Healthy People 2010 has placed the elimination of racial and ethnic health disparities at the top of our nation’s health agenda. States, in addition to the federal government, have a vital role to play in meeting this goal. In a political environment that has increasingly transferred social policy responsibility from federal to state government, it is critical to document and understand state variation in minority health policy.
A state minority health report card may provide an important tool to evaluate and promote state involvement in activities and policies that reduce health disparities. It may also facilitate feedback to key state leaders on their relative performance and provide a forum for sharing innovative state programs in minority health.
The goals of this study are:
To develop a set of criteria that can form the basis of a state report card in minority health,
To use these criteria to evaluate performance in all fifty states, and
To explore potential predictors of activity and effort in minority health at the state level.
A structured review of the literature was conducted to evaluate prior comparative analyses of state minority health performance and policy. Key informant interviews with leaders in health policy and health policy researchers were used to inform the development of a state minority health report card. Structured phone surveys of staff were conducted in 25 of the 30 state Offices of Minority Health (OMH). Finally, data from the Kaiser Commission on Medicaid and the Uninsured, United States 2000 Census, the AMA Physician Masterfile, State Vital Statistics Reports, and the National Council of State Legislators Database were analyzed.
Based on key informant input, I developed a reporting tool focusing on five critical areas:
Racial/Ethnic disparities in health insurance coverage for low-income, non-elderly residents
The composition of the state’s physician workforce measured against that state’s demographic composition
The establishment of an Office of Minority Health and the level of resources available to that Office
The quality of state race/ethnicity vital statistics reporting
The presence and extent of state legislation on minority health
Analyses using the above criteria reveal a wide variation in state performance on these five key measures of minority health policy. Future research should be conducted on other potential predictors of state variation in health policy and connections between state policy and health outcomes for minorities. There is also a critical need for strategic dissemination of this information to key state leaders as a vehicle for improving minority health.
John McDonough, Dr.PH., Schneider Institute for Health Policy, Brandeis University