ELIMINATING HEALTH DISPARITIES...CREATING HEALTH EQUITY by Elmer R. Freeman

On behalf of the 65+ organizations statewide, that have worked together for more than 2 years as the Disparities Action Network (DAN) to craft legislation that would provide for an Office of Health Equity to be located in the Executive Office of Health and Human Services, as Co-Chair I wish to express our great disappointment in the House budget released last week for its failure to support this provision as it was contained in Governor Patrick’s budget proposal.

As we get ready to “celebrate” the second anniversary of the Massachusetts health care experiment, the message in the House budget is clear; there is no political will or budgetary authority for addressing the most challenging issues for true health reform.

For the past two years the Connector has extolled the success of Chapter 58 as if access is the only measure of success. Other provisions of the law have failed to deliver the real promise of health reform. The Quality and Cost Council has no apparent agenda for controlling spiraling costs and have failed to make the link between cost and quality for consumers, despite their dependence on “an educated consumer” for ensuring accountability in the health care system. The Disparities Council was just named and put in place at the end of 2007 and has met only once since then despite the report of the Special Legislative Commission chaired by Senator Dianne Wilkerson and Representative Peter Koutoujian calling for such an Office as to eliminating disparities and creating health equity.

The time and the circumstances present a unique opportunity for Massachusetts to address the persistent racial and ethnic disparities in health and health care and lead the nation yet again in what is clearly the leading human and civil rights issue of the 21st Century. Dr. King’s assertion in 1966 … “of all forms of inequality, injustice in health care is the most shocking and inhumane” has never been more true. Excess mortality and morbidity and unnecessary deaths of racial and ethnic minorities, the shame of the American health care system has been the focus of a seminal report of the Institute of Medicine, the research efforts of the National Institutes of Health, the Massachusetts Legislature and State Department of Public Health, and the Boston Public Health Commission. Advocates for change know that health disparities are a downstream outcome of the varied social, political and economic determinants upstream that have to do with education, jobs, transportation, housing, and environmental policy. An Office of Health Equity at the Cabinet level under Secretary Bigby ensures the coordination of state policy at the highest level in the Executive branch to shape policy upstream to change outcomes downstream. It could provide the structural home and administrative support for the work of the Disparities Council. It is the essential authority needed to lead an initiative that will eliminate disparities through coordinated and collaborative efforts between the Secretariats.

It’s time for the Legislative branch to get on board. The members of the DAN call on Speaker DiMasi, House leadership, and members to support the amendment of Representative Rushing to restore the Office of Health Equity to the House budget.

Elmer Freeman, Executive Director, Center for Community Health Education Research and Service, Inc. and Co-Chair, Disparities Action Network.