Oregon Health Authority Evaluates Performance on Health Equity

The three-phase study finds there is a consistent disparity, especially for African and Native Americans
The Lund Report

October 31, 2011—A report examining the outcome of programs run by the Oregon Health Authority and the Department of Human Services shows there’s a lot of work to do to achieve health equity based on race and ethnicity.

Outcome-based goals, called “key performance measures,” were used to gauge the performance and success of these programs in the recently released “State of Equity” report.

“Most key performance measures have not been looked at through race and ethnicity in the past,” said Tricia Tillman, director of the health authority’s Office of Multicultural Health, who presented the findings to the Oregon Health Policy Board earlier this month.

Out of 31 key performance measures, 20 showed disparities exist according to race and ethnicity. A majority of those disparities occurred among the African American and Native American populations.

Here are some of the findings:

--In 2009, 55 percent of uninsured African Americans were served by safety net clinics. The next highest served community was Native Americans, 31 percent of whom received services at safety net clinics. Those figures compare to 15 percent among the non-Latino white (or Caucasian) population.

--43 percent of the African American and 50 percent of the Native American population reported having intended pregnancies, compared to 50 percent in the white population.

--38 percent of Native American and 30 percent of African American adults smoke, compared to 20 percent in the white population, and 10 percent of the Asian/Pacific Islander population.

--After completing alcohol and drug treatment, only 46 and 47 percent of the African American and Native American population no longer abused alcohol or drugs, compared to 66 percent in the white population, and 72 percent in the Asian population.

That many of the key performance measures showed these disparities among the African American and Native American communities is “striking, especially given the diversity in the measures and data collection systems,” according to the report.

“We have a lot of work to do to live up to our commitment to service and health equity for all Oregonians ” wrote Dr. Bruce Goldberg and Erinn Kelley-Siel, the directors of the Oregon Health Authority and Department of Human Services, in a joint letter introducing the report.  

To have health equity in a population, people have equal access to being as healthy as possible, regardless of race, ethnicity, income, and other social factors. Health measures, such as life expectancy and likelihood of dying heart disease, would not be measured by those factors.

This isn’t the first time Oregon has taken a look at health equity disparities. During Governor John Kitzhaber’s first term as governor, he convened the Racial and Ethnic Health Task Force in 1999.

The state adopted an Action Plan for Health that was created by the Oregon Health Policy Board in 2009 to guide the state’s health reform efforts to improve health and reduce costs.

Organizations representing minority interests have also studied health inequity: the Urban League of Portland released a “State of Black Oregon” report in 2009 and the Coalition for Communities of Color released “An Unsettling Profile,” which showed numerous disparities among non-white communities in the Portland metropolitan area.

The State of Black Oregon shows sobering statistics about African American health. Among the report’s many findings, it states that 42 percent of African Americans suffer from high blood pressure, compared to 25 percent in the white community, and the diabetes rate among African Americans is 13 percent, compared to 6 percent among the white population. The report also showed that African Americans have an increased likelihood of dying from heart disease or a stroke, and that infant mortality is 50 percent higher than the white population.

Marcus Mundy, the Urban League of Portland’s executive director, said the Oregon Health Authority’s report is valuable, especially because it contains recently released 2010 census data. “This is another wave in the relentless torrent of people reminding [the state] that this problem is not going away unless we address it,” he said.

Tillman, during her presentation to the Oregon Health Policy Board, said her office is holding meetings with leaders in the African American and Native American communities to seek their assistance in devising strategies to eliminate the disparities.

The Office of Multicultural Health is currently working with state officials to create a list of “indicators,” to track and report across race and ethnicity. These indicators will be related to “the need for services and programs, access to services and programs, customer service quality and related outcomes.” A report on these indicators is expected in November, which will likely to be presented to the policy board, which oversees the Oregon Health Authority.

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