HEALTH FOR ALL: CALIFORNIA'S STRATEGIC APPROACH TO ELIMINATING RACIAL AND ETHNIC HEALTH DISPARITIES

All members of a community are affected by the poor health status of its least healthy members.
-Institute of Medicine

California has long been a leader in health-and has developed tremendous capacity in health research, treatment, and prevention. But people of color in California consistently face higher rates of morbidity and mortality than whites across a broad spectrum of illnesses and injuries. These higher rates result from both higher incidences of disease and once ill, poorer treatment outcomes.

The California Campaign to Eliminate Racial and Ethnic Disparities in Health was initiated in April 2001 to address this inequity. Formed through a partnership between the American Public Health Association and the California Health and Human Services Agency, the Campaign is a statewide coalition of leaders from the public and private arenas of policy, health care, public health, and philanthropy. The Campaign released its Strategic Approach in November 2003.

Addressing Health Disparities

The National Institutes of Health defines health disparities as "differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States." The California Campaign identified nine Priority Medical Issues that cause significant morbidity and/or mortality among people of color: 1) cardiovascular disease, 2) breast cancer, 3) cervical cancer, 4) diabetes, 5) HIV/AIDS, 6) infant mortality, 7) asthma, 8) mental health, and 9) trauma (including intentional and unintentional injury).

Disparate health outcomes are due to a broad range of social, economic, and community conditions -- deteriorated housing, poor education, limited employment opportunities and role models, limited household resources, and ready availability of cheap high-fat foods -- that are particularly exacerbated in low-income neighborhoods where people of color are more likely to live.

Illness and injury generate tremendous social costs in the form of lost productivity and expenditures for disability, worker's compensation, and public benefit programs. By 2040 two out of three Californians will be people of color. As the state becomes increasingly diverse, a healthy and productive California will require the elimination of racial and ethnic disparities by improving the health of communities of color.

California's Strategic Approach to Eliminating Racial and Ethnic Health Disparities has two primary goals:

Goal 1: Prevent the development of illness and injury by fostering healthy behaviors, healthy community environments, and institutional support of good health outcomes.

Goal 2: Reduce the severity of illness and injury by providing high-quality medical care to all.

Engaging Stakeholders in California's Strategic Approach

Improving health behaviors, strengthening community environments, and improving access and quality of health care requires participation from key public and private institutions in partnership with communities. Banks, businesses, government, schools, health care, and community service groups have a major influence on community environments. The decisions they make -- such as whether to accommodate pedestrian and bicycle travel on city streets, where to locate supermarkets or alcohol outlets, where to invest and purchase, or what efforts to take to reduce hazardous emissions -- influence health behaviors and health outcomes.

Moving Toward a Healthy and Productive California

Achieving health for all Californians is both a moral imperative and a matter of good economics. The Strategic Approach describes specific pathways from root factors, to behaviors and environmental factors, to medical services that either exacerbate or reduce these health problems. This roadmap points the way towards interventions California and Californians must take.

The vision of a healthy, productive California must be translated into commitment. Action is needed to strengthen community environments and shift behaviors to prevent disease and injury and to ensure health services are high quality, accessible, and culturally competent. There is a critical job for the health sector to improve the availability and quality of medical care for all California's ethnic and racial groups. It is also vital that every public and private institution step forward to improve the environments that beget good health. The next step is to coordinate action by institutions and in communities across the state. Now that the pathways to health for all have been described, taking action to alter them is essential.

The California Campaign was made possible with support from:

• The California Endowment
• The California Wellness Foundation
• Kaiser Permanente

For more information: The summary document of California's Strategic Approach to Eliminating Racial and Ethnic Health Disparities is available electronically at www.apha.org and preventioninstitute.org/healthdis.html. For more information, please contact Sabrina Fernandes at 510-444-7738 or Sabrina@63.134.213.124.

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