HHS Action Plan to Reduce 

Racial and Ethnic Health Disparities 

A NAtioN free of dispArities 

iN heAlth ANd heAlth cAre 
 

 TABLE OF CONTENTS 

A Nation Free of Disparities in Health and Health Care 

Introduction and Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 

New Opportunities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 

Vision and Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 

Overarching Secretarial Priorities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 

Goal I: Transform Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 

Goal II: Strengthen the Nation’s Health and Human Services Infrastructure 

and Workforce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 

Goal III: Advance the Health, Safety, and Well-Being of the American People . . . . . . . . . . 25 

Goal IV: Advance Scientific Knowledge and Innovation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 

Goal V: Increase Efficiency, Transparency, and Accountability of HHS Programs . . . . . . . 33 

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 

Appendix A: Provisions of the Affordable Care Act that Address Health Disparities . . . . . 39 

Appendix B: Key Opportunities to Advance Health Disparity Reduction at HHS . . . . . . . . 42 

Appendix C: Key Disparity Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 

Appendix D: Acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 

 

 

A Nation Free of Disparities in Health and Health Care 1 

INTrODuCTION AND BACkgrOuND 

Introduction and Background 

“It is time to refocus, reinforce, 

and repeat the message that 

health disparities exist and that 

health equity benefits everyone.”
	

– Kathleen G. Sebelius, Secretary, 

Health & Human Services 

Medical advances and new technologies have provided people in 

America with the potential for longer, healthier lives more than ever 

before. However, persistent and well-documented health disparities 

exist between different racial and ethnic populations and health equity 

remains elusive. Health disparities — differences in health outcomes 


that are closely linked with social, economic, and environmental 

disadvantage — are often driven by the social conditions in which 

individuals live, learn, work and play. This document provides a brief
 

overview of racial and ethnic health disparities and unveils a Department 

of Health and Human Services (HHS) Action Plan to Reduce Racial and 

Ethnic Health Disparities (“HHS Disparities Action Plan”). 

The HHS Disparities Action Plan complements the 2011 National Stakeholder Strategy for Achieving 

Health Equity, a product of the National Partnership for Action (“NPA Stakeholder Strategy”). The NPA 

Stakeholder Strategy reflects the commitment of thousands of individuals across the country in almost 

every sector. It resulted from a public-private collaboration that solicited broad community input with the 

assistance of state and local government and Federal agencies. The NPA Stakeholder Strategy proposes 

a comprehensive, community-driven approach to reduce health disparities in the U.S. and achieve health 

equity through collaboration and synergy. Now, this first-ever HHS Disparities Action Plan and the NPA 

Stakeholder Strategy can be used together to coordinate action that will effectively address racial and 

ethnic health disparities across the country. Furthermore, the HHS Disparities Action Plan builds on national 

health disparities’ goals and objectives recently unveiled in Healthy People 2020, and leverages key 

provisions of the Affordable Care Act and other cutting-edge HHS initiatives. 

With the HHS Disparities Action Plan, the Department commits to continuously assessing the impact of 

all policies and programs on racial and ethnic health disparities. Furthermore, the Department can now 

promote integrated approaches, evidence-based programs and best practices to reduce these disparities. 

Together, the HHS Disparities Action Plan and the NPA Stakeholder Strategy provide strong and visible 

national direction for leadership among public and private partners. While the Department respects and 

recognizes the critical roles other Federal departments play in reducing health disparities, this action plan 

focuses on HHS initiatives. 
 

 

2 A Nation Free of Disparities in Health and Health Care 

INTrODuCTION AND BACkgrOuND 

Overview of Racial and Ethnic Health Disparities 

The societal burden of health and health care disparities in America manifests itself in multiple and major 

ways. In one stark example, Murray et al show a difference of 33 years between the longest living and 

shortest living groups in the U.S.5

 Another study, The Economic Burden of Health Inequalities in the United 

States, by the Joint Center for Political and Economic Studies, concludes that “the combined costs of health 

inequalities and premature death in the United States were $1.24 trillion” between 2003 and 2006.6

 Such 

health disparities arise from both biologic factors and social factors that affect individuals across their 

lifespan. Regarding the latter, the World Health Organization (WHO) defines these “social determinants 

of health” as the conditions in which people are born, grow, live, work and age that can contribute to or 

detract from the health of individuals and communities.7

 Marked difference in social determinants, such 

as poverty, low socioeconomic status (SES), and lack of access to care, exist along racial and ethnic lines. 

These differences can contribute to poor health outcomes.8 

Individuals, families and communities that have systematically experienced social and economic 

disadvantage face greater obstacles to optimal health. Characteristics such as race or ethnicity, religion, 

SES, gender, age, mental health, disability, sexual orientation or gender identity, geographic location, or 

other characteristics historically linked to exclusion or discrimination are known to influence health status.9 

While this HHS Disparities Action Plan focuses primarily on health disparities associated with race and 

ethnicity, many of the strategies can also apply across a wide array of population dimensions. For example, 

expanding healthcare access, data collection, and the use of evidence-based interventions will contribute to 

health equity for vulnerable populations that are defined by income, geography, disability, sexual orientation 

or other important characteristics. 

The Burden of Racial and Ethnic Health Disparities: Major Dimensions 

The leading health indicators have demonstrated little improvement in disparities over the past decade, 

according to recent analyses of progress on Healthy People 2010 objectives. Significant racial and ethnic 

health disparities continue to permeate the major dimensions of health care, the health care workforce, 

population health, and data collection and research. 

Disparities in Health Care: The Institute of Medicine’s (IOM) landmark 2002 report, Unequal Treatment: 

Confronting Racial and Ethnic Disparities in Health Care, identifies the lack of insurance as a significant 

driver of healthcare disparities.11 Lack of insurance, more than any other demographic or economic barrier, 

negatively affects the quality of health care received by minority populations. Racial and ethnic minorities 

are significantly less likely than the rest of the population to have health insurance.12 They constitute about 

one-third of the U.S. population, but make up more than half of the 50 million people who are uninsured.13 
 

A Nation Free of Disparities in Health and Health Care 3 

INTrODuCTION AND BACkgrOuND 

Members of racial and ethnic minority groups are also overrepresented among the 56 million people in 

America who have inadequate access to a primary care physician.14 Minority children are also less likely 

than non-Hispanic White children to have a usual source of care.15 

Since 2002, the annual Agency for Healthcare Research and Quality (AHRQ) National Health Disparities 

Reports (NHDR) have documented the status of healthcare disparities and quality of care received by racial, 

ethnic and socio-economic groups in the United States.16 The NHDR documented that racial and ethnic 

minorities often receive poorer quality of care and face more barriers in seeking care including preventive 

care, acute treatment, or chronic disease management, than do non-Hispanic White patients.17 Minority 

groups experience rates of preventable hospitalizations that are, in some cases, almost double that of 

non-Hispanic Whites.18 African Americans have higher hospitalization rates from influenza than other 

populations.19 African American children are twice as likely to be hospitalized and more than four times as 

likely to die from asthma as non-Hispanic White children.20 

Major efforts to provide quality health care to racial and ethnic populations occur through both longstanding safety net programs, such as the Health Resources and Services Administration (HRSA)-funded 

Community Health Center Program, and new initiatives such as those aimed at increasing meaningful use of 

health information technology by primary care providers. The Community Health Center Program provides 

vulnerable populations access to comprehensive, culturally competent, quality primary healthcare services. 

Of the nearly 19 million patients currently served through these HRSA-funded community health centers, 63 

percent are racial and ethnic minorities and 92 percent have incomes below the federal poverty level.21 

Disparities in the Nation’s Health and Human Services Infrastructure and Workforce: The 2004 

IOM report, In the Nation’s Compelling Interest: Ensuring Diversity in the Health Care Workforce, underscores 

the significant differences in the racial and ethnic composition of the healthcare workforce compared to 

the U.S. population.22 More recently, the American Association of Medical Colleges reported that in 2008, 

Hispanics made up approximately 16 percent of the U.S. population, but accounted for less than 6 percent of 

all physicians.23 African Americans accounted for a similar proportion of the U.S.’s population, but just over 6 

percent of physicians24. 

Racial and ethnic minorities are more likely than non-Hispanic Whites to report experiencing poorer quality 

patient-provider interactions, a disparity particularly pronounced among the 24 million adults with limited 

English proficiency.25 Diversity in the healthcare workforce is a key element of patient-centered care. The 

ability of the healthcare workforce to address disparities will depend on its future cultural competence 

and diversity. 

In addition to cultural competency and diversity issues, shortages of physicians and other health 

professionals in underserved areas significantly affect the health of racial and ethnic minorities. HRSA’s 
 

INTrODuCTION AND BACkgrOuND 

4 A Nation Free of Disparities in Health and Health Care 

National Health Service Corps (NHSC) invests in the healthcare workforce by placing health professionals 

in Health Professional Shortage Areas to care for underserved populations. Currently, 7,000 NHSC 

clinicians provide healthcare services in underserved areas in exchange for loan repayment or scholarships: 

approximately 33 percent of these clinicians are minorities and half serve in community health centers.26 

Disparities in the Health, Safety, and Well-Being of the American People: All people should have 

the opportunity to reach their full potential for health. Yet, those who live and work in low socioeconomic 

circumstances (which disproportionately include racial and ethnic minorities) often experience reduced 

access to healthy lifestyle options and suffer higher rates of morbidity and mortality as compared to their 

higher-income counterparts.27 The recently released Centers for Disease Control and Prevention (CDC) 

report, Health Disparities and Inequalities, demonstrates that African American, Hispanic, Asian American 

and American Indian and Alaska Native populations suffer higher mortality rates than other populations.28 

Cardiovascular diseases, for example, account for the largest proportion of inequality in life expectancy 

between African American and non-Hispanic Whites. Childhood obesity affects racial and ethnic minority 

children at much higher rates than non-Hispanic Whites, driving up rates of associated diabetes.29 

Addressing disparities at the population level involves both new and well-established efforts. For the past 

decade, the CDC’s Racial and Ethnic Approaches to Community Health (REACH) program has empowered 

residents to seek better health, helped change local healthcare practices, and mobilized communities to 

implement evidence-based public health programs to reduce health disparities across a broad range of 

health conditions. More recently, as part of the American Recovery and Reinvestment Act (ARRA) and with 

additional funds from the Affordable Care Act, the 50 CDC-funded Communities Putting Prevention to Work 

(CPPW) programs are supporting statewide and community-based policy and environmental changes in 

nutrition, physical activity, and tobacco control, directly targeting factors that may harm people’s health. 

These recent efforts join well-established programs to provide comprehensive child development services 

to economically disadvantaged children and families. Specifically, the Administration for Children and 

Families’ (ACF) Head Start program promotes the social and cognitive development of children by providing 

educational, health, nutritional, social and other services to enrolled children and families. The Head 

Start program helps parents make progress toward their educational, literacy, and employment goals, 

and engages them in their children’s learning. Most recent data indicate that racial and ethnic minorities 

make up 79 percent of the population served by Head Start, making this program a critical vehicle for 

addressing the social determinants of health disparities.30 And the National Institutes of Health (NIH) has 

woven innovative pilot projects into the Healthy Start setting as a strategy to address the disproportionate 

burden of asthma among minority children and children living in poverty. These projects serve as models for 

developing healthy learning environments to introduce health and asthma self-management skills to children 

and their families. 
A Nation Free of Disparities in Health and Health Care 5 

 INTrODuCTION AND BACkgrOuND 

Disparities in Scientific Knowledge and Innovation: The recent IOM Subcommittee on Standardized 

Collection of Race/Ethnicity Data for Healthcare Quality report emphasizes that inadequate data on race, 

ethnicity, and language lowers the likelihood of effective actions to address health disparities.31 The Office 

of Management and Budget (OMB) has promulgated minimum standard categories for racial and ethnic 

data collection by federal agencies. The race categories include: American Indian or Alaska Native, Asian, 

Black or African American, Native Hawaiian or Other Pacific Islander, and White. The ethnicity category 

includes Hispanic. Enhanced and standardized data on the race, ethnicity, and language spoken by patients 

and other users of the healthcare system would allow better understanding of the barriers faced by racial 

and ethnic minority populations. The lack of standards related to data collection remains a challenge for 

adequately collecting, reporting, and tracking data on health disparities. 

 

A Nation Free of Disparities in Health and Health Care 7 

 NEW OPPOrTuNITIES 

New Opportunities to Reduce Racial and Ethnic Health Disparities 

The Affordable Care Act 

This HHS Disparities Action Plan builds upon the Affordable Care Act – the landmark law signed by 

President Obama last year – that will bring insurance coverage to more than 30 million people. The 

Affordable Care Act not only includes provisions related broadly to health insurance coverage, health 

insurance reform, and access to care, but also provisions related to disparities reduction, data collection 

and reporting, quality improvement, and prevention. The Affordable Care Act will also reduce health 

disparities by investing in prevention and wellness, and giving individuals and families more control over 

their own care. Appendix A provides additional details on the provisions that will affect health disparities. 

Two important initiatives mandated by the Affordable Care Act are the National Strategy for Quality 

Improvement in Health Care, which will include priorities to improve the delivery of health care, and the 

National Prevention and Health Promotion Strategy, which aims to bring prevention and wellness to the 

forefront of national policy. 

HHS Initiatives 

In addition to the Affordable Care Act, the Department can leverage other key national initiatives in its 

effort to reduce racial and ethnic health disparities. 

Healthy People 202032: One of the four overarching goals of the recently unveiled Healthy People 2020 

initiative is “to achieve health equity, eliminate disparities and improve the health of all groups.” Throughout 

the next decade, the Healthy People 2020 initiative will assess health disparities in the U.S. population by 

tracking rates of death, chronic and acute diseases, injuries, and other health-related behaviors for subpopulations defined by race, ethnicity, gender identity, sexual orientation, disability status or special health 

care needs, and geographic location. 

Let’s Move!33 : First Lady Michelle Obama launched the Let’s Move! initiative with the goal of solving the 

challenge of childhood obesity within a generation. The Let’s Move! initiative has five key pillars: (1) creating 

a healthy start in life for our children, from pregnancy through early childhood; (2) empowering parents 

and caregivers to make healthy choices for their families; (3) serving healthier food in schools; (4) ensuring 

access to healthy, affordable food; and (5) increasing physical activity. To bring this initiative to the local 

level, the Secretary, with the First Lady, called on mayors and other local officials to be public leaders of the 

Let’s Move! Cities and Towns initiative. 
 

8 A Nation Free of Disparities in Health and Health Care 

 NEW OPPOrTuNITIES 

The National HIV/AIDS Strategy34: Released by the President in July 2010, the National HIV/AIDS 

Strategy offers a vision that “the United States will become a place where new HIV infections are rare and 

when they do occur, every person, regardless of age, gender, race and ethnicity, sexual orientation, gender 

identity, or socioeconomic circumstance, will have unfettered access to high-quality, life-extending care, 

free from stigma and discrimination.” 

HHS Strategic Action Plan to End the Tobacco Epidemic35: Released in November 2010 by the 

Secretary, this plan is anchored around the four pillars of (1) engaging the public; (2) supporting evidencebased tobacco control policies at the state and local levels; (3) having HHS lead by example; and (4) 

advancing research, especially in the context of new Food and Drug Administration (FDA) authority to 

regulate tobacco. 

Efforts to Reduce Disparities in Influenza Vaccination36: The HHS Seasonal Influenza Task Force has 

launched efforts to maximize vaccinations in targeted racial and ethnic minority groups through coordinated 

Departmental efforts as well as private-public partnerships. 

Interagency Working Group on Environmental Justice37: Executive Order 12898 directs each federal 

agency to make achieving environmental justice part of its mission. HHS and other participating agencies 

are committed to identifying and addressing disproportionately high adverse human health or environmental 

effects on minority and low-income populations. 

HHS Infrastructure 

Critical to the Department’s success is strengthening its infrastructure to prioritize the challenges of 

reducing health disparities and to fully implement this HHS Disparities Action Plan. As mandated by the 

Affordable Care Act, HHS has not only established offices of minority health in six agencies (AHRQ, CDC, 

FDA, HRSA, Centers for Medicare and Medicaid Services [CMS], and Substance Abuse and Mental Health 

Services Administration [SAMHSA]), but also elevated the National Center on Minority Health and Health 

Disparities (now NIMHD) to an institute level at the NIH. Key action steps for these offices include: 

1.	 Enhancing the integration of the missions of offices across the Department to avoid the 

creation of silos. 

2.	 Aligning core principles and functions with the goals, strategies, and actions presented in the 

HHS Disparities Action Plan. 

Collectively, these entities will improve coordination of health disparity efforts across HHS and build 

partnerships with public and private stakeholders. The directors of agency offices of minority health and 
 

A Nation Free of Disparities in Health and Health Care 9 

 NEW OPPOrTuNITIES 

senior staff in other key agencies will constitute the HHS Health Disparities Council overseen by the 

Assistant Secretary for Health. The Council will serve as the venue to share information, leverage HHS 

investments, coordinate HHS activities, reduce program duplication, and track progress on the strategies 

and actions of the HHS Disparities Action Plan. 

In addition, HHS will reinvigorate and reaffirm its continuing commitment by: 

•	 Promoting closer collaboration between operating and staff divisions to achieve a more coordinated 

national response to health disparities; 

•	 Coordinating more effectively its investments in research, prevention, and health care among HHS 

agencies and across the federal government; 

•	 Developing improved mechanisms to monitor and report on progress toward achieving the vision of 

the HHS Disparities Action Plan; and 

•	 Facilitating public input and feedback on Departmental strategies and progress. 

Partnerships with Other Federal Departments 

To help ensure successful implementation of the HHS Disparities Action Plan, the Department will 

collaborate with the Federal Interagency Health Equity Team (FIHET). FIHET seeks to facilitate activities of 

the NPA between federal agencies to increase the efficiencies and effectiveness of policies and programs at 

the local, tribal, state and national levels. This team, which includes representatives of the Departments of 

Agriculture (USDA), Commerce (DOC), Education (ED), Housing and Urban Development (HUD), Labor (DOL), 

Transportation (DOT), and the Environmental Protection Agency (EPA), can collectively address the broad 

range of social determinants of health. 

 

A Nation Free of Disparities in Health and Health Care 11 

VISION AND PurPOSE 

Vision and Purpose 

In November 2010, Secretary Kathleen Sebelius charged HHS with developing a Department-wide action 

plan for reducing racial and ethnic health disparities. This HHS Disparities Action Plan was developed 

through a collaborative, Department-wide process that actively engaged all HHS agencies. The action plan 

emphasizes approaches that are evidence-based and will achieve a large-scale impact. The action plan will 

be operational across HHS immediately. 

The vision of the HHS Disparities Action Plan is: 

“A nation free of disparities in health and health care.” 

The HHS Disparities Action Plan proposes a set of Secretarial priorities, pragmatic strategies, and highimpact actions to achieve Secretary Sebelius’s strategic goals for the Department. The five goals from the 

HHS Strategic Plan for Fiscal Years (FY) 2010-2015 provide the framework for the HHS Disparities Action 

Plan.38 They are: 

I. Transform health care; 

II. Strengthen the nation’s Health and Human Services infrastructure and workforce; 

III. Advance the health, safety, and well-being of the American people; 

IV. Advance scientific knowledge and innovation; and 

V. Increase the efficiency, transparency, and accountability of HHS programs. 

The actions presented in this HHS Disparities Action Plan represent mainly new efforts beginning in FY 

2011 and beyond. The actions are also intended to be carried out with current agency resources, so that 

implementation can proceed without delay. This plan will also serve as guidance for future development, 

subject to the availability of resources. The following pages outline the strategies and actions, with further 

background provided in the two appendices. Appendix A highlights the new opportunities in the Affordable 

Care Act to reduce health disparities. Appendix B summarizes other relevant efforts begun prior to FY 2011 

that also serve to create the strong foundation for the HHS Disparities Action Plan. Implementation of the 

actions will be led either by a single agency or co-led by agencies working in partnership. 

This HHS Disparities Action Plan begins with the Secretarial priorities then presents the goals, strategies, 

and actions. 
 

12 A Nation Free of Disparities in Health and Health Care 

 OVErArCHINg SECrETArIAL PrIOrITIES 

Overarching Secretarial Priorities 

Implementation of the HHS Disparities Action Plan will uphold four overarching Secretarial priorities to 

assure coordination and transformation of both existing programs and new investments. These priorities 

aim to: 

1.	 Assess and heighten the impact of all hhs policies, programs, processes, and 

resource decisions to reduce health disparities. HHS leadership will assure that: 

a.	 All staff and operating divisions will review their strategic plans, 

communications, programs, and regulations to assure that the goals, 

strategies, and actions in the HHS Disparities Action Plan are included to the 

fullest extent possible. 

b.	 Every staff and operating division will assess its current and future capacity to 

support this HHS Disparities Action Plan, and will realign resources to best meet 

the goals. 

c.	 Program grantees, as applicable, will be required to submit health disparity 

impact statements as part of their grant applications. Such statements can 

inform future HHS investments and policy goals, and in some instances, could be 

used to score grant applications if underlying program authority permits. 

2.	 increase the availability, quality, and use of data to improve the health of 

minority populations. Strong surveillance systems must monitor trends in health and 

quality of care measures, as well as patient-centered research activities. HHS will: 

a.	 Ensure that data collection standards for race, ethnicity, sex, primary language, 

and disability status are implemented throughout HHS-supported programs, 

activities, and surveys. 

b.	 Assure public access to data that is appropriately disaggregated and deidentified in order to promote disparities research and assure that data on race 

and ethnicity in federally supported programs, activities, or surveys is routinely 

reported in a format that is available for external analysis. This is consistent with 

the HHS Open Government Initiative. 

c.	 Identify and map high-need/disparity areas and align HHS investments to meet 

these needs. One example of this action is the Value-Driven Health Disparities 

Collaboration Project, which will use data to map and accelerate comprehensive 

planning to coordinate local disparities reduction activities. Working with 
 

A Nation Free of Disparities in Health and Health Care 13 

OVErArCHINg SECrETArIAL PrIOrITIES 

health plans and local health systems, this demonstration project will conduct 

local assessments and map “hot spots” of particular chronic conditions, health 

concerns, or factors known to contribute to ill health. The project will also 

identify gaps in services, programs, funds, and/or actions to effectively address 

the “hot spots” and take advantage of opportunities to promote healthier 

lifestyles. It will also establish ongoing partnerships with the community and 

private sector to reduce health disparities. 

d.	 Develop a system of public reporting of preventable hospital admissions by race 

and ethnicity (non-Hispanic White, African American, Hispanic) for dually eligible 

(Medicare/Medicaid) beneficiaries by hospital and state, with presentation of the 

data as unadjusted and adjusted relative risk ratios. 

e.	 Publicly display aggregately collected Medicaid and Medicare quality measurement 

data in new ways that call attention to racial and ethnic disparities. 

3.	 Measure and provide incentives for better healthcare quality for minority 

populations. Racial and ethnic minorities often receive poorer quality of care and face 

more barriers to seeking care than non-Hispanic Whites.39 Providing incentives for quality 

care in these populations is critical for improving patient outcomes and creating a highvalue healthcare system that promotes equity. HHS will: 

a.	 Implement through CMS an initiative that sets measures and provides incentives 

to improve health care quality, particularly for vulnerable populations. This effort 

will assess and refine current or new measures of chronic disease burdens 

for racial and ethnic minorities, such as heart attack, renal failure, stroke, 

hypertension, and diabetes. CMS will review current measures including those 

used in hospital value-based purchasing, Hospital Compare, Home Health 

Compare, Children’s Health Insurance Program (CHIP) Pediatric Quality Measures 

Programs, and other special payment models. 

b.	 Develop cross-departmental and inter-agency collaborations between CMS, 

HRSA, AHRQ, SAMHSA, and Indian Health Service (IHS) to provide incentives 

for improvements of health care quality. For example, SAMHSA will collaborate 

with CMS to support the development of measures and incentives related to the 

racial and ethnic health burden of depression. 

c.	 Expand health disparities projects, including a CMS initiative to reduce avoidable 

hospital admissions for people dually eligible for Medicare and Medicaid, racial 

and ethnic analyses of CMS Survey and Claims Data, and Quality Improvement 

Organization Disparities Special Initiatives addressing diabetes self management 

training, patient safety, and clinical pharmacy services. 
 

 

 

14 A Nation Free of Disparities in Health and Health Care 

 OVErArCHINg SECrETArIAL PrIOrITIES 

4.	 Monitor and evaluate the department’s success in implementing the hhs 

disparities Action plan. HHS is committed to ensuring program integrity, effective 

program performance, and responsible stewardship of Federal funds. Regular reviews of 

progress will determine not only when goals are being reached, but also when refining or 

changing direction is necessary. 

a.	 Identify cross-cutting areas for collaboration across agencies and offices to 

conduct joint health and healthcare disparities research. 

b.	 On a biannual basis, Office of the Assistant Secretary for Health/Office of 

Minority Health (OASH/OMH) and Assistant Secretary for Planning and 

Evaluation (ASPE) will review and report results of Agency Head progress made 

under this plan. Agencies and offices will refine strategies for improving the 

timeliness and quality of results. 

c.	 On a biannual basis, review progress on Departmental efforts to improve 

coordination in the administration of grants, contracts, and intramural research 

that address reduction of disparities. Reduce duplication, align, or leverage 

resources where appropriate, and eliminate administrative burdens that limit 

efficient use of resources. 
 

 

A Nation Free of Disparities in Health and Health Care 15 

gOAL I 

Goal I: Transform Health Care 

Transforming the current healthcare system and building a high-value healthcare system requires insuring 

the uninsured, making coverage more secure for those who have it, and improving quality of care for all. 

The 2010 Affordable Care Act offers the potential to meet these goals and address the needs of racial 

and ethnic minority populations. Specific provisions, such as those supporting improvements in primary 

care, creating linkages between the traditional realms of health and social services, as well as ongoing 

investments in health information technology, can transform health care and reduce disparities. 

strategy i.A: reduce disparities in health insurance coverage and access to care. Racial and 

ethnic minorities have far lower rates of health insurance coverage than the national average, with 

approximately two of every five persons of Hispanic ethnicity and one of every five non-Hispanic African 

Americans uninsured.40 Removing barriers to coverage based on health status through the Affordable 

Care Act will offer an unprecedented opportunity for access to care, particularly for racial and ethnic 

minorities who have disproportionately higher rates of chronic disease. 

Actions: 

i.A.1 increase the proportion of people with health insurance and provide patient 

protections in Medicaid, chip, Medicare, health insurance exchanges, and 

other forms of health insurance. The Affordable Care Act: (1) allows those with preexisting conditions (first children and eventually everyone) to gain and keep coverage; (2) 

ends lifetime limits on care; (3) covers preventive services recommended with an A or B 

by the U.S. Preventive Services Task Force (USPTF) in Medicare and private health plans; 

and (4) promotes coverage of preventive services recommended with an A or B by the 

USPTF in Medicaid. 

•	 Medicaid coverage will be expanded to individuals under age 65 with incomes 

up to 133 percent of the federal poverty level by 2014, including individuals who 

are not pregnant or are without dependent children. Grants to community-based 

and non-profit organizations, local governments, tribes, and states will support 

outreach activities and enrollment of children who are currently uninsured but 

eligible for Medicaid and CHIP. Such activities will have a focus on reducing 

disparities in coverage for racial and ethnic minorities and those experiencing 

language barriers. 

•	 Each Health Insurance Exchange will offer grants to organizations to establish 

navigator programs, which will raise awareness of the Health Insurance 

Exchange and draw diverse populations to gain access to coverage through the 
 

 

16 A Nation Free of Disparities in Health and Health Care 

 gOAL I 

Health Insurance Exchange. Navigators will provide information in a manner 

that is culturally and linguistically appropriate to the needs of the population 

being served. 

•	 Enrollment procedures will be streamlined to facilitate linkage of children and 

families to health insurance and human service programs by building on the 

existing Express Lane Eligibility. Linking enrollment of children and families in 

CHIP and Medicaid to enrollment in human service programs will improve the 

access and availability of both health care and human services for underserved 

populations. (Express Lane agencies are identified by a Medicaid or CHIP 

program as entities that have the authority to determine program eligibility). 

lead/participating Agencies: CMS, ACF, HRSA, IHS, SAMHSA, USDA 

timeline: FY 2011-2014 

strategy i.B: reduce disparities in access to primary care services and care coordination. 

Access to timely and needed primary healthcare services continues to be a major challenge for racial and 

ethnic minorities.41 The actions below will expand primary care services and invest in training primary 

care providers. A special effort will be made to expand primary care and increase care coordination for 

migrant and seasonal farm workers, people experiencing homelessness, and residents of public housing. 

Actions: 

i.B.1 increase the proportion of persons with a usual primary care provider and 

patient-centered health homes. 

•	 HRSA will award 350 New Access Point grant awards to support new health 

center service delivery sites in medically underserved areas. Doing so will 

improve comprehensive, culturally competent, primary and preventive health 

care services. Funds will not only expand such services (including oral health, 

behavioral health, pharmacy, and/or enabling services) at existing health 

center sites, but will also support major construction and renovation projects at 

community health centers nationwide. 

•	 HRSA will expand its NHSC by placing more primary care providers in 

communities with designated health professional shortage areas. Physicians, 

nurse practitioners, and dentists will receive payments that help satisfy their 

educational loans in return for providing health care in underserved communities. 

•	 Community-based health teams will establish agreements with primary care 

physicians and other health care professionals to improve care coordination 

through patient-centered health homes. This involves coordination of disease 
 

 

A Nation Free of Disparities in Health and Health Care 17 

gOAL I 

prevention services, management of transitions between healthcare providers, 

and improvement of connectivity to a usual source of primary care. 

•	 HRSA will expand its health center quality initiative that provides technical 

assistance and resources to health centers to: (1) become nationally 

recognized as health homes; (2) adopt and meaningfully use health information 

technology; (3) track clinical control of blood pressure and clinical management 

of diabetes; and (4) track reductions in racial and ethnic disparities in low birth 

weight child births. 

lead/participating Agencies: HRSA/CMS, ACF, CDC, SAMHSA 

timeline: Starting in FY 2011 

strategy i.c: reduce disparities in the quality of health care. The quality of care received by racial 

and ethnic minorities continues to be suboptimal, as demonstrated by the 2010 NHDR core indicators of 

quality care in preventive care, acute treatment, and chronic disease management.42 The actions below 

will enhance the quality of care provided to racial and ethnic minorities by removing barriers to the 

timeliness, patient-centeredness of care, and the equitable use of evidence-based clinical guidelines. 

Actions: 

i.c.1 improve the quality of care provided in the health insurance exchanges. Health 

plans participating in the Health Insurance Exchanges, new private, competitive health 

insurance markets for individuals and small employers to be established by 2014, will 

implement a quality improvement strategy using financial and non-financial incentives to 

promote activities to reduce disparities in health and health care. Activities may include 

language services, community outreach, cultural competency training, health education, 

wellness promotion, and evidence-based approaches to manage chronic conditions. 

lead/participating Agencies: CMS 

timeline: FY 2011-2014 

i.c.2 improve outreach for and adoption of certified electronic health record (ehr) 

technology to improve care through the regional extension centers program 

and other federal grant programs. Racial and ethnic minority communities will 

be specifically targeted for EHR outreach and adoption through federal and private 

sector partnerships with HHS agencies, the National Health Information Technology 

Collaborative, and other health organizations. The soon-to-be released “HHS Health 

Information Technology (HIT) Plan to End Health Disparities” will promote HIT interagency 

collaborations and disseminate best practices to improve care provided in underserved 
 

 

 

 

18 A Nation Free of Disparities in Health and Health Care 

 gOAL I 

racial and ethnic communities through the use of technologies such as telehealth, 

electronic health records, clinical tools, and personal health records. 

lead/participating Agencies: ONC, CMS, OASH/OMH, HRSA, NIH 

timeline: Starting in FY 2011 

i.c.3 develop, implement, and evaluate interventions to prevent cardiovascular 

diseases and their risk factors. Heart attacks and strokes are the leading causes of 

premature death for racial and ethnic minorities. This initiative will focus multiple efforts 

on the prevention of cardiovascular diseases and their risk factors. HHS will implement 

interventions that will range from quality of care improvement opportunities to potential 

reimbursement incentives for policy and health system changes. This initiative will involve 

working both with minority providers and providers serving minority populations. 

lead/participating Agencies: CDC, AHRQ, CMS, HRSA, NIH, OASH, ONC, 

timeline: Starting in 2011 

i.c.4 increase access to dental care for children in Medicaid and chip. Given the 

relatively high percentage of racial and ethnic minority children (under the age of 19) with 

public insurance, this action will help to address disparities in coverage and access to 

oral health services. Specifically, this initiative seeks to increase by 10 percent the rate 

of children up to age 20 enrolled in Medicaid or CHIP who receive any preventive dental 

service and the rate of enrolled children ages six to nine who receive a dental sealant on a 

permanent molar tooth. The initiative includes working with states to develop oral health 

action plans, strengthening technical assistance to states and tribes, improving outreach 

to dental healthcare providers, increasing outreach to beneficiaries and partnering with 

other relevant governmental agencies and private sector organizations. 

lead/participating Agencies: CMS, ACF, CDC, HRSA, OASH/OMH 

timeline: Starting in 2011 
 

 

A Nation Free of Disparities in Health and Health Care 19 

gOAL II 

Goal II: Strengthen the Nation’s Health and Human Services Infrastructure 

and Workforce 

Strengthening the nation’s health and human services infrastructure involves addressing the critical 

shortage of primary care physicians, nurses, behavioral health providers, long-term care workers, and 

community health workers in the U.S. With growing national diversity, the disparity between the racial and 

ethnic composition of the healthcare workforce and that of the U.S. population widens as well. 

Strategies to address the gaps in workforce diversity and shortages includes expanding the use of 

healthcare interpreters to overcome language barriers, improving the quality of patient-provider interactions 

in clinical settings, improving cultural competence education and training for health care professionals, and 

increasing racial and ethnic diversity in the healthcare workforce.43 

strategy ii.A: increase the ability of all health professions and the healthcare system to 

identify and address racial and ethnic health disparities. Racial and ethnic minorities, and 

especially people whose primary language is not English, are more likely to report experiencing poorer 

quality patient-provider interactions than non-Hispanic Whites.44 The actions below will address this 

disparity and optimize patient-provider interactions. 

Actions: 

ii.A.1 support the advancement of translation services. 

•	 promote the healthcare interpreting profession as an essential component 

of the healthcare workforce to improve access and quality of care for people 

with limited english proficiency. In partnership with national organizations for 

certification of interpreters, HHS will improve quality of care for people with limited 

English proficiency. This includes promoting the knowledge, skills, and abilities required 

for healthcare interpreting, educating individuals about the pathways into the healthcare 

interpreting profession, and establishing an accessible online national registry of 

certified interpreters to allow healthcare facilities and providers to quickly identify 

certified interpreters. Collaborations with community colleges will develop effective 

training programs that help build the profession of healthcare interpreters and deliver 

credentialing examinations for healthcare interpreters. 

•	 improve language access in Medicaid. This initiative will pilot test software for 

a web-based enrollment system that enables Medicaid staff to interview non-English 

speaking or low-literacy applicants, and help those applicants to apply for Medicaid and 
 

 

20 A Nation Free of Disparities in Health and Health Care 

 gOAL II 

CHIP benefits. This will allow a higher federal matching rate for state administrative 

costs dedicated to translation/interpretation services, including American Sign 

Language or Braille. This initiative will also encourage states to: employ staff members 

to provide translation or interpretation functions; pay for direct translator/interpreter 

support to medical providers; translate brochures, commercials, radio and newspaper 

advertisements, and other promotional material into other languages; and provide 

interpretation hotlines for Medicaid and CHIP recipients. 

lead/participating Agencies: OASH/OMH, CMS, HRSA 

timeline: Starting in FY 2011 

ii.A.2 collaborate with individuals and health professional communities to 

make enhancements to the current National standards for culturally and 

linguistically Appropriate services in health care (clAs). The CLAS Standards, 

released in 2000, represent the first national standards for culturally competent 

healthcare service delivery. These standards will be updated, via a CLAS Standards 

Enhancement Initiative. Improvements will be informed by the responses received 

throughout the recently ended public comment period and three previously held regional 

public meetings. HHS will maximize public input, stakeholder dialogue, and subject 

matter expertise to ensure that the enhanced CLAS Standards serve the health needs of 

populations experiencing health disparities. 

lead/participating Agencies: OASH/OMH, SAMHSA 

timeline: Starting in FY 2011 

strategy ii.B: promote the use of community health workers and promotoras. While Health 

Insurance Exchanges and expansions in Medicaid created by the Affordable Care Act offer much promise 

for racial and ethnic minorities, targeted efforts are necessary to ensure that they are enrolled and 

receive the health benefits for which they are eligible. Promotoras are individuals who provide health 

education and support to their community members. Community health workers and Promotoras can 

provide enrollment assistance and serve as critical liaisons between community members and health and 

human services organizations.45 

Actions: 

ii.B.1 increase the use of promotoras to promote participation in health education, 

behavioral health education, prevention, and health insurance programs. This 

initiative includes: establishing a National Steering Committee for Promotoras; developing 

a national training curriculum and uniform national recognition for them; creating a 
 

 

 

 

A Nation Free of Disparities in Health and Health Care 21 

gOAL II 

national database system to facilitate recruitment and track training and certification of 

Promotoras; and supporting and linking Promotoras’ networks across the Nation. As part 

of ACF’s Head Start Program, Promotoras and community health workers can help parents 

effectively navigate the healthcare system and manage health care for their children. 

lead/participating Agencies: OASH/OMH, ACF, CDC, CMS, HRSA, SAMHSA 

timeline: Starting in FY 2011 

ii.B.2 promote the use of community health workers by Medicare beneficiaries. 

This initiative will promote the use of community health workers as members of 

interdisciplinary teams and multi-sector teams. Enabling payment of community 

health workers as members of diabetes self-management training teams, for example, 

improves the provision of health care, health education, disease prevention services, 

and connection to health homes will be enhanced. These workers will improve patients’ 

diabetes self-management skills in many ways including the provision of plain language 

health-related information in non-clinical community settings. 

lead/participating Agencies: CMS, CDC, HRSA, IHS, OASH 

timeline: Starting in FY 2011 

strategy ii.c: increase the diversity of the healthcare and public health workforces. Numerous 

studies have shown racial and ethnic minority practitioners are more likely to practice in medically 

underserved areas and provide health care to large numbers of racial and ethnic minorities who are 

uninsured and underinsured. This strategy includes actions to increase the diversity of the health care and 

public health workforces to address the compelling need for reductions in healthcare disparities.46 

Actions: 

ii.c.1 create a pipeline program for students to increase racial and ethnic diversity in 

the public health and biomedical sciences professions. Create an undergraduate 

pipeline program to increase racial and ethnic diversity in the health professions. This 

initiative will fund a national program to provide early educational opportunities for 

undergraduate students from health disparity populations to encourage careers in public 

health and biomedical sciences. 

lead/participating Agencies: CDC, NIH 

timeline: Starting in FY 2011 

ii.c.2 increase education and training opportunities for recipients of temporary 

Assistance for Needy families (tANf) and other low-income individuals 
 

 

 

22 A Nation Free of Disparities in Health and Health Care 

 gOAL II 

for occupations in healthcare fields through health profession opportunity 

Grants (hpoG) program. HPOGs aim to improve the work readiness and employment 

outcomes for low-income workers and TANF beneficiaries. The ACF’s Offices of Family 

Assistance and Refugee Resettlement will promote linkages between the HPOG grantees 

and refugee communities to offer the training programs. Training programs can include 

home care aides, certified nursing assistants, medical assistants, pharmacy technicians, 

emergency medical technicians, licensed vocational nurses, registered nurses, dental 

assistants, and health information technicians. Graduates of the training programs receive 

an employer- or industry-recognized certificate or degree. 

lead/participating Agencies: ACF 

timeline: Starting in FY 2011 

ii.c.3	 increase the diversity and cultural competency of clinicians, including the 

behavioral health workforce. 

•	 HRSA will develop a plan for targeted recruitment of students from backgrounds 

that are underrepresented in the healthcare workforce. Activities will include 

implementing innovative strategies to encourage student interest in primary care 

and application to the NHSC scholarship program. In addition, HRSA will develop 

new approaches for reaching minority health professions students before they 

enter the job market through the loan repayment program. HRSA will assess 

the results of targeted efforts to expand outreach, mentorship, partnership, and 

recruitment practices. 

•	 Through the newly funded Center for Integrated Health Solutions (CIHS) that 

works with higher-education institutes, SAMHSA will grow a diverse workforce 

to provide services in integrated primary care and behavioral health settings 

for vulnerable populations. CIHS will strengthen the capacity and skills of 

practitioners working in integrated care settings to better address the needs of 

racial and ethnic minority populations. 

•	 Utilizing its National Network to Eliminate Disparities in Behavioral Health 

(NNED), SAMHSA will launch two new Communities of Practice for providers. 

This includes accessing virtual training and technical assistance to implement 

evidence-based behavioral health interventions focused on trauma and traumarelated disorders geared to minority populations. 

•	 Through its Historically Black Colleges and Universities (HBCU) Center for 

Excellence, SAMHSA will increase the diversity of the workforce by training 

teams of clinicians, faculty, and students from HBCUs on best practices in 

behavioral health promotion, screening, and intervention. The Behavioral Health 

Policy Academy and related virtual events will serve as the primary venue for 
 

 

A Nation Free of Disparities in Health and Health Care 23 

gOAL II 

capacity development across 105 HBCUs. 

lead/participating Agencies: HRSA, NIH, SAMHSA 

timeline: Starting in FY 2011 

ii.c.4	 increase the diversity of the hhs workforce. The Office of Human Resources 

recently launched the Hispanic Initiative focused on the hiring, recruitment, and retention 

of Hispanics into the HHS workforce as the Department lags behind many agencies in the 

percentage of Hispanics that make up its workforce. Utilizing a multi-faceted approach, 

HHS will continually track Hispanic employment and recruitment efforts and conduct 

quarterly meetings to monitor progress. HHS is pursuing implementation of the Hispanic 

Serving Institution Fellowship Program, developed with the Hispanic Association of 

Colleges and Universities (HACU), which would provide HHS professional rotations for 

Hispanic academics working in the education and science field. HHS is also working with 

HACU to provide internships to college students in an effort to connect HHS with young 

Hispanic professionals at the start of their careers. HHS is also developing a Toolkit for 

managers and supervisors to provide guidance on methods of outreach, recruitment, and 

retention of Hispanics and other underrepresented populations in the HHS workforce. 

HHS recently signed a Memorandum of Understanding (MOU) with five Hispanic-serving 

organizations to establish a framework for cooperative initiatives. HHS and these 

organizations are phasing in a variety of programs over the coming year to increase 

Hispanic employment in HHS occupations. 

lead/participating Agencies: ASA, all other HHS Agencies 

timeline: Starting in FY 2011 

 

 

 

A Nation Free of Disparities in Health and Health Care 25 

gOAL III 

Goal III: Advance the Health, Safety, and Well-Being of the American People 

Advancing the health, safety, and well-being of the American people has special relevance for racial and 

ethnic minorities who fare far worse than their non-Hispanic White counterparts across a broad range 

of health indicators.47 Creating environments that promote healthy behaviors to prevent and control 

chronic diseases and their risk factors requires renewed commitment to prevention, with an emphasis on 

strengthening community-based approaches to reduce high-risk behaviors. 

strategy iii.A: reduce disparities in population health by increasing the availability and 

effectiveness of community-based programs and policies. The actions under this strategy include 

the implementation of both universal and targeted interventions to close the modifiable gaps in health, 

longevity, and quality of life among racial and ethnic minorities. 

Actions: 

iii.A.1 Build community capacity to implement evidence-based policies and 

environmental, programmatic, and infrastructure change strategies. 

•	 Through the Affordable Care Act, the CDC Community Transformation Grants 

Program will implement, evaluate, and disseminate evidence-based community 

preventive health activities. The goal is to reduce chronic disease rates, prevent 

the development of secondary conditions, address health disparities, and 

develop a stronger evidence base for effective prevention programming. Funded 

communities will work across multiple sectors to reduce heart attacks, cancer, 

and strokes by addressing a broad range of risk factors and conditions including 

poor nutrition and physical inactivity, tobacco use, and others. While the program 

is designed to reach the entire population, special emphasis is placed on 

reducing health disparities and reaching rural and frontier areas. 

lead/participating Agencies: CDC 

timeline: Starting in FY 2011 

iii.A.2 implement an education and outreach campaign regarding preventive benefits. 

The campaign will be a national public-private partnership to raise public awareness 

of health improvement across the lifespan supported by the Affordable Care Act. 

The campaign will reach racial and ethnic minority populations with messages on the 

importance of accessing preventive services to relevant to nutrition, physical activity, and 

tobacco use. 

lead/participating Agencies: CDC, CMS, HRSA, IHS, SAMHSA

 timeline: Starting in FY 2012 
 

 

 

 

26 A Nation Free of Disparities in Health and Health Care 

 gOAL III 

iii.A.3 

iii.A.4 

iii.A.5 

develop, implement, and evaluate culturally and linguistically appropriate 

evidence-based initiatives to prevent and reduce obesity in racial and ethnic 

minorities. 

•	 HRSA will sponsor a Healthy Weight Learning Collaborative to disseminate 

evidence-based and promising clinical and community practices to promote 

healthy weight in communities across the nation. 

•	 The Childhood Obesity Research Demonstration Project, led by CDC, will 

develop, implement, and evaluate multi-sectoral and multi-level interventions for 

underserved children aged two to 12 years and their families. The project uses an 

integrated model of primary care and public health approaches to lower risk for 

obesity in racial and ethnic minority communities. 

lead/participating Agencies: CDC, HRSA, ACF, AHRQ, CDC, NIH 

timeline: Starting in FY 2011 

reduce tobacco-related disparities through targeted evidence-based 

interventions in locations serving racial and ethnic minority populations. 

Reducing smoking prevalence among racial and ethnic minorities will require programs 

and interventions that are both culturally relevant and evidence based. Efforts will include 

tobacco-free policies, quitline promotion, and counseling and cessation services in sites 

such as public housing, community health centers, substance abuse facilities, mental 

health facilities, and correctional institutions. 

lead/participating Agencies: OASH/OMH, CDC, FDA, ACF, HRSA, IHS, NIH, SAMHSA, 

OASH/OWH 

timeline: Starting in FY 2011 

increase education programs, social support, and home-visiting programs to 

improve prenatal, early childhood, and maternal health. HRSA’s Maternal, Infant, 

and Early Childhood Home Visitation program aims to meet the diverse needs of children 

and families in at-risk communities, particularly underserved minority women and their 

families with limited social support networks. Eligible entities can implement effective 

home-visiting services -- including coordination and referrals to other community services 

-- that can lead to improved outcomes in prenatal, maternal, newborn, and child health 

and development; parenting skills; school readiness; and family economic self sufficiency. 

These services can also lead to reductions in crime, domestic violence, and parental 

substance abuse. 

lead/participating Agencies: ACF, HRSA, OASH/OPA, SAMHSA 

timeline: Starting in FY 2011 
 

A Nation Free of Disparities in Health and Health Care 27 

gOAL III 

iii.A.6 implement targeted activities to reduce disparities in flu vaccination. This 

initiative will improve vaccination rates in racial and ethnic minority communities. 

These activities, building on demonstration efforts in the 2010-2011 flu season, will 

include working with the private sector (pharmacy chains, health plans, and others), 

medical associations, community-based organizations, and state and local public health 

departments to increase the availability of flu vaccine and communicate a common set of 

messages about the seriousness of flu and the safety of the vaccine. 

lead/participating Agencies: OASH/NVPO, OASH/OMH, CDC, ACF, CMS, FDA, HRSA 

timeline: Starting in FY 2011 

iii.A.7 implement targeted activities to reduce asthma disparities. 

•	 implement the coordinated federal initiative to reduce Asthma 

disparities. This interagency initiative, part of the President’s Task Force 

on Environmental Health Risks and Safety Risks to Children, will promote 

best practices in asthma care to reduce disparities. These practices include: 

implement HHS clinical practice guidelines; link public and private stakeholders 

at the community level to deliver comprehensive, consistent, and integrated 

programs; optimize the tracking and targeting of populations disproportionately 

affected by childhood asthma; and develop a coordinated research agenda on 

asthma prevention and decreasing asthma severity. 

•	 Measure and promote better asthma care for racial and ethnic minorities 

through Medicaid and CHIP demonstration grants to states. Activities will 

support environmental interventions, nontraditional asthma educators, and 

testing of core asthma measures. 

lead/participating Agencies: NIH, AHRQ, CDC, CMS, HRSA, and all other 

HHS agencies 

timeline: Starting in FY 2011 
 

 

28 A Nation Free of Disparities in Health and Health Care 

 gOAL III 

strategy iii.B: conduct and evaluate pilot tests of health disparity impact assessments of 

selected proposed national policies and programs. Entities ranging from local health departments, 

national foundations, the World Health Organization, and several countries, are conducting health impact 

assessments on proposed policies and programs. Health disparity impact assessments have the potential 

to inform policymakers of likely impacts of proposed policies and programs on health and healthcare 

disparities among racial and ethnic minorities, and to reduce disparities through improving new policies 

and programs. 

Actions: 

iii.B.1 Adopt a “health in all policies” approach. Develop, implement, and monitor 

strategies addressing health disparities by engaging other key federal departments, the 

private sector, and community-based organizations to adopt a “health in all policies” 

approach, including a health impact assessment for key policy and program decisions. 

lead/participating Agencies: OASH/OMH, All HHS Agencies 

timeline: Starting in FY 2012 

iii.B.2. evaluate use of health disparity impact assessment for proposed policies and 

programs. HHS will collaborate with national foundations to conduct and evaluate pilot 

tests of health disparity impact assessments of selected proposed national policies and 

programs. 

lead/participating Agencies: OASH/OMH, All HHS Agencies 

timeline: Starting in FY 2012 
 

A Nation Free of Disparities in Health and Health Care 29 

gOAL IV 

Goal IV: Advance Scientific Knowledge and Innovation 

While scientific advances have improved the longevity and quality of life for people in America, these gains 

have not been experienced equally by racial and ethnic minorities.48 Advancing scientific knowledge and 

innovation can improve patient-centered research in the areas of prevention, screening, diagnostic and 

treatment services, and strengthen existing information systems to reduce and improve the quality of health, 

public health, and biomedical research. These efforts must benefit all populations. 

strategy iV.A: increase the availability and quality of data collected and reported on racial and 

ethnic minority populations. The capacity of HHS to identify disparities and effectively monitor efforts 

to reduce them is limited by a lack of specificity, uniformity, and quality in data collection and reporting 

procedures. Consistent methods for collecting and reporting health data by race, ethnicity, and language 

are essential. 

Actions: 

iV.A.1 implement a multifaceted health disparities data collection strategy across 

hhs. This initiative will: 

•	 Establish data standards and ensure federally conducted or supported health 

care or public health programs, activities, or surveys collect and report data in 

five specific demographic categories: race, ethnicity, gender, primary language, 

and disability status as authorized in the Affordable Care Act; 

•	 Oversample minority populations in HHS surveys; 

•	 Develop other methods for capturing low-density populations (Native Americans, 

Asian Americans and Pacific Islanders) when oversampling is not fiscally feasible; 

•	 Use analytical strategies and techniques, such as pooling data across several 

years, to develop estimates for racial and ethnic minority populations; 

•	 Publish estimates of health outcomes for racial and ethnic minority populations 

and subpopulations on a regular, pre-determined schedule; 

•	 Improve public access to HHS minority data and promotion of external 

analyses; and 

•	 Develop and implement a plan for targeted special population studies, internally 

or through research grant funding announcements and contracts. 

This initiative will also address gaps in subpopulations traditionally missed by 

standard HHS data collection activities. 

lead/participating Agencies: ASPE/Data Council, AHRQ, CDC, CMS, OASH/ 

OMH, all other HHS Agencies 

timeline: Starting in FY 2011 
 

30 A Nation Free of Disparities in Health and Health Care 

 gOAL IV 

strategy iV.B: conduct and support research to inform disparities reduction initiatives. Health 

disparities research can inform initiatives to improve the health, longevity, and quality of life among racial 

and ethnic minorities by bridging the gap between knowledge and practice. 

Actions: 

iV.B.1 develop and implement strategies to increase access to information, tools, and 

resources to conduct collaborative health disparities research across federal 

departments. Bringing together various federal departments to pool government 

resources and expertise to utilize and disseminate health disparities research results 

will accelerate efforts to address social determinants of health in multiple settings. This 

initiative will develop coordinated research protocols and Memoranda of Agreement to 

facilitate collaboration across departments and agencies. 

lead/participating departments/Agencies: HHS/NIH, DOE, DOL, ED, EPA, USDA, VA 

timeline: Starting in FY 2011 

iV.B.2 develop, implement, and test strategies to increase the adoption and 

dissemination of interventions based on patient-centered outcomes research 

among racial and ethnic minority populations. Patient-centered outcomes research 

informs healthcare decisions by providing evidence on the effectiveness, benefits, and 

harms of different treatment options. By working collaboratively with research and 

healthcare institutions, HHS can develop, implement, and test strategies to increase 

the adoption and dissemination of interventions based on patient-centered outcomes 

research among racial and ethnic minority populations. Targeted health conditions will 

include diabetes mellitus, asthma, arthritis, and cardiovascular diseases including stroke 

and hypertension. 

lead/participating Agencies: NIH, AHRQ, ASPE, OASH/OMH 

timeline: Starting in FY 2011 

iV.B.3 promote community-based participatory research (cBpr) approaches 

to increase cancer awareness, prevention, and control to reduce health 

disparities. The NIH is supporting various CBPR approaches that integrate the complex 

and multi-level determinants of health to reduce the burden of disease such as cancer, 

cardiovascular diseases, and diabetes within communities. This initiative will fund 

new cooperative agreements through the existing National Cancer Institute (NIH/NCI) 

Community Networks Program centers to increase knowledge of, access to, and utilization 

of biomedical and behavioral procedures for reducing cancer disparities. Such efforts 

range from prevention through early detection, diagnosis, treatment, and survivorship in 
 

A Nation Free of Disparities in Health and Health Care 31 

gOAL IV 

racial and ethnic minorities and other underserved populations. The Centers also provide 

an opportunity for training health disparity researchers (particularly new and early-stage 

investigators) in CBPR approaches and cancer health disparities. 

lead/participating Agencies: NIH 

timeline: Starting in FY 2011 

iV.B.4 expand research capacity for health disparities research. This initiative will 

support efforts to expand faculty-initiated health disparities research programs 

and improve the capacity for training future research scientists. Through extending 

infrastructure like the NIMHD Research Infrastructure in Minority Institutions Program, 

HHS will support researchers to study health disparities to improve the scientific 

infrastructure needed to find solutions. 

lead/participating Agencies: NIH, HRSA, OASH/OMH 

timeline: Starting in FY 2011 

iV.B.5 leverage regional variation research in search of replicable success in health 

disparities. Studies of systems where racial and ethnic minorities receive the highest 

quality of care and have the best health outcomes can reveal important tools to improve 

health disparities. Thorough research may reveal the specific mechanisms that solve this 

recalcitrant issue. HHS will support researchers who search for successful models and 

identify effective solutions to address health disparities. 

lead/participating Agencies: NIH, AHRQ 

timeline: Starting in FY 2011 

 

A Nation Free of Disparities in Health and Health Care 33 

gOAL V 

Goal V: Increase Efficiency, Transparency, and Accountability of 

HHS Programs 

Promoting better collaboration and streamlining efforts can improve the efficiency of HHS programs. 

Addressing racial and ethnic health disparities in an efficient, transparent, and accountable manner will 

require better coordination and integration of the minority health infrastructure and programs. Using 

transparent measures can help the Department hold itself accountable. Other HHS open-government 

activities such as the Community Health Data Initiative — a major new public-private effort to help people 

understand health and healthcare performance in their communities and to spark and facilitate action to 

improve performance — will promote local application of measures. 

streamline grant administration for health disparities funding. The Department will improve 

the coordination of the administration of grants that address health disparities by identifying effective 

ways to implement processes that simplify grant administrative activities for communities, communitybased organizations, tribes, and states. This will include moving toward standardizing grantee reporting 

requirements, developing common metrics to reduce inefficiencies, and identifying opportunities to 

leverage investments.

 Monitor and evaluate implementation of the hhs disparities Action plan. To assure 

accountability and a clear focus on performance and outcomes, HHS will employ a multi-level monitoring 

and evaluation approach to track progress on implementation and outcomes of the HHS Disparities Action 

Plan. Goal, strategy and action-level indicators will be assessed. At the goal level, HHS will monitor 

disparities data to assess the extent to which progress is being made in the five goals. At the strategy 

level, HHS will undertake program evaluations to assess the extent to which changes in strategy-level 

objectives are correlated with action steps. At the action level, HHS will track performance data to 

determine the extent to which actions are completed and assess the timeliness of completion. Collectively, 

these evaluation activities will help us to understand our progress toward achieving the vision of the HHS 

Disparities Action Plan.

 Goal-level disparities Monitoring and surveillance. To monitor the nation’s overall progress 

toward achieving desired changes in disparities indicators, HHS will annually track progress on measures 

selected from multipurpose national data systems such as population-based surveys to track progress. 

These measures will reflect the goals of the HHS Disparities Action Plan, Healthy People 2020 disparity 

objectives, and Affordable Care Act provisions. Measures will be publicly accessible and will provide timely 

updated information. HHS data systems will be used to provide data for these measures. Measures are 

listed in Appendix C. 
 

34 A Nation Free of Disparities in Health and Health Care 

 gOAL V 

strategy-level evaluation. HHS will work with lead agencies to develop an evaluation plan for 

relevant actions within the HHS Disparities Action Plan. Evaluations will focus on the extent to which 

outcomes from implemented actions are correlated with desired strategies and changes. For example, HHS 

may conduct an evaluation to assess whether the creation of specific payment structure incentives by Health 

Insurance Exchanges have improved health outcomes among racial and ethnic and low-income populations. 

These evaluation efforts will build upon existing monitoring and evaluation infrastructures. Each agency 

of the Department routinely conducts evaluations designed to assess the process, outcomes, and 

effectiveness of its own programs based on what aspects of disparity are targeted. Efforts are made to 

ensure all programs have measurable objectives that can be used to direct program activities and measure 

the benefits accruing to the target populations. To this end, the agency may directly collect data in the 

process of administering the program relating to performance. It may also conduct special evaluation 

studies to assess program outcomes and impacts. All monitoring and evaluation is designed in full 

recognition that in addition to actions outlined in the plan, changes in disparities are also related to ongoing 

efforts at various levels in government and private sector organizations, including efforts that address social 

determinants of health.

 Action-level Monitoring. HHS will routinely monitor agency and office progress in completing actions 

within the HHS Disparities Action Plan. As a part of this process, HHS will utilize existing performance 

measures, such as Government Performance and Results Act (GPRA) measures, and other program 

performance monitoring data systems. Additional performance metrics may be identified to allow HHS to 

identify barriers to action success and assess overall progress on HHS Disparities Action Plan implementation. 
 

A Nation Free of Disparities in Health and Health Care 35 

CONCLuSION 

Conclusion 

This HHS Disparities Action Plan in support of the National Stakeholder Strategy will accelerate national 

momentum toward reducing racial and ethnic health care disparities. The Affordable Care Act represents 

the most significant federal effort to reduce disparities in the country’s history. By building on the 

Affordable Care Act and shaping the Department’s health disparities reduction activities around the 

Secretary’s priorities, the Department will lead by example. Through the release of this Action Plan, the 

Department commits to the vision of a nation free from disparities in health and health care for racial and 

ethnic minority populations. 
 

36 A Nation Free of Disparities in Health and Health Care 

 rEFErENCES 

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The National Academies Press; 2002 
 

A Nation Free of Disparities in Health and Health Care 39 

APPENDICES
 

Appendix A: Provisions in the Affordable Care Act that Address 

Health Disparities 

Expanding coverage and access to care: Mechanisms such as Medicaid expansion (2014) and Health 

Insurance Exchanges (2014) will give millions of people and small businesses access to affordable coverage. 

The Medicaid program provided services to an average of 50 million people in 2009; with the expected 

expansion (2014), the number could potentially increase by 16 million by 2019. Health Insurance Exchanges 

and new private competitive health insurance markets will help individuals and small employers select 

and enroll in high-quality, affordable private health plans. These will make purchasing health insurance 

easier and more understandable. Special efforts should be made to reach target populations and put 

greater choice in the hands of individuals and small businesses. Additionally, the Affordable Care Act 

requires health plans and encourages state Medicaid programs to place a strong emphasis on prevention, 

specifically by encouraging coverage for: i) any clinical preventive service recommended with a grade A or B 

by the U.S. Preventive Services Task Force (USPTF); and ii) for immunizations recommended by the Advisory 

Committee on Immunization Practices (ACIP). Through the Medicare program, beneficiaries can now receive 

personalized prevention plans, an initial preventive physical examination, and any Medicare-covered 

preventive service recommended (grade A or B) by the USPTF. 

Nondiscrimination: Section 1557 of the Affordable Care Act extends the application of existing federal civil 

rights laws prohibiting discrimination on the basis of race, color or national origin, gender, disability, or age 

to any health program or activity receiving federal financial assistance; any program or activity administered 

by an executive agency; or any entity established under Title 1 of the Act or its amendments. Entities 

subject to § 1557 must provide information in a culturally and linguistically appropriate manner in 

order to comply with the relevant anti-discrimination provisions of Title VI of the Civil Rights Act of 

1964 (§ 1557 explicitly references the legal protections of Title VI of the Civil Rights Act of 1964, Title 

IX of the Education Amendments of 1972, the Age Discrimination Act of 1975, and section 504 of the 

Rehabilitation Act of 1973). 

Data: Section 4302 of the Affordable Care Act contains provisions to strengthen federal data collection 

efforts by requiring that all federally funded programs to collect data on race, ethnicity, primary language, 

disability status, and gender. 

HRSA Community Health Center Program: The Affordable Care Act expands access to primary health care 

by investing $11 billion into the HRSA Community Health Center program over the next five years. Together 

with funds from ARRA, the Affordable Care Act will enable the Community Health Center programs to 
 

40 A Nation Free of Disparities in Health and Health Care 

APPENDICES
 

nearly double the number of patients served over the next five years. A key component of the health 

center program will be the implementation of the New Access Points (NAPs) grant program. For Fiscal Year 

2011, HRSA has committed to support 350 NAPs to increase preventive and primary healthcare services 

for eligible public and nonprofit entities including tribal, faith-based and community-based organizations. 

Additional funding of up to $335 million will be available this year for expanded services in existing health 

centers and $10 million for 125 planning grants to help communities without a health center to develop 

one. The Community Health Center program provides care to vulnerable populations by assuring access to 

comprehensive, culturally competent, quality primary healthcare services. Of the nearly 19 million patients 

currently served through these HRSA-funded health centers, 63 percent are racial and ethnic minorities, and 

92 percent are below the federal poverty level. 

Health Professional Opportunity Grants (HPOG): HPOG are human service program grants that primarily 

assist organizations that serve populations with high concentrations of Native American, Hispanic, and 

African American people. The TANF program provides grants to states to administer a time-limited welfare 

program to assist needy families in achieving self-sufficiency. Recognizing the need for a larger, welltrained healthcare workforce, HPOG will provide comprehensive healthcare-related training to low-income 

workers and TANF participants to improve their ability to enter various health professions. To increase their 

opportunity for success, HPOG will work with community partners to enhance supportive services such as 

transportation, dependent care, and temporary housing for low-income workers and TANF participants. 

Maternal, Infant, and Early Childhood Home Visitation Program: The Affordable Care Act provides support for 

the Maternal, Infant, and Early Childhood Visitation Program. Home visiting is an effective and relatively 

low-cost strategy used by public health and human services programs to foster child development and 

improve prenatal and postnatal health outcomes. The families that benefit from these visits are in 

communities with concentrations of premature births, low birth-weight infants, infant mortality, poverty, 

crime and domestic violence, high rates of high school dropouts, substance abuse, and unemployment. 

National Health Service Corps (NHSC): The Affordable Care Act provides $1.5 billion over five years to 

expand the NHSC. Of note, since the 1970s, the NHSC funds and places health professionals in Health 

Professional Shortage Areas to provide healthcare services to underserved populations. Currently, 7,000 

NHSC clinicians are providing healthcare services in underserved areas in exchange for loan repayment or 

scholarships, with approximately half of them in health centers. Approximately one-third of these clinicians 

are minorities. 
 

A Nation Free of Disparities in Health and Health Care 41 

APPENDICES
 

Prevention and Public Health Funds: Community Transformation Grants: The Affordable Care Act authorizes 

Community Transformation Grants to state and local governmental agencies, tribes and territories, and 

national and community-based organizations for the implementation, evaluation, and dissemination of 

evidence-based community preventive health activities to reduce chronic disease rates, prevent the 

development of secondary conditions, and address health disparities. This program is intended to build on 

CDC’s “Communities Putting Prevention to Work” program. 

Promotoras, also known as peer leaders, community ambassadors, patient navigators or health advocates: The 

Affordable Care Act authorizes promotion of these community health workers uniquely skilled in providing 

culturally and linguistically appropriate services, particularly in diverse, underserved areas. Community 

health workers can play a critical role in providing enrollment assistance to racial and ethnic minorities. 
 

42 A Nation Free of Disparities in Health and Health Care 

APPENDICES
 

Appendix B: Key Opportunities to Advance Health Disparity Reduction 

Activities at the U.S Department of Health and Human Services 

The following healthcare initiatives and prevention programs present a unique opportunity to use innovative 

approaches to improve and change healthcare practices and policies across the public health system to 

sharply reduce disparities among racial and ethnic minority populations. 

Center for Integrated Health Solutions (CIHS). This Center, co-funded with HRSA, falls within the SAMHSA 

Primary and Behavioral Health Care Integration Program. CIHS is dedicated to addressing the comprehensive 

care needs of people in or seeking long-term recovery from addiction and mental illness by improving the 

coordination of healthcare services in publicly funded community settings, and promoting whole health and 

recovery self management. SAMHSA recognizes that members of underserved racially and ethnically diverse 

communities are more likely to seek care from a primary care provider than from a community behavioral 

health provider. CIHS supports primary care providers to enhance their capacity to appropriately screen 

and refer individuals for behavioral health issues, with emphasis on the potential issues arising from the 

particular needs of diverse communities. 

Communities Putting Prevention to Work (CPPW). As part of the 2009 American Recovery and Reinvestment 

Act and with additional funds from the Affordable Care Act, the CDC has funded 50 “Communities Putting 

Prevention to Work” programs committed to reducing chronic diseases related to obesity and tobacco 

use by implementing effective strategies that develop public health policy and strengthen the community 

environment to improve and support health. 

Culturally and Linguistically Appropriate Services (CLAS). HHS’s Office of Minority Health issued national 

Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS) to ensure that all 

people entering the healthcare system receive equitable and effective care in a culturally and linguistically 

appropriate manner. The Standards are meant to be inclusive of all populations, but are specifically designed 

to meet the needs of racial, ethnic, and linguistic populations that experience unequal access to healthcare 

services. The CLAS Standards on Language Access Services (Standards 4-7) are mandated for all programs 

receiving federal funds. Many states and healthcare organizations have used the CLAS Standards to help 

improve the provision of care. 

Healthy Weight Collaborative. HRSA funded a Prevention Center for Healthy Weight to launch a firstever learning collaborative to address obesity in children and families. HRSA’s learning collaboratives 

assist service delivery systems in rapidly moving the best available evidence into practice. The learning 

collaboratives have shown promise for improving the quality of care and clinical outcomes of underserved 

populations in community-based settings. 
 

A Nation Free of Disparities in Health and Health Care 43 

APPENDICES
 

Head Start Program: The Head Start program provides grants to local public and private nonprofit and 

for-profit agencies to provide comprehensive child development services to economically disadvantaged 

children and families. Head Start programs promote school readiness by enhancing the social and cognitive 

development of children. Efforts include the provision of educational, health, nutritional, social, and other 

services to enrolled children and families. The Head Start program engages parents in their children’s 

learning and helps them in making progress toward their educational, literacy, and employment goals. 

National Network to Eliminate Disparities in Behavioral Health (NNED). This is a network funded by 

SAMHSA, NIMHD, and foundations to link community-based behavioral health and multi-service 

organizations serving racial and ethnic minority populations. The NNED supports workforce development, 

linkages between providers and researchers, and resource and information exchange among these 

community organizations to improve access to and delivery of evidence-supported quality behavioral 

health care. 

Racial and Ethnic Approaches to Community Health (REACH). REACH, a national multi-level program that 

has developed innovative approaches that focus on racial and ethnic groups, improves people’s health 

in communities, healthcare settings, schools, and worksites. REACH communities have empowered 

residents to seek better health, changed local healthcare practices, and mobilized communities to 

implement evidence-based public health programs that address their unique social, historical, economic, 

and cultural circumstance. The CDC currently funds 40 communities to implement best practices to reduce 

health disparities. 

Regional Extension Centers. Regional Extension Centers, funded by the ONC to assist more than 100,000 

primary care providers in achieving meaningful use of certified electronic health record (EHR) technology, 

improve care by providing outreach, education, EHR support, and technical assistance. Regional Extension 

Centers serve local communities around the country, focusing on those healthcare settings that provide 

primary care services to those who lack adequate coverage or medical care. 

Task Force on Environmental Health Risks and Safety Risks for Children. Co-Chaired by HHS and EPA, this 

Task Force is supported by a Senior Steering Committee constituted of senior representatives of several 

federal departments, agencies, and White House offices. The Steering Committee has identified asthma 

disparities, chemical exposures, and healthy settings (where children live, learn, and play) as the three initial 

priorities for improving coordination of federal efforts and developing interagency collaborations to address 

environmental health risks and safety risks to children. 
 

44 A Nation Free of Disparities in Health and Health Care 

APPENDICES 

Appendix C: Key Disparity Measures 

I . Transform Health Care 

Measure 1: Percentage of the U.S. nonelderly population (0-64) with health coverage 

Measure 2: Percentage of people who have a specific source of ongoing medical care 

Measure 3: Percentage of people who did not receive or delayed getting medical care due to cost in the 

past 12 months 

Measure 4: Percentage of people who report difficulty seeing a specialist 

Measure 5: Percentage of people who reported that they experienced good communication with their 

health care provider 

Measure 6: Rate of hospitalization for ambulatory care-sensitive conditions 

Measure 7: Percentage of adults who receive colorectal cancer screening as appropriate 

II . Strengthen the Nation’s Health and Human Services Infrastructure and Workforce 

Measure 1: Percentage of clinicians receiving National Health Service Corps scholarships and loan 

repayment services 

Measure 2: Percentage of degrees awarded in the health professionals, allied and associated health 

professionals fields 

Measure 3: Percentage of practicing physicians, nurses, and dentists 

III . Advance the Health, Safety, and Well-Being of the American People 

Measure 1: Percentage of infants born at low birthweight 

Measure 2: Percentage of people receiving seasonal influenza vaccination in the last 12 months 

Measure 3: Percentage of adults and adolescents who smoke cigarettes 

Measure 4: Percentage of adults and children with healthy weight 

The indicators will be displayed by race and ethnicity and income. 
 

A Nation Free of Disparities in Health and Health Care 45 

APPENDICES
 

Appendix D: List of Acronyms 

Acf – Administration for Children and Families 

Acip – Advisory Committee on Immunization Practices 

AhrQ – Agency for Healthcare Research and Quality 

ArrA – American Recovery and Reinvestment Act 

AsA – Assistant Secretary for Administration 

Aspe – Assistant Secretary for Planning and Evaluation 

cBpr – Community-Based Participatory Research 

cchi – Certification Commission for Healthcare Interpreters 

cdc – Centers for Disease Control and Prevention 

chip – Children’s Health Insurance Program 

cihs – Center for Integrated Health Solutions 

clAs – Culturally and Linguistically Appropriate Services 

cMs – Centers for Medicare and Medicaid Services 

cppW – Communities Putting Prevention to Work
 

doc – Department of Commerce
 

doe – Department of Energy
 

dol – Department of Labor
 

dot – Department of Transportation
 

ed – Department of Education
 

ehr – Electronic Health Records
 

epA – Environmental Protection Agency
 

fdA – Food and Drug Administration
 

fihet – Federal Interagency Health Equity Team 

GprA – Government Performance and Results Act 

hAcU – Hispanic Association of Colleges and Universities 

hBcU – Historically Black Colleges and Universities 

hhs – Department of Health and Human Services 

hiA – Health Impact Assessment 

hit – Health Information Technology 

hpoG – Health Profession Opportunity Grants 

hrsA – Health Resources and Services Administration 

hUd – Department of Housing and Urban Development 

ihs – Indian Health Service
 

ioM – Institute of Medicine
 

NAp – New Access Points
 
 

46 A Nation Free of Disparities in Health and Health Care 

APPENDICES
 

Nci – National Cancer Institute
 

Nhdr – National Health Disparities Report
 

Nhsc – National Health Service Corps
 

Nih – National Institutes of Health
 

NiMhd – National Institute on Minority Health and Health Disparities
 

NNed – National Network to Eliminate Disparities in Behavioral Health
 

NpA – National Partnership for Action
 

NVpo – National Vaccine Program Office
 

oAsh – Office of the Assistant Secretary for Health
 

oMB – Office of Management and Budget 

oMh – Office of Minority Health 

oNc – Office of the National Coordinator of Health Information Technology 

oWh – Office on Women’s Health 

reAch – Racial and Ethnic Approaches to Community Health 

sAMhsA – Substance Abuse and Mental Health Services Administration 

tANf – Temporary Assistance for Needy Families 

UsdA – Department of Agriculture 

Uspstf – U.S. Preventive Services Task Force 

VA – Department of Veterans Affairs 

Who – World Health Organization