BILL ANALYSIS
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Date of Hearing: March 24, 2009
ASSEMBLY COMMITTEE ON HEALTH
Dave Jones, Chair
ACR 29 (Jones) - As Introduced: February 19, 2009
SUBJECT : Health disparities: racial and ethnic populations.
SUMMARY : Requests the California Health and Human Services
Agency (CHHSA) to provide leadership and place a priority focus
on preventing, reducing, and eliminating health disparities
among racial and ethnic populations. Specifically, this
resolution :
1)Requests CHHSA to provide leadership to ensure that, within
existing resources and programs, departments within CHHSA
implement programs, activities, and strategies that place a
priority focus on preventing, reducing, and eliminating health
disparities among racial and ethnic populations.
2)Encourages interdepartmental collaboration with an emphasis on
the complex social, environmental, and behavioral factors that
contribute to health disparities, particularly when
identifying strategies aimed at the prevention of chronic
diseases, including, but not limited to, cardiovascular
disease.
3)Makes the following legislative findings regarding the
prevalence, severity, impact, and cost of health disparities
in California:
a) The National Institutes of Health defines health
disparities as the "differences in the incidence,
prevalence, mortality, and burden of diseases and other
adverse health conditions that exist among specified
population groups in the United States;"
b) Communities of color are much more likely to experience
poor quality of health and health care than their white
counterparts across a broad spectrum of illnesses,
injuries, and treatment outcomes;
c) African Americans, Alaska Natives, American Indians,
Asian Americans, Latinos, and Pacific Islanders are more
likely than whites to have poor health, to be uninsured,
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and to die prematurely;
d) Heart disease is the leading cause of death in
California, accounting for more than 73,000 deaths, or
almost one-third of all deaths in the state and people of
color die disproportionately from heart disease;
e) Poor health outcomes carry significant individual and
societal costs. In 2008, the direct and indirect costs of
cardiovascular disease in the United States were $448.5
billion.
f) Heart disease, diabetes, and other chronic diseases can
be prevented not only by addressing behavioral factors such
as lifestyle and personal habits, but by changing the
social and physical environments that contribute to those
unhealthy behaviors.
EXISTING LAW establishes the CHHSA, the state agency tasked with
administration and oversight of California's state and federal
programs for health care, social services, public assistance,
and rehabilitation through the following 12 departments:
Department of Aging; Department of Alcohol and Drug Programs;
Department of Public Health; Department of Health Care Services;
Department of Mental Health; Managed Risk Medical Insurance
Board; Emergency Medical Services Authority; Office of Statewide
Health Planning and Development; Department of Child Support
Services; Department of Community Services and Development;
Department of Developmental Services; and, Department of
Rehabilitation.
FISCAL EFFECT : This resolution has not been analyzed by a
fiscal committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, low-income
populations and communities of color disproportionately
experience worse health and safety outcomes across a broad
spectrum of illnesses, injuries, and treatments. The author
maintains that efforts to reduce racial and ethnic disparities
in health and health care in California will continue to fall
short unless the complex interplay of social, physical, and
environmental influences are addressed through collaborative
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interdisciplinary actions. As the lead agency tasked with
administrative oversight of California's state and federal
programs for health, the CHHSA is the most appropriate state
entity to take a leadership role and facilitate collaboration
with state departments in order to address ethnic and racial
health disparities in California. The author maintains, that
while some departments within CHHSA independently operate
various programs that address racial and ethnic disparities,
the purpose of this resolution is to encourage CHHSA to assist
with bridging the silos that currently exist in state
government and to move toward a more comprehensive strategy.
2)BACKGROUND . The term "health disparities" refers to a gap in
quality of health and health care across racial, ethnic, and
socioeconomic groups. The federal Health Resources and
Services Administration defines health disparities as
"population-specific differences in the presence of disease,
health outcomes, or access to health care."
In the United States, health disparities are well documented in
the African American, Native American, Asian American, and
Latino populations. When compared to whites, these
communities of color have a higher incidence of chronic
diseases, higher mortality, and poorer health outcomes. Among
the disease-specific examples of racial and ethnic disparities
in California, cardiovascular disease ranks as the leading
cause of death among Latinos, accounting for 23 % of all
deaths. In addition, adult African Americans and Latinos have
approximately twice the risk as whites of developing diabetes.
Communities of color also have higher rates of cancer,
HIV/AIDS, and infant mortality than whites.
Research indicates that the health of an individual is a
combination of heredity, environmental, behavioral, economic,
and structural factors. Research also suggests that
behavioral and environmental factors are responsible for 70%
of premature deaths in the United States. For example, the
neighborhood a person lives in affects health through such
factors as access to exercise space; availability of healthy
food; air and water quality; and, proximity to health care
services. As a result, while actions to alleviate disparities
for people of color must include attention to quality and
access to health care, it is also really important to focus on
the social, environmental and behavioral factors affecting
health.
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The demographic changes that are anticipated over the next
decade magnify the importance of addressing disparities in
health status. California groups currently experiencing
poorer health status are expected to grow - by 2020, the
Latino population is expected to grow to 43% and the Asian
American population is expected to increase by almost 13%.
The future health of California as a whole will be influenced
substantially by the state's success in improving the health
of these groups.
3)SUPPORT . According to supporters of this resolution, studies
show that members of communities of color are much more likely
to experience poor quality of health and health care than
their white counterparts. Supporters also state that the
resolution is an essential step in the development of a
comprehensive strategy that addresses racial and ethnic health
disparities and improving the overall health status of
Californians.
4)PRIOR AND RELATED LEGISLATION .
a) AB 330 (Hayashi) of 2007 would have required the Office
of Statewide Health Planning and Development (OSHPD), in
conjunction with CHHSA, to develop a health disparity
report by January 1, 2009, based on patient hospital
discharge data. AB 330 (Hayashi) was held under submission
in the Assembly Health Committee.
b) ACR 114 (Coto), Chapter 151, Statutes of 2006,
establishes the Legislative Task Force on Diabetes and
Obesity (Task Force), consisting of 20 members, as
specified, to study the factors contributing to the high
rates of diabetes and obesity in Latinos, African
Americans, Asian Pacific Islanders, and Native Americans in
this country, and requires the Task Force to prepare a
report containing recommendations, no later than December
31, 2007, regarding ways to reduce the incidence of those
debilitating conditions.
c) AB 2047 (Machado) of 2002 would have created the Chronic
Disease Prevention Council (Council) in DPH (formerly the
Department of Health Services [DHS]) to coordinate and
prioritize disease prevention programs. AB 2047 was vetoed
by former Governor Gray Davis. Governor Davis' veto
message stated that committees similar to the Council
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already existed within DHS and directed DHS to utilize an
existing advisory committee or council to fulfill the
objectives of the proposed Council.
d) AB 1847 (Wayne) of 2000 would have created a 12 member
Cardiovascular Disease and Stroke Prevention and Treatment
Task Force within DHS, to create a comprehensive plan that
contained recommendations addressing changes to statute,
regulations, and policies related to cardiovascular disease
and stroke prevention. AB 1847 was vetoed by then Governor
Gray Davis. Governor Davis primarily cited outstanding
fiscal concerns in his veto message, but also raised the
question of overlap between the requirements of AB 1847 and
the activities of existing DHS programs.
REGISTERED SUPPORT / OPPOSITION :
Support
American Diabetes Association
American Federation of State, County and Municipal Employees,
AFL-CIO
Asian & Pacific Islander American Health Forum
California Black Health Network, Inc.
California Communities United Institute
California Healthcare Institute
Daiichi-Sankyo
GlaskoSmithKline
Health Access California
Latino Coalition for Healthy California
Scripps Whittier Diabetes Institute
Director, Heart Disease Prevention Program, University of
California Irvine College of Medicine
Opposition
None on file.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097