State and Local Policy Initiatives to Reduce Health Disparities Workshop Summary (2011) / Chapter Skim
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4 Health Disparities in Great Britain and Massachusetts: Policy Solutions
4 Health Disparities in Great Britain and Massachusetts: Policy Solutions
Pages 33-46
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From page 33... ...
This chapter shares information about disparities reduction efforts in England (Annette Williamson) and the state of Massachusetts (Joel Weissman)
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From page 34... ...
The new system also moved control and responsibility for health outcomes from the national level to the local level. The NHS is organized into 10 different regions called "strategic health authorities." These authorities, in turn, provide oversight to 152 primary care trusts.
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NSTs provide technical support to the local primary care trusts. They have targeted the key drivers of health inequalities in infant mortality, for example, and have created interventions that are potential solutions.
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NATIONAL SUPPORT TEAMS: EMERGING THEMES FROM THE INFANT MORTALITY SUPPORT TEAM VISITS Annette Williamson is the program manager of the Department of Health National Support Team for infant mortality in England. She is a trained registered nurse, midwife, and health visitor and has worked as both an operational manager and, more recently, as a commissioner of
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From page 37... ...
A series of follow-up visits by the NST also occurs. The feedback from those primary care trusts that the NST has visited has been very positive, with the trusts reporting that they value the support and recommendations that the NST gives to address challenging health inequalities.
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Williamson outlined five emerging strategic themes from her work with the infant mortality NST. These are outlined in Box 4-4.
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From page 39... ...
Health care, social care, and voluntary organizations prepare local area agreements, which are cross-cutting plans that incorporate service delivery, and must agree to the targets and to deliver services together to affect the target. Second, social marketing is a key component in focusing the local community on meeting health targets.
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He noted that, in fact, the idea for using commercial marketing techniques to achieve social goals actually originated in the United States. An audience member asked about the "rigid, hierarchical class system" in England and whether that affects infant mortality rates in disadvantaged populations.
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From page 41... ...
Will Universal Coverage Lead to Reductions in Disparities? Weissman described a study by Michael McWilliams and colleagues looking at the effects of near-universal Medicare coverage on cardiovascular disease and diabetes rates using NHANES (National Health and Nutrition Examination Survey)
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From page 42... ...
First, Section 16O mandates provisions for an ongoing Health Disparities Council. Second, Section 25 describes a pay-for-performance plan, specifically including "the reduction of racial and ethnic health disparities in the provision of care." Third, Section 16L requires the formation of a Health Care Quality and Cost Council (QCC)
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From page 43... ...
The Disparities Report Card for Massachusetts covers the following outline: health status indicators; health utilization, access, and quality indicators; personal health practices and individual factors; social determinants; and laws and social policies affecting health that may disproportionately affect racial and ethnic minorities. One example of such a social policy can be seen in the original creation of the federal Social Security program.
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From page 44... ...
" Weissman estimated that only 5 to 10 hospitals in Massachusetts actually have sufficient numbers of cases involving racial and ethnic minority patients, making the goal of disparities reduction difficult. Fourth, Weissman described what he called the "between problem." Disparities not only exist within a health care setting but also exist across the settings themselves.
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One health plan in Massachusetts used the indirect method to use data to directly affect racial and ethnic health disparities. The Harvard Vanguard health plan has used the indirect method to look at a community where many diabetic patients who were members of minority groups were not getting eye exams.
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From page 46... ...
Joel Weissman responded that in large cities, large differences exist between communities within that city; in other words, as he stated, "not all minority communities are the same." The indirect estimation technique has the advantage of allowing more detailed information about a community to be collected. For example, one community may not have adequate bus service for its residents to access health care in a neighboring community.
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