At a commemorative event two years ago, I heard a historian say that history is not a steady stream of events, but rather a series of punctuation points, like ripples from stones tossed into water. I believe that we are at the cusp of just such a punctuation point today as we commemorate National Minority Health Month and the 30th anniversary of the landmark Report of the Secretary’s Task Force on Black and Minority Health (also known as the Heckler Report). The Heckler Report marked the first time the U.S. government convened a group of health experts to conduct a comprehensive study of the health status of minorities. This legacy health equity tome elevated minority health onto a national stage and continues to serve as a driving force for the monumental changes in research, policies, programs and legislation to end health disparities in America.
Over the past 30 years, the influence of the Heckler Report has advanced our nation’s progress toward health equity through new techniques in data collection; dedicated institutes, centers, offices, and commissions of minority health across the country; innovative community-level interventions and transformative legislative measures. These advances reflect the vision of former U.S. Department of Health and Human Services (HHS) Secretary Margaret M. Heckler who, in 1985, determined that we must act swiftly to address the excess deaths among racial and ethnic minorities and the health inequity that plagued our country. In her words, health disparities were “an affront both to our ideals and to the ongoing genius of American medicine.”
Secretary Heckler, members of the Task Force that was convened to develop the report and other visionaries had an unwavering commitment and a heart of service to enact change. And with that commitment came a tremendous opportunity. The Heckler Report created an opportunity to engage the nation in thoughtful discussions about the health needs of minority communities. Individuals from across the nation – public health professionals and health care providers to advocacy groups, researchers to academic institutions and policymakers – began to ponder solutions to a dilemma that required immediate scrutiny.
As a result, milestones began to line the path toward health equity: the Jackson Heart Study explored reasons for certain cardiovascular health disparities; the Healthy Start program brought infant mortality prevention efforts to underserved communities; the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care gave guidance on how health care organizations can provide respectful and responsive services to diverse communities; and an HHS mandate reaffirmed the commitment to the appropriate inclusion of data on minority groups in HHS research, services and related activities.
And, nearly a generation after the Heckler Report, the pivotal Affordable Care Act and its key tenet of quality, affordable and accessible health care is touching the lives of Americans every day. When President Obama signed this powerful legislation into law five years ago, it opened up a remarkable window of opportunity in the movement to reduce health disparities and achieve health equity. The Affordable Care Act is expanding access to coverage with approximately 16.4 million uninsured people having gained health coverage since March 2010. The law is also expanding access to primary health care through investments in community health centers; increasing the diversity of the nation’s health workforce; strengthening the federal minority health infrastructure to reduce health disparities by establishing Offices of Minority Health within six HHS agencies and elevating the National Center on Minority Health and Health Disparities to a NIH Institute; ensuring individuals are protected from discrimination in health care; and improving data collection and research on health disparities.
The Affordable Care Act and the health disparity gaps that have been reduced since the Heckler Report are signs of progress: cancer deaths among blacks have decreased; HIV mortality rates in black communities have declined; obesity rates among low-income preschoolers have declined for the first time in three decades; childhood vaccination disparities between racial and ethnic minorities and whites are nearly nonexistent; and teen pregnancy among black, Hispanic, American Indian/Alaska Native and Asian American and Pacific Islander populations have shown recent declines, as has infant mortality among mothers of all ages in these racial and ethnic minority groups.
But, we recognize that health and health care is only one piece of the puzzle. We must also look to the conditions in which individuals live, learn, work and play – the social determinants of health – to help solve the health disparities issue that afflicts so many Americans. To this end, we rely on the HHS Action Plan to Reduce Racial and Ethnic Health Disparities and the National Partnership for Action to End Health Disparitiesto both guide our path and mobilize our communities toward health equity; to set goals for workforce development and other determinants and help racial and ethnic minorities reach their full health potential. Our work is not done. We are still a nation where minorities are less likely to get the preventive care needed to stay healthy, less likely to receive quality care, and more likely to face poorer health outcomes. The death rate among racial and ethnic minorities has decreased since 1985, but minorities still face the grim reality of dying due to preventable illness in higher numbers than whites. These disparities persist, but there is hope. We have ground-breaking developments in science, transformative advances in public health and health care reform, and new multi-sector collaborations at our disposal – opportunities that create an environment ripe for action.
Today, we are standing before a remarkable moment to fulfill the American promise of equality and opportunity. And whether we rise to meet it – whether we can look back another 30 years from now and consider this period in history as the moment when we faced an unprecedented opportunity for change, and made the most of it – depends on all of us to answer the call for ending health disparities in our communities.
Throughout this banner 30th anniversary year, we will raise a clarion call to continue to take action toward ending health disparities. For some this means getting connected to care for the first time, for others it means educating the next generation through awareness raising activities. Health disparities impact us all and we all must do our part, and through our collective efforts we can accelerate momentum toward achieving a nation free of disparities in health and health care.
J. Nadine Gracia, MD, MSCE, is the Deputy Assistant Secretary for Minority Health and the Director of the Office of Minority Health at the U.S. Department of Health and Human Services (HHS).