Home > Advocacy > Testimony In Support of House Bill 2071 and Senate Bill 985: 'An Act to Eliminate Racial and Ethnic Health Disparities in the Commonwealth'

Testimony In Support of House Bill 2071 and Senate Bill 985: 'An Act to Eliminate Racial and Ethnic Health Disparities in the Commonwealth'

April 9, 2013

Before the Joint Committee on Public Health

The Massachusetts Medical Society is in strong support of House Bill 2071 and Senate Bill 985, legislation that would establish an Office of Health Equity in the Executive Office of Health and Human Services to provide both coordination of – and accountability for – all state efforts to eliminate racial and ethnic health disparities. This legislation would also build upon the Health Reform Law (Chapter 58 of the Laws of 2006) by incorporating the Health Disparities Council established by that measure as an on-going advisory body to the Office of Health Equity. In addition, it would mandate a number of important initiatives that would help the Office to achieve its goal.

The Society’s House of Delegates has adopted the Policy: “That the Massachusetts Medical Society support the elimination of racial and ethnic disparities in health care as an issue of high priority.” This Policy was adopted for good reason!

It has long been clear from the medical literature that racial and ethnic minorities in the United States are at greater risk of death and disease from a variety of illnesses, and that they often do not receive the same quality of health care as do other patients. These disparities continue and include access to appropriate cancer diagnostic tests and treatment; screening, diagnostic, and therapeutic interventions for heart disease and stroke; diabetes care; clinical procedures for cerebrovascular disease; HIV care; renal transplantation; asthma care; and, a range of other preventive and specialty health services such as: maternal and child health care, immunizations, mental health, rehabilitative services, long-term care, and pain management.

Part of the problem was in the disparate lack of health insurance coverage for racial and ethnic populations, an issue which has been addressed for many by the implementation of the Health Reform Law (Chapter 58 of the Acts of 2006). However, access to insurance coverage has not solved the problem of access to quality health care for racially and ethnically diverse populations in Massachusetts. There are non-coverage factors that also relate to health disparities. Commonly identified factors include cultural differences in understandings of the causes of illness, language barriers, individual bias, lack of patient trust in the health care system, lack of health literacy and poor communications by all parties. Recent studies show that these issues continue. In the February 2011 issue of the Journal of the American Medical Association, researchers found that among elderly Medicare recipients, black patients were more likely to be readmitted after hospitalization for 3 common conditions, a gap that was related to both race and to the site where care was received. Specifically, elderly black Medicare patients had higher odds of 30-day readmission than white patients for acute myocardial infarction, congestive heart failure, and pneumonia. These disparities were related to race itself as well as to the site where care was provided: black patients had a 13% higher odds of readmission than white patients, while patients discharged from minority-serving hospitals had a 23% higher odds of readmission than patients discharged from non–minority-serving hospitals.

The Massachusetts Medical Society served as an active member of the State Commission on the Elimination of Racial and Ethnic Health Disparities since its inception in 2004 and participates in the Health Disparities Council established by Chapter 58. The Society also continues to participate in the national Commission to End Health Care Disparities, led by the American Medical Association, the National Medical Association and the National Hispanic Medical Association. The recommendations embodied in House Bill 2071 and Senate Bill 985 derive from the Final Report of the State Commission (August 2007) and would go a long way towards the reduction and eventual elimination of racial and ethnic health disparities. In addition to coordination and oversight, the Office of Health Equity would review proposed state activities regarding their impact on health disparities, promote health literacy and issue an annual “report card” assessing progress made. The Office would also provide grants to community agencies to conduct research and to recruit and train community health workers.

A particularly longstanding concern to the MMS has been the need to create a more diverse healthcare workforce. The Society has long been committed to expanding educational opportunities for racial and ethnic populations in medicine and in the biomedical sciences. While the recruitment and retention of physicians in Massachusetts has increasingly become a major workforce problem, the recruitment of physicians who come from diverse racial and ethnic backgrounds is of particular concern. The lack of diversity extends throughout most levels of the professional healthcare workforce.

In order to help increase the diversity in the healthcare workforce, the MMS continues to participate in the AMA’s Doctors Back to School program. This program sends minority physicians and medical students into the community as a way to introduce children to professional role models. Doctors Back to School aims to inspire students of all ages, especially those from underrepresented racial and ethnic groups, to pursue careers in medicine.

The Society also hosts programs such as “Reality Medicine.” This program allows medical students, residents, fellows and young physicians to talk with experienced physicians about issues of interest to them, including career choices, the clinical practice environment, the business of medicine, community advocacy, and keys to success. The most recent Reality Medicine program, held on Friday, April 5, was attended by students from all four Massachusetts medical schools, as well as residents, fellows and new physicians who discussed their interest in the future of medicine in Massachusetts, and of patients of diverse populations.

According to HHS’ recent Action Plan to Reduce Racial and Ethnic Health Disparities, 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. 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.

Under the legislation before you, the Office of Health Equity would empower all future Secretaries of the Executive Office of Health and Human Services to work with their counterparts in the executive branch – including the Secretary of Education, the Secretary of Labor and Workforce Development, and the heads of the many quasi-public economic development agencies in the state – to develop the training and education programs necessary to prepare for the multi-cultural healthcare workforce we need as part of our efforts to reduce and eliminate disparities.

Supporting the bills will also be in keeping with the national efforts by HHS and its Action Plan to Reduce Racial and Ethnic Health Disparities. This action plan is aimed at reducing the health disparities that affect people in the United States. The report includes five goals to eliminate disparities: