NC OMHHD 2010 1

National Academy for State Health Policy’s 23rd

Annual State Health Policy Conference Session: Closing the Gap: Reducing Disparities & Achieving Health Equity

October 4-6, 2010

Barbara Pullen-Smith, MPH, DirectorOffice of Minority Health and Health DisparitiesDivision of Public HealthNC Department of Health and Human Services

Healthy Communities. Every One Matters.

NC OMHHD 2010 2

Scotland

Guilford

Rockingham

Moore

AnsonUnion Richmond

Mecklenburg

CabarrusStanly

SurryAshe

WilkesYadkin

Forsyth

Stokes

Davidson

RandolphRowanLincoln

ClevelandGaston

Iredell

Caldwell Alexander

CatawbaBurke

McDowellBuncombe

Rutherford

Polk

MadisonYancey

Watauga

Cherokee

Graham

ClayMacon

Jackson

Swain

Avery

Davie

Montgomery

Mitchell

Henderson

Transylvania

Haywood

Wake

GranvillePerson

Orange

Lee

Hoke

Robeson

Columbus

Brunswick

PenderBladen

Sampson

Duplin

Onslow

Jones

LenoirWayne

Johnston

Harnett

Carteret

CravenPamlico

BeaufortHyde

TyrrellDare

Gates

Hertford

Bertie

Martin

PittGreene

Wilson

NashFranklin

Warren

Halifax

Northampton

Edgecombe

Vance

DurhamAlamance

Cumberland

Washington

CurrituckCamden

Pasquotank

Perquimans

Chowan

NewHanover

Chatham

CaswellAlleghany

North Carolina

Quick Facts:

•100 counties

•@ 9.3 million residents

•High School Grad @ 78%

•Median income @$47,000

•Poverty @ 15%

•1.7million uninsured

NC OMHHD 2010 3

North Carolina Population Estimates 2008

Non-Hispanic Black21.6%

Non-Hispanic American

Indian1.2%

Non-Hispanic White67.8%

Non-Hispanic Asian/Pacific

Islander2.0%Hispanic

7.4%

Data Source: National Center for Health Statistics & US Census Bureau 2008 Bridged Population Estimates

NC OMHHD 2010 4

NC Office of Minority Health and Health Disparities-Research and Data Tools-

Population Specific Fact Sheets

www.schs.state.nc.us/SCHS or www.ncminorityhealth.org

NC OMHHD 2010 5

Racial and Ethnic Health Disparities in North Carolina

REPORT CARD2010

Office of Minority Health and Health Disparities

And

State Center for Health Statistics

North Carolina Department of Health and Human Services

NC OMHHD 2010 6

Health Disparities Report Card 2010 Update

State Center for Health Statistics

Vital Records: Mortality Data Behavioral Risk Factor

Surveillance System (BRFSS) Youth Risk Behavior Survey

(YRBSS) Pregnancy Risk Assessment

Monitoring System (PRAMS) NC Nutrition and Physical

Activity Surveillance System (NC-NPASS)

American Fact Finder US Census Bureau: American Community Survey HIV/AID Surveillance CHAMPS Hospital Data National Center for Health

Statistics NC Cancer Registry

Data Collection Sources Include:Data Collection Sources Include:

NC OMHHD 2010 7

Health Disparities Report Card 2010 Update

Focus Areas

Social and economic well-being

Maternal and Infant Health

Adult Health

Communicable Diseases

Violence and Injuries

Child and Adolescent

HealthRisk Behaviors and Health Promotion

NC OMHHD 2010 8

Health Disparities Report CardDisparity Ratio and Grades

0.0 - 0.5 = A 0.6 - 1.0 = B 1.1 - 1.9 = C 2.0 - 2.9 = D 3.0 or Greater = F

In cases where the minority rates are better than the white comparison rate, the disparity ratio was not utilized, and the grade is reported as an “A.”

Source: NC Division Public Health Epidemiology Team; NC OMHHD Research Associate; NC State Center for Health Statistics

Guidelines Used to Assign Grades:Guidelines Used to Assign Grades

NC OMHHD 2010 9

NC Infant Mortality Disparity Ratios by Race/Ethnicity

2.4

1.0

2.1

1.0

0

0.5

1

1.5

2

2.5

3

African American American Indian Asian/PacificIslander

Hispanic/Latino

Dis

par

ity

Rat

e R

atio

s

2004-2008

Grade D

GradeD

GradeA

GradeB

Any Rate Ratios that are >1.0 indicate a Disparity Gap. Here, African American and American Indian babies are more likely to die at a higher rate than Whites.

Data Source: State Center for Health Statistics

NC OMHHD 2010 10

Social and Economic Disparity Rate Ratios in N.C. 2008

3.0

2.5

1.1

3.03.2 3.2

1.2

3.7

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

Dis

par

ity

Rat

e R

atio

s

AAGrade

FAI

Grade D

AsianGrade

C

H/LGrade

F

AAGrade

F

AIGrade

F

AsianGrade

C

H/LGrade

F

% Children < 18yrsLiving Below Poverty

% of Families LivingBelow Poverty

3 out of 4 racial/ethnic groups have children that live in poverty at least 2.5 times more often than the majority white population.

NC OMHHD 2010 11

NC OMHHD 2010 12

African Americans - vs- White PopulationDeath Rate Ratios Over 5 Year Period

2004-2008

4.6

2.01.5

2.4

13.8

2.82.5

0

2

4

6

8

10

12

14

16

InfantMortality

Stroke Diabetes KidneyDisease

HIV/AIDS ProstateCancer

Homicide

Dis

pari

ty R

atio

s

Grade D Grade C Grade D

Grade F

Grade D Grade F

Ove

Any Rate Ratios that are >1.0 indicate that African Americans are more likely to die at a higher rate than Whites.

Data Source: State Center for Health Statistics

Grade D

NC OMHHD 2010 13

NC OMHHD 2010 14

American Indian -vs- White PopulationDeath Rate Ratios Over 5 Year Period:

2004-2008

2.2

5.7

1.11.11.5

1.6

1.7

0

1

2

3

4

5

6

HeartDisease

Stroke Diabetes KidneyDisease

ProstateCancer

Homicide MotorVehicle

Dis

par

ity

Rat

ios

GradeC

GradeC

GradeC

GradeC Grade

C

GradeF

GradeD

Any Rate Ratios that are >1.0 indicate that American Indians are more likely to die at a higher rate than Whites.

Data Source: State Center for Health Statistics

NC OMHHD 2010 15

Hispanic/Latinos -vs- White Population Death Rate Ratios Over 5 Year Period: 2004-2008

1.0

2.3

2.9

1.3

0

0.5

1

1.5

2

2.5

3

3.5

Infant Mortality Motor Vehicle Homicide HIV/AIDS

Dea

th R

ate

Rat

ios

GradeB

GradeC

GradeD

GradeD

Any Rate Ratios that are >1.0 indicate that Hispanic/Latinos are more likely to die at a higher rate than Whites.

Data Source: State Center for Health Statistics

NC OMHHD 2010 16

Asian/Pacific Islander -vs- White Population Death Rate Ratios Over 5 Year Period: 2004-2008

0.6

0.5

0.4

0.7

1.1

1.0

0

0.2

0.4

0.6

0.8

1

1.2

InfantMortality

Homicide Stroke ColorectalCancer

Diabetes Motor Vehicle

Dea

th R

ate

Rat

ios

GradeA

GradeC

Grade A

Grade A

GradeA

Grade A

Any Rate Ratios that are >1.0 indicate that Asians are more likely to die at a higher rate than Whites. Ratios of <= 1 indicate that Asian death rates are equal to, or below those of Whites.

Data Source: State Center for Health Statistics

NC OMHHD 2010 17

Prevention for the Health of North Carolina: Prevention Action Plan www.nciom.org

NC Healthy Carolinians 2010 Plan ( 2020 State Plan in progress) www.healthycarolinians.org

Health Policy 1987 First Race/Ethnicity Data Reports –State Center for Health Statistics –updates

approximately every 3 years www.schs.state.nc.us/SCHS 2009 Legislation- Health Providers Required to Report Race/Ethnicity Data ( self-

reported)

NC Department of Health and Human Services (DHHS) Call To Action To Eliminate Health Disparities)

www.ncminorityhealth.org

North Carolina’s Response

NC OMHHD 2010 18

North Carolina’s Response continued

Division of Public Health, DHHS (state level) http://ncpublichealth.com

Public Health Departments (county level profiles) www.healthycarolinians.org

Community Based, Non Traditional Agencies www.ncminorityhealth.org

Health Care “Safety Nets” (examples) Office of Rural Health & Community Care www.ncdhhs.gov/orhcc NC Community Health Association www.ncchca.org NC Association of Free Clinics www.ncfreeclinics.org

NC OMHHD 2010 19

Eliminating Health DisparitiesPerformance Measures

Health Disparities Trend Data NC Health Carolinians Plan Targets Local Public Health Departments Accreditation Healthy Carolinians Partnerships

Certification/Recertification Standards NC Prevention Action Plan- 11 Priorities Department of Health and Human Services

Performance indicators and reporting requirements

NC OMHHD 2010 20

Systems Change = Key

Based on 3 Guiding Principles: Integration Investment Accountability

NC OMHHD 2010 21

On Behalf of the NC OMHHD Thank You for Being a Partner in the Fight to

Eliminate Health Disparities!

Office of Minority Health and Health DisparitiesOffice of Minority Health and Health DisparitiesDivision of Public HealthDivision of Public Health

NC Department of Health and Human ServicesNC Department of Health and Human Services1906 Mail Service Center1906 Mail Service CenterRaleigh, NC 27699-1906Raleigh, NC 27699-1906

(919)707-5040(919)707-5040

www.ncminorityhealth.orgwww.ncminorityhealth.org

Healthy Communities. Every One Matters.