TB Challenge: Partnering to Eliminate TB
in African Americans
“CDC Working Across the Board with A Stronger
for Eliminating Health Disparities”
Gail Burns-Grant and Michael Fraser, DTBE/ FSEB
TB Challenge: Dr. Dean, when did you assume the role of
Director, NCHSTP, Office of Health Disparities (OHD)?
Hazel Dean: September 2003.
TBC: Looking back over the year, what is different now regarding
the Center's position on closing health disparity gaps?
HD: In the past, the Center's activities around health disparities
were scattered across the Office of the Director (OD) and the Divisions
and were largely uncoordinated. The creation of the Office of Health
Disparities (OHD) was meant to create a stronger focus on this issue
and to improve the coordination and impact of these activities in
TBC: What racial and ethnic groups are primarily impacted
by health disparities?
HD: That depends on the specific disease or health condition.
African Americans account for 39% of all AIDS cases reported so
far in the United States, and this percentage continues to increase.
Hispanics are also disproportionately affected by AIDS. Asians,
African Americans, Hispanics, and American Indians/ Alaska Natives
all have TB rates that are dramatically higher than the rates for
whites. In addition, our office also addresses the significant health
disparities among corrections populations, such as those persons
in prisons and jails or on probation or parole.
TBC: Dr. Dean, what is the mandate for the Center's OHD?
HD: We're engaged in several activities related to our overall
mandate of reducing health disparities. Among these are funding
and technical support for research, surveillance activities, education,
training, and pilot programs. We also work to promote a diverse
workforce through internships, fellowships, training programs, and
TBC: Who are some of the internal and external partners
of the OHD?
HD: Of course we work closely with CDC's Office of Minority
Health, but we are also involved in many projects with NCHSTP's
Divisions, as collaborators, coordinators, consultants, or as a
source of funding or other assistance. We also chair the Cross-Centers
Corrections Work Group and work with other centers, institutes,
and offices (CIOs) on specific projects. We have a long list of
external partners. We work with other federal agencies such as HRSA
(the Health Resources and Services Administration), the Indian Health
Service, and the Department of Justice. Some of our projects also
involve state and local government agencies, professional organizations,
and colleges and universities.
TBC: What are some of the initiatives that are funded from
the OHD? Can you discuss a few that you feel will have a large impact
on addressing health disparities (and why)?
HD: We are just completing a 5-year project called the “CDC/HRSA
Corrections Demonstration Project,” which is funding several states
and one city (Chicago) to implement innovative continuity-of-care
programs for inmates infected with HIV, STDs, TB, and hepatitis
who are being released from prisons, jails, or juvenile detention
centers. Such a project, if widely implemented, could have a significant
public health impact on these diseases, which are highly prevalent
in these populations. We are also working with historically black
colleges and universities to help them develop public health curricula
and recruit and train minority public health researchers. Increasing
the number and expertise of such researchers is critical in overcoming
some of the neglect and mistakes made in the past with minority
communities. We also have several projects related to improving
disease surveillance, clinical care, case management, and disease
prevention for American Indians. It has long been acknowledged that
this population bears a disproportionate burden of health problems
compared with the general U.S. population.
TBC: Dr. Dean, will there be more funding opportunities
that will allow for collaboration between Centers on such diseases
as TB and HIV?
HD: Funding, of course, is always dependent on Congress.
However, one result of the Futures Initiative should be an ability
to identify more opportunities for collaborative efforts across
Divisions and CIOs.
TBC: Are there opportunities for funding nongovernmental
entities? If so, how does one learn of such opportunities?
HD: NCHSTP does fund some nongovernmental entities. Opportunities
for such funding, as with most CDC programs, are made known through
standard funding mechanisms, such as RFPs (Requests for Proposals)
or RFCs (Requests for Contracts). OHD also provides some funding
for programs and projects initiated in the Divisions.
TBC: Does the OHD work across divisions on health disparity
issues, or is the primary focus within NCHSTP?
HD: We do both. Even when projects are initiated and managed
in OHD, we seek input from the Divisions as appropriate. Our staff
is relatively small. It has special expertise with populations that
evidence health disparities, but it certainly needs the subject-matter
expertise in our Divisions to be most effective. The opposite would
also be true. Divisions seeking to have an impact on health disparities
would do well to take advantage of expertise in OHD.
TBC: Are there collaborations with schools of public health
to attract minorities into public health careers? Can you explain
what schools you have collaborated with and what opportunities CDC
has provided for students?
HD: We have provided financial support to the MPH program
at Meharry Medical College in Tennessee, the Public Health Sciences
Institute at the Atlanta University Center, the Minority Health
Professions Foundation, and the Consortium of African-American Public
Health Programs. All of these organizations are working to establish
or strengthen public health programs in minority colleges and universities
and to attract minorities to public health careers, as well as to
provide education and training for those interested in public health.
We also provide support to summer internship and fellowship programs
at CDC for minority students.
TBC: How is the OHD increasing the awareness of the African-American
community, the larger community, and potential partners to health
HD: We are in the process of developing and disseminating
two special journal issues: one on HIV/AIDS among racial and ethnic
minority populations in the United States, which will appear in
the Journal of the National Medical Association, and another on
the use of public health data for HIV prevention and care planning
for the journal AIDS Education and Prevention. We maintain a comprehensive
Internet Web site (http: //www.cdc.gov/nchstp/od/cccwg/) on public
health and criminal justice. We provide financial support to the
Tuskegee University National Center for Bioethics in Research and
Health Care and the Tuskegee Human & Civil Rights Multicultural
Center. These organizations seek to keep alive the lessons learned
from the Tuskegee Syphilis Study and to bring a bioethics focus
to research and health care in minority populations. We regularly
support conferences and training events which focus on health disparities,
such as the University of North Carolina's Minority Health Project's
interactive videoconference, the International Conference on Women
and Infectious Disease, and the DHHS Office of Women's Health meeting
on “Women of Color, Taking Action for a Healthier Life.” OHD staff
also present workshops, seminars, and talks at various governmental
and professional meetings on the topic of health disparities.
TBC: Dr. Dean, what is your vision for the OHD?
HD: We recently held a planning retreat for the Office of
Health Disparities because I felt that our vision must be the product
of the understanding, experience, and commitment of the professionals
who work in OHD. It was clear that the group was dedicated to achieving
equity of access to the benefits of the U.S. health care system
and, ultimately, equity in health outcomes for all underserved and