Welcome New DRA Project Partners!  
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The DRA Project continues to accelerate appropriate advances and consolidate the learning from its current 60 partner and sponsor network. The committed partners form a diverse group of organizations that are involved in providing the critical participation and support to help reduce health disparities. We welcome our new Partners:  

Feature Articles
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Cancer Navigator Story On September 13, 2007 the Wall Street Journal covered the tragic story of Shirley Lowe, a cancer patient, ultimately a victim, and her turmoil in getting and not getting treatment in Texas and Colorado. Her diagnosis of a rare form of breast cancer was made in the wrong clinic, so she was not initially covered.   Part of her aid came from a patient navigator, Linda Burhansstipanov, in dealing with the arcane and inconsistent legislation and regulations and the seemingly uncaring health care providers. The case is a good, but sad example of why both navigators and more effective and consistent access to health care are needed. click to visit    

The Emerging Field of Genomics Genomics is a rapidly growing field with important implications for health and healthcare disparities.  Genomics will ultimately be used to assess the impact of genes and their interaction with behavior, diet and the environment on the population's health. The University of Washington is a leading center for health and genomic research and has created a center, deemed by the NIH to be a Center for of Excellence in Ethical, Legal and Social Implications Research that has a focus on genomics and disparities.  A major challenge in genomic health care is to insure that medically underserved communities can fully benefit from genomic technology without experiencing additional disparities due to genetic discrimination.  The University of Washington Center for Genomics and Health Care Equality is funded by the National Human Genome Research Institute and the National Institute for Child Health and Human Development and led by Wylie Burke MD PhD. click to visit  

Realities of the US Health System 2006 National Healthcare Disparities Report Developed by: Agency for Healthcare Research and Quality (AHRQ)   The Agency for Healthcare Research and Quality (AHRQ) has released its fourth annual National Healthcare Quality Report (NHQR) providing the broadest analysis and measurements of the improvement and deterioration of the quality of health care in America. The most scientifically credible measurements and data sources are used when analyzing the four dimensions of quality care- effectiveness, patient safety, timeliness and patient centeredness. Four emerging themes from the 2006 NHQR:

  • The measures of quality improved, but the pace of change is modest.
  • The quality of improvement varies by states.
  • Some aspects of healthcare quality improve while others deteriorate.
  • Disparities in healthcare remains high.
Relative to the three previous consecutive reporting years, a greater percentage of measures have shifted from the "no significant change" category into the "improvement" category.  Hospitals demonstrate the highest rates of improvement with a 7.8% increase.  This acceleration and many others are attributed to new focuses on quality improvement programs and policies that support improvement initiatives. Other measures of improvements are: patient centeredness which involves better communication between providers and patients; a decrease in respiratory disease shown by more tuberculosis patients completing their 12 month curative course of treatment; more diabetic adults are receiving three important screening tests for the management of diabetes which is leading to a decrease in admission for lower extremity amputation; a higher percentage of smokers are being advised to stop smoking during routine check-ups, which is decreasing heart disease.  Despite many increases, there are two measures that continued to show deterioration in healthcare: timeliness in the emergency rooms and an increase in suicide death rates.  Health Disparities vary by state on selective measures.  The chart below compares five state rankings bases on healthcare qualities, with 1 being the state ranking the highest quality and 50 the lowest.  

Measure Florida Rank Hawaii Rank Mississippi Rank California Rank D.C. Rank

Florida Rank

Hawaii Rank

Mississippi Rank

California Rank

D.C. Rank

Breast cancer deaths per 100,000

5

1

42

13

50

Children fully vaccinated

2

31

14

30

20

Suicide deaths per 100,000

34

13

28

11

2

Getting appointments for care-Medicare

46

39

37

42

45

Patient experience of care-Medicare

49

1

10

45

39


In effort to reduce disparities, the Agency for Healthcare Research and Quality has been working in collaboration with dozens of state as well as public and private stakeholders to improve the quality of care for people with diabetes and asthma.

These partnerships seek to move beyond collecting and reporting quality measures.  They are moving towards actively addressing problems with quality and disparities, which include:

  • National Health Plan Learning Collaborative to Reduce Disparities and Improve Quality.
  • Goal setting and State plans for quality improvement.
  • Improving diabetes care in communities.
  • Improving implementation of diabetes improvement programs through ongoing evaluation.
  • Decreasing disparities in pediatric asthma.

Overall, the quality of healthcare continues to improve in America; however the pace of change is slow.  A significant improvement in healthcare can progress with the continuation of public reporting on both quality and disparities as well as active and persistent interventions. cliick to visit 
 
Achieving Health Equity: from root causes to fair outcomes
 Written by WHO Commission on Social Determinants of Health
  
It is evident that health inequalities exist within our nation's borders and worldwide.  The Commission on Social determinants of Health (CSDH) identifies the causes of health inequity as man-made problems and seeks man-made solutions.  The CSDH envisions a world where people have the freedom to lead lives in which they value.  They view the key determinants of health as a social justice issue.  
  
In an effort to launch a global movement to reduce health inequity and improve global health, the Commission is building partners with governments, civil society, international organizations and all stakeholders in the public sectors in an effort to take action leading to empowerment for people, communities and countries.  Leading the Commission is a group of highly experienced global and national level policy-makers, scientist, practitioners and civil society leaders from all over the world.
The Commission focuses on improving health and reducing disparities by recognizing that economic and social conditions under which people live determine people's heath. Once these social determinants are identified, action can be taken to reduce the hierarchy between low-income and high-income populations.  
Here are some examples of major inequalities stemming from social determinants:

  • Over the last century, life expectancy for a European child increased by about 30 years, while the life expectancy for a sub-Saharan African child increased by four months.
  • In poor countries, the ratio of maternal mortality exceeds 500 per 100,000 live births, as opposed to in Sweden where the ratio is 2 per 100,000 live births.
  • In the Scottish city of Glasgow, life expectancy of men in one of the most deprived areas was 54 years, compared with the 82 years in the more affluent area.
  • An occupational hierarchy exists even within professionals; Swedish adults with a Ph.D. have a lower mortality rate that adults with a master's degree.
  • Women in Kerala, India are better educated and nourished than the countries average, putting Kerala in the lead with the lowest infant mortality rate at one third of the countries infant mortality rate.
  • Only 38% of the population in low-income countries have access to improved sanitation facilities, whereas the figure is 100% in high-income countries (World Bank, 2006).
  • Unemployment rates in France are about twice as high among its immigration population (ILO, 1998).
  • In regards to gender discrimination, 150 million girls under the age of 18 years experienced forced sexual intercourse or other forms of physical and sexual violence in 2002 (Pinheiro, 2006)

In the era of globalization, people are interconnected more now than ever before and the nature of both communicable and noncommunicable diseases are linked between rich and poor countries. The Commission recognizes this interconnectedness and continues to maintain, promote and provide better health for everyone, by advocating for change with those responsible for health-related decisions. 
click to visit

Gender Inequity
The WHO Commission for Social Determinants released their final report on Unequal, Unfair, Ineffective and Inefficient, Gender Inequity In Health: Why it exists and how we can change it.   It strongly argues that gender inequalities damage the physical health of millions of girls and women in the world. Their strategy to reduce health inequities is to take action by addressing women's rights in efforts to motivate and mobilize governments, people and especially women.  Seven approaches are addressed for making a difference. They are outlined in WHO's report: click to visit

DRA Project Partners at Work:  Reports and News
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2008 National School-Based Health Care Convention  
The National Assembly on School- based Health Care (NASBHC) is holding a convention in Los Angeles, California on June 25-28, 2008 called, Taking Action Against Health Disparities. The convention will be organized into seven workshop tracks, each to include a series of concurrent sessions, they include:  Mental Health Skills, Primary Care, Oral Health and Nutrition, Evaluation and Quality, Operations and Administration, Policy and Advocacy, Youth and Community Engagement, Leadership in Child and Adolescent Health.  NASBHC promotes and supports school-based health centers to assure that all children receive high quality, comprehensive health care. click to visit   

Lance Armstrong Foundation
Written by Melissa Sileo, Education Resource Director, Lance Armstrong Foundation

The Centers for Disease Control and Prevention (CDC) and the Lance Armstrong Foundation (LAF) recently created two new addenda to the National Action Plan for Cancer Survivorship: Advancing Public Health Strategies focusing on the needs of the African American and Native American populations.  Members of the African American and Native American communities prioritized the needs and topics included in the original national action plan and provided comments on each topic area. The resulting addendum provide a framework for actively addressing the critical needs of cancer survivors in these diverse communities. Access to care and patient navigation were ranked as the top priorities for both populations, and culturally competent provider education was identified as another critical need for both communities.  The identified priorities will help state agencies and other organizations to increase awareness of the needs of African Americans and Native Americans cancer survivors and to take direct and focused action to meet those needs.  In 2002, the CDC and the LAF led a public health effort to address the issues faced by the growing number of cancer survivors. Their collaboration, A National Action Plan for Cancer Survivorship: Advancing Public Health Strategies, charts a course for the public health community to more effectively and comprehensively address cancer survivorship with the goal of improving the quality of life for survivors.  To download the National Action Plan for Cancer Survivorship and the new addenda, visit www.livestrong.org/nationalactionplan click to visit, National Action Plan for Cancer Survivorship: African American Priorities click to visit, National Action Plan for Cancer Survivorship: Native American Priorities, click to visit

Quick Links...
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The DRA Project Website click to visit ://www.dra.gov
More About the Institute for Alternative Futures click to visit ://www.altfutures.com