Racial and Ethnic Approaches

to Community Health (REACH) U.S.

Finding Solutions to Health Disparities

2007

AT A GLANCE

“The greatness about REACH is that we have trained and empowered everyday people in the community. These are folks 

who are going to sustain it long after we leave, and these are the true champions of REACH.”

Larry Johnson, MPH

Program Manager, REACH for Wellness, Fulton County, Georgia

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention

Coordinating Center for Health Promotion

Chugachmuit Native 

Organization

University of

Alabama at

Birmingham

Community Health

Councils of Los Angeles

Special Services

for Groups

San Francisco 

Department of Health

University of California,

San Francisco

University of 

Nevada, Reno

African American

Health Coalition

Seattle-King County

Department of Health

Access Community

Health Network

Missouri Coalition for 

Primary Care

University of 

Illinois at Chicago Chicago Department 

of Health

Genesee County

Health Department

Community Health

and Social Services

Lowell Community

Health Center

Greater Lawrence

Family Health Center

Center for Community Health, 

Education, and Research

New Hampshire 

Minority Health 

Coalition

Boston Public 

Health Commission

Institute for Urban Family Health

Trustees of Columbia University

Eastern Band of Cherokee Indians

Charlotte Mecklenburg Hospital System

Medical University of South Carolina

United South and Eastern Tribes, Inc.

Fulton County Department of

Health and Wellness

Florida International University

Matthew Walker 

Comprehensive Health

Black Women's 

Health Imperative

Latino Education 

Project

Migrant Health

Promotion Choctaw Nation

of Oklahoma

Oklahoma State 

Department of Health

Association of American 

Indian Physicians

Hidalgo Medical 

Services

National Indian

Council on Aging

Los Angeles Biomedical

Research Institute at

Harbor-UCLA Medical Center

Albuquerque

Area Indian

Health Board

Capacity building funding for tribal communities (5 sites)

Basic implementation funding (31 sites)

Projects targeting older adults (4 sites)

REACH Communities, 2006

Revised April 2007
Despite great improvements in the overall health of the nation,

health disparities remain widespread among members of racial 

and ethnic minority populations. Members of these groups 

are more likely than whites to have poor health and to die 

prematurely, as the following examples illustrate.

 • African Americans. Although the nation’s infant death 

rate has decreased, the rate for African Americans is almost 

double the national rate. Heart disease death rates are 30% 

higher for African Americans than for whites, and stroke 

death rates are 41% higher. Black women have a higher 

death rate from breast cancer than white women, despite 

having nearly identical mammography screening rates. 

Diabetes remains nearly twice as high among non-Hispanic 

blacks compared with whites. Although pneumonia and 

annual flu vaccinations are covered by Medicare, only 39% 

of non-Hispanic black adults aged 65 years or older are 

likely to receive either shot, compared with 63% of whites; 

only 40% receive the pneumonia shot, compared with 61% 

of whites. African Americans have the highest HIV/AIDS 

diagnosis rate of all racial and ethnic groups and account 

for 50% of all HIV/AIDS cases.

 • American Indians and Alaska Natives. The infant death 

rate for American Indians is almost double the rate for 

whites. Diabetes rates are 2.5 times higher among American 

Indians and more than twice as high among Alaska Natives

compared with whites. American Indians and Alaska Natives

also have the third highest rate of HIV/AIDS diagnoses.

 • Asian Americans. Vietnamese American women have a 

higher cervical cancer incidence rate than any ethnic group 

in the United States—five times that of non-Hispanic white 

women. Asians in California are 1.5 times more likely than 

whites to receive a diagnosis of type 2 diabetes.

 • Hispanics/Latinos. Only 18% of Hispanics with high 

blood pressure have this condition under control, compared 

with 30% of whites. Type 2 diabetes is being diagnosed 

more often in Hispanic children and adolescents than

in the past. Only 42% of Hispanics aged 65 years or older 

receive a pneumonia or annual flu shot, compared with 

63% of whites. Only 28% receive the pneumonia shot, 

compared with 61% of whites. Hispanics have the second 

highest rate of HIV/AIDS diagnoses and account for 18% 

of all HIV/AIDS cases.

 • Pacific Islanders. Pacific Islanders are more than twice as 

likely as whites to receive a diagnosis of diabetes. Although 

the estimated HIV/AIDS rate among Pacific Islanders is the 

lowest in the United States compared with all other racial 

and ethnic groups, the rate increased an average of 9% each 

year during 2001–2004.

2

The Facts on Racial and Ethnic Disparities in Health 

Health Disparities Can Be Overcome

For years, public health officials, program managers, and 

policy makers in the United States have been frustrated by the 

seemingly intractable problem of health disparities. Officials 

at all levels have been at a loss for solutions. In response, CDC

created REACH U.S. (formerly REACH 2010), a program 

that is demonstrating that health disparities can be reduced 

and the health status of groups traditionally most affected

by health inequities can be improved. REACH U.S. supports 

CDC’s strategic goals by addressing health disparities in the 

critical life stages of infancy, childhood, adolescence, adulthood,

and old age. The program also has developed innovative

approaches to dealing with racial and ethnic groups, and these 

approaches are improving people’s health in our communities, 

health care settings, schools, and work sites.

CDC’s Leadership Role

REACH U.S. supports community coalitions that design, 

implement, and evaluate community-driven strategies to 

eliminate health disparities in key health areas, such as heart 

disease, diabetes, breast and cervical cancer, immunizations, 

infant mortality, and HIV/AIDS. In fiscal year 2007, Congress

allocated $34.1 million to support the REACH program.

CDC provides training, technical assistance, and support

to REACH communities to help them understand social

determinants of health and their relationship to health

disparities. CDC also helps communities develop, implement, 

and sustain effective interventions; evaluate their programs; 

and disseminate strategies that work.

As a result, REACH communities are

 • Empowering community members to seek better health.

 • Bridging gaps between the health care system and the

community by encouraging residents to seek appropriate 

care and by changing local health care practices.

 • Changing local social and physical environments to

overcome barriers to good health.

 • Mobilizing to implement evidence-based public health

programs that fit their unique social, political, economic, 

and cultural circumstances.

 • Moving beyond interventions that address individual 

behavior to the systematic study of community and systems 

change.
3

Data Show REACH is Working

Data from the REACH Risk Factor Survey show that the 

REACH U.S. program is helping people to significantly 

reduce their health risks and manage their chronic diseases. 

This survey assesses improvements in health-related behaviors 

and reductions in health disparities within the 27 REACH 

communities that focus on breast and cervical cancer prevention, cardiovascular health, and diabetes management. Survey 

results include the following:

 • In 2001, the proportion of African Americans in REACH 

communities who were screened for cholesterol was below 

the national average. By 2004, this percentage exceeded the 

national level (see figure).

 • Since 2001, the sizable gap in cholesterol screening rates

between Hispanics in REACH communities and the

national average has been shrinking.

 • The proportion of American Indians in REACH communities who are taking medication for high blood pressure 

increased from 67% in 2001 to 74% in 2004 (see figure).

 • The rate of cigarette smoking among Asian American men 

in REACH communities decreased from 35% in 2001

to 24% in 2004.

The Keys to Success

REACH U.S. has identified the following key principles and 

supporting activities that can be used to “unlock” the unique 

causes of health disparities in racial and ethnic minority communities across the United States.

• Trust. Building a culture of collaboration with communities

that is based in trust.

 • Empowerment. Giving individuals and communities the 

knowledge and tools they need to create change by seeking

and demanding better health and building on local resources.

 • Culture and History. Designing health initiatives that 

acknowledge and are based in the unique historical and 

cultural context of racial and ethnic minority communities 

in the United States.

 • Focus. Assessing and focusing on the underlying causes 

of poor community health and implementing solutions 

that are designed to remain embedded in the community’s 

infrastructure.

 • Community Investment and Expertise. Recognizing and 

investing in local community expertise and working to

motivate communities to mobilize and organize existing 

resources.

 • Trusted Organizations. Embracing and enlisting organizations within the community that are valued by community 

members, including groups whose primary mission is not 

related to health.

 • Community Leaders. Helping community leaders and key 

organizations be catalysts for change in their communities.

 • Ownership. Developing a collective outlook that promotes 

shared interest in a healthy future through widespread community engagement and leadership.

 • Sustainability. Making changes to organizations, community environments, and policies that will help to ensure 

that health improvements are long-lasting and community 

activities and programs are self-sustaining.

 • Hope. Fostering optimism, pride, and a promising vision 

for a healthier future.

* Data are from REACH communities with cardiovascular disease 

and diabetes projects.

† National comparison data from the Behavioral Risk Factor

Surveillance System (BRFSS) include all racial and ethnic groups.

African Americans Who Have Had

Their Cholesterol Checked

Percent (%)

2001 2002 2003 2004

Year

70

72

74

76

78

80

82 REACH 2010

Communities

National Comparison

(BRFSS)

†

African Americans

 (BRFSS)

†

Percent (%)

2001

60

62

64

66

68

70

72

74

76

78

80

2002 2003 2004

National Comparison (BRFSS)

†

REACH 2010

Communities

Year

American

Indians (BRFSS)

†

American Indians on Medication

for High Blood Pressure 

REACH Risk Factor Survey*
4

South Carolina: Dramatic Improvements in Diabetes

Outcomes for African Americans

The REACH 2010: Charleston and Georgetown Diabetes 

Coalition focuses on diabetes care and control for more than 

12,000 African Americans with diabetes. As a result of the 

coalition’s work, a 21% gap in annual blood sugar testing

between African Americans and whites has been virtually 

eliminated. In addition, more African Americans in the target 

area are getting the recommended annual tests to monitor 

their cholesterol levels and kidney function and being referred 

for eye exams and blood pressure checkups. Lower-extremity

amputations among African Americans with diabetes also 

have decreased sharply. For example, in Charleston County, 

the percentage of amputations decreased by almost 36%, 

from 31% in 1999 to less than 20% in 2002. In Georgetown 

County, the percentage decreased from 44% in 1999 to 24% 

in 2002.

California: REACHing out to Vietnamese American 

Women to Promote Cervical Cancer Screening

The Vietnamese REACH for Health Initiative Coalition 

works to prevent cervical cancer among Vietnamese American

women in Santa Clara County, California. Numerous activities

have been implemented to improve screening rates among 

Vietnamese American women in this community, including 

a lay health worker outreach program, continuing medical 

education for physicians, and a media education campaign. 

The coalition also set up a low-cost clinic for Pap test screening that employs a female Vietnamese American physician 

and staff who speak Vietnamese. As a result of this program, 

47.7% of Vietnamese American women in Santa Clara County

who had never had a Pap test received one after meeting with 

a lay health worker. The overall percentage who received Pap 

tests increased by 15% during 2000–2004.

New York: The Start Right Coalition Works

to Improve Immunization Rates

The Northern Manhattan Start Right Coalition is a community program that works to increase childhood immunization 

rates for children younger than age 5 years in the Harlem and 

Washington Heights areas of New York City. Children aged 

19–35 months who were enrolled in the program had immunization rates 10% below the national average in 2002. 

In 2003, the same age group surpassed the national average 

for all racial and ethnic groups by 13% and was nearly 10% 

above the New York City average.

Massachusetts: Empowering Latinos Makes

a Difference in Diabetes Care and Control

The REACH 2010 Latino Health Project developed culturally

tailored interventions to reduce the diabetes burden in the 

Latino community. As a result, participants showed dramatic 

improvements in control of high blood sugar and high blood 

pressure, which are risk factors for diabetes-related complications. During 2001–2003, blood sugar measures below 7.0 

improved by 8.7% (from 20.7% to 22.5%), systolic blood 

pressure below 130 mm Hg improved by 17.5% (from 53.6% 

to 63%), and diastolic blood pressure below 80 mm Hg 

improved by 14.4% (from 69.6% to 79.6%). In addition, the 

proportion of participants who were referred for eye exams 

improved 26.5%, from 51% in 2001 to 64% in 2003.

Future Directions

REACH communities are demonstrating every day that 

health disparities among racial and ethnic minority groups 

can be reduced. In addition, the success of the REACH U.S. 

program has been featured in numerous publications, including special issues of the following journals: Preventing Chronic 

Disease (2006;3[3]), The Journal of Health Care for the Poor 

and Underserved (2006;17[2]), Health Promotion Practice

(2006;7[suppl 1]), and Ethnicity and Disease (2004;14[3]

[suppl 1]).

CDC and REACH communities know enough now to urge 

the spread of effective strategies nationwide, and CDC will 

increase its efforts in this area. By sharing these strategies and 

the lessons learned in REACH communities, CDC will give 

more communities and public health programs across the 

country the tools they need to eliminate health disparities 

among minority populations.

CDC and REACH communities also will continue to work 

together to analyze local data and evaluate program strategies. 

In 2007, the REACH U.S. program will begin a new 5-year 

cycle of community funding, with an increased emphasis

on disseminating effective strategies.

For more information, please contact the Centers for Disease Control and Prevention

 National Center for Chronic Disease Prevention and Health Promotion

4770 Buford Highway NE, Mail Stop K-45, Atlanta, GA 30341-3717

Telephone: 770-488-5269 • E-mail: ccdinfo@cdc.gov • Web: http://www.cdc.gov/reach

REACH Communities in Action

For profiles of all REACH communities,

visit the REACH U.S. Web site at

www.cdc.gov/reach

CS110431