Background and Rationale

Ana Penman-Aguilar, PhD

Karen Bouye, PhD

Leandris C. Liburd, PhD

Office of Minority Health and Health Equity, CDC

In 2011, CDC published the first CDC Health Disparities and Inequalities Report (CHDIR) (1). This report examined health disparities in the United States associated with various characteristics, including race/ethnicity, sex, income, education, disability status, and geography. Health disparities were defined as "differences in health outcomes and their determinants between segments of the population, as defined by social, demographic, environmental, and geographic attributes" (1). Among other recommendations, the 2011 CHDIR emphasized the need to address health disparities with a dual intervention strategy that focuses on populations at greatest need and improves the health of the general population by making interventions available to everyone. The 2013 CHDIR included updates on most topics from the 2011 CHDIR and on new topics (2). Compared with the 2011 CHDIR, the 2013 CHDIR included more reports on social and environmental determinants of health and emphasizes the importance of multisector collaboration. The 2013 CHDIR highlights the need for a "comprehensive, community-driven approach" to reducing health disparities in the United States.

The U.S. Department of Health and Human Services defines health equity as "attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities" (3). A salient challenge in the field of health equity is to move from monitoring to action. Certain groups within and outside CDC have accepted the challenge of identifying what works to decrease and eliminate health disparities. For example, the Community Preventive Services Task Force systematically reviews interventions to reduce health inequities (differences or disparities that are systematic, avoidable, and unfair) (4,5) among racial and ethnic minorities and low-income populations (6). As for the CHDIRs, many reports include brief descriptions of activities that address particular health disparities (1,2). However, in-depth discussions of interventions are beyond the scope of the CHDIRs.

To complement the CHDIR series, this report highlights selected CDC-sponsored interventions that have been applied to decrease health disparities. To identify reports for this supplement, CDC's Office of Minority Health and Health Equity (OMHHE) examined selected CDC-sponsored interventions that address health disparities. Eleven interventions met the following criteria: topics highlighted in the 2011 CHDIR were addressed, programs were effective or showed promise for decreasing health disparities, and sufficient data had been collected to enable evaluation. Five of these interventions are presented in this report.

The first report highlights the Vaccines for Children Program, a national initiative that reduced and in some cases (e.g., measles-mumps-rubella and poliovirus vaccines) eliminated racial and ethnic disparities in childhood vaccination coverage in the United States (7). The second and third reports describe interventions that were initially evaluated in randomized controlled trials in specific populations. "Healthy Love" is an HIV-prevention intervention for heterosexual black women (8). "Many Men, Many Voices" addresses HIV risk behaviors in black men who have sex with men (9). The fourth report describes how four American Indian nations addressed elevated rates of motor vehicle–related injuries by adopting proven strategies selected from The Community Guide (10). The fifth report (11) describes a project funded by the Racial and Ethnic Approaches to Community Health (REACH) program (12), the goal of which was to build healthy communities through overall increases in knowledge and motivation to live a healthy lifestyle. Its implementation in three Southeast Asian communities (two Vietnamese and one Cambodian) in the United States was associated with decreased rates of smoking among Vietnamese and Cambodian men.

Health disparities in the United States were well documented in the 2011 CHDIR and 2013 CHDIR (1,2). Identifying these disparities creates the opportunity to design intervention programs. Interventions can be applied at different levels; those highlighted in this supplement vary by their level of application (e.g., local or national) and their reach. For example, national legislation eliminated some important disparities in national child vaccination coverage. Local community- and tribal-level interventions reduced tobacco use among Vietnamese and Cambodian men in three communities and motor vehicle–related injuries among four American Indian tribes. HIV-prevention interventions, widely disseminated to small groups of heterosexual black women and to black men who have sex with men, led to reductions in self-reported HIV risk behaviors. Although only one analysis in this supplement (Vaccines for Children Program) involved measurement of health disparities at a national level (7), the other interventions can be considered effective in reducing health disparities because they focus on populations at elevated risk for illness or death (e.g., from HIV infection) and show reductions in risk factors or, in the case of motor vehicle–related injuries, in outcomes themselves.

Reducing and eliminating health disparities is central to achieving "the highest level of health for all people" in the United States (3), and in coming years, OMHHE will continue to describe CDC-sponsored programs that address health disparities.

References

1. CDC. CDC health disparities and inequalities report—United States—2011. MMWR 2011;60 (Suppl; January 14, 2011).
2. CDC. CDC health disparities and inequalities report—United States, 2013. MMWR 2013;62 (No. Suppl 3).
3. US Department of Health and Human Services, National Partnership for Action to End Health Disparities. Health equity and disparities. March 4, 2011. Available at http://minorityhealth.hhs.gov/npa.
4. Braveman P. Health disparities and health equity: concepts and measurement. Annu Rev Public Health 2006;27:167–8.
5. Braveman P, Gruskin S. Defining equity in health. J Epidemiol Community Health 2003;57:254–8.
6. Community Preventive Services Task Force. The guide to community health services: promoting health equity. April 25, 2013. Available at http://www.thecommunityguide.org/healthequity/index.html.
7. CDC. Reduction of racial and ethnic disparities in vaccination coverage, 1995–2011. In: Strategies for reducing health disparities—selected CDC-sponsored interventions, United States, 2014. MMWR 2014;63(No. Suppl 1).
8. CDC. Community-based program to prevent HIV/STD infection among heterosexual black women. In: Strategies for reducing health disparities—selected CDC-sponsored interventions, United States, 2014.MMWR 2014;63 (No. Suppl 1).
9. CDC. Evidence-based HIV/STD prevention intervention for black men who have sex with men. In: Strategies for reducing health disparities—selected CDC-sponsored interventions, United States, 2014. MMWR 2014;63(No. Suppl 1).
10. CDC. Tribal motor vehicle injury prevention programs for reducing disparities in motor vehicle–related injuries. In: Strategies for reducing health disparities—selected CDC-sponsored interventions, United States, 2014. MMWR 2014;63(No. Suppl 1).
11. CDC. Decreasing smoking disparities among Vietnamese and Cambodian communities—findings from the Racial and Ethnic Approaches to Community Health (REACH) project, 2002–2006. In: Strategies for reducing health disparities—selected CDC-sponsored interventions, United States, 2014. MMWR 2014;63(No. Suppl 1).
12. CDC. Racial and Ethnic Approaches to Community Health (REACH). October 19, 2012. Available at http://www.cdc.gov/reach.