MARYLAND






 

MARYLAND
Office of Minority Health and Health Disparities
Prepared by National Association of State
Offices of Minority Health (NASOMH)
 
Arlee Wallace, Acting Director
Minority Health and Health Disparities
Department of Health and Mental Hygiene
201 W. Preston Street,  Room 500
Baltimore, MD  21201

Telephone:  410-767-1052
FAX:   410-333-5100
Email:     Arlee.Gist@Maryland.gov 
Website:
 www.dhmh.maryland.gov/mhhd
 
Organizational Structure/History
 
During Maryland’s 2003 Legislative Session, HB 883 paved the foundation for Maryland’s Health Care Disparities Initiative that is interwoven within HB 86 and SB177. These bills are codified in the Maryland Annotated Code Health – General § 20-1001, et seq. and § 20-901 et seq. The Maryland 2004 Legislative Session enacted House Bill 86 and Senate Bill 177, officially establishing Maryland’s Office of Minority Health and Health Disparities (MHHD), in the Office of the Secretary of the Department of Health and Mental Hygiene (DHMH), effective October 1, 2004. 
 
With the passing of HB 883, the Secretary’s Task Force on Eliminating Health Disparities was established as a DHMH internal advisory group. MHHD created and leads a health disparities data work group that consists of DHMH program members holding responsibility in data management. Additionally, the Secretary has established a Minority Health Disparities Task Force and Work Group that serves as a senior level steering committee to guide the internal assessment. 
 
During the 2-year development of the Maryland Plan to Eliminate Minority Health Disparities, four working committees served as a resource to MHHD to provide advice and guidance in identifying key information sources, provide recommended goals to eliminate minority health disparities, and to ensure that key community and professional perspectives were represented. The four committee focus areas were: Health Profession Education, Identifying Funding Strategies, Access to Quality Healthcare Services, and Measuring Health Disparities.
 
Purpose/Mission Statement
 
In fulfillment of the Department’s mission to promote the health of all Maryland citizens, the Office of Minority Health and Health Disparities shall focus the Department’s resources on eliminating health disparities, partner with statewide organizations in developing policies and implementing programs, and monitor and report the progress to elected officials and the public. The target ethnic/racial groups shall include Native Americans, African Americans, Hispanic/Latino Americans and Asian Americans.
 
The Maryland Department of Health and Mental Hygiene envisions a state in which health care services are organized and delivered in a manner designed to eliminate health disparities among its ethnic and racial populations, thereby leading the way to a Healthy Maryland in the New Millennium.
 
Program Focus/Activities
 
 
Legislative Initiative
MHHD reviews existing laws and regulations to ensure that they facilitate adequate health care to minorities and recommend changes. During the Maryland 2009 Legislative Session, MHHD reviewed 28 bills, prepared two fiscal notes, and submitted two letters of support. Bills related to minority health issues that were passed during the Session included one that established voluntary cultural competency training programs for health care professionals offered through health professional associations in Maryland. 
 
Annual Statewide Health Disparities Conference
Starting in 2004, MHHD has hosted an annual statewide health disparities conference to provide individuals from around the State an opportunity to come together to share strategies, best practices, successes, and barriers to addressing and reducing minority health disparities in Maryland. The conferences provide input and recommendations to the state from a diverse cross section of Marylanders on how health disparities can be eliminated and addressed. Collectively, over 2,412 individuals have attended these annual conferences.  
 
Workforce Diversity and Cultural Competency Initiative
The goal of the Workforce Diversity and Cultural Competency Initiative is to increase minority representation in Maryland’s health workforce and enhance cultural competency skills among the state’s health professionals. This is being accomplished through partnerships with Maryland’s health professional schools to increase the number of minority matriculates and graduates; adaptation of national best practices; implementation of a campaign to increase awareness of the need for greater diversity in the health workforce; and the collection of baseline and annual data to monitor progress and reinforce best practices. Currently, MHHD is working with four Maryland hospitals to address cultural competency issues as well as the state’s Higher Education Commission, the Health Occupations Boards and the national Sullivan Alliance to Transform the Health Workforce. This is a five-year initiative funded under the States Partnership Cooperative of the HHS – Office of Minority Health.  
 
Systems Change
The Systems Change Initiative includes Departmental Assessment, Dissemination of Best Practices, Review of Managing For Results (MFR) objectives, and program partnerships and collaborations with other DHMH programs and local health departments. The Departmental Assessment is an initiative to identify and develop DHMH capacity to direct its resources to address minority health disparities. The components of this initiative are: Action Plans, Managing for Results (MFR) Review, and Identification and Dissemination of Best Practices. The goal of this initiative is to apply a systems change approach to developing program strategies with a targeted focus on reducing minority health disparities at the Department of Health and Mental Hygiene. The DHMH Secretary has established a Minority Health Disparities Task Force and Work Group. This Work Group continues to review program Action Plans. MFR objectives have been reviewed for FY ‘06, ’07, ’08, ’09, and ‘10. Over this period, DHMH has maintained a total of about 225 objectives, and minority-related objectives have remained at 5% of all MFR objectives.
 
Additionally, MHHD has published and disseminated “Best Practices in Capacity Building and Disease Management and Prevention to Address Minority Health Disparities,” a collection of programs illustrating best practices and strategies in addressing minority health disparities.
 
To demonstrate best and promising practices in Maryland, DHMH’s Office of Minority Health and Health Disparities has begun an initiative to offer cooperative agreement grants to Maryland jurisdictions to develop targeted local community programs to reduce minority health disparities. The goal of this MHHD initiative is to support the development of local infrastructure, assist in obtaining resources and provide technical assistance in sustainability for eventual local takeover. Pilot demonstration grants were offered to Charles County, Baltimore City, Prince George’s County, and Montgomery County. Promising practices featured in these projects are: the use of community health workers, county-wide stakeholder coalitions, interjurisdictional partnerships, community outreach, and the provision of culturally enhanced clinical services. From the results of these pilots, we hope to better understand workable strategies to address minority health disparities that can then be replicated and/or adapted toward successful efforts in all Maryland jurisdictions, with eventual community sustainability.
 
Efforts in the Systems Change initiative are supported by a five-year grant under the States Partnership Cooperative of the HHS – Office of Minority Health, and Program Development funds provided by the Maryland General Assembly.
 
Minority Health Disparities Data
MHHD is coordinating a Departmental effort to develop an optimal and standardized approach to racial and ethnic data collection, data analysis, and data reporting. Such optimized data systems are essential for the development and assessment of statewide health disparities’ strategic plans. In addition to leading the health disparities data workgroup, MHHD published the Maryland Chartbook of Minority Health and Minority Health Disparities Data in November of 2007. The MHHD data program also produces smaller data reports, data highlights, for various purposes, including public events and briefings, to legislators and the executive branch. The data program also provides assistance to Maryland’s local health departments in the collection, analysis, and reporting of racial and ethnic health data. The MHHD data program enhances the Department’s ability to track progress in reducing racial and ethnic health disparities.
The data program has most recently been pursing data on the cost of disparities to support the business case for disparities elimination. The data program has developed a methodology for determining the cost of excess healthcare utilization due to disparities, and presented this method (see http://apha.confex.com/apha/136am/webprogram/Paper180599.html) at the 2008 APHA Annual Meeting.
           
Information Clearinghouse
The office maintains the Department’s Health Disparities Initiative Website, www.mdhealthdisparities.org, which contains national and state minority health disparities data, national and state health disparities reports, minority resources, a calendar of minority health events, best practices, health disparities website links, and funding opportunities. Information specific to women’s health, men’s health, and cultural competency is available. A language translation tool is available for the languages of French, German, Italian, Portuguese, Spanish, Chinese, Korean and Japanese. The purpose of the website is to provide an information clearinghouse and library for groups interested in minority health issues. Since 2005, the website logged approximately 1,400,000 hits. Within the clearinghouse, MHHD has compiled over 1,000 health disparities-related documents, reports, books, and other materials. Additionally, MHHD publishes a newsletter three times per year as a means to provide information to constituents in a print format.
 
Minority Outreach and Technical Assistance (MOTA)
With passage of SB896/HB1425 in 2000, the Maryland General Assembly established the Cigarette Restitution Fund Program (CRFP) with MOTA being part of the Statewide Public Health component. MOTA focuses on educating, enlightening and empowering ethnic minorities to impact cancer and tobacco health care decisions in their local jurisdictions. Since 2000, annual grants are awarded to minority and minority-serving community-based, grass-roots, and faith-based organizations to reduce cancer and tobacco use disparities. Thus far, MOTA grantees have recruited 489 organizations to advocate for the health needs of targeted minorities through work with local health departments. Cancer and tobacco health messages were provided to 371,555 individuals through cultural events, educational workshops, and information distribution. Additionally, 3,005 minority grantees and individuals have contributed minority input by working closely with cancer and tobacco coalitions with local health departments. 
 
Eliminating Health Disparities Statewide Initiatives
 
The Maryland Plan to Eliminate Minority Health Disparities, preliminary copy, was released in December of 2006. The Plan promotes dialogue across Maryland on the causes, solutions and challenges faced by the state. The development of the Plan, two years in the making, was a coordinated effort of MHHD, the public, health professionals, academia, community health groups, other stakeholders, and DHMH.  It also included the four health disparity committees, five Roundtable discussions, and six Town Hall meetings. More than 1,000 ideas and recommendations were received. Major themes that emerged from this dialogue include improving cultural competence among health providers, increasing minority representation in the health professions, and improving data systems in the state relating to the collection of racial/ethnic data.
 
MHHD is conducting work sessions with health professional academic institutions to review existing standards that promote cultural competency and collaborate in advancing practical applications and sharing best practices to address minority health disparities. Additionally, partnerships are being developed among public and private sector agencies and advocacy groups to implement recommendations for change. An electronic copy of the Plan is located at www.mdhealthdisparities.org/planelimdisp.html
 
 
Level of Funding Sources
                    
Year                 Federal              State                 

FY 2005
 
359,037
FY 2006     
148,750
373,029
FY 2007    
   186,326
326,109
FY 2008
159,250
326,109
FY 2009
143,020 
1,146,970
FY 2010
134,250
1,115,753

  
Resources
 
MHHD is led by a full-time director and a deputy director who also direct the state’s Cigarette
Restitution Fund Program. Additionally, the deputy director oversees the Minority Outreach and
Technical Assistance program. The MHHD team also includes a full-time Assessment Director, Workforce Diversity Director, Program Manager, Health Policy Analyst, Research Analyst, Information Specialist, Agency Budget Specialist Supervisor, Executive Assistant, and Secretary. A part-time (75%) Epidemiologist/Preventive Medicine Physician is also a member of the MHHD team.  
 
 
Recent Publications
 
MHHD publications:
  • Maryland Chartbook of Minority Health and Minority Health Disparities Data – 2007
  • Practices in Capacity Building and Disease Management Prevention to Address Minority Health Disparities - 2007
  • Maryland Plan to Eliminate Minority Health Disparities, preliminary copy – 2006
  • Maryland Minority Health Disparities Statewide Data Update, February 2009
 
MHHD collaborative publications:
            In collaboration with the Maryland Health Care Commission:
o   Spotlight on Disparities: Differences in Hospitalizations for Ambulatory Care Sensitive Conditions Among             Maryland Medicare Beneficiaries—2006
o   Assessment of Disparities in Potentially Avoidable Hospitalizations of Maryland Medicare Patients
 
MHHD participatory publications:
            Participating with the National Business Group on Health:
o   Eliminating Racial and Ethnic Health Disparities: Business Case Update for Employers
 
MHHD presentations:
o   136th American Public Health Association Annual Meeting in San Diego, CA (October 2008)  Presented the business case for eliminating health disparities: a "cost of disparity" methodology for state health departments
o   Coordinated and co-hosted with the Maryland General Assembly, a Legislative Summit focusing on health disparities, cost, and quality of care (October 2008)
o   Congressional Black Caucus and Congressional Hispanic Caucus (May 2009) Joint meeting: Presented information on immunization and health disparities
o   NIH Health Disparities Conference (December 2008) - Presented information on mortality disparities data in Maryland
o   Hosted and participated in screenings of select episodes of the documentary Unnatural Causes: Is Inequality Making Us Sick to departmental programs and community hospitals.