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Remarks to a Meeting of Health Careers Opportunity Program and Centers of Excellence Program Grantees

H R S A Speech

U.S. Department of Health & Human Services
Health Resources and Services Administration

HRSA Press Office: (301) 443-3376
http://newsroom.hrsa.gov


by HRSA Administrator Mary K. Wakefield

February 1, 2011
Bethesda, MD


First, let me welcome you to the Washington area.  I’m glad you were able to meet with us, and 
I’m very happy to be able to talk with you today.

The Health Careers Opportunity Program and the Centers of Excellence Program are important parts of HRSA’s portfolio, because they help us meet one of the main goals in our new strategic plan: that is, to strengthen the health workforce.  One very important way that we’ll meet that goal is by assuring a diverse workforce.

Clearly, your work is a key ingredient in that effort, both in giving students from disadvantaged background a way to enter the health professions and in helping under-represented minorities succeed in their quest to become health professionals and to stay in their chosen field.  And at HRSA we’re working to strengthen that focus – even within our organizational structure.

For example, to solidify our commitment to diversity in the health professions, the Bureau of Health Professions created a Senior Advisor for Diversity, and that position is filled by Michele Richardson.  Her task is to carry out my expectation to make diversity in the health professions a priority at HRSA.  You’ll meet Michele in a few minutes. Ensuring diversity in the health care workforce is a key strategy to achieve the broader aim of equity in health and health care.  That is not just a goal for HRSA; it’s a goal for the entire Obama administration.

At the department level, HHS Secretary Kathleen Sebelius has requested the development of a Health Disparities Strategic Action Plan.  She has identified this focus as one of her highest priorities.  Consequently, various HHS components, including HRSA, are commenting on and contributing substantively to the plan. Her aim is the same as ours: to build a nation free of disparities in health and in health care.  And as I’ve followed the shaping of this strategic plan, I’m confident you’ll see real and meaningful action steps embedded in it. 

Two weeks ago, in a speech at Howard University, Secretary Sebelius reminded the audience that thousands of primary care providers are being trained, developed and placed as a result of the Recovery Act stimulus and the Affordable Care Act.  These laws are instrumental in helping Americans from all backgrounds to fulfill their dream of being healers in their communities.  The providers that the Secretary referenced are, of course, being trained and supported by HRSA’s health professions programs.

Secretary Sebelius knows, as we do, that if we invest in our primary care workforce – with a special focus on health professionals from underserved communities – we build health equity.  We build health equity because research shows that many of those health professionals will return home to practice or will practice in communities similar to the ones they hail from.  And by doing so they will chip away at the “underserved” status of their communities. In addition to addressing health equity through a strengthened and diverse workforce, the Affordable Care Act put in place some common sense rules of the road for insurance companies, like ending the practice of denying coverage to people because of pre-existing health conditions.

This is especially important because we know that nearly half of African-Americans have a chronic condition or disability, and Latinos have higher rates of chronic, preventable disease compared to whites. As such, they are prime targets for insurance discrimination.  Under the Affordable Care Act, it’s now illegal for insurers to deny coverage to children based on their health status.  And, starting in 2014, discrimination against pre-existing conditions will be gone for all Americans – gone for good.

Today, one in five African-Americans doesn’t have health insurance, and rates of uninsurance among Hispanics are even worse – the highest of any racial or ethnic group in the United States.  This puts all of them – and anyone else without coverage – one bad hospital bill away from a financial disaster.

But the Affordable Care Act will give every American access to affordable health coverage. By 2014, all Americans will be able to choose between a range of affordable coverage choices thanks to the new health insurance exchanges that the ACA will create.  These exchanges are designed to be consumer-friendly, largely state-based insurance markets where Americans will have the same coverage choices as members of Congress.  And many working families will receive tax credits to help them buy health insurance for themselves and their children.

Access to care also is being expanded through an expanded community health center system.  The Affordable Care Act directed to HRSA $11 billion over the next five years to open and expand health centers across the country.  Currently, health centers provide high-quality primary and preventive care to 19 million predominantly low-income, minority patients, about 40 percent of whom have no health insurance.  Thanks to President Obama and the Affordable Care Act, we will nearly double the health center system’s capacity by 2015.

All of these are reasons why Secretary Sebelius called the Affordable Care Act the most important legislation to reduce health disparities since Medicare.  Put simply, the Act restores some basic and long overdue fairness to our health care system.

It will make a huge difference for the health of all Americans.  But it will have an especially big impact on African-American, Hispanic, American Indian and Alaska Natives, some Asian American and Pacific Islander groups, and for other minority communities that have often lagged behind in both access to health care and in health status.

As I’ve said, your programs play an important role in building a future health care workforce in the United States that actually looks more like the population in the United States.

And while clearly much, much more needs to be done, we have optimistic reports from our National Health Service Corps and from the most recent nurses survey that diversity in the health professions is, indeed, increasing.

Of the 7,500 providers currently serving in the National Health Service Corps, more than 3,100 are minorities.  That includes more than 1,600 Hispanics, almost 900 African-Americans, more than 100 American Indians and 32 Hawaiians and Pacific Islanders, as self-reported by participants. 

You probably know that the Affordable Care Act dedicates $1.5 billion to the NHSC over the next 5 years.  That’s enough to fund about 3,000 new loan-repayment contracts and scholarships for primary care clinicians, a huge group of whom – if the trends I just mentioned hold – will be under-represented minorities.

We also have encouraging news among nurses.  In the nursing survey that HRSA released last September, we determined that the percentage of nurses who were Asian, Black/African-American, American Indian/Alaska Native or Hispanic had risen to 16.8 percent in 2008, an increase from 12.2 percent in 2004.

But even with those encouraging trends, the current percentage of African American or Hispanic and other underrepresented minority health professionals does not come close to meeting their percentage of the population.

Greater equality in those percentages is not just a good idea for the sake of equity.  As I earlier indicated, it’s good for the delivery of health care and the improvement of health outcomes among minority populations.

We know it’s true and several studies confirm it. 

A 2006 review of studies in the field funded by HRSA confirmed what many of us have long known:

  • that underrepresented minority health professionals disproportionately serve minority populations –thus, greater diversity will increase access to care by those groups;
  • that minority patients tend to get better interpersonal care from practitioners of their own race or ethnicity, particularly in primary care and mental health settings; and
  • that minority professionals also are more likely to serve other underserved populations: the poor, the uninsured, and Medicaid patients.

And the HRSA-supported literature review followed a 2004 Institute of Medicine report which found that diversity contributes to greater patient choice and satisfaction, better communication between health professional and patients, and better educational experiences for students in training.

So programs like yours that help to improve representation of minorities in health careers – with the aim of equity in health and health care – are good public policy.  Your programs not only make America fairer, they make America healthier. Personally, I have no doubt that your work is moving us toward a more just America and that these programs are wise investments of taxpayer dollars.

We have examples that this is true.  For instance, Meharry Medical College School of Medicine, a Centers of Excellence grantee, has an agreement with seven Historically Black Colleges and Universities to identify and cultivate students to be candidates for careers in the health professions.  That’s a great recruiting strategy that wisely and efficiently leverages HRSA’s investment.

The Mount Sinai School of Medicine, which receives HCOP and COE funds from HRSA, enlists universities like the University of Medicine and Dentistry of New Jersey and Area Health Education Centers, another HRSA-funded program, to extend the reach of their activities.

So I know the reach and value of these programs and some of the successes that you’ve enjoyed.You know, too, that President Obama values a strong and diverse workforce and is on your side. 

But in budget terms, all of us face a rugged, even brutal future.  In his State of the Union address last week, President Obama proposed a five-year spending freeze in non-defense, discretionary spending, a category which includes programs like yours.   Many in Congress, of course, prefer to go beyond a freeze to make deep spending cuts in discretionary programs. The situation we confront is one in which all discretionary programs must prove their value.  We must prove that they meet the public policy goals that Congress intended them to reach. That is the challenge all health programs face, not just yours.  And it is an exercise that all health professions programs are deeply involved in.

BHPr is working to improve performance measures in all of its 40 programs.  The first step in the process is the development of the logic model, and that’s why we invited your input on that. I thank all of you who participated. The bottom line is that we absolutely must improve performance measures so that they accurately and more completely reflect the value and accomplishments of your programs. We need Congress to know how valuable your programs are to creating a future free of health disparities in the United States.  We invited you here to get your input, and that’s why your participation today and tomorrow is so valuable to us. 

In HCOP, for example, we know it is a challenge to measure how Saturday academies or afterschool academic enhancements activities influence or improve an HCOP participant’s academic performance.  It is a difficult task. But let me congratulate the UMass Donahue Institute for designing an evaluation that seeks to understand whether their HCOP students have more successful outcomes than a non-HCOP-enrolled peer group. The evaluation examines whether the current high school curriculum adequately prepares students for the rigors of college and how HCOP has impacted their preparation.  That’s the kind of thing we’re looking for.

So, in closing, I encourage you to engage with the presenters you will hear this afternoon and to work closely with us on developing the performance measures.  In addition, I encourage you to listen to each other and trade good ideas about what you’re doing in this area.

We must take your quantifiable success stories in guiding more disadvantaged and under-represented minorities to careers in the health professions and tell those stories through performance measures and other instruments like the reports HRSA must submit under the Government Performance and Results Act.

That is the challenge that we share.  I’m glad you’re here, and I look forward to your efforts on this front.