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U.S. Department of Health and Human Services

  

TB Challenge: Partnering to Eliminate TB
in African Americans

“CDC Working Across the Board with A Stronger Focus
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 the Center.

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 the like.

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 disparities?

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 vulnerable populations.

 


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination - http://www.cdc.gov/tb

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