A task force was made up of a variety of people, both of color as well as provider institutions across the Commonwealth, and we conducted 14 community forums throughout the Commonwealth to talk to them about their perspective at the community level as to what the important issues and strategies are, in terms of the way they view access to health care and the quality of it. We often don’t know who to work with, or what strategies have been tried, or the baseline we’re trying to compare our own community with. This document provides the cold, hard facts about disparities.

RSZ: We used our state health data center. We looked at morbidity and mortality data, the kinds of vital records that we have as the Health Department, and compared it county-by-county with national records. We have a behavioral risk factor surveillance survey that’s done every year throughout the Commonwealth and compare it with national experience on risk factors. We even do it down to a level that it can be statistically useful at a community level. We have morbidity registries, like the one for cancer that registers every tumor in Pa., not just deaths. We pulled together this data and compared it with the national Healthy People 2010.

RSZ: There are fairly remarkable disparities related to cardiovascular disease, heart disease, stroke, lung cancer mortality, breast cancer mortality, homicide, infant mortality, low birth weight, lack of prenatal care, birth to minors, syphilis, AIDS and tuberculosis.

RSZ: Current information about biologic and genetic characteristics of minority populations did not explain health disparities experienced by these groups compared with the white or non-Hispanic population. They’re really a result of the complex interaction among generic variations, environmental factors and specific health behaviors. If you look at what we call excess deaths—the years of lost life—that were preventable in this country, fully 70 percent of that excess death is attributable to things that are related to individual behaviors or environmental factors. If you want to have an intervention that reduces or eliminates disparities in diseases that are accounted for by individual behaviors or environmental factors, you need to do it in a way that is culturally appropriate, and that involves the community in partnership to address those problems in a way that they find acceptable.

RSZ: I don’t know that you can quantify that. Clearly, clinical medicine had done a lot in terms of infant mortality. But keeping someone alive through medical intervention is a lot different from having early, appropriate, regular prenatal care. It involves both the educational approach and support for that individual in terms of caring for themselves during pregnancy, and not just access to medical care. A lot of the very population that experiences the disparity in many cases does have insurance. It may be through Medicaid or other means, but if the services are not appropriate and are not accessible or acceptable to the population that it’s trying to influence and support, then it’s not going to be effective. That’s one of the messages for both public health and the clinical side: it’s not all technical interventions. I think the way you widen the approach is to work with communities, like we do with our community health partnerships in general, and present them with information. You help them identify what the common underlying causes or problems are that they want to address. And you find people coming to the table with resources that are far beyond what public health can offer. Even in clinical medicine—the better part of the equation in terms of whether you have success is the attitude, behavior and attention that you have on the part of the patient.

RSZ: For example, lack of immunization is an underlying cause for a host of vaccine-preventable illnesses. Others are lack of physical activity, unhealthful eating behavior, risky sexual behaviors, lack of screening and monitoring. Those underlying causes may have a direct impact on a number of clinical conditions, for example, heart disease, cancer, so by addressing underlying causes and conditions you address more than one clinical condition. The report is broken down into six categories: chronic disease, communicable disease, family health, violence and injury, environmental health and health service delivery systems.

RSZ: We selected one proposal from each of our six districts in which a minority community, or a minority-based organization or a community health partnership had a focus on minority health, or wanted to have one. We would provide them, based on the strength of their application, some monies for a planning year and monies for two successive years where they would develop implementation strategies and find ways to use the partnership model with and for the minority communities in this state. We wanted to put more money into it than usual by paying for a planning year. We want to give technical assistance. We wanted the grantee to determine, based on some evidence base, what kind of problem set that they wanted to address as a community so they could get enough people around the table to put their resources on the table in a way that they could have some synergy and create a model. The grants are $250,000 each—that’s $50,000 for the first planning year and $100,000 each for the following two implementation years. Our health partnership model, the State Health Improvement Plan (SHIP), is community-centered, using data and drawing comparisons between communities, and providing information to communities that can be used for them to assess what problems they want to focus on. We have gone from seven community health partnerships in the Commonwealth in 1999 with SHIP to about 50 right now. We wanted to take that community health partnership model and make sure that it works with, for, and by minority communities.