In the year since taking charge of the state’s health department, Commissioner Mary E. O’Dowd has taken a hard look at the results New Jersey gets for the millions of dollars it spends each year aimed at leveling the healthcare playing field for minorities.
In the past the emphasis was on process, O’Dowd told the state’s first Health Equity Summit on Monday. “How many visits, or how many programs or how many educational sessions” did state health programs rack up.
Now she’s asking the more pertinent question: “Did this result in an improvement in health?”
The work is directed at decreasing the disparities in health — among African Americans, with high rates of HIV/AIDS, and Hispanics with diabetes and asthma – by scrutinizing the effectiveness of health outreach programs and seeking to ensure that state grants to community healthcare providers are directed toward those who demonstrate improved public health outcomes.
“I think in the past, everything the Department of Health has done has felt right,” O’Dowd said. Under her tenure, the agency is “focusing on showing that it actually is doing what we want to achieve.”
Efforts to reverse health disparities are focused on obesity, HIV/AIDS, cancer, and infant mortality. These are areas with “significant disparities in outcomes among various racial/ethnic groups in New Jersey,” she said. “We are analyzing the impact that our programs have had in reducing disparities and using that data to inform our decisions.”
Dr. Philip Bonaparte, vice president, clinical affairs, for Horizon Blue Cross Blue Shield of New Jersey, said the social determinants of health are the economic and social conditions that influence health. “If I dig another level lower, we find poverty, unequal access to healthcare, lack of education, stigma and racism. These are the contributing factors to health inequities.”
New Jersey has been changing its approach to healthcare to the life course model, which considers how to improve health through the different stages of life, from infancy to old age. Gloria Rodriguez, assistant commissioner of the health department’s division of family health services, said this approach is a paradigm shift. Instead of looking at maternal health, for example, the goal is to improve the woman’s health before she becomes pregnant.
Health disparities can be seen in the different levels of positive and negative health factors found when comparing whites with minorities, Rodriguez said. For example, on average, white women who smoke have a better birth outcome than African American women who don’t smoke, she said. “Societal determinants include health throughout the entire lifespan.”
Progress requires “a community approach to continually create and improve the physical and social environment and expand community resources that enable people to mutually support each other,” she said.
O’Dowd’s efforts to reduce health disparities is being carried out by the Office of Minority & Multicultural Health, which is looking at strategies that work, and figuring out how to replicate them on a larger scale. One success story is the Hispanic Family Center of Southern New Jersey, which O’Dowd said was able to reduce ER visits for asthma by 44 percent, from 212 to 119, resulting in fewer school absences related to asthma.
The seminar heard from public health officials in Trenton and Camden, cities that have been pioneering a team approach to caring for their residents, the majority who are lower income and African Americans or Hispanics, and in the habit of using the hospitals as a primary care office.
In both cities, hospitals and the federal and state-funded health centers are working together to reduce excessive visits to hospital emergency rooms and inpatient hospital stays by making it easier to get an appointment with a primary care practitioner.
O’Dowd noted that two weeks ago, when she announced $8 million in grants to providers of HIV/AIDS care, the winners were those who “maximize resources to best reach those in need.” Among them was the Henry J. Austin Health Center in Trenton, which has consolidated all services, including behavioral health, in a “health home” designed to improve access to care and to provide patients with a regular physician who knows their medical condition.
O’Dowd credited the work of providers like Henry J. Austin for the state’s progress in stemming the HIV/AIDs epidemic. There has been a 68 percent decline in the annual number of new cases of HIV/AIDS in New Jersey from 2000 and 2009, and in 2010, only 4 New Jersey infants were born HIV positive, a decline of 90 percent. Still there remains the stark reality of the African American disparity in HIV/AIDS: African Americans are 14 percent of the state’s total population but represent 54 percent of infections.
Obesity rates are skewed by disparities, with the rate for whites at 23 percent, Hispanics at 27 percent, and blacks, at 36 percent, according to the health department. O’Dowd said in the past, obesity prevention was focused on changing individual behaviors. Today, the department’s Shaping NJ program is striving to create physical activity and food choice environments in New Jersey that support healthy behavior. Shaping NJ has been funding local projects that promote physical activity and healthier eating, including community gardens, farmers markets, walking clubs, and recreation trails.