NORTH DAKOTA






 

NORTH DAKOTA
Office for the Elimination of Health Disparities
Prepared by National Association of State
Offices of Minority Health (NASOMH)
 
Phyllis Howard, Director
Office for the Elimination of Health Disparities
North Dakota Department of Health
600 East Boulevard Ave – Dept 301
Bismarck, ND 58505-0200
Phone: (701) 328-2439
Fax: (701) 328-1645


Organizational Structure/History
 
In 2002, the Governor declared health to be one of the pillars of his plan for North Dakota. This declaration helped spawn groups to address health disparities.
 
A Disparities Work Group (DWG) was formed within the North Dakota Department of Health (NDDoH). Their mission was to “Provide leadership to raise the awareness of and to eliminate health disparities affecting North Dakota citizens.” The vision statement was simply, “Health equity for all North Dakotans.” For the definition of health disparities, the group agreed on a comprehensive statement that is stated below:
 
Health disparities in North Dakota are defined as inequalities in health status, utilization, or access due to structural, financial, personal, or cultural barriers. Population categories affected include, but are not limited to, those identified by race or ethnicity, age, education or income, disability, geographic location, gender, or sexual orientation.
 
Another effort that grew from the governor’s interest in health was Healthy North Dakota (HND), which is a framework for individuals and organizations to support North Dakotans in their efforts to make healthy choices by focusing on wellness and prevention. Through this structure the HND Health Disparities Committee (HDC) was formed to coordinate efforts addressing health disparities in North Dakota.  Phyllis Howard, Director of the Office for Elimination of Health Disparities (OEHD) is chair of the committee and Dr. John Baird, Field State Medical Officer is co-chair of the committee. The committee is comprised of American Indians, organizations, agencies, programs, and minority groups from across North Dakota.
 
The Healthy North Dakota HDC completed a Logic Model in May 2005 that maps the desired progress of addressing health disparities in North Dakota for seven to ten years. A key objective in the logic model was to develop an office in the state department of health to concentrate on health equity issues. In 2007, the North Dakota Legislature approved 1.5 FTEs and spending authority for an Office for the Elimination of Health Disparities (OEHD). Dr. Terry Dwelle, NDDoH State Health Officer, authorized the creation of the office, beginning July 2, 2007, which was the beginning of the Special Populations Section in the health department. Dr. John Baird became Section Chief for the Special Populations Section, which includes the OEHD and Children’s Special Health Services (CSHS) and Primary Care Program.
 
Currently the office has one permanent full-time director and one half-time assistant. The staff is supported through the three-year grant received from the Office of Minority Health’s State Partnership Program. In May 2008 Ms. Phyllis Howard became the permanent director of the Office for Elimination of Health Disparities. Carrie L. Stanley is the half-time Administrative Assistant. Dr. John Baird has continued to be a part of the grant as administrative consultant.
 
A project goal is to develop a basic state plan. Therefore, utilizing the Logic Model a draft basic strategic plan was written in 2007. The OEHD Committee is continuing to work on revising and updating the basic strategic plan by developing a formal State Health Disparities Plan. This summer a committee is working on updating the Logic Model. Since the OEHD has limited staff in the office, linkages and coordination with others is very important for the work. Under the direction of Ms. Howard the Health Disparities Committee has increased the number of Native American minority committee members drawing from the tribally controlled community colleges, American Indian tribe’s health and education offices, diabetes programs, and tribal emergency management.    
 
 
Program Focus/Activities
 
North Dakota’s population includes 5.6% American Indians (AI), who are the largest minority population in North Dakota. Initial emphasis on this population was the focus of the HND Disparities Committee. The North Dakota Indian Affairs Commission under new leadership continues to participate in the HND Health Disparities Committee; however, the tribal liaison with the ND Department of Human Services resigned her position and has not been replaced. There are an increased number of American Indian members on the HDC representing North Dakota tribes. Early initiatives targeted American Indian health disparities and will continue to target this group.
 
The Hispanic/Latino population in North Dakota makes up 1.2 percent of the total. During the summer growing and harvesting season, the eastern part of the state receives an influx of migrant workers, mainly of Hispanic/Latino heritage. The Asian population in North Dakota is very small, 0.6 percent; Native Hawaiians and other Pacific Islanders make up less than 0.5 percent. In North Dakota, African Americans make up only 0.6 percent of the population. In recent years, North Dakota has received around 500 refugee and 600 immigrant settlers annually. Cass County in the eastern part of the state has one of the highest per capita ratios of resettled refugees in the country with approximately 20 different cultures represented. Language barriers are a significant issue in accessing health care. The largest groups of refugees are primarily Bosnian, Somali and Sudanese, and Kurdish. Another disparate population targeted by the OEHD Committee is North Dakotans over 65 years of age. An initial partnership has been established with the Aging Services Division with representation on the OEHD Committee. A member of the Governor’s Council on Aging is a member of the Health Disparities Committee.
 
Progress has been made since the opening of the OEHD Office:
 
  • The OEHD website was established in the NDDoH. The website can be accessed at http://www.ndhealth.gov/. To access the website click on Special Populations and follow the Office for Elimination of Health Disparities name. Tribes are using the website to publish their health news. The office will soon publish the State Health Plan and other important publications on the website. Developing a website is a rapid means of communication reaching all race and ethnic minority groups in the state.
 
  • The OEHD Library was established through the North Dakota State Library. The North Dakota State Library’s goal is to provide services to state agencies and state employees. The Library assisted OEHD in cataloguing its library material and added the OEHD holdings to the ODIN (Online Dakota Information Network), the statewide online catalog. Under the Memorandum of Agreement between the NDDoH and North Dakota State Library the library will pay the cataloguing fees and maintain the OEHD library when documents are checked in and out as requested.
 
  • The OEHD has partnered with the Aberdeen Area Tribal Chairmen’s Health Board, Northern Plains Epidemiology Center to assist with the Assessing Sexually Transmitted Infections and HIV/AIDS (ASHSS) Project. The ASHSS Project’s main purpose is to describe STI and HIV risk behaviors, testing behaviors, perceptions of STI’s and HIV/AIDS, and use local prevention activities among reservation-based and urban American Indians in North Dakota. Tribal resolutions are currently being addressed by two Tribes and one Native American Health Service Area. The Turtle Mountain Band of Chippewa Tribal Council passed a resolution of support to participate in the project in May 2009.
 
  • Tribal State Public Health System Assessment was performed on the reservations and prompted one tribe to explore developing a primary preventive care model and comprehensive health board. The Wilson Health Planning Collaborative reorganized the collaborative into a 501( C) (3) organization and is continuing to develop a comprehensive and integrated health system plan for an eight-county region in North Dakota that includes the Fort Berthold Reservation. The OEHD director participates in the meetings with the group and provides input into the health care needs of American Indians in this eight-county region. Fort Berthold Reservation’s new state-of-the-art health care facility which will serve native and non-native members in an expanded 11-county area recently held groundbreaking ceremonies with construction to begin soon on the health facility.
 
  • The director is collaborating with thirteen different health committees in the health department to develop linkages and coordination which is very important for the work of the OEHD. The Health Disparities Committee holds bimonthly meetings with an average of 10 to 15 individuals in attendance.   
 
 
 
  • The American Indian Community Health Representatives Project is at a standstill. Previously the American Indian Community Health Representatives had met with a work group exploring ways to increase reimbursement for the valuable work they do on reservations. Meetings were held with the North Dakota Department of Medicare and Medicaid to establish a reimbursement programs for work done by the Community Health Representatives. However, the individual who was instrumental in representing the CHR issue of reimbursement resigned her position and has not been replaced, so the OEHD Director will continue to move forward with the reimbursement program.   
 
Impact of Program Activities on Communities
 
Though collective efforts addressing health disparities have graduated from early stages in North Dakota to more formal efforts the impact is noteworthy. In a relatively short period of time, a small group of NDDoH staff concerned about health equity issues has grown into a formal, funded (though minimally) Office for the Elimination of Health Disparities. The benefit to North Dakota communities and disparate populations lies in the fact there is now a centralized repository to document needs and to coordinate initiatives. Efforts toward increased reimbursement, recording and personalizing health disparities, and advancements in comprehensive health care in various American Indian communities all impact native health and are an encouragement for additional initiatives. As NDDoH programs and statewide organizations continue to expand collaborations, there is opportunity for increasing impact on North Dakota communities through increasing health equity and reducing health disparities through systemic change in the health care of American Indians.
 
Level of Funding Sources
 

 
Federal
State
FY 2006
$75,000
$0
FY 2007-08
$125,000
$0
FY 2008-09
$125,000
$0

 
Resources
 
Several activities were carried out with the initial grant funds: the funding received from the DHHS Office of Minority Health helped establish a State Office of Minority Health Infrastructure Building Project and a basic strategic plan for addressing health disparities was written which will help enlarge partnerships and collaborations. The three-year cooperative agreement from the DHHS Office of Minority Health has provided funds for the office and staffing, as well as the opportunity to continue current efforts to reduce health disparities in North Dakota by building on systemic change in health care for American Indians. A number of NDDoH programs devote resources for minority health issues; thus, the Office for the Elimination of Health Disparities continues to capitalize on these pooled and in-kind contributions, while functioning as lead agency and clearinghouse for activities.