Addressing Health Inequality with the Economic Recovery Package

The investment of billions of dollars of federal stimulus money in state and local economies presents an unprecedented opportunity to address many of "the systemic and avoidable social and economic problems that are the fundamental causes of health inequality," writes the Health Policy Institute at the Joint Center on Political and Economic Studies in The Potential of the Economic Stimulus Package to Address Health Inequality. Stimulus funding, like $2.1 billion for Head Start and Early Head Start Programs, $1.5 billion for health center improvements, and $8.4 billion for public transit, should be implemented with a clear intent of reducing racial and ethnic health disparities and achieving equitable resource distribution across communities.  

Disparity in Lifespans: The extent of racial and ethnic disparities in health care is well documented, and stark. The life expectancy for African-Americans is 73.3 years, five years shorter than it is for whites; 47 African-Americans per 100,000 people die from complications caused by diabetes, compared to just over 22 deaths among whites; and, people of color in the United States are less likely to receive routine medical care as well as quality health care services.  While people of color are more likely to be uninsured than whites, lack of medical coverage is only one of many factors causing disparities. As the Prevention Institute and the Joint Center's Health Policy Institute at write, Community conditions—such as air, water, and soil quality; access to healthy food, safe affordable housing, and transit; and access to safe parks—shape health and safety outcomes. [And] Poverty, racism, and lack of educational and economic opportunities are among the fundamental determinants of poor health, lack of safety, and health inequities.  

The Opportunity of the Recovery Plan: As the Joint Center's Health Policy Insitute documents, the hundreds of billions of dollars being invested in health care, education, transportation, the environment, and community programs across the country provide this unique opportunity to improve access to quality health care services for people of color and increase opportunities for healthy living and educational and professional advancement.  Specific opportunities created by the stimulus package (in addition to those mentioned above), include:

• $87 billion for Medicaid to prevent state cuts 
• $19 billion to encourage greater use of health information technology by Medicaid and Medicare providers
• $5 billion for the Weatherization Assistance Program to help low-income families make energy efficiency improvements in their homes
• $3.2 billion in block grants to local governments to support energy efficiency and conservation programs
• $825 million to make streets safer for walking and biking
• $7.2 billion to promote high-speed internet programs (access to broadband improves educational opportunities and increases access to services)
• $3.95 billion for job training and employment services
• And, several billions of dollars for affordable and emergency housing

Policies to Ensure Greater Health Equity: To ensure health and resource equity are key considerations for the use and tracking of stimulus funds, advocates, lawmakers, public agency heads, and others can:  

• Ensure state offices of health equity are included in the planning and implementation of stimulus funding, to guarantee communities of color and low-income neighborhoods are receiving resources, such as public transit investments. Pennsylvania's new Office of Health Equity is one of approximately 35 state offices focused on health disparities.
• Establish the goal of achieving health and resource equity as a key metric for implementing and measuring the success of stimulus funded programs.
• Include robust data collection as part of stimulus supported programs.  Data collection - recording race, gender, ethnicity, language, as well as medical conditions - is vital for programs, particularly in health care, designed to eliminate disparities.
• Fund language services and cultural competency training for medical providers at hospitals and community health centers, and other institutions providing key community services.

The federal stimulus package does not fix state and local budget problems, but it provides immediate and necessary support for key public programs and initiatives and, in some cases, frees up state and local dollars to be invested in other beneficial ways.    

Resources:
Health Policy Institute at the Joint Center on Political and Economic Studies - The Potential of the Economic Stimulus Package to Address Health Inequality
Prevention Institute and the Health Policy Institute at the Joint Center on Political and Economic Studies - Reducing Inequities in Health and Safety Through Prevention
Institute of Medicine - Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care
Progressive States Network - Eliminate Health Disparities
ProPublica - The Stimulus Plan: A Detailed List of Spending