1. Resolving Disparities in the
United States Using Policy
Interventions
KINE 3350
DR. GREEN

2. Overview
 Review the Healthy People Initiative that provides the imperative
and direction to U.S. to resolve these health disparities.
 Review a comprehensive framework and both theory- and
evidence-based strategies for eliminating national disparities.
 Review a specific course of action, accounting for practical
challenges and barriers

3. Healthy People Initiative
 The Healthy People Initiative has spanned the past thirty years and
represents the most comprehensive national effort to improve the
health of Americans in this new century.
 The initiative is primarily a series of reports that set the health
agenda for the nation. Each report sets measurable goals and then
reports on progress to date.

4. Goals of Healthy People 2020
 Attain high-quality, longer lives free of preventable disease, disability, injury, and
premature death.
 Achieve health equity, eliminate disparities, and improve the health of all groups.
 Create social and physical environments that promote good health for all.
 Promote quality of life, healthy development, and healthy behaviors across all life
stages.

5. HP2020 Foundation Health Measures

6. Healthy People 2020
Objectives
 Includes 42 Focus Areas with two different types of objectives:
 Measurable objectives contains a data source and a national baseline value. Baseline
data provide the point from which a 2020 target is set.
 Developmental objectives currently do not have national baseline data. These
objectives indicate areas that need to be placed on the national agenda for data
collection.

7. Healthy People 2010 Action Model
Source: Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020, 2008;
http://www.healthypeople.gov/hp2020/advisory/PhaseI/PhaseI.pdf (accessed 4-26-11).

8. Resolving Disparities in Health and Health
Care
 Strategies to Resolve Racial/Ethnic Disparities
 Strategies to Resolve SES Disparities
 Strategies to Resolve Disparities by Health Insurance

9. Strategies to Resolve Racial/Ethnic Disparities
 Policy Interventions
 Laws mandating equal access to education and employment
 Laws prohibiting racial discrimination in public places
 Affirmative action laws
 Social policies to reduce institutionalized discrimination in higher
education, the workplace, and clinical settings
 Social and health policies to address cultural barriers influencing
access to and quality of medical care
 Health Careers Opportunity Program provides support for minorities
complete healthcare professions degrees.

10. Strategies to Resolve Racial/Ethnic Disparities
 Health Care Interventions
 Tailor health care interventions to cultural differences in health beliefs,
values, preferences, and behaviors (cultural competence). This is not
the same as language competence; it requires a more complex
understanding of social and cultural influences on individual beliefs
and expectations about health and health care, and how these may
influence health behaviors and the delivery of health care at multiple
levels of the health care delivery system.
 Three-level framework for improving cultural competence:
organizational interventions, structural interventions, clinical
interventions

11. Strategies to Resolve Racial/Ethnic Disparities
 Health Care Interventions
 Professional development programs to teach providers to deliver
culturally appropriate care
 Complementary or alternative medicine (CAM) is used for
greater compatibility with individual views on health and illness,
and also by individuals dissatisfied with conventional medicine.
Minorities may be more comfortable with alternative care,
leading to greater patient satisfaction, and on to higher rates of
continuity with primary source of care, which ultimately benefits
the patient’s health.

12. Strategies to Resolve SES Disparities
 Policy Interventions
 To reduce rates of low SES, it is necessary to intervene in each of
its antecedents: income, education, and occupation.
 The Fair Labor Standards Act requires at least a set minimum
wage, regulates child labor, and ensures that education and
safety are prioritized.
 The Earned Income Tax Credit reduces the federal tax required
of lower-income families.

13. Policy Interventions to Resolve Disparities by
Health Insurance
 Encouraging Enrollment for Eligible Individuals
 74% of uninsured children and 5% of uninsured adults are
eligible for, but not enrolled in Medicaid or CHIP.
 Barriers are administrative procedures, not knowing about the
programs, and not wanting/needing the coverage.
 The process of documenting income for means-tested programs
can discourage individuals from completing the process.

14. Course of Action for Resolving Disparities
1. Enhance Awareness
2. Demonstrate Severity
3. Establish Relevance
4. Expand the Focus to Multiple Risk Factors
5. Stress the Multilevel Integration of Interventions
6. Ensure Feasibility
7. Apply Effective Implementation Strategies
8. Persevere
9. Use Guided Incrementalism
10. Evaluate and Refine Programs and Initiatives

15. Policy Decision Making
 Rational Model- A process used for making sound decisions in policy-
making. It is defined as “a style of behavior that is appropriate to the
achievement of given goals, within the limits imposed by given conditions
and constraints.”
 Group Decision Making- a process in which individuals collectively make a
choice form the alternatives before them. The decisions are often made by
interest groups that do not always have a stake in the matter that is being
decided on
 Incremental Policy (“muddling through”)- A less radical approach to policy
making that makes small changes to an existing policy rather than
adopting an entirely new policy.

16. Current Policy Examples

17. Right to Try Laws
 Current federal regulations give patients with serious or life-threatening
illnesses two primary options to access experimental therapies that have
not been approved by the FDA
 Participate as a human subject in a clinical trial
 Apply to the FDA for access to the experimental drug under expanded access
 The application process to the FDA is cumbersome which discourages
patients and physicians from applying
 As a result, more than 20 states have introduced laws aimed at making
experimental therapies more easily accessible to patients with terminal
illness and 5 of them have been signed into law (Right-to-Try laws)
 The argument is that these laws might introduce new risks for patients
while undermining laws meant to protect public safety
 Right-to-try laws have proved to be very popular and should increase in
popularity as the awareness of them increases
 http://www.wsj.com/video/opinion-right-to-try-laws-sweep-states/77AEE3AB-55D4-
4003-A294-20EA2BBAD8B9.html

18. Birth Control Vending Machines
 http://www.cnn.com/2012/02/08/us/p
lan-b-vending-machine/index.html

19. Sex Education in Schools
 http://www.wral.com/cumberland-
schools-suspend-sex-ed-program-
after-parents-complain/17029739/