# Presentation: 466935

## Office of Minority Health and Health Disparities (OMHD)

**An Overview**

**Centers for Disease Control & Prevention (CDC)**

**Notes:**
Office of Minority Health and Health Disparities (OMHD)
An Overview
Updated May 2008

## What is a “Health Disparity”?Conceptual Issues

- Inequality
- Difference in condition, rank
- Lack of equality as of opportunity, treatment, or status
- Inequity
- Unfair and unjust
- Unnecessary and avoidable

**Notes:**
What is a “Health Disparity”?
Conceptual Issues
-- Inequality
-- Difference in condition, rank
-- Lack of equality as of opportunity, treatment, or status
-- Inequity 
Unfair and unjust
Unnecessary and avoidable

First, let me define, “Health Disparity” and discuss some conceptual issues. 
Most dictionaries define “disparity” as: inequality; difference in age, rank, condition. .. Disparity and difference are synonyms in most dictionaries. Inequality is defined as: lack of equality as of opportunity, treatment or status. Inequity, though, signifies an ethical judgment, an instance of unfairness or unjustness.  Another level is added if one includes a judgment of what is unnecessary and avoidable. There are disagreements regarding the definition and use of the terms “disparity”, “inequality”, and “inequity”.  These disagreements center on which term to use, whether a judgment of what is avoidable and unfair is included, and how these judgments are made.  These conflicting views have implications for resource allocation and reflect different political ideologies.  Decisions regarding what is avoidable and unjust are not simple, but are based upon what we currently know, are political decisions based on resources and ideology, who is deciding what is avoidable and unjust, and how it is decided.  For example, if you start with the premise that health is solely an individual’s responsibility, then you will not consider other factors that are amenable to intervention. In the context of public health and social science, “Disparity” has begun to take on the implication of injustice, but still may be distinguished from the general term “inequality.” Conceptually, a “health disparity” could be viewed as a chain of events signified by a difference in: 1) health status; 2) a particular health outcome that deserves scrutiny; 3) access to, utilization of, and quality of care; or 4) environment. Such a difference should be evaluated in terms of both inequality and inequity, since what is unequal is not necessarily inequitable.

Source: “Slides for Judith.ppt”

## “Health Disparity” in Public Health – Operational Definition

- Quantitative measures: rates, percents, means...
- The Quantity that separates a group from a reference point on a particular measure of health
- Calls attention to differences in health between groups _regardless of cause_
- Can be measured in absolute or relative terms

**Notes:**
“Health Disparity” in Public Health – Operational Definition
Quantitative measures: rates, percents, means...
The Quantity that separates a group from a reference point on a particular measure of health
Calls attention to differences in health between groups regardless of cause
Can be measured in absolute or relative terms
-Source: Dr. Williams’ Slide Set

Disparity and difference are synonyms in most dictionaries.

The population-based objectives in HP2010 are measured in terms of rates, percents, means, proportions, or some other quantitative measure.

In the context of public health, a disparity is the quantity that separates a group from a reference point on a particular measure of health that is expressed in terms of a rate, proportion, mean, or some other quantitative measure.

The purpose of the second goal of HP2010 is to call attention to differences in health between groups regardless of the cause....

To eliminate disparities, ultimately specific causes or determinants need to be identified.

Changes in disparity over time can be measured in absolute or relative terms. ADD notes:  see pages 7-8, Keppel et al.

Source: “Slides for Judith.ppt”

## Health DisparitiesCommunities of Colorare Disproportionately Affected

**Health Disparities*****Communities of Color******are Disproportionately Affected***

**Notes:**
Health DisparitiesCommunities of Color are Disproportionately Affected

We need to sharpen and intensify our national focus on health disparities so we can close up -- if not eliminate -- the health status gaps in this country. The need to take action could not be more urgent.
Since 1950, considerable gains in health status have been documented in the United States among racial and ethnic minority groups. 
However, racial disparities in health have changed little since then. In fact in many health areas, the statistics show that the gap has actually widened for some health indicators. 

Source: “Slides for Judith.ppt”

## Racial and Ethnic Minority Populations

- American Indian/Alaska Native (AI/AN)
- Asian American
- Black or African American
- Hispanic or Latino
- Native Hawaiian or Other Pacific Islander (NHOPI)

## Other Populations By . . . 

- Socio-economic status
- Geography (urban or rural)
- Gender
- Age
- Disability status
- Risk status related to sex and gender

**Notes:**
Health disparities have been described among other Populations By . . . (insert definitions when they become available)
-- Socio-economic status 
-- Geography (urban or rural)
-- Gender
-- Age
-- Disability status
-- High-risk status related to sex and gender

Source: Functional Plan for CDC’s Office of Minority Health and Health Disparities (OMHD)

## CDC Vision

- 	CDC’s Vision for the 21st Century is “Healthy People in a Health World – Through Prevention.

**CDC Mission**

- 	To Promote Health and Quality of Life by Preventing and Controlling Disease, Injury, and Disability.

## OMHD Mission

- 	The Office of Minority Health and Health Disparities (OMHD) aims to accelerate CDC’s health impact in the U.S population and to eliminate health disparities for vulnerable populations as defined by race/ethnicity, socio-economic status, geography, gender, age, disability status, and risk status related to sex and gender, among other populations identified to be at-risk for health disparities.

**Notes:**
OMHD Mission
OMHD aims to accelerate CDC’s health impact in the U.S. population and to eliminate health disparities for vulnerable populations as defined by race/ethnicity, socio-economic status, geography, gender, age, disability status, and risk status related to sex and gender.

Source: Functional Plan for CDC’s Office of Minority Health and Health Disparities (OMHD) (with revisions by Dr. Williams)

## OMHD Guiding Principle

- 	The future health of the nation will be determined to a large extent by how effectively we work with communities to eliminate health disparities among those populations experiencing gaps in disease, disability, and death.

## What are OMHD Critical Goals?

- Equity in health impact
- Diversity in customer focus
- Access to and participation in public health systems
- Participation in the conduct and use of public health research to solve community wide health problems
- The benefits of global health protection, especially among immigrants and border populations
- A verifiable commitment to operational efficiency, program effectiveness, and accountability for public resources.

**Notes:**
What are OMHD Critical Goals?
OMHD’s goals derive from the strategic imperatives and address CDC’s need to achieve health impact for at-risk populations:

(1) equity in health impact, 
(2) diversity in customer focus, 
(3) access to and participation in public health systems, 
(4) participation in the conduct and use of public health research to solve community-wide health problems, 
(5) the benefits of global health protection, especially among  immigrants, indigenous and border populations, and 
(6) a verifiable commitment to operational efficiency, program effectiveness, and accountability for public resources. 

Source: Increasing CDC’s Impact on Health Disparities, slide 14
Stakeholder Meeting on Health Equity2.ppt

## What are the OMHD Core Functions?

- 1.  Maintaining core functions of the _**Office of Minority Health (OMH)**_ without loss of priority, resources, or visibility
- 2.  Developing CDC-wide **health** **disparities elimination** **strategies**, policies, goals, and programs

**Notes:**
What are the OMHD Core Functions?
1. Maintaining core functions of the Office of Minority Health (OMH) without loss of priority, resources, or visibility-- Promoting minority heath and eliminating racial and ethnic health disparities
-- Promoting health and preventing disease in Indian Country (i.e., American Indian and Alaska Native communities, their sovereign governments and other institutions in the U.S.)  

2. Developing CDC-wide health disparities elimination strategies, policies, goals, and programs
-- Defining disparities elimination sub-goals for each health impact goal
-- Monitoring and reporting progress toward health disparities elimination goals  
-- Evaluating impact of policies and programs to achieve health disparities elimination

Source: Functional Plan for CDC’s Office of Minority Health and Health Disparities (OMHD)

## What are the OMHD Core Functions?

- 3. Managing **health disparities elimination** **goals** through scanning, analysis, knowledge management, decision-support systems, and reporting  Key Performance Indicators *,  Government Performance and Results Act**,  Program Assessment Rating Tool***
-       *(GPRA) **( PART) ***(KPI)

**Notes:**
What are the OMHD Core Functions?
3. Managing health disparities elimination goals through scanning, analysis, knowledge management, decision-support systems, and reporting  Key Performance Indicators *,  Government Performance and Results Act**,  Program Assessment Rating Tool***
-- Mobilizing resources and advocating for health disparities elimination  programs 
-- Aligning use of resources with accomplishment of health disparities elimination goals
*(GPRA) **( PART) ***(KPI)

Source: Functional Plan for CDC’s Office of Minority Health and Health Disparities (OMHD)

## What are the OMHD Core Functions?

- 4. Supporting internal and external **partnerships** to advance the science, practice, and workforce for eliminating health disparities inside and outside CDC
- 5. Synthesizing, disseminating, and encouraging use of **scientific evidence** about effective interventions to achieve health disparities elimination outcomes

**Notes:**
What are the OMHD Core Functions?
4. Supporting internal and external partnerships to advance the science, practice, and workforce for eliminating health disparities inside and outside CDC 
-- Maintaining critical linkages with federal partners including OS/HHS and representing CDC on related scientific and policy committees
-- Establishing external advisory capacity and internal advisory and action capacity   
-- Coordinating CDC-wide minority health and health disparities elimination initiatives

5. Synthesizing, disseminating, and encouraging use of scientific evidence about effective interventions to achieve health disparities elimination outcomes
-- Stimulating innovation in science and practice (idea incubators, change management, Team B)
-- Providing decision support to the Executive Leadership Board (ELB) in allocating CDC resources to agency-wide programs of surveillance, research, intervention, and evaluation

Source: Functional Plan for CDC’s Office of Minority Health and Health Disparities (OMHD)

## CDC’s Office of Minority Health (OMH), 1988 

- Established by CDC Director-- 1988
- A response to Secretary Heckler’s report on excess deaths in certain groups and internal advocacy
- Coordination vs. program management
- Small staff, small budget, no large programs

**Notes:**
CDC’s Office of Minority Health (OMH), 1988
Established by CDC Director-- 1988
A response to Secretary Heckler’s report on excess deaths in certain groups and internal advocacy
Coordination vs. program management 
Small staff, small budget, no large programs

In January 1984, the Secretary of DHHS established the Task Force on Black and Minority Health in response to the national paradox of steady improvement in overall health, with substantial inequities in the health of U.S. minorities.

DHHS released its Report of the Secretary’s Task Force on Black and Minority Health on October 16, 1985.  The report documented the disparity in key health indicators among certain groups of the U.S. population: blacks, Hispanics, Asian/Pacific Islanders, and Native Americans, compared to that of whites.

The DHHS “Office of Minority Health” was established following release of the report, to manage implementation of the report’s recommendations.  CDC’s OMH was established in 1988, in response to the Heckler report and internal advocacy for a minority health office at CDC.

In general, the focus of this office was coordination rather than program management.  The office had a small staff (~ 9), small budget (~ $ 1-2 million), and had no large program activities.

Note:  2-4 cooperative agreements established.  $1-2 million budget.

## CDC’s OMH, 1988-1998  Major Goals

- Assuring that policies direct activities toward minority health
- Enhancing research to reduce the disproportionate disease burden in minority groups
- Developing effective internal and external communication networks

**Notes:**
CDC’s OMH, 1988-1998  Major Goals
Assuring that policies direct activities toward minority health
Enhancing research to reduce the disproportionate disease burden in minority groups
Developing effective internal and external communication networks

Major goals of the CDC’s OMH during 1988-1998 are shown here.

## Strategic Redirection of OMH, 1998 

- Executive retreat, agency-wide deliberations on draft paper on new   vision/policy/strategy/action (1998)
- Senior Staff reviews, briefings & deliberations (1999-2001)
- Policy/Action items approved (Oct 2001)

**Notes:**
Strategic Redirection of OMH, 1998
Executive retreat, agency-wide deliberations on draft paper on new   vision/policy/strategy/action (1998) 
Senior Staff reviews, briefings & deliberations (1999-2001)
Policy/Action items approved (Oct 2001)

New OMH Leadership appointed in 1998.  In addition, the President had committed the Nation to eliminating health disparities, and Secretary Shalala and Surgeon General/ASH David Satcher were drawing national attention to the Healthy People 2010 health disparity elimination goal and leading the effort to develop an HHS response. 

A strategic planning process was initiated starting with an Executive retreat and agency-wide deliberations on draft paper describing a new, unified minority health vision/policy/strategy/action agenda (1998). 

Senior staff reviews, briefings, and deliberations occurred during 1999 -2001 (CIO Directors; Minority Health Coordinators (1999-2000), Senior Staff briefings & deliberations (Jan – Aug 2001)).

Policy/Action items approved (Oct 2001).

## Action Items for Improving Minority Health: 2000 - 2005

**Cross- Cutting Actions**:  Activities each CIO should undertake
**Infrastructure**:  Mobilizing people, information systems, and resources
**Program Development and Implementation:  **Improving programs
**Monitoring and Accountability**: Tracking and assuring quality

**Notes:**
Action Items for Improving Minority Health: 2000 – 2005
Cross- Cutting Actions:  Activities each CIO should undertake
Infrastructure:  Mobilizing people, information systems, and resources
Program Development and Implementation:  Improving programs
Monitoring and Accountability: Tracking and assuring quality

## OMH Functions/Priorities 2001-2004

- Strategic planning (minority health priorities)
- Policy initiatives (analysis, development)
- Leadership/coordination of minority health initiatives and Executive Branch activities
- Support for minority-serving institutions of higher learning
- Cooperative agreements to conduct research, prevention activities, student/faculty development
- Student traineeships
- Epidemiologic studies
- External partnerships (technical assistance/symposia)
- Direct support to CDC/ATSDR programs (SME)

**Notes:**
OMH Functions/Priorities 2001-2004
Strategic planning (minority health priorities)
Policy initiatives (analysis, development)
Leadership/coordination of minority health initiatives and Executive Branch activities
Support for minority-serving institutions of higher learning
Cooperative agreements to conduct research, prevention activities, student/faculty development
Student traineeships
Epidemiologic studies
External partnerships (technical assistance/symposia)
Direct support to CDC/ATSDR programs (SME)

Note:  Futures activities began, June 2003.

Establishing a Strategic Vision/Effective Execution
Major functions and operations
Supporting evidence - based policy and action
Providing leadership for Special Initiatives and Policy
Enhancing effective internal and external partnerships
Enhancing internship/fellowship opportunities
Undertaking research targeting key populations
Support to CDC programs
Seeking resources to support activities

**Notes:**

Despite these significant successes, we want to make health disparities a much bigger focus for our entire agency 
The Futures Initiative provides an opportunity for CDC’s OMH, its partners, and the rest of CDC to do more, faster, to eliminate health disparities in the United States.
I know there has been concern about how Futures will impact the Office of Minority Health. CDC’s executive leadership teams is examining ideas to strengthen – not weaken – its current efforts and activities. We want to place the Office of Minority Health where it can have optimal impact and this summer we held a conference call with over 30 external partners to get their input. 
One visible manifestation of this expanded effort: At each senior staff meeting, we go center by center, highlighting one particular program a month that is addressing health disparities in a direct way and identifying what lessons can we can learn from that and how we can utilize those lessons to improve our programs across the board.
This spring CDC held a media conference on Racial/Ethnic Health Disparities Focusing on Heart Disease and HIV/AIDS 
First Conference on Increasing the Number of American Indian, Alaska Native, & Native Hawaiian Professionals in public health careers. (July 20 in Atlanta)

Source: Improving Health, Eliminating Disparities, Oct. 27, 2004 – GerberdingMorehousePrimaryCareConference2b

## Enhancing Impact on Health Disparities: New Proposals

**Office of Minority Health & Health Disparities **
**Goal management &  resource allocation to address disparities **
** ****Accountability **
**performance measurement**
**external input**

- OMH Stakeholders Meeting

**Notes:**
Enhancing Impact on Health Disparities: New Proposals
Office of Minority Health & Health Disparities 
Goal management &  resource allocation to address disparities 
Accountability 
performance measurement
external input

Despite some significant successes, we want to make health disparities a much bigger focus for our entire agency 

The “New CDC” Futures Initiative provides an opportunity for CDC’s OMHD, its partners, and the rest of CDC to do more, faster, to eliminate health disparities in the United States.

CDC’s executive leadership teams examined ideas to strengthen OMH’s current efforts and activities. The intent was to place the Office of Minority Health where it can have optimal impact.  CDC’s Executive leadership voted to create a new Office of Minority Health and Health Disparities that will continue its long standing focus on minority health while expanding the office to include a focus on disparities in other high risk populations defined by age, gender, geography, race and ethnicity, disability status, SES, and high prevalence of behavioral risks.

   It was felt the office would be best positioned to accelerate health impact for vulnerable populations in the U.S. as a staff office within the Office of Strategy and Innovation (OSI) with a unique administrative code and budget allocation account.  Through the goals management process, OMHD is anticipated to have greater influence on resource allocation to address disparities and accountability. 

## Office of Minority Health and Health Disparities (OMHD)Organizational Units

**Notes:**
Updated July 24, 2008

## NCIPC

**NCIPC**

**NCZSVBD**

**Coordinating Office for GLOBAL HEALTH**

**Coordinating Office for**
**TERRORISM PREPAREDNESS & EMERGENCY RESPONSE**

**Coordinating Center for ENVIRONMENTAL****HEALTH & ****INJURY ****PREVENTION**

**Coordinating Center for INFECTIOUS**** ****DISEASES**

**Coordinating Center for HEALTH ****PROMOTION**

**Coordinating Center for HEALTH INFORMATION ****& SERVICES**

**CDC Washington Office**

**Office of the Chief of Public Health Practice**

**Office of the Chief Operating Officer**

**Office of Chief of Staff**

**Office of Enterprise Communication**

**Office of Strategy & Innovation**

**Office of Workforce & Career Development**

**Office of the Chief Science Officer**

**Office of the Director**

**NCPHI**

**NCHM**

**NCHS**

**NCHHSTP**

**NCIPRD**

**NCEIC**

**NIOSH**

**OPHG**

**NCEH**

**NCBDDD**

**NCHPDP**

**CDC Organizational Structure**

**Office of Minority Health & Health Disparities (ADMH)**

**Notes:**
Updated July 24, 2008
NCEH: National Center for Environmental Health
NCIPC: National Center for Injury Prevention & Control
NCHS: National Center for Health Statistics
NCHM: National Center for Health Marketing
NCPHI: National Center for Public Health Informatics
NCHPDP: National Center for Health Promotion & Disease Prevention
NCBDDD: National Center on Birth Defects and Developmental Disabilities
OG: Office of Public Health Genomics
NCEIC: National Center for Emerging Infections & Control
NCIPRD: National Center for Immunization Programs & Respiratory Diseases
NCHHSTP: National Center for HIV, Hepatitis, STDs, and Tuberculosis Prevention
NCZVBD: National Center for Zoonotic & Vectorborne Diseases
NIOSH: National Institute of Occupational Safety & Health

## Unequal Access

- Healthcare Cost Increases

- Race and ethnicity

- Culture

- Demographics

- Language

**Notes:**
Demographics, Culture, Healthcare Cost Increases, Unequal Access, Language, Race & Ethnicity, Health Care Quality

Compelling evidence indicate that race and ethnicity correlate with persistent, and often increasing health disparities among U.S. populations.  The disparities occur for a variety of reasons including unequal access to health care (including clinical and community preventive services), discrimination, language and cultural barriers (as indicated in several  IOM Reports including the report on Unequal Treatment).
Eliminating racial and ethnic disparities in health will require the use of several research and planning components:
New knowledge about the determinants of disease, causes of disparities and effective interventions for prevention and treatment;
Collection and use of standardized data to correctly identify all high risk populations and monitor the effectiveness of health interventions targeting these groups;
Enhanced efforts to prevent disease, promote health, and deliver appropriate care;
Creation/expansion of culturally appropriate, community-driven approaches to identifying causes of disparities;
Improvement in access to quality preventive and treatment services and innovative ways of working in partnership with health care systems, minority academic institutions, and local communities.

Source: “Slides for Judith.ppt”

## Population Data and Representative Mortalityand Case Rates

**Notes:**
Population Data and Representative Mortality and Case Rates

Added per Walter’s suggestion

## Leading Causes of DeathAfrican Americans, U.S., 2005

- Heart Disease
- Cancer
- Stroke
- Unintentional Injuries
- Diabetes

- Homicide
- Chronic Lower Respiratory Diseases
- Nephritis, Nephrotic Syndrome, & Nephrosis
- HIV Disease
- Septicemia

- Source: CDC, NCHS, Health, United States, 2007, Table 31.

**Notes:**
Health disparities have been described among other Populations By . . . (insert definitions when they become available)
-- Socio-economic status 
-- Geography (urban or rural)
-- Gender
-- Age
-- Disability status
-- High-risk status related to sex and gender

Source: Functional Plan for CDC’s Office of Minority Health and Health Disparities (OMHD)

## Leading Causes of DeathHispanic/Latinos, U.S., 2005

- Heart Disease
- Cancer
- Unintentional Injuries
- Stroke
- Diabetes

- Chronic Liver Disease & Cirrhosis
- Homicide
- Chronic Lower Respiratory Disease
- Influenza & Pneumonia
- Certain Conditions Originating in the Perinatal Period

- Source: CDC, NCHS, Health, United States, 2007, Table 31.

**Notes:**
Health disparities have been described among other Populations By . . . (insert definitions when they become available)
-- Socio-economic status 
-- Geography (urban or rural)
-- Gender
-- Age
-- Disability status
-- High-risk status related to sex and gender

Source: Functional Plan for CDC’s Office of Minority Health and Health Disparities (OMHD)

## Leading Causes of DeathAmerican Indian/Alaska Natives, U.S., 2005

- Heart Disease
- Cancer
- Unintentional Injuries
- Diabetes
- Stroke

- Chronic Liver Disease & Cirrhosis
- Chronic Lower Respiratory Diseases
- Suicide
- Influenza & Pneumonia
- Nephritis, Nephrotic Syndrome, & Nephrosis

- Source: CDC, NCHS, Health, United States, 2007, Table 31.

**Notes:**
Health disparities have been described among other Populations By . . . (insert definitions when they become available)
-- Socio-economic status 
-- Geography (urban or rural)
-- Gender
-- Age
-- Disability status
-- High-risk status related to sex and gender

Source: Functional Plan for CDC’s Office of Minority Health and Health Disparities (OMHD)

## Leading Causes of DeathAsian or Pacific Islanders, U.S., 2005

- Cancer
- Heart Disease
- Stroke
- Unintentional Injuries
- Diabetes

- Influenza & Pneumonia
- Chronic Lower Respiratory Diseases
- Nephritis, Nephrotic Syndrome, & Nephrosis
- Suicide
- Alzheimer’s Disease

- Source: CDC, NCHS, Health, United States, 2007, Table 31.

**Notes:**
Health disparities have been described among other Populations By . . . (insert definitions when they become available)
-- Socio-economic status 
-- Geography (urban or rural)
-- Gender
-- Age
-- Disability status
-- High-risk status related to sex and gender

Source: Functional Plan for CDC’s Office of Minority Health and Health Disparities (OMHD)

## Population by Race & Hispanic Origin: United States, 2000 & Projected 2050

**Source: **U.S. Census Bureau, May 2001

**Notes:**
Population by Race & Hispanic Origin United States, 2000 & Projected 2050 
In 2000, non-Hispanic whites made up more than two-thirds of the total population, according to the 2000 US. Census.  By the year 2050, the Census Bureau predicts the proportion of the population that is non-Hispanic white will diminish to just over half the total population.  The largest increase is expected in the Asian American/Pacific Islander (AAPI) population, which is expected to almost triple it’s current size by 2050.  The Hispanic/Latino population is expected to almost double by 2050.  African American and American Indian/Alaska Native (AI/AN) populations are also expected to increase. (JW)

The anticipated demographic changes magnify the importance of addressing disparities in health status. Groups currently experiencing poorer health status are expected to grow as a proportion of the total U.S. population; therefore, the future health of America as a whole will be influenced substantially by improving the health of these racial and ethnic minorities. A national focus on disparities in health status is particularly important as major changes unfold in the way in which health care is delivered and financed. (1)

A combination of three factors contribute to this shift in population distribution: differential fertility, differential net immigration, and differential age distributions among the race and Hispanic origin groups.  Higher fertility rates and net immigration levels would elevate the increased proportions of of the expanding groups.  At the same time, the non-Hispanic population would experience an increase in the number of deaths as more and more of this population enters old age groups where the risk of mortality is the highest.  (2)

Slide sources (3-5)

## Infant Mortality Rates per 1,000 Live Births by Detailed Race and Hispanic Origin of Mother: U.S., 2002

**Notes:**
Infant Mortality Rates per 1,000 Live Births by Detailed Race and Hispanic Origin of Mother: U.S., 2002
Overall, infant mortality is much higher for African Americans and American Indians/Alaska Natives (AI/ANs) when compared with other groups (13.8 and 8.6 per 1,000 live births, respectively).  However, this slide shows that infant mortality rates also vary widely within racial/ethnic groups.  For example, Asian Americans and Pacific Islanders (AAPIs) have the lowest overall infant mortality rate (4.8), but the rate for Native Hawaiians (9.6) is more than three times the rate for Chinese Americans (3.0), and higher than the rate for AI/ANs (8.6).  Similarly, the rate for Puerto Ricans (8.2) is more than twice as high as for Cubans (3.7), both subgroups of the Hispanic/Latino population. (JW)

Some of the disparities in infant mortality are caused by disparities in Sudden Infant Death Syndrome (SIDS).  The rate of SIDS in 2001 per 1,000 live births were as follow (also see next slide) (6):
All populations: 55.5		American Indian: 124.2
Non-Hispanic white: 50.4		Asian/Pacific Islander: 15.5
African American: 122.9		Hispanic/Latino: 29.3

Another significant cause of disparities in infant mortality is disorders related to short gestation and low birthweight.  Mortality data for 2001 for short gestation and low birthweight per 1,000 live births are as follow (6):
All populations: 109.5		American Indian: 71.6
Non-Hispanic white:  76.2	Asian/Pacific Islander: 46.9
African American: 302.7		Hispanic/Latino: 78.9

Slide source (7)

## Infant Mortality Rates per 1,000 Live Births by Detailed Race and Hispanic Origin of Mother: U.S., 2003.

## Sudden Infant Death Syndrome (SIDS) Rates per 1,000 Live Births by Race and Hispanic Origin: U.S., 2001

- Source: National Vital Statistics Report Nov. 7, 2003, 52(9): 69-77

**Notes:**
Sudden Infant Death Syndrome Rates per 1,000 Live Births by Race and Hispanic Origin: U.S., 2001
Though American Indians/Alaska Natives (AI/ANs) have an infant mortality rate that is significantly lower than African Americans, the rate of Sudden Infant Death Syndrome (SIDS) is slightly higher among AI/ANs than African Americans, and significantly higher than among other populations – 2.2 times higher than among all populations combined. (JW)
Some of the disparities in infant mortality are caused by disparities in Sudden Infant Death Syndrome (SIDS).  The rate of SIDS in 2001 per 1,000 live births were as follow (also see next slide) (6):
All populations: 55.5		American Indian: 124.2
Non-Hispanic white: 50.4		Asian/Pacific Islander: 15.5
African American: 122.9		Hispanic/Latino: 29.3

Another significant cause of disparities in infant mortality is short gestation and low birthweight.  Mortality data for 2001 for short gestation and low birthweight per 1,000 live births are as follow (6):
All populations: 16.0 		American Indian: 8.0
 Non-Hispanic white: 13.3 	Asian/Pacific Islander: 12.7
African American: 21.6		Hispanic/Latino: 14.4

Slide source (6)

## Age-Adjusted Death Rates per 100,000 Persons by Race and Hispanic Origin for All Causes: U.S., 2005

**Notes:**
Updated 6/2/08 by SB.
Age-Adjusted Death Rates per 100,000 Persons by Race and Hispanic Origin for All Causes: U.S., 2002
Compelling evidence that race and ethnicity correlate with persistent, and often increasing, health disparities among U.S. populations demands national attention. Indeed, despite notable progress in the overall health of the Nation, there are continuing disparities in the burden of illness and death experienced by African Americans, Hispanics/Latinos, American Indians and Alaska Natives (AI/ANs), and Native Hawaiian and Other Pacific Islanders (NHOPIs), compared to the U.S. population as a whole.  Current information about the biologic and genetic characteristics of minority populations does not explain the health disparities experienced by these groups compared with the white, non-Hispanic population in the United States. These disparities are believed to be the result of the complex interaction among genetic variations, environmental factors, and specific health behaviors. (1)

The death rate for African Americans is 2.3 times as high as for AAPIs, and 1.3 times as high as for white Americans.  African Americans have comparatively high death rates for many of the leading causes of death, such as cardiovascular disease (CVD), Diabetes, and AIDS. (JW)

Multiple factors contribute to racial/ethnic health disparities, including socioeconomic factors (e.g., education, employment, and income), lifestyle behaviors (e.g., physical activity and alcohol intake), social environment (e.g., educational and economic opportunities, racial/ethnic discrimination, and neighborhood and work conditions), and access to preventive health-care services (e.g., cancer screening and vaccination). Recent immigrants also can be at increased risk for chronic disease and injury, particularly those who lack fluency in English and familiarity with the U.S. health-care system or who have different cultural attitudes about the use of traditional versus conventional medicine. Approximately 6% of persons who identified themselves as Black or African American in the 2000 census were foreign-born. (8)

For blacks in the United States, health disparities can mean earlier deaths, decreased quality of life, loss of economic opportunities, and perceptions of injustice. For society, these disparities translate into less than optimal productivity, higher health-care costs, and social inequity. By 2050, an estimated 61 million black persons will reside in the United States, amounting to approximately 15% of the total U.S. population. (8)

Slide source (9)

## Age-Adjusted Mortality Rates per 100,000 Persons by  Race/Ethnicity for 3 Health Focus Areas: U.S., 2005 

**Notes:**
Updated 6/2/08 by SB.Age-Adjusted Mortality Rates per 100,000 Persons by  Race/Ethnicity for 3 Health Focus Areas (Heart Disease, Cancer, Stroke): U.S., 2002
African Americans have the highest all-cause death rate (1083.3 per 100,000), and as this slide shows, the highest death rate for three of the leading causes of death.  They also lead in deaths from diabetes (49.5, vs. 25.4 per 100,000 for all populations); homicide (21.0, vs. 6.1 per 100,000 for all populations); influenza and pneumonia (24.0, vs. 22.6 per 100,000 for all populations); and breast (34.0), prostate (62.0), and lung cancer (61.9).  (All populations cancer death rates, Breast: 25.6, Prostate: 27.9, Lung: 54.9.).  (9)

African Americans have a higher cancer death rate than white Americans, even though white Americans have a higher prevalence of cancer -- 7.8% for whites, compared to 3.4% for African Americans. This suggests some racial disparity in cancer screening and/or treatment. (10)

Slide source (9)

## Age-Adjusted Death Rates per 100,000 Persons by Race and Hispanic Origin for Diabetes: U.S., 2005

**Notes:**
Updated 6/2/08 by SB.

## Age-Adjusted Case Rates Per 100,000 Persons by Race/Ethnicity for Tuberculosis (TB): U.S., 2007

**Source:** CDC, MMWR, March 21, 2008 / 57(11);281-285, Trends in TB, US, 2007, Table:  _[http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5711a2.htm](http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5711a2.htm)_

**Notes:**
Updated 6/2/08 by SB.
Age-Adjusted Case Rates Per 100,000 Persons by Race/Ethnicity for Tuberculosis (TB): U.S., 2001
Asian Americans and Pacific Islanders (AAPIs) are 2.4 times as likely to have Tuberculosis (TB) as African Americans, and 5.8 times as likely as all races. (JW)  

Several important factors likely contribute to the disproportionate burden of TB in minorities.  In foreign-born persons from countries where TB is common, TB disease may result from infection acquired in the country of origin.  In racial and ethnic minorities, unequal distribution of TB risk factors, such as HIV infection, may also contribute to increased exposure to TB or to an increased risk of developing TB once infected with M. tuberculosis.  However, much of the increased risk of TB in minorities has been linked to lower socioeconomic status and the effects of crowding, particularly among U.S.-born persons. (14)

Slide source (15) 

## Age-Adjusted Death Rates per 100,000 Persons by Race, and Hispanic Origin for Motor Vehicle-Related Injuries: U.S., 2005

**Notes:**
Updated 6/2/08 by SB.Age-Adjusted Death Rates per 100,000 Persons by Race, and Hispanic Origin for Motor Vehicle-Related Injuries: U.S., 2002 
Motor vehicle crashes and pedestrian-related injury were the leading causes of unintentional injury-related death among American Indians/Alaska Natives (AI/AN) adults 20 years and older in 2003. Adult motor vehicle-related death rates for AI/ANs were almost twice that of whites and blacks. (16)  

Compared to their female counterparts, AI/AN males ages 20 years and older are twice as likely to die from a motor vehicle crash (crude rates: males: 48.7 per 100,000; females: 22.1 per 100,000) (17). Among Native Americans 19 years and younger, motor vehicle crashes were the leading cause of injury-related death, followed by suicide, homicide, drowning, and fires.  (16) 

Adult pedestrian crude death rates (ages 20+, age-adjusted) for AI/ANs (6.7 per 100,000) were more than three times that of non-Hispanic whites (2.1 per 100,000) and almost twice that of blacks (3.6 per 100,000).  (17)

Slide source (9)

## Age-Adjusted Death Rates per 100,000 Persons by Race, and Hispanic Origin for Human Immunodeficiency Virus (HIV) Disease: U.S., 2005

**Notes:**
Updated 6/2/08 by SB.
Age-Adjusted Death Rates per 100,000 Persons by Race, and Hispanic Origin for Human Immunodeficiency Virus (HIV) Disease: U.S., 2002
The HIV/AIDS epidemic is a health crisis for African Americans. In 2001, HIV/AIDS was among the top three causes of death for African American men aged 25–54 years and among the top 4 causes of death for African American women aged 20–54 years. It was the number one cause of death for African American women aged 25–34 years. (18) 

According to the 2000 Census, African Americans make up 12.3% of the U.S. population. However, they have accounted for 368,169 (40%) of the 929,985 estimated AIDS cases diagnosed since the epidemic began.  During 2000–2003, HIV/AIDS rates for African American females were 19 times the rates for white females and 5 times the rates for Hispanic females.  Rates for African American males were 7 times those for non-Hispanic white males and 3 times those for Hispanic males. (18)

Causes for the Disparity:
--According to a recent study of HIV infected and noninfected African American men who have sex with men (MSM), approximately 20% of the study participants reported having had a female sex partner during the preceding 12 months. In another study of HIV-infected persons, 34% of African American MSM reported having had sex with women, even though only 6% of African American women reported having had sex with a bisexual man. 
--Injection drug use is the 2nd leading cause of HIV infection for African American women and the 3rd leading cause of HIV infection for African American men. 
-- The highest rates of sexually transmitted diseases (STDs) are those for African Americans. In 2003, African Americans were 20 times as likely as whites to have gonorrhea and 5.2 times as likely to have syphilis. Partly because of physical changes caused by STDs, including genital lesions that can serve as an entry point for HIV, the presence of certain STDs can increase one’s chances of contracting HIV by 3- to 5-fold. Similarly, a person who is coinfected has a greater chance of spreading HIV to others 
-- Studies show that a significant number of African American MSM identify themselves as heterosexual.  As a result, they may not relate to prevention messages crafted for men who identify themselves as homosexual. 
-- Nearly 1 in 4 African Americans lives in poverty. Studies have found an association between higher AIDS incidence and lower income. The socioeconomic problems associated with poverty, including limited access to high-quality health care and HIV prevention education, directly or indirectly increase HIV risk. A recent study of HIV transmission among African American women in North Carolina found that women with HIV infection were more likely than noninfected women to be unemployed, receive public assistance, have had 20 or more lifetime sexual partners, have a lifetime history of genital herpes infection, have used crack or cocaine, or have traded sex for drugs, money, or shelter. (18)

Slide source (9)

## Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin for Chronic Liver Disease & Cirrhosis: U.S., 2005

**Notes:**
Updated 6/2/08 by SB.
Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin for Chronic Liver Disease & Cirrhosis: U.S., 2002 
Analysis shows a strong correlation between death rates from liver cirrhosis, regardless of cause, and drinking levels nationwide. Consistent with this association, deaths from chronic liver disease and cirrhosis are about 4 times more prevalent among American Indians/Alaska Natives (AI/ANs) than among the general US population. However Hispanics/Latinos are approximately twice as likely as whites to die from cirrhosis or liver disease, despite a lower prevalence of drinking and heavy drinking. (19) 

The reason for this discrepancy is unclear. Evidence exists that Hispanics/Latinos tend to consume alcohol in higher quantities per drinking occasion than do whites, resulting in a higher cumulative dose of alcohol. Data from nationwide surveys of adults show that both current drinking (defined as consumption of 12 or more drinks in the past year) and heavy drinking are most prevalent among AI/ANs and Native Hawaiians and lowest among AAPIs.  (19)

Slide source (9)

## Age-Adjusted Incidence Case Rates per 100,000 Persons by Race/Ethnicity for Acute Hepatitis B (HBV): U.S., 2006

**Source:** CDC MMWR, V57, SS2, March 21, 2008, p5. _[http://www.cdc.gov/mmwr/PDF/ss/ss5702.pdf](http://www.cdc.gov/mmwr/PDF/ss/ss5702.pdf)_

**Notes:**
Updated 6/2/08 by SB
Age-Adjusted Incidence Case Rates per 100,000 Persons by Race/Ethnicity for Acute Hepatitis B: U.S., 2001 
Viral hepatitis has historically been common in American Indian/Alaska Native (AI/AN) communities. However, the number of viral hepatitis infections in these communities has been reduced. In 2001, 86% of AI/AN children ages 19-35 months had received the hepatitis B vaccine, compared with 89% of the total population.  In that same year, 1.86 per 100,000 AI/AN were reported with acute HBV, compared with 1.31 per 100,000 white non-Hispanic Americans (20).  In 2002, 50 percent of those infected with HBV were Asian American or Pacific Islander (AAPI).  Black teenagers and young adults become infected with Hepatitis B three to four times more often than those who are white. (21)

Immunization with hepatitis B vaccine is the most effective means of preventing hepatitis B virus (HBV) infection and its consequences. However, while the rate of acute HBV among AAPIs has been decreasing, the reported rate in 2001 was more than twice as high among AAPIs (2.95 per 100,000 population) as among white Americans (1.31 per 100,000 population). In 2001, 90% of AAPI children ages 19-35 months had received hepatitis B vaccine, compared with 89% of the total population.  For Hispanic/Latino children, as for African American children, disparities have been closed or greatly reduced for most vaccines. (20)

-- The highest rates of new and long-term HBV infections occur among African Americans.-- The number of new HBV infections per year in the U.S. has declined from an average of 450,000 in the 1980s to about 78,000 in 2001.-- An estimated 1.25 million Americans have chronic HBV infection. (22)

Slide source (22)

## Sources

- Centers for Disease Control and Prevention (CDC):
- National Center for Health Statistics (NCHS)
- Health U.S., 2007
- National Vital Statistics Report
- National Center for HIV, STD, and TB Prevention (NCHSTP)
- National Center for Injury Prevention and Control (NCIPC)
- MMWR
- March 21, 2008 / 57 (SS2): 5. _[http://www.cdc.gov/mmwr/PDF/ss/ss5702.pdf](http://www.cdc.gov/mmwr/PDF/ss/ss5702.pdf)_
- March 21, 2008 / 57(11); 281-285.  _[http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5711a2.htm](http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5711a2.htm)_
- National Institute on Alcohol Abuse and Alcoholism
- National Women’s Health Information Center (NWHIC)
- U.S. Census Bureau

## Slide 42

## Age-Adjusted Death Rates per 100,000 Persons by Race and Hispanic Origin for Heart Disease: U.S., 2005

**Notes:**
Updated 6/2/08 by SB.
Age-Adjusted Death Rates per 100,000 Persons by Race and Hispanic Origin for All Causes: U.S., 2002
Compelling evidence that race and ethnicity correlate with persistent, and often increasing, health disparities among U.S. populations demands national attention. Indeed, despite notable progress in the overall health of the Nation, there are continuing disparities in the burden of illness and death experienced by African Americans, Hispanics/Latinos, American Indians and Alaska Natives (AI/ANs), and Native Hawaiian and Other Pacific Islanders (NHOPIs), compared to the U.S. population as a whole.  Current information about the biologic and genetic characteristics of minority populations does not explain the health disparities experienced by these groups compared with the white, non-Hispanic population in the United States. These disparities are believed to be the result of the complex interaction among genetic variations, environmental factors, and specific health behaviors. (1)

The death rate for African Americans is 2.3 times as high as for AAPIs, and 1.3 times as high as for white Americans.  African Americans have comparatively high death rates for many of the leading causes of death, such as cardiovascular disease (CVD), Diabetes, and AIDS. (JW)

Multiple factors contribute to racial/ethnic health disparities, including socioeconomic factors (e.g., education, employment, and income), lifestyle behaviors (e.g., physical activity and alcohol intake), social environment (e.g., educational and economic opportunities, racial/ethnic discrimination, and neighborhood and work conditions), and access to preventive health-care services (e.g., cancer screening and vaccination). Recent immigrants also can be at increased risk for chronic disease and injury, particularly those who lack fluency in English and familiarity with the U.S. health-care system or who have different cultural attitudes about the use of traditional versus conventional medicine. Approximately 6% of persons who identified themselves as Black or African American in the 2000 census were foreign-born. (8)

For blacks in the United States, health disparities can mean earlier deaths, decreased quality of life, loss of economic opportunities, and perceptions of injustice. For society, these disparities translate into less than optimal productivity, higher health-care costs, and social inequity. By 2050, an estimated 61 million black persons will reside in the United States, amounting to approximately 15% of the total U.S. population. (8)

Slide source (9)

## Age-Adjusted Death Rates per 100,000 Persons by Race and Hispanic Origin for Cancer: U.S., 2005

**Notes:**
Updated 6/2/08 by SB.
Age-Adjusted Death Rates per 100,000 Persons by Race and Hispanic Origin for All Causes: U.S., 2002
Compelling evidence that race and ethnicity correlate with persistent, and often increasing, health disparities among U.S. populations demands national attention. Indeed, despite notable progress in the overall health of the Nation, there are continuing disparities in the burden of illness and death experienced by African Americans, Hispanics/Latinos, American Indians and Alaska Natives (AI/ANs), and Native Hawaiian and Other Pacific Islanders (NHOPIs), compared to the U.S. population as a whole.  Current information about the biologic and genetic characteristics of minority populations does not explain the health disparities experienced by these groups compared with the white, non-Hispanic population in the United States. These disparities are believed to be the result of the complex interaction among genetic variations, environmental factors, and specific health behaviors. (1)

The death rate for African Americans is 2.3 times as high as for AAPIs, and 1.3 times as high as for white Americans.  African Americans have comparatively high death rates for many of the leading causes of death, such as cardiovascular disease (CVD), Diabetes, and AIDS. (JW)

Multiple factors contribute to racial/ethnic health disparities, including socioeconomic factors (e.g., education, employment, and income), lifestyle behaviors (e.g., physical activity and alcohol intake), social environment (e.g., educational and economic opportunities, racial/ethnic discrimination, and neighborhood and work conditions), and access to preventive health-care services (e.g., cancer screening and vaccination). Recent immigrants also can be at increased risk for chronic disease and injury, particularly those who lack fluency in English and familiarity with the U.S. health-care system or who have different cultural attitudes about the use of traditional versus conventional medicine. Approximately 6% of persons who identified themselves as Black or African American in the 2000 census were foreign-born. (8)

For blacks in the United States, health disparities can mean earlier deaths, decreased quality of life, loss of economic opportunities, and perceptions of injustice. For society, these disparities translate into less than optimal productivity, higher health-care costs, and social inequity. By 2050, an estimated 61 million black persons will reside in the United States, amounting to approximately 15% of the total U.S. population. (8)

Slide source (9)

## Age-Adjusted Death Rates per 100,000 Persons by Race and Hispanic Origin for Stroke: U.S., 2005

**Notes:**
Updated 6/2/08 by SB.

## Age-Adjusted Death Rates per 100,000 Persons by Race and Hispanic Originfor Prostate Cancer: U.S., 2005

**Notes:**
Updated 6/2/08 by SB.

## Age-Adjusted Death Rates per 100,000 Persons by Race and Hispanic Originfor Trachea, Bronchus & Lung Cancer: U.S., 2005

**Notes:**
Updated 6/2/08 by SB.

## Age-Adjusted Death Rates per 100,000 Persons by Race and Hispanic Originfor Unintentional Injuries: U.S., 2005

**Notes:**
Updated 6/2/08 by SB.

## Age-Adjusted Death Rates per 100,000 Persons by Race and Hispanic Originfor Chronic Lower Respiratory Disease: U.S., 2005

**Notes:**
Updated 6/2/08 by SB.

## Age-Adjusted Death Rates per 100,000 Persons by Race and Hispanic Originfor Breast Cancer: U.S., 2005

**Notes:**
Updated 6/2/08 by SB.

## Age-Adjusted Death Rates per 100,000 Persons by Race and Hispanic Originfor Colon, Rectum & Anus Cancer: U.S., 2005

**Notes:**
Updated 6/2/08 by SB.

## Age-Adjusted Death Rates per 100,000 Persons by Race and Hispanic Origin for Influenza & Pneumonia: U.S., 2005

**Notes:**
Updated 6/2/08 by SB.

## Age-Adjusted Death Rates per 100,000 Persons by Race and Hispanic Origin for Suicide: U.S., 2005

**Notes:**
Updated 6/2/08 by SB.

## Age-Adjusted Death Rates per 100,000 Persons by Race and Hispanic Origin for Homicide: U.S., 2005

**Notes:**
Updated 6/2/08 by SB.

## Slide 55