Washington cannot become the Healthiest State in the Nation if disparities persist
in illness rates and in the health care received by our state's growing proportion
of racial and ethnic minorities.
WHF is proud of its role in passing a package of bills during the 2006 Legislative
Session that is already increasing awareness (in state agencies and in the larger
community) of the health disparities problem. We applaud Governor Gregoire and the
state board of health for the priority they have placed on naming the members of
the Governor's Health Disparities Coordinating Council. We look forward to implementation
of the remaining elements of last year's health disparities legislative package,
including the first health disparities impact review. These efforts place us all
in a strong position to seek new action on health disparities at the community,
corporate and governmental levels in 2007.
While WHF stands ready to work with community groups on any strategy with significant
promise to eliminate health disparities, we have selected three health disparities
policy priorities for the coming year:
- A redoubling of efforts to address tobacco use in communities of color;
- Focused efforts to improve early learning, enhance academic achievement and increase
high school completion rates in communities of color; and
- Promoting health care workforce diversity.
Tobacco use is the leading cause of preventable death among all Washingtonians,
but the burden of disease is higher within most communities of color. Despite recent
changes, general tobacco control efforts in our state, largely controlled by the
majority community, have not adequately penetrated cultural barriers in communities
of color, and thus have had little effect there. Now, communities of color themselves,
in partnership with some local health jurisdictions, have begun to dig deeper for
solutions, developing some promising answers. WHF will look for opportunities during
2007 to support such community collaborations. We call on state government to focus
future tobacco cessation resources on such efforts, even as it struggles to find
funds to sustain those efforts as tobacco settlement funds are exhausted.
2. Focused efforts to improve early learning, enhance academic achievement and increase
high school completion rates in communities of color.
We agree with former U.S. Surgeon General Joselyn Elders that it is impossible to
educate an unhealthy child, and it is impossible to keep an uneducated child healthy.
None of WHF's Report Card measures aligns more closely to health outcomes than high
school graduation rates. The Education Achievement Gap is a problem compelling urgent
attention in the Washington Learns preliminary report as it tells of graduation
rates among African-Americans, Native Americans and Hispanics that are merely fractions
of Caucasian rates. The Washington Learns ideas about improving education overall
will help communities of color. So WHF supports their recommended next steps toward
transforming childcare into early learning, reducing class size, increasing teacher
salaries and moving toward full-day kindergarten.
But more directly targeted effort is required in communities of color. The state
must address levy equalization, the need for academic remediation, dropout prevention,
and social and health needs in communities of color.
We need targeted dropout programs like those recommended by the Washington Learns
K-12 Sub-committee. Using proven interventions with high-risk kids, the program
aims to half the high school dropout rate in five years, reducing it most in communities
of color.
Two elements are especially important for success. The first is early literacy.
It is difficult to over-emphasize its importance to continued engagement with the
learning process. The second is family and community strategies. In racially and
ethnically diverse communities especially, these influences can be attributed to
retaining kids' engagement and supporting the educational mission.
Similarly, a Coordinated School Health Program1 together with the expansion
of on-site school nurses, outreach workers and aides2 recommended in
the Washington Learns K-12 Sub-committee's consultant report is no more important
anywhere than in low-income schools where racial and ethnic minorities and health
problems are usually over-represented. In addition, funding to support regular physical
activity and improved nutrition are critical.
3. Promoting health care workforce diversity.
We know that when language and culture are barriers in health care, outcomes suffer.3
Therefore, diversity in the health care workforce is highly important. Diversity
should begin with encouraging students of color who are interested in math and science
toward health care careers beginning in middle school and high school, and continuing
in community college and four-year universities. WHF will be looking for opportunities
to support greater enrollment, scholarship opportunities, mentoring and completion
of health professional education by racial and ethnic minorities.
However, health care workforce diversity alone cannot assure culturally competent
care. So efforts to provide interpreter services and increase cultural competency
among health professionals will remain key.
Other Health Disparities Elimination Strategies
Increasing the members of color on public and private boards and commissions holds
promise for increasing social equity that will reduce health disparities. WHF calls
on the networks of community organizations in communities of color to develop and
support the identification and training of their own community leaders as candidates
for these positions.
Other opportunities exist to reduce health disparities in Washington, including
the assurance that public and private health, housing and education budgets, and
management accountability mechanisms reflect the vision of eliminating health disparities.
What gets measured, gets results. Therefore, increasing the collection and use of
race, ethnicity and language information fields in health-related databases will
enable continuing attention to health disparities among providers, administrators,
policymakers and the general public.
1Recommended by the federal Centers for Disease Control; one
of several evidence-based strategies for improving health and educational outcomes.
Such models involve a comprehensive assessment of educational systems and other
elements of the school environment to promote health, including self-care, emergency
medical care and referral to community providers, nutrition, physical activity,
safety and environmental health.
2Washington Learns, "Evidence Based Report", page 58 (http://www.washingtonlearns.wa.gov/materials/EvidenceBasedReportFinal9-11-06_000.pdf).
3"The Evidence Base for Cultural and Linguistic Competency in Health
Care" at http://www.cmwf.org/publications/publications_show.htm?doc_id=413821