff,
members of the health care workforce, and interested participants from
the general public.
SCOPE OF THE WORKSHOP
On May 11, 2009, the Institute of Medicine’s Roundtable on the
Promotion of Health Equity and the Elimination of Health Disparities
sponsored a public workshop to discuss the role of state and local policy
initiatives in reducing health disparities. With the advent of health care
reform at the federal level, it is all the more important that ways of reducing
existing disparities and promoting health equity at the state and local levels
be examined. Institutional policies, such as those created by health plans,
should also be studied in conjunction with state and local concerns. In this
summary, information about policies to reduce disparities within Kaiser
Permamente and Allina Health System is also presented.
The workshop, entitled State and Local Policy Initiatives to Reduce
Health Disparities, was organized to look beyond federal initiatives to
the state and local levels to learn more about what works. The hope is
to advance the dialogue about health disparities by facilitating discussion
among stakeholders in the community, academia, health care professions,
business, policy-making entities, and philanthropic organizations. The goal
of the meeting was to discuss how to highlight the importance of “com-
munity” when ways to address health disparities are addressed. A focus
on several different geographic areas could help identify commonalities in
community strategies, best practices, and lessons learned from community
successes and failures in addressing health disparities.
WORKSHOP AGENDA
The workshop began with the presentation of a paper commissioned by
the Roundtable and authored by Larry Cohen, Rachel Davis, and Sharon
Rodriguez of the Prevention Institute and Anthony Iton of the Alameda
County Department of Public Health. Their paper, A Time for Opportunity:
Local Solutions to Reduce Inequities in Health and Safety, outlines several
dozen recommendations for reducing health disparities and promoting
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3
INTRODUCTION
health equity at the local level. The full version of the paper can be found
in Appendix A.
The participants spent the rest of the morning hearing more about
efforts being undertaken in Minneapolis, Minnesota, in particular and in
the state of Minnesota in general. Minneapolis Mayor R. T. Rybak spoke
about the changes taking place in Minneapolis at the community level,
including efforts to create more affordable housing and supporting a local
food movement. Gordon Sprenger, former chief executive officer of Allina
Health Systems, gave the history of the development of the Allina Back-
yard Project, an ambitious neighborhood-based program designed to create
jobs and incorporate other structural changes into a plan to reduce health
disparities. The final speaker of that morning, Sanne Magnan, who is the
Commissioner of Health in Minnesota, presented data on health disparities
at the state level and described plans being undertaken statewide to improve
health equity.
The afternoon sessions presented additional discussions of efforts at
the state level as well as those at the national level in England. Annette
Williamson of the Department of Health in England described the National
Support Teams program, designed specifically to reduce infant mortality
rates across that country. Although England has national health goals, the
support teams at the local level can determine how best to meet those goals
in their communities. Joel Weissman of the Executive Office of Health and
Human Services in the Commonwealth of Massachusetts spoke about how
state-level reforms have affected health disparities.
The day concluded with reactions to the earlier presentations by a
three-member panel: Winston Wong of Kaiser Permanente, Brian Smedley
from the Joint Center for Political and Economic Studies, and Atum Azzahir
of the Phillips-Powderhorn Cultural Wellness Center. These individuals
shared their perceptions of the information presented throughout the day.
Following this panel, Nicole Lurie, chair of the Roundtable, offered con-
cluding remarks.
The following is a summary of the presentations and discussions at
the workshop and as such is limited to the views presented and discussed
during the workshop. The broader scope of issues pertaining to this subject
area is recognized but could not be addressed in this summary. Appendix
B provides the workshop agenda, and Appendix C presents biographical
sketches of all workshop presenters.
KEY THEMES
Throughout the workshop, speakers, and workshop participants high-
lighted several recurring themes:
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4 POLICY INITIATIVES TO REDUCE HEALTH DISPARITIES
• Residential segregation. Gentrification, urban renewal, and the his-
torical practice of redlining (refusing to lend money to borrowers
based upon race or refusing to lend money to purchase housing in
an area with a high concentration of minorities) all affect where
low-income people of color can live. This, in turn, affects their
health.
• Race and racism. Race interacts with the process of residential
segregation and thus cannot be ignored when health outcomes are
evaluated.
• Lack of access to health care. Lack of access, especially for specialty
care, is a major problem for people of color living in low-income
communities.
• Lack of community infrastructure. A lack of safe places to walk
and exercise and a lack of access to large grocery stores in a com-
munity affect the health of the residents in that community. These
are important because skyrocketing obesity rates in some racial and
ethnic minority groups are contributing to rising rates of chronic
diseases, such as diabetes, which can be ameliorated by exercise
and a healthy diet.
• Other community factors. Poverty and violence are major contribu-
tors to racial and ethnic health disparities.
• Shorter life spans for future generations. Several speakers noted
that if current trends continue, children born today will not live as
long as their parents do. Studies of foreign-born immigrant chil-
dren and U.S.-born children of immigrant parents indicate that the
U.S.-born children will have shorter life spans than their parents.
ORGANIZATION OF THE REPORT
The report that follows summarizes the presentations and discussions
that occurred during the workshop.
Chapter 2 reviews the presentation and discussion of the commis-
sioned paper, A Time for Opportunity: Local Solutions to Reduce Inequi-
ties in Health and Safety. Chapter 3 describes the efforts made to reduce
health disparities at the local level in Minneapolis and at the state level in
Minnesota.
Chapter 4 includes a set of introductory comments from Roundtable
member Tom Granatir, followed by Annette Williamson’s presentation
about efforts in England. Joel Weissman’s observations about the effects of
health care reform at the state level follow. Finally, Chapter 5 describes the
comments and observations of the reactor panel and the concluding com-
ments of the Roundtable chair, Nicole Lurie.
