Veterans Health Administration

Office of Health Equity -VHA 10A6

Washington DC

Office of Health Equity

What is it all about?

November 4, 2013

HSR&D Cyber seminar November 4, 2013 

Uche S. Uchendu, MD

Chief Officer, Office of Health Equity

uchenna.uchendu2@va.gov

http://vaww.pdush.med.va.gov/programs/ohe/oheDefault.aspx
VETERANS HEALTH ADMINISTRATION

VHA Office of Health Equity- W hat is it all about? 

 

 How is VHA joining the dialogue on health disparities in 

vulnerable populations? 

 What actions can each of us take in our areas of influence to 

move towards attainment of the highest level of health for 

all? 

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Poll Question #1

• What is your primary role in VA? 

– student, trainee, or fellow

– clinician

– researcher

– manager or policy-maker

– Other
VETERANS HEALTH ADMINISTRATION

Global Perspective – making a case for health equity

 Benefits of reducing health inequalities

 The benefits of reducing health inequalities are economic as well as social. 

 The cost of health inequalities can be measured in 

 human terms - lost years of life and active life

 Economic terms - the cost to the economy of additional illness

 What is the global burden of disease?

 What is the Veteran burden of disease?

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The Marmot Review 
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Action model to achieve Healthy People 2020 overarching goals

Action model to achieve Healthy People 2020 overarching goals.

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Indicators of Population Health

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ACA and Health Equity 

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Andrulis DP and Siddiqui NJ : http://www.texashealthinstitute.org/health-care-reform.html
VETERANS HEALTH ADMINISTRATION

Global Perspective – making a case for health equity 

 The National Partnership for Action to End Health Disparities (NPA) was 

established by HHS OMH to mobilize a nationwide, comprehensive, 

community-driven, and sustained approach to combating health 

disparities and to move the nation toward achieving health equity – 2000 

Partners

 The mission of the NPA is to increase the effectiveness of programs that 

target the elimination of health disparities through the coordination of 

partners, leaders, and stakeholders committed to action

 VA made commitment as one of the federal partners in NPA

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VETERANS HEALTH ADMINISTRATION

VHA Office of Health Equity - Vision

 The Veterans Health Administration provides 

appropriate individualized health care to each Veteran in a 

way that eliminates disparate health outcomes and assures 

health equity.

 Office of Health Equity champions the advancement 

of health equity and reduction of health disparities

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VETERANS HEALTH ADMINISTRATION

VHA Office of Health Equity –VHA Strategic Plan

 VHA Strategic Plan Goal 1 of 3: 

 VHA GOAL (1): PROVIDE VETERANS PERSONALIZED, PROACTIVE, PATIENT-DRIVEN 

HEALTH CARE

 Objective: (NLC Committee -HDC, HQVC)

1e. Quality & Equity – Veterans will receive timely, high quality, 

personalized, safe effective and equitable health care, irrespective of 

geography, gender, race, age, culture or sexual orientation

 A section on the VHA strategic plan means weaving it into discussions at 

all levels of policy, decision making, resource allocation, practice , 

performance plans etc.

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VETERANS HEALTH ADMINISTRATION

VHA Office of Health Equity -Organizational Structure

Principal Deputy Under 

Secretary for Health

Communication & Cultural Competency

Program Management Officer

Program Analyst 

Training Specialist

Program Analyst Health Care Outcomes

Program Director

Executive Assistant

Program Assistant

OHE Chief Officer

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VETERANS HEALTH ADMINISTRATION

VHA Office of Health Equity- With USH

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VETERANS HEALTH ADMINISTRATION

VHA - Organizational Structure : OHE=10A6

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VETERANS HEALTH ADMINISTRATION

VHA Office of Health Equity - Definitions

 Health equity is attainment of the highest level of 

health for all people.

 Achieving health equity requires valuing everyone 

equally with focused and ongoing societal efforts to 

address avoidable inequalities, historical and 

contemporary injustices, and the elimination of 

health and healthcare disparities. 

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VETERANS HEALTH ADMINISTRATION

VHA Office of Health Equity - Definitions

 A health disparity is a particular type of health difference that is closely 

linked with social or economic disadvantage. 

 Health disparities adversely affect groups of people who have 

systematically experienced greater social and/or economic obstacles 

to health and/or a clean environment based on these: 

• Racial or ethnic group

• Gender

• Age

• Geographic location

• Religion

• Socio-economic status 

• Sexual orientation

• Mental health

• Disability 

 cognitive /sensory / physical

• other characteristics historically 

linked to discrimination or 

exclusion

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VETERANS HEALTH ADMINISTRATION

VHA Office of Health Equity - Definitions

 Not all health differences amount to a health disparity

 A subset of differences linked with social disadvantage 

 Adverse health in a socially disadvantaged / vulnerable group

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VETERANS HEALTH ADMINISTRATION

Question for Participants

 Which of the following Veterans is likely to have a health disparity?

 Select all that apply

 A. An African American male who served in Vietnam and lives in Hope, Arkansas

 B. A Transgender white Veteran with PTSD who lives in Iowa City, Iowa

 C. A Hispanic female Veteran with HIV who lives in Houston, Texas

 D. 60 year old unemployed Veteran who sleeps on the steps of the Capitol in DC

 E. A Native American Veteran who lives in Winnemucca, Nevada

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The issue with Averages... 

• “The poor are getting poorer, but with the rich getting richer it all averages out 

in the long run.”

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cartoonbank.com New Yorker 2000
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Quotes on Health Disparity and/or Health inequity

"Of all the forms of inequality, injustice in health care is the most shocking and 

inhumane." -- Dr. Martin Luther King, Jr. 

Excerpt from comments made in a Civil Rights protest against racially discriminatory practices of Chicago hospitals. 

March 1966, Chicago

• "It is time to refocus, reinforce, and repeat the message that 

health disparities exist and that health and equity benefits 

everyone" – Kathleen G. Sebelius, Secretary, Health & Human Services ( HHS disparities Action Plan)

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VETERANS HEALTH ADMINISTRATION

Raising the bar by elevating the disadvantaged 

outliers 

 Performance Measures track percentage on target for particular measure

 What if we tracked the same measure(s) with an equity lens?

 What if the percent on target is broken down by age, gender, race, ethnicity, 

geography, sexual orientation, mental , medical and physical disabilities?

 Would your facility still meet the measure for all populations?

 If the answer is no, THIS IS your call to action!

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VETERANS HEALTH ADMINISTRATION

VHA Office of Health Equity - Mission

 OHE Mission 

 Champion efforts to address health disparities through education, training, 

communications and information

 Coordinate programs, projects and initiatives that address health disparities 

and equality, in order to bring synergy and break down silos within the 

organization

 Represent VHA and serve as liaison to other governmental and nongovernmental organizations working to achieve health equity

 Position VHA as a national leader in achieving equitable health care and 

outcomes

 capitalize on the existing network of minority advocates ....to coordinate and 

harness efforts to advance health equity by achieving equitable health care 

and outcomes

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VETERANS HEALTH ADMINISTRATION

VHA Office of Health Equity - Goals and Functions

 Leadership

 Awareness 

 Health Outcomes 

 Diversity and Cultural Competency of the Workforce 

 Data, Research and Evaluation

o Five-goal framework of the NPA National Stakeholder Strategy for Achieving Health Equity

o The Affordable Care Act under Title IV. “Prevention of Chronic Disease and Improving public Health”; 

Section 4302 – “Understanding health disparities: data collection and analysis” 

 

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VETERANS HEALTH ADMINISTRATION

VHA Office of Health Equity - Goals and Functions

 Leadership

 Leadership -Strengthen and broaden the ability of VA leadership 

to address health inequalities and reduce health disparities 

through operations, policy, oversight and research. 

 

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VETERANS HEALTH ADMINISTRATION

VHA Office of Health Equity - Goals and Functions

 Awareness 

 Awareness -Increase awareness of the significance of health 

inequalities and disparities, their impact on the nation, and 

the actions necessary within VHA to improve health care and 

health outcomes for disadvantaged populations

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VETERANS HEALTH ADMINISTRATION

VHA Office of Health Equity - Goals and Functions

 Health Outcomes 

 Health Outcomes -Improve health and health care outcomes 

for Veteran sub-populations experiencing health disparities

o The Affordable Care Act under Title IV. “Prevention of Chronic Disease and Improving public Health”; 

Section 4302 – “Understanding health disparities: data collection and analysis” 

o Also linked to the Community Health Needs Assessment Provision of ACA

 

 

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VETERANS HEALTH ADMINISTRATION

VHA Office of Health Equity - Goals and Functions

 Diversity and Cultural Competency of the Workforce 

 Diversity and Cultural Competency of the Workforce

Improve cultural and linguistic competency and the diversity 

of the VA workforce involved in advancing the health and 

well-being of Veterans

o Also linked to the Workforce Diversity section in ACA

 

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VETERANS HEALTH ADMINISTRATION

VHA Office of Health Equity - Goals and Functions

 Data, Research and Evaluation

 Data, Research and Evaluation -Improve the availability, 

coordination, and utilization of data and diffusion of research 

and evaluation outcomes in order to track progress towards 

the achievement of health equity 

o The Affordable Care Act under Title IV. “Prevention of Chronic Disease and Improving public Health”; 

Section 4302 – “Understanding health disparities: data collection and analysis”

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VETERANS HEALTH ADMINISTRATION

VHA Office of Health Equity - Expected Deliverables

 Integrative VHA Health Equity Action Plan *

 Comprehensive Health Equity Communication Plan 

 Analyses using process, outcomes, and satisfaction metrics that enhance 

understanding and track progress towards achieving health equity 

 Multifaceted Cultural Competency Training Program

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VETERANS HEALTH ADMINISTRATION

Audience question

o Five-goal framework of the NPA National Stakeholder Strategy for Achieving 

Health Equity includes all the following except:

 A. Affordable Care Act

 B. Awareness 

 C . Health Outcomes 

 D. Diversity and Cultural Competency of the Workforce 

 Data, Research and Evaluation

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VETERANS HEALTH ADMINISTRATION

VHA Office of Health Equity -Health Equity 

Coalition - PDUSH 

 Established by the VHA PDUSH 

 Memo signed March 21, 2013 tasked to Program offices

 Chief Officer, Office of Health Equity = Chair of the Coalition

 Coalition responsible for:

 Assuring that there is a comprehensive and aligned approach across VHA

 Ensuring the availability of necessary resources, and 

 Ongoing assessment of impact on improvements

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VETERANS HEALTH ADMINISTRATION

VHA Office of Health Equity -Health Equity Coalition 

> Charge

 Maintain a professional connection to the mission and leadership of OHE

 Advise & assist OHE in the development of the Health Equity Action Plan

 Commit appropriate organizational resources to 

 Implement the initiatives, programs and strategies in the Health Equity Action Plan

 Set milestones and review progress to ensure timely completion of initiatives

 Provide the necessary support to ensure that VHA emerges as a national 

leader in coordinated, system-wide efforts to achieve health care equity

 Encouraged to engage as appropriate with external organizations that 

have expertise in health equity

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VETERANS HEALTH ADMINISTRATION

VHA Office of Health Equity -Health Equity Coalition 

> Membership

 Center for Minority Veterans

 Office of Communications

 Office of ADUSH for Clinical 

Operations

 Network Director – identified by 10N

 Office of Patient-Centered Care and 

Cultural Transformation

 Office of the ADUSH for Informatics 

and Analytics

 Office of ADUSH for Policy and 

Planning

 Office of Nursing*

 Office of Public Health

 Office of ADUSH for Patient Care Services

 Office of Women’s Health

 Office of Research and Development

 Director Center for Health Equity 

Research and Promotion

 National Center for Ethics in Health Care

 Office of the ADUSH for Workforce 

Services

 Office of ADUSH for Quality, Safety & 

Value

 VISN Chief Medical Officer*

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VETERANS HEALTH ADMINISTRATION

VHA Office of Health Equity -Health Equity Coalition 

>Kick off

 Maiden meeting - Thursday, May 30 , 2013

 The expanse of coverage for vulnerable Veteran populations noted

 Agreed to prioritize over time

 Take stock of “what we know” and include other stakeholders

 Presentations: Health Equity + Policy and Planning +Informatics and Analytics+ 

Public Health +ESP

 Meetings – May 30, June 25, July 24, 2013

 1.5 day Face to Face meeting September 2013 – >>>>>>>>

 Draft of the First VHA Health Equity Action Plan

 A guide and in flux as we chart new territories in VHA Health Equity.

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VETERANS HEALTH ADMINISTRATION

VHA Office of Health Equity - Current Projects

Health Equity Coalition*

 VHA Strategic Plan goal 1 Objective e- Quality and Equity

Goal 1e- in progress with OP&P, OSI – complete. NLC next , then implementation

 Clinical Look at Unconscious Bias – CLUB In response to ACMV 2012

OHE in collaboration with CHERP –Houston, Martinsburg and Pittsburgh -Conclusion anticipated in Q2 of FY14

 Healthcare Equality Index – HEI 2013 Complete! LGBT Workgroup task to OHE

92 VAMCs made Leader status - 121 participated

 Creating awareness of OHE mission and building critical partnerships

Presentations/dialogue within and outside of VHA including ALL OF YOU On this cyber seminar!

 Active involvement on the Federal Interagency Health Equity Team –FIHET 

OHE active on the workgroups including one exploring a federal disparity/health equity related data repository

Exploring Community Health Workers

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VETERANS HEALTH ADMINISTRATION

Audience Poll by Molly

• Have you seen the OHE Call For Papers for VA Health Equity American Journal of 

Public Health Supplement? 

• Yes 

• No

• May be

• Do not know

• What is that?

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VETERANS HEALTH ADMINISTRATION

HEI Press Conference July 2013 @ VACO

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121 VAMCs participated, 92 made Leader status!
VETERANS HEALTH ADMINISTRATION

VHA Office of Health Equity - Current Projects 2

Military Cultural Awareness Workgroup*-Complete

Chaired by OHE Lisa Red- Recommendations in review and discussion for next steps

Did you know there was a TMS training for Military Cultural Awareness?

Exploratory work & education on health outcomes & issues on LGBT Veterans

In progress by OHE Dr. George Brown and Dr. Kenneth Jones with IRB via Mountain Home TN VAMC

Collaboration with the Patient Care Services LGBT coordinators 

LGBT coordinators aligned under Patient Care Services – Dr. Michael Kauth and Dr. Jillian Shipherd

Collaboration with Researchers and Data Analysts-> *Think Tank July 2013

Input and project ideas + collaboration opportunities

Evidence Synthesis Program topic nomination

OHE topic nomination for HSR&D ESP on PC Access for Mentally Ill Veterans – > Durham ESP Center

American Journal of Public Health Supplement on VA Health Equity

Have you seen the OHE- AJPH Call For Papers? Deadline Jan 10, 2014!

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VETERANS HEALTH ADMINISTRATION

VA Health Equity AJPH Supplement

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VETERANS HEALTH ADMINISTRATION

VHA Office of Health Equity – Project CLUB “Pilot”

 Clinical Look at Unconscious Bias – CLUB

 OHE In partnership with CHERP

 The pilot intended for PACTs – MD, RN, LPN, SW, Pharm-D, MSA &Dieticians

 Interactive cultural competency training program for PACTs that addresses 

unconscious bias

 Assess feasibility and acceptability of the program by implementing it in a 

small sample of PACTs

 Collect preliminary data to assess the impact of the program on select 

patient and provider outcomes

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VETERANS HEALTH ADMINISTRATION

VHA Office of Health Equity- W hat is it all about? 

 

 How is VHA joining the dialogue on health disparities in 

vulnerable populations? 

 What actions can each of us take in our areas of influence to 

move towards attainment of the highest level of health for 

all? 

39
VETERANS HEALTH ADMINISTRATION

What can you do?

 VHA Strategic Plan Goal 1 Objective e

 Quality and Equity

 1.e.1. (Strategy): VHA will develop an understanding of where health and 

health care inequities exist and identify factors that contribute to 

inequity in Veteran populations, and intervene to eliminate inequities. 

 Performance Plan:

 Demonstrates understanding of where health and health care inequity 

exists and addresses disparities. 

1
VETERANS HEALTH ADMINISTRATION

What can you do? A conceptual framework

• Kilbourne A, Switzer G, Hyman K, Crowley-Matoka M, Fine M. 2006. Advancing 

health disparities research within the health care system: a conceptual framework. 

Am. J. Public Health 96:2113–21 

41 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1698151/. 
VETERANS HEALTH ADMINISTRATION

What can you do?

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VETERANS HEALTH ADMINISTRATION

Health Disparities Research

 Health disparities research= a broad multi-faceted field that includes 

basic, applied, clinical, social and behavioral research that relates to 

significant disparities in the overall rate of disease incidence, prevalence, 

morbidity or survival rates in a population, including individuals and 

members of such populations

 Includes the causes of such disparities and methods to identify, prevent, 

diagnose and treat such disparities, with the eventual goal to addressing 

causes and implementing solutions 

43

Dankwa-Mullan – NIH- NIMHD
VETERANS HEALTH ADMINISTRATION

Health equity action research trajectory

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Thomas et al - www.annualreviews.org
VETERANS HEALTH ADMINISTRATION

Population Health Research

• Population health research examines the health outcomes of a group of 

individuals, including the distribution of such outcomes within the group 

• Research approaches include metrics of health outcomes, patterns of 

health determinants and policies and programs that link these two 

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Dankwa-Mullan – NIH-NIMHD
VETERANS HEALTH ADMINISTRATION

What can you do?

 Cast an equity lens on all decisions and actions

 Become aware of your unconscious bias

 Get culturally competent

 Target vulnerable Veteran populations for Quality Improvement and 

Research Projects

 Recall performance measure questions earlier...

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VETERANS HEALTH ADMINISTRATION

Raising the bar by elevating the disadvantaged outliers 

 Performance Measures track percentage on target for particular measure

 What if we tracked the same measure(s) with an equity lens?

 What if the percent on target is broken down by age, gender, race, ethnicity, 

geography, sexual orientation, mental , medical and physical disabilities?

 Would your facility still meet the measure for all populations?

 If the answer is no, THIS IS your call to action!

 Repeat exercise for several other scenarios relevant to your work and area of 

influence

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VETERANS HEALTH ADMINISTRATION

Did you Know?

 You may already be doing work that is addressing health disparities 

 If you are working with any of the vulnerable populations, you are in a 

position to make a difference

 The demographics and vulnerable populations vary from one VAMC to 

another - one size does NOT fit all

 You can take control of the activities pertinent to your region/facility and 

demographics.

 OHE wants to partner with you and learn about your best practices/work in 

health equity 48
VETERANS HEALTH ADMINISTRATION

Quotes on Health Disparity and/or Health inequity

 The “Geography of Opportunity” – the spaces and places where people live, work, study, 

pray, and play powerfully shape health and life opportunities. 

 Geography and Health – the U.S. Context and Health – Brian D.Smedley NIMHD summer 2013

 HPI’s research, publications, activities, and projects are designed to accelerate 

progress beyond listing and analyzing a litany of health disparities. Rather, they 

are directed toward collective strategies that will produce real change—and real 

opportunities for health. -- http://www.jointcenter.org/hpi/

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VETERANS HEALTH ADMINISTRATION

VHA Office of Health Equity – Get involved!

 The pursuit of Health Equity should be everyone’s business.

 It is a journey that takes time and effort.

 What can you do today in your area of influence to improve health equity?

 At a minimum - in all your actions - do not increase the disparity.

Thank you!

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VETERANS HEALTH ADMINISTRATION

Useful Links: 

CFP VA Health Equity Supplement

http://ajph.aphapublications.org/. 

National Partnership for Action ( NPA)

http://minorityhealth.hhs.gov/npa/

The Economic Burden of Health Inequalities in the United States 

www.jointcenter.org/hpi

Office of Health Equity

http://vaww.pdush.med.va.gov/programs/ohe/oheDefault.aspx

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VETERANS HEALTH ADMINISTRATION

Question/Comments...

Contact Information:

Uche S. Uchendu, MD

Chief Officer, Office of Health Equity

uchenna.uchendu2@va.gov

http://vaww.pdush.med.va.gov/programs/ohe/oheDefault.aspx

___________________________________

 Do you have Implicit (Unconscious) Bias?

• Take the test @

• https://implicit.harvard.edu/implicit/demo/

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