There is much that is unknown about the determinants of health disparities such as why some individuals are more adversely affected and why some people with fewer resources fare better in some health conditions than the population as a whole. Projects need to be undertaken to gain knowledge and understanding of the impacts and determinants of health disparities. These issues need to be jointly explored together by the residents of neighborhoods most affected by health disparities, policy makers, funders, and service providers to understand how the synergistic effects of biological, cultural, socio-economic, racism, and political factors influence health outcomes.
As cited in the Centers for Disease Control and Prevention Performance Plan XV: Eliminating Racial and Ethnic Disparities, the health status areas targeted are infant mortality, cancer screening and management, cardiovascular disease, diabetes, HIV infection/AIDS, and child and adult immunizations. In addition the Surgeon General of the United States has produced two new specific reports that emphasize issues related to mental health, substance abuse, and a call to action to address suicides.
Eliminating racial and ethnic disparities in health will require new knowledge about causes of health disparities, enhanced efforts at preventing disease, innovative methods of promoting health and delivering culturally competent and linguistically specific preventive and clinical services.
Research dedicated to a better understanding of the relationships between health status and different racial and ethnic minority backgrounds will help us acquire new insights into eliminating the disparities and developing new ways to apply our existing knowledge toward this goal. This initiative will require working more closely with providers to deliver preventive and clinical services and with the community, to identify needs, and to plan and conduct research.
Citizenry should be empowered to develop programs to promote healthy lifestyles. Collaborations between local merchants, civic organizations, and service providers need to work together to build opportunities for health behavior changes.
The Austin/Travis County Health and Human Services Department proposes a model for reducing health disparities which will utilize the services and maximize the resources of private and public clinics, community-based organizations, and the CAN partners for wellness and prevention services. This model incorporates two tracks to providing prevention and wellness services to targeted neighborhoods where health disparities are most prevalent. The components of this model includes the implementation of:
- Community-based education and screening services; and
- Community-based prevention and outreach services.
The Community-based education and screening services would be incorporated into services provided at six neighborhood centers. These centers are located in sections of the community where health disparities are the most prevalent. These services would complement, not compete with, the primary care system. Services would focus on preventing disease and illness by providing:
- Early screening services for both chronic and communicable diseases;
- Health education classes and one-on-one counseling to improve healthy behaviors;
- Disease case management;
- Violence and injury prevention counseling and education;
- Women's health services; and
- Environmental health services.
Linkages and enrollment to other health partners' services would also be streamlined to improve access. The centers would act as a hub for a community outreach team to interact with the local neighborhood to gain understanding and help eliminate barriers to wellness and prevention services. The centers would serve as the main source of information and connection to health and human services for individuals living in neighborhoods where economic and infrastructure services are not equal to the greater community at large.
To fully implement this model a minimum staffing for each center would include:
- A Site Manager;
- A Community Liaison (Health Educator);
- Three Community Outreach Workers;
- A Social Worker; and
- A Public Health Nurse
Where possible individuals from the targeted neighborhoods would be recruited to work at the Community-based centers.
The Community-based prevention and outreach services would reach out to neighborhoods not in close proximity to a community center, which are primarily rural areas. The services would be similar to those of the community-based centers and would require similar staffing. This outreach service would employ the utilization of a mobile health van currently in use. Using the community centers as staging areas, the unit also would rotate among the centers to supplement their services.
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