REACH 2010: Working Together to Achieve the Goal of Eliminating Health Disparities

We have experienced remarkable achievements in the health of this nation. However, some Americans have not benefited equally. A consistent body of research demonstrates that in the U.S. racial and ethnic minorities suffer disproportionately from diseases such as cardiovascular disease, diabetes, cancer, and HIV/AIDS; experience a lower quality of health care service delivery; and are less likely to receive routine medical services.

These longstanding disparities are simply unacceptable. With the expectation that by the year 2030 racial and ethnic minorities will constitute 40% of the U.S. population, the imperative to stem the tide of needless death and disability is before us. We must take action if we are to remain healthy, strong, and vibrant as a nation. I want you to know that disparities in health are a challenge that we at the Department of Health and Human Services (HHS) have taken to heart.

In addition to the federal government, state and local governments, and especially communities have important roles to play in reducing disparities as they can concentrate their efforts on the specific needs of their constituencies. This issue of the Journal of Health Care for the Poor and Underserved shows the impact communities can have on improving the health and welfare of its residents. The Racial and Ethnic Approaches to Community Health 2010, or REACH 2010, initiative is finding effective ways to close health gaps separating racial and ethnic minority populations from the majority.

Launched in 1999, REACH 2010 is designed to address disparities in the following six areas: cardiovascular disease, immunizations, breast and cervical cancer screening and management, diabetes, HIV/AIDS, and infant mortality. It is one of the cornerstones of our efforts in HHS to eliminate disparities.

REACH 2010 supports community coalitions in designing, implementing, and evaluating community-driven strategies to eliminate health disparities. Each coalition comprises a community-based organization and three other organizations, of which at least one is either a local or state health department or a university or research organization. REACH 2010 grantees use local data to create and evaluate interventions that address one or more of the six priority areas and target one or more racial and ethnic groups including African Americans, Hispanic Americans, American Indians, Alaska Natives, Asian Americans, and Pacific Islanders.

REACH programs exemplify the power and importance of local people working with community coalitions to make a real and significant difference. Key ingredients of REACH 2010 programs include continuing education on disease prevention for health care providers, health education and health promotion programs that use lay health workers to reach community members, and health communications campaigns that work. Last year, the CDC received $34.5 million for this program. In fiscal year 2004, the CDC supported 40 REACH 2010 projects, four of which serve the elderly. The CDC also supported a new emphasis on American Indian and Alaska Native communities by continuing to fund core capacity building projects in Albuquerque, New Mexico; Oklahoma City and Talihina, Oklahoma; Anchorage, Alaska; and Nashville, Tennessee.

Another key component of successful community-based programs is cultural competency. Cultural competency is fundamentally a quality of care issue, and we in the Office of Minority Health (OMH) are helping transform that awareness into practical applications. We have developed tools for culturally competent care to enhance providers' ability to deliver linguistically appropriate and competent services to diverse minority populations.¹ Our tools have received national recognition and are accredited by the American Medical Association, the American Association of Family Practitioners, and Medicare's Quality Improvement Organizations for continuing medical education. Tools for nurses are under development.

There are significant data demonstrating the need to address environmental/system issues in order to further our efforts to eliminate disparities. It is important to recognize that perception plays a key role as well. In a recent study conducted by national African American organizations in partnership with OMH, respondents had much higher levels of risk for heart disease and diabetes than they perceived. Such perceptions can lead to delays in seeking care until symptomatic and later detection of risk factors or diseases. In a 2005 Morbidity & Mortality...