States need to improve the health infrastructure's response to the prevalence of health disparities:

  • Supporting the Safety Net and Community Health Centers:  People of color and low-income communities lack adequate access to services.  Working to fill the gap are Community Health Centers, which have grown substantially over the past several years and serve a disproportionate percentage of non-white communities.  Health Centers with dedicated chronic care management programs showed dramatically better quality of care than those without strong intervention programs -- programs aimed at warding off disease and helping patients stay healthy.
  • Data Collection:  To develop effective programs for eliminating disparities, such as chronic care management systems, accurate and timely data is essential.  This data allows states to identify disparities and develop targeted initiatives.  Some state data collection systems categorize all racial and ethnic groups as only black or white, which is far too limited.  The Commonwealth Fund recommends states adopt the Revised OMB Directive 15 racial and ethnic categories as the minimum for collecting and reporting health data.
  • State Offices of Health Equity and Long Term Planning:  At least 35 states have an office coordinating state policy to address disparities, but many lack resources and institutional structure to be effective.  New efforts, however, are improving state response to disparities.  In 2007, Colorado enacted SB 242 requiring the Office of Health Disparities to educate the public about disparities and cultural competency, support local public health systems, promote diversity in the health care workforce, and reduce language barriers.  A recent study shows that eliminating disparities related to diabetes alone would save taxpayers in Colorado more than $80 million each year.  In 2006 Washington State created the Governor's Interagency Coordinating Council on Health Disparities (SB 6197), which will evaluate state policies and legislation to determine whether they will help eliminate or worsen health disparities.  Michigan's Health Disparities Reduction Program is developing a strategic framework for reducing racial and ethnic disparities in the state.  Additionally, the program funds community-based organizations to target health conditions in specific groups and requires Medicaid managed care organizations to develop and implement programs to reduce health disparities. 


New England Journal of Medicine - Improving the Management of Chronic Disease at Community Health Centers

Washington State - 2006 SB 6197, Creating the Governor's Interagency Coordinating Council on Health disparities

Commonwealth Fund - Michigan Tackles Health Care Disparities

Colorado - 2007 SB 242, expanding the responsibilities of the Office of Health Disparities