Community Approaches to Addressing Health Disparities
AUTHORS: Carol Horowitz, M.D., M.P.H., and Edward F. Lawlor, Ph.D. Paper presented at the Roundtable workshop on Differences in U.S. Life Expectancy, St. Louis, Missouri (July 30, 2007)
INTRODUCTION: A major national enterprise has grown up since the IOM Report devoted to documenting health disparities; understanding their clinical, service, and social determinants; and mounting specific projects that address particular combinations of health status and racial and ethnic populations.This work has given extraordinary visibility to the existence of significant and stubborn disparities and mobilized an impressive number of university centers, provider groups, and community partners. Significant federal and private foundation funding has mapped onto this agenda. A great deal of innovation and adaptation has been spawned in this field, most notably the establishment and federal support for a broad body of community based participatory research. Important state policy initiatives, such as the recently enacted Massachusetts Health Reform, have specific governance and accountability for disparities reductions. Despite the number and variety of health disparities initiatives, there is growing restlessness that this enterprise is not yielding effective and scalable approaches, and, most importantly, evidence of significant outcomes (Lurie, 2006). For example, the CDC’s recent interim report on Healthy People 2010 worried that among the 195 disparities objectives there has only been measurable improvements in 24 categories, declines in 14, and no change in 157 (CDC, 2007).