Strategic Plan to Eliminate Health Disparities in NJ, 2007

Introduction

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In the United States, there have always been wide gaps between the health of whites and the health of racial and ethnic minorities. Data indicate that blacks have experienced disproportionately higher rates of morbidity and mortality in nearly all of the medical areas addressed in this Plan.  New Jersey is like the nation in that minorities in this State are at greater risk than whites for premature death and preventable disease. Disparities in health, health care and access across racial, ethnic, and socioeconomic backgrounds in the United States are well documented.

Background
In 1985, addressing gaps in health care and health status became a priority on a national level and as a result, the U.S. Department of Health and Human Services (HHS) established the Office of Minority Healthⁱ. State offices of minority health were subsequently established as were numerous initiatives to address health disparities. In New Jersey, the Governor signed into law P.L. 1991, Chapter 401 which established the Office of Minority Health in 1992. New Jersey was one of the first states to create such an office.  In 1979, the first set of national health objectives was published by HHS.  In September 1990, the HHS released, Healthy People 2000—a national strategy for improving the health of Americans. This initiative sets goals to improve health nationwide by the end of the decade.  With Healthy People 2010, the HHS set a goal to eliminate health disparities nationally by 2010.  Healthy New Jersey 2010 (HNJ 2010 - www.state.nj.us/health/chs/hnj2010u05/index.shtml) is this State’s equivalent of that federal program, setting goals for New Jersey to improve health in specific areas and measuring progress toward accomplishing those goals. HNJ 2010 is an integral document to the Department’s efforts to address health disparities. This document focuses on many health indicators and establishes goals for reducing and ultimately ending health disparities in New Jersey.  It is available on the Department’s website at www.nj.gov/health/chs/hnj.htm.

Most recently, the Department and the Office of Minority and Multicultural Health collaborated with the Policy Research Institute for the Region at the Woodrow Wilson School of Public and International Affairs at Princeton University to conduct a roundtable of public health researchers, practitioners and scholars to discuss promising practices in addressing health disparities. A summary of that roundtable can be obtained directly from the Institute. Key public health stakeholders in the New Jersey/New York/Pennsylvania region agreed on one key idea in addressing health disparities:  “Even with the right data, the right definitions, and the right indicators, initiating a successful program to address a particular disparity in health care requires three other elements: the will to make change, meaningful partnerships, and the implementation of targeted and effective programs, with an eye toward installing systems that will outlast changes in priority and staff at both health departments and provider institutions.”ⁱⁱ

The Plan reflects the research literature, as well as the internal discussions and extensive work of the Department to address health disparities. There are several strategies that can be implemented to contribute to eliminating racial and ethnic health disparities in New Jersey.

Throughout its history, the OMMH has held summits, sponsored studies and supported community-based efforts that focus attention on eliminating health disparities. From this work, there have been “lessons learned” that have helped OMMH identify and highlight several crosscutting issues. They are:

• the need to improve and standardize data collection methods for gathering race/ethnicity and primary language spoken information;
• the need to develop and support cultural competency training programs for health care providers;
• the need to develop strategies that increase access to care;
• the need to increase the numbers of minorities entering the health professions; and
• the need to establish measurable outcomes for health disparities initiatives.

The OMMH established recommendations for addressing health disparities in New Jersey based on these crosscutting issues. These recommendations have been supported by the Department and OMMH’s Advisory Commission.

Need for a Plan
While there have been numerous initiatives at national and state levels to address health disparities, racial and ethnic health disparities remain persistent. In 2002, The Institute of Medicine (IOM) documented deep and pervasive disparities in health and health care for minorities in its report, Unequal Treatment. This is a critical reason why key stakeholders, public health experts and advocates, affected communities and community leaders and legislators have called for a comprehensive effort to coordinate health disparities initiatives—to provide guidance, set standards and be a foundation for a cohesive, targeted effort to eliminate health disparities. Hence, the development of the Plan to strengthen internal efforts that ultimately contribute to reducing health disparities. The Plan provides a framework for putting the discussions, recommendations and policies around health disparities into one coordinated Plan. The Department is committed to addressing health disparities through the many programs that have been established provided that state and federal resources continue to sustain them.

Plan Design
The Plan is organized on several focused health areas identified in N.J.S.A. 26:2-167.1 (asthma, breast, cervical, colorectal and prostate cancer, cardiovascular disease, obesity, diabetes, HIV/AIDS, infant mortality and unintentional injuries).  It provides a snapshot of the Department’s strengths to date in the specific areas of focus. Finally, the Plan outlines the Department’s goals in those areas, the steps needed to accomplish the goals, and the benchmarks for measuring progress.  Section I of the Plan consists of the following segments:

Medical Area of Emphasis – In this section, the Plan gives a synopsis of available health statistics on the health of New Jersey residents for each of the focus medical areas. These areas of emphasis were identified in the Eliminating Health Disparities legislation.

Building on Success – In this section, the Plan highlights existing or planned Department programs that have been effective or show promise in reducing health disparities within each specific health area.

Goal – In this section, the Plan states its main goal(s) as it relates to eliminating health disparities.

Action Plan – In this section, the Plan lists the strategic steps identified for reaching the set goals.

Outcome Measures – Here, the Plan lists specific outcomes which are also the foundation for evaluating the effectiveness of the program.

In conclusion, the Summary of Actions lists point-by-point the intended actions of the Department. The Department will use the Plan to guide and implement initiatives in a comprehensive effort to eliminate racial/ethnic health disparities in New Jersey. This is one component of a broader effort to address health disparities throughout the state.