Office of Minority Health and
Health Disparities (OMHD)
An Overview
Centers for Disease Control & Prevention (CDC)
What is a “Health Disparity”?
Conceptual Issues
Inequality
Difference in condition, rank
Lack of equality as of opportunity,
treatment, or status
Inequity
– Unfair and unjust
– Unnecessary and avoidable
“Health Disparity” in Public
Health – Operational Definition
Quantitative measures: rates, percents,
means…
The Quantity that separates a group from
a reference point on a particular measure
of health
Calls attention to differences in health
between groups regardless of cause
Can be measured in absolute or relative
terms
Health Disparities
Communities of Color
are Disproportionately Affected
Racial and Ethnic Minority
Populations
American Indian/Alaska Native (AI/AN)
Asian American
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
(NHOPI)
Other Populations By . . .
Socio-economic status
Geography (urban or rural)
Gender
Age
Disability status
Risk status related to sex and gender
CDC Vision
CDC’s Vision for the 21st Century is
“Health Protection…Health Equity”
CDC Mission
Collaborating to create the expertise, information, and tools
that people and communities need to protect their health
– through health promotion,
prevention of disease, injury and disability,
and preparedness for new health threats
OMHD Mission
The Office of Minority Health and Health
Disparities (OMHD) aims to accelerate CDC’s
health impact in the U.S population and to
eliminate health disparities for vulnerable
populations as defined by race/ethnicity, socioeconomic status, geography, gender, age,
disability status, and risk status related to sex
and gender, among other populations identified
to be at-risk for health disparities.
OMHD Guiding Principle
The future health of the nation will be
determined to a large extent by how
effectively we work with communities to
eliminate health disparities among those
populations experiencing gaps in disease,
disability, and death.
What are OMHD Critical Goals?
(1) Equity in health impact
(2) Diversity in customer focus
(3) Access to and participation in public health systems
(4) Participation in the conduct and use of public health
research to solve community wide health problems
(5) The benefits of global health protection, especially
among immigrants and border populations
(6) A verifiable commitment to operational efficiency,
program effectiveness, and accountability for public
resources.
What are the OMHD Core
Functions?
1. Maintaining core functions of the Office
of Minority Health (OMH) without loss
of priority, resources, or visibility
2. Developing CDC-wide health disparities
elimination strategies, policies, goals,
and programs
What are the OMHD Core
Functions?
3. Managing health disparities elimination
goals through scanning, analysis,
knowledge management, decisionsupport systems, and reporting Key
Performance Indicators *, Government
Performance and Results Act**,
Program Assessment Rating Tool***
*(GPRA) **( PART) ***(KPI)
What are the OMHD Core
Functions?
4. Supporting internal and external
partnerships to advance the science,
practice, and workforce for eliminating
health disparities inside and outside CDC
5. Synthesizing, disseminating, and
encouraging use of scientific evidence
about effective interventions to achieve
health disparities elimination outcomes
CDC’s Office of Minority
Health (OMH), 1988
Established by CDC Director-- 1988
A response to Secretary Heckler’s report
on excess deaths in certain groups and
internal advocacy
Coordination vs. program management
Small staff, small budget, no large
programs
CDC’s OMH, 1988-1998 Major
Goals
Assuring that policies direct activities
toward minority health
Enhancing research to reduce the
disproportionate disease burden in
minority groups
Developing effective internal and external
communication networks
Strategic Redirection of OMH,
1998
Executive retreat, agency-wide
deliberations on draft paper on new
vision/policy/strategy/action (1998)
Senior Staff reviews, briefings &
deliberations (1999-2001)
Policy/Action items approved (Oct 2001)
Action Items for Improving
Minority Health: 2000 - 2005
Cross- Cutting Actions: Activities each
CIO should undertake
Infrastructure: Mobilizing people,
information systems, and resources
Program Development and
Implementation: Improving programs
Monitoring and Accountability: Tracking
and assuring quality
OMH Functions/Priorities
2001-2004
Strategic planning (minority health priorities)
Policy initiatives (analysis, development)
Leadership/coordination of minority health initiatives
and Executive Branch activities
Support for minority-serving institutions of higher
learning
Cooperative agreements to conduct research,
prevention activities, student/faculty development
Student traineeships
Epidemiologic studies
External partnerships (technical
assistance/symposia)
Direct support to CDC/ATSDR programs (SME)
Enhancing Impact on Health
Disparities: New Proposals
Office of Minority
Health & Health
Disparities
Goal management &
resource allocation to
address disparities
Accountability
– performance
measurement
– external input
OMH Stakeholders Meeting
Office of Minority Health and Health Disparities (OMHD)
Organizational Units
Director/ADMH
CAPT Walter W. Williams, MD, MPH
Strategic Management Team
CAPT Walter W. Williams, MD, MPH
Tamara J. Kicera, Deputy Director
Benedict I. Truman, MD, MPH, Associate Director for Science
Vacant, Assoc. Director Minority Health & Health Disparities Policy
Science & Goals Management
Karen Bouye, MPH, MS, PhD, Senior Advisor for Research
CAPT Ralph T. Bryan, MD, Senior Tribal Liaison
Ramal Moonesinghe, PhD, Senior Mathematical Statistician
Sarah Berry, Web Developer / Manager
Vacant, Epidemiologist
Vacant, Communications Specialist
Partnerships & Preparedness
CAPT Pelagie “Mike” Snesrud, Senior Tribal Liaison, AI/AN
Vacant, Public Health Analyst AAPI
Vacant, Public Health Analyst AA
Vacant, Public Health Analyst, HISP
Public Health Preparedness
CAPT Sonja Hutchins, MD, MPH, DrPH, Team Leader
Benita Harris, MPH, Senior Public Health Advisor
Vacant, Health Communications Specialist
Vacant, Health Communications Specialist
Resources & OMHD Operations
Theresa Potts, Assistant to the Director
Carol Irvin Grant, Secretary
Vacant, Lead Management & Program Analyst (FTE)
Vacant, Administrative Support Specialist
Vacant, Program Specialist
Vacant, Administrative Assistant
Vacant, Computer Clerk
CDC Organizational Structure
Office of the Chief
Science Officer
Office of the Chief
Operating Officer
Office of the Chief of
Public Health
Practice
CDC Washington
Office
Office of the
Director
Office of Strategy &
Innovation
Office of Minority
Health & Health
Disparities
(ADMH)
Office of Chief of
Staff
Office of Enterprise
Communication
Office of Workforce &
Career Development
Coordinating
Office for
GLOBAL
HEALTH
Coordinating
Office for
TERRORISM
PREPAREDNESS
& EMERGENCY
RESPONSE
Coordinating
Center for
ENVIRONMENTAL
HEALTH &
INJURY
PREVENTION
NCEH
NCIPC
Coordinating
Center for
HEALTH
INFORMATION
& SERVICES
Coordinating
Center for
HEALTH
PROMOTION
Coordinating
Center for
INFECTIOUS
DISEASES
NCHS
NCHPDP
NCEIC
NCHM
NCBDDD
NCIPRD
NCPHI
OPHG
NCHHSTP
NCZSVBD
NIOSH
Population Data and
Representative Mortality
and Case Rates
Leading Causes of Death
African Americans, U.S., 2006
Heart Disease
Cancer
Stroke
Unintentional
Injuries
Diabetes
Homicide
Nephritis, Nephrotic
Syndrome, & Nephrosis
Chronic Lower
Respiratory Diseases
HIV Disease
Septicemia
Source: CDC, NCHS, Health, United States, 2008, Table 30.
Leading Causes of Death
Hispanic/Latinos, U.S., 2006
Heart Disease
Cancer
Unintentional
Injuries
Stroke
Diabetes
Chronic Liver Disease &
Cirrhosis
Homicide
Chronic Lower
Respiratory Disease
Influenza & Pneumonia
Certain Conditions
Originating in the
Perinatal Period
Source: CDC, NCHS, Health, United States, 2008, Table 30.
Leading Causes of Death
American Indian/Alaska Natives, U.S., 2006
Heart Disease
Cancer
Unintentional
Injuries
Diabetes
Chronic Liver
Disease & Cirrhosis
Stroke
Chronic Lower
Respiratory Diseases
Suicide
Nephritis, Nephrotic
Syndrome, & Nephrosis
Influenza & Pneumonia
Source: CDC, NCHS, Health, United States, 2008, Table 30.
Leading Causes of Death
Asian or Pacific Islanders, U.S., 2006
Cancer
Heart Disease
Stroke
Unintentional
Injuries
Diabetes
Chronic Lower
Respiratory Diseases
Influenza & Pneumonia
Nephritis, Nephrotic
Syndrome, & Nephrosis
Suicide
Alzheimer’s Disease
Source: CDC, NCHS, Health, United States, 2008, Table 30.
Population
of the United States by Race & Hispanic Origin:
2008 & Projected 2050
% Percent of Total U.S. Population
100
Non-Hispanic White
90
African American
80
American Indian / Alaska Native
70
66
Asian
60
Hispanic/Latino
46
50
40
30
30
20
10
15
14
1.6
5.1
15
9.2
2
0
2008
2050
Source: U.S. Census Bureau, 2008 National Population Projections, August 14, 2008
http://www.census.gov/Press-Release/www/releases/archives/population/012496.html
Infant Mortality
Rates per 1,000 Live Births by Detailed Race & Hispanic Origin of Mother: U.S.,
Infant Mortality Rate per 1,000 Live Births
2002
15
13.9 13.8
9.6
10
8.6
8.2
7.1
7.0
5.8 5.8
5
5.7
4.9
4.8
4.7
5.6 5.4
5.1
3.7
3.0
0
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er
th
O
a
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n
an
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ut
o
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ic
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m
A
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Source: Health, United States, 2006. http://www.cdc.gov/nchs/data/hus/hus06.pdf#summary Table 19.
H
a
isp
c
ni
in
at
/L
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Infant Mortality
Rates per 1,000 Live Births by Detailed Race & Hispanic Origin of Mother: U.S.,
15
13.6 13.3
10
8.3
8.1
6.9
5.8
5.7
5.6
4.9
6.4
5.5
4.7
4.4
5
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&
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tin
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is
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c/
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S
l&
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en
O
Source: CDC, NCHS, Health, United States, 2008, Table 18
http://www.cdc.gov/nchs/data/hus/hus08.pdf
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Infant Mortality Rate per 1,000 Live Births
2005
Infant Death Under 1 Year
Rates per 1,000 Live Births by Race & Hispanic Origin: U.S.,
Age-Adjusted Death Rate per 1,000 Infants
2005
15
13.7
10
6.9
5.7
5.7
Non-Hispanic
White
White
5.8
5
0
All Races
African
American
Hispanic
Source: National Vital Statistics Report, 56(16), 6/11/08: Deaths: Preliminary Data
for 2006, Table 4, p22 http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_16.pdf
Sudden Infant Death Syndrome (SIDS)
Rates per 100,000 Live Births by Race & Hispanic Origin: U.S.,
Age-Adjusted Death Rate per 100,000 Live Births
2006
99.1
100
80
60
50.3
50.7
42.4
40
23.5
20
0
All Races
Non-Hispanic
White
White
African
American
Hispanic
Source: National Vital Statistics Report, 56(16), 6/11/08: Deaths: Preliminary Data
for 2006, Table 8, p32 http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_16.pdf
Maternal Mortality
for Complications of Pregnancy, Childbirth, & the Puerperium
Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin: U.S.,
Age-Adjusted Maternal Mortality Rate
per 100,000 Persons
2005
35
31.7
30
25
20
15
12.4
10
9.6
9.1
Non-Hispanic
White
White
8.2
5
0
All Races
African
American
Source: CDC, NCHS, Health, United States, 2008, Table 42.
http://www.cdc.gov/nchs/data/hus/hus08.pdf
Hispanic
All Causes
Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin: U.S.,
Age-Adjusted Death Rate per 100,000 Persons
2005
1200
1016.5
1000
798.8
800
785.3
663.4
590.7
600
440.2
400
200
0
All Races
White
African
American
American Asian/Pacific
Indian/Alaska
Islander
Native
Source: Health, United States, 2007. http://www.cdc.gov/nchs/data/hus/hus07.pdf#029 Table 29.
Hispanic
Heart Disease, Cancer, & Stroke
Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin: U.S.,
Age-Adjusted Death Rate per 100,000 Persons
2005
300
271.3
Heart Disease
Cancer
Stroke
250
222.7
211.1
200
207.8
183.8
182.6
157.3
141.8
150
123.2
113.3110.5
122.8
100
65.2
50
46.6
44.7
34.8
38.6
35.7
0
All Races
White
African
American
American
Indian/Alaska
Native
Asian/Pacific
Islander
Source: Health, United States, 2007. http://www.cdc.gov/nchs/data/hus/hus07.pdf#029 Table 29.
Hispanic
Diabetes
Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin: U.S.,
Age-Adjusted Death Rate per 100,000 Persons
2005
50
46.9
45
41.5
40
33.6
35
30
25
24.6
22.5
20
16.6
15
10
5
0
All Races
White
African
American
American
Asian/Pacific
Indian/Alaska
Islander
Native
Source: Health, United States, 2007. http://www.cdc.gov/nchs/data/hus/hus07.pdf#029 Table 29.
Hispanic
Motor Vehicle-Related Injuries
Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin: U.S.,
Age-Adjusted Death Rate per 100,000 Persons
2005
24.8
25
20
15.2
15.6
15
14.7
14.5
10
7.6
5
0
All Races
White
African
American
American Asian/Pacific
Indian/Alaska
Islander
Native
Source: Health, United States, 2007. http://www.cdc.gov/nchs/data/hus/hus07.pdf#029 Table 29.
Hispanic
Human Immunodeficiency Virus (HIV) Disease
Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin: U.S.,
Age-Adjusted Death Rate per 100,000 Persons
2005
19.4
20
15
10
5
4.7
4.2
2.7
2.2
0.6
0
All Races
White
African
American
American Asian/Pacific
Indian/Alaska
Islander
Native
Hispanic
Source: Health, United States, 2007. http://www.cdc.gov/nchs/data/hus/hus07.pdf#029 Table 29.
Chronic Liver Disease & Cirrhosis
Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin: U.S.,
Age-Adjusted Death Rate per 100,000 Persons
2005
25
22.6
20
13.9
15
10
9.0
9.2
7.7
5
3.6
0
All Races
White
African
American
American Asian/Pacific
Indian/Alaska
Islander
Native
Source: Health, United States, 2007. http://www.cdc.gov/nchs/data/hus/hus07.pdf#029 Table 29.
Hispanic
Tuberculosis (TB) Case Rates
Age-Adjusted Case Rates Per 100,000 Persons by Race & Ethnicity: U.S.,
2007
30
Age-Adjusted Cases per 100,000 Persons
25.8
25
23.4
20
15
9.3
10
8.4
6.0
5
0.8
1.1
Multi Racial
non-Hispanic
White
0
non-Hispanic
Black
American Indian
/ Alaska Native
(AI/AN)
Asian American
Hispanic/Latino
Source: CDC, MMWR, March 21, 2008 / 57(11);281-285, Trends in TB, US, 2007, Table:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5711a2.htm
Native Hawaiian
& Other Pacific
Islanders
(NHOPI)
Acute Hepatitis B (HBV) Incidence Case Rates
Age-Adjusted Incidence Case Rates per 100,000 Persons by Race & Ethnicity: U.S.,
2006
Age-Adjusted Cases per 100,000 Persons
3
2.3
2
1.2
1.1
1.1
1
0
White non-Hispanic
Black non-Hispanic
Asian/Pacific Islander
Hispanic/Latino
Source: CDC MMWR, V57, SS2, March 21, 2008, p5. http://www.cdc.gov/mmwr/PDF/ss/ss5702.pdf
Sources
Centers for Disease Control and Prevention (CDC):
National Center for Health Statistics (NCHS)
Health U.S., 2008 http://www.cdc.gov/nchs/data/hus/hus08.pdf
National Vital Statistics Report http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_16.pdf
National Center for HIV, STD, and TB Prevention (NCHSTP)
National Center for Injury Prevention and Control (NCIPC)
MMWR
March 21, 2008 / 57 (SS2): 5. http://www.cdc.gov/mmwr/PDF/ss/ss5702.pdf
March 21, 2008 / 57(11); 281-285. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5711a2.htm
National Institute on Alcohol Abuse and Alcoholism
National Women’s Health Information Center (NWHIC)
U.S. Census Bureau
Heart Disease
Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin: U.S.,
Age-Adjusted Death Rate per 100,000 Persons
2005
300
271.3
250
211.1
207.8
200
157.3
141.8
150
113.3
100
50
0
All Races
White
African
American
American
Asian/Pacific
Indian/Alaska
Islander
Native
Source: Health, United States, 2007. http://www.cdc.gov/nchs/data/hus/hus07.pdf#029 Table 29.
Hispanic
Cancer
Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin: U.S.,
Age-Adjusted Death Rate per 100,000 Persons
2005
250
222.7
200
183.8
182.6
150
123.2
122.8
110.5
100
50
0
All Races
White
African
American
American
Asian/Pacific
Indian/Alaska
Islander
Native
Source: Health, United States, 2007. http://www.cdc.gov/nchs/data/hus/hus07.pdf#029 Table 29.
Hispanic
Stroke
Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin: U.S.,
Age-Adjusted Death Rate per 100,000 Persons
2005
70
65.2
60
50
46.6
44.7
38.6
40
34.8
35.7
30
20
10
0
All Races
White
African
American
American
Asian/Pacific
Indian/Alaska
Islander
Native
Source: Health, United States, 2007. http://www.cdc.gov/nchs/data/hus/hus07.pdf#029 Table 29.
Hispanic
Prostate Cancer
Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin: U.S.,
Age-Adjusted Death Rate per 100,000 Persons
2005
60
55
53.3
50
45
40
35
30
25
20
24.5
22.6
18.5
17.6
15
10.4
10
5
0
All Races
White
African
American
American
Asian/Pacific
Indian/Alaska
Islander
Native
Source: Health, United States, 2007. http://www.cdc.gov/nchs/data/hus/hus07.pdf#029 Table 29.
Hispanic
Trachea, Bronchus & Lung Cancer
Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin: U.S.,
Age-Adjusted Death Rate per 100,000 Persons
2005
60
55
58.4
52.6
53.1
50
45
40
34.1
35
30
25
20
25.7
22.4
15
10
5
0
All Races
White
African
American
American
Asian/Pacific
Indian/Alaska
Islander
Native
Source: Health, United States, 2007. http://www.cdc.gov/nchs/data/hus/hus07.pdf#029 Table 29.
Hispanic
Unintentional Injuries
Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin: U.S.,
Age-Adjusted Death Rate per 100,000 Persons
2005
60
55
50
45
40
54.7
39.1
40.1
38.7
35
31.3
30
25
20
17.9
15
10
5
0
All Races
White
African
American
American
Asian/Pacific
Indian/Alaska
Islander
Native
Source: Health, United States, 2007. http://www.cdc.gov/nchs/data/hus/hus07.pdf#029 Table 29.
Hispanic
Chronic Lower Respiratory Disease
Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin: U.S.,
Age-Adjusted Death Rate per 100,000 Persons
2005
50
45
43.2
45.4
40
35
30.6
30
29.1
25
19.3
20
14.9
15
10
5
0
All Races
White
African
American
American
Asian/Pacific
Indian/Alaska
Islander
Native
Source: Health, United States, 2007. http://www.cdc.gov/nchs/data/hus/hus07.pdf#029 Table 29.
Hispanic
Breast Cancer
Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin: U.S.,
Age-Adjusted Death Rate per 100,000 Persons
2005
35
32.8
30
25
24.1
23.4
20
15.2
15
15.0
12.2
10
5
0
All Races
White
African
American
American
Asian/Pacific
Indian/Alaska
Islander
Native
Source: Health, United States, 2007. http://www.cdc.gov/nchs/data/hus/hus07.pdf#029 Table 29.
Hispanic
Colon, Rectum & Anus Cancer
Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin: U.S.,
Age-Adjusted Death Rate per 100,000 Persons
2005
24.8
25
20
17.5
16.9
15
12.0
12.4
11.2
10
5
0
All Races
White
African
American
American
Asian/Pacific
Indian/Alaska
Islander
Native
Source: Health, United States, 2007. http://www.cdc.gov/nchs/data/hus/hus07.pdf#029 Table 29.
Hispanic
Influenza & Pneumonia
Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin: U.S.,
Age-Adjusted Death Rate per 100,000 Persons
2005
25
21.7
20.3
20.4
20.2
20
16.8
15.5
15
10
5
0
All Races
White
African
American
American
Asian/Pacific
Indian/Alaska
Islander
Native
Source: Health, United States, 2007. http://www.cdc.gov/nchs/data/hus/hus07.pdf#029 Table 29.
Hispanic
Suicide
Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin: U.S.,
Age-Adjusted Death Rate per 100,000 Persons
2005
15
12.0
11.7
10.9
10
5.2
5.2
5.6
5
0
All Races
White
African
American
American
Asian/Pacific
Indian/Alaska
Islander
Native
Source: Health, United States, 2007. http://www.cdc.gov/nchs/data/hus/hus07.pdf#029 Table 29.
Hispanic
Homicide
Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin: U.S.,
Age-Adjusted Death Rate per 100,000 Persons
2005
25
21.1
20
15
10
7.7
7.5
6.1
3.7
5
2.9
0
All Races
White
African
American
American
Asian/Pacific
Indian/Alaska
Islander
Native
Source: Health, United States, 2007. http://www.cdc.gov/nchs/data/hus/hus07.pdf#029 Table 29.
Hispanic
Review Questions (Developed by the
Supercourse team)
•
What is the definition of
disparities?
•Why does the American
Indians/Alaskan natives have a
lower death rate than whites or
African Americans?