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Medicare Plan, Louisville Program Take Aim At Health Disparities

Phalinn Ooi/Creative Commons

The Centers for Medicaid and Medicare Services released a comprehensive plan to reduce health disparities earlier this week, and efforts are already under way in Louisville that address some of the findings.

The agency's Equity Plan for Improving Quality in Medicare is its first-ever effort to address health equity among Medicare beneficiaries. The plan aims to reduce disparities in four years by increasing understanding and awareness of shortcomings in care, creating and sharing solutions, and accelerating the implementation of corrective actions.

In 2012, more than 793,000 Kentuckians received Medicare services, according to Kaiser Family Foundation.

The plan focuses on Medicare recipients who experience disproportionately high instances of disease, lower quality of care and barriers to accessing care, including racial and ethnic minorities, sexual and gender minorities, people with disabilities, and those living in rural areas.

The Medicare plan comes 30 years after the federal government first examined racial health disparities in the general population. The 1985 Heckler Report  offered a deep analysisof the health status of minorities and recommendations for how to improve it.

Dr. Nadine Gracia, director of the Office for Minority Health at the U.S. Department of Health and Human Services, said health disparities have existed for many years, and closing the gap will take a continued focus.

"It will require a sustained effort and for everyone to be involved, so that we can achieve a vision and a future for our country which is a nation that is free of disparities," she said.

Monique Ingram, program director for University of Louisville's Office of Public Health Practice, said all people have a right to health, but disparities arise when groups are marginalized.

"People in these groups not only experience worse health, but they also tend to have less access to the social determinants that would provide opportunities for good health," she said.

Ingram said access to healthy food, good housing, good education, safe neighborhoods, and freedom from racism and discrimination contribute to a healthier population and environment.

She and her colleagues at OPHP recently relocated to Old Walnut Street Development in an effort to build stronger relationships with residents living in West Louisville. The team's goal is to develop, implement and evaluate tailored strategies to address health issues.

"It's hard to do work in a community if you haven't penetrated the community," she said. "If you haven't become a part of the network, if you haven't become a part of what they see as family, they don't really want your help."

Ingram said the lack of political, social or economic power are all characteristics of groups that experience health inequity. She said  interventions that aim to remedy inequities need to go beyond addressing a particular health inequality.

"Also look at and be intentional about empowering the group in question through systemic changes such as law reform or changes in economic or social relationships," she said.

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