IjItitc4States Genc~ral Accounting Of‘fiw -- Fxt Sheet for the Chairman, Subcommittee on Health and the Environment, Committee on Energy and Commerce, House of Representatives MINORITY HEALTH Information on Activities of HHS’s Office of Minority Health 3 HI llllIllIlllx 141672 United States GAO General Accounting Office Washington, D.C. 20548 Human Resources Division B-239933 June 6,199O The Honorable Henry A. Waxman Chairman, Subcommittee on Health and the Environment Committee on Energy and Commerce House of Representatives Dear Mr. Chairman: This fact sheet is in responseto your request for information relating to activities of the Department of Health and Human Services’(HHS)Office of Minority Health (OMH).The 1990 censusis expected to reflect signifi- cant increasesin minority populations. You stated that it is important to obtain information on OMH’S activities in considering legislation to improve the quality and accessof health care services available to these populations. In general, the requested information relates to OMH’S goals and objectives, funding, staffing, and program activities. Background Organizationally, OMHis under HHS’SPublic Health Service. For fiscal year 1990, OMHhas 17 staff and an operating budget of about $8 million. OMHwas established in December 1985 and was given responsibility for implementing recommendations contained in the HHSSecretary’s Task Force Report on Black and Minority Health, issued in August 1986. The task force was created to investigate the health problems of blacks, Native Americans, Hispanics, and Asian Americans and Pacific Islanders. Its recommendationswere directed at reducing the disparity in health status between minorities and nonminorities. Specifically, the task force’s recommendations focused on the following minority health problem areas: (1) inadequate health information and education, (2) need to improve financing and delivery of health services, (3) development of more minority health professionals, (4) improved cooperation between the federal and private sectors on minority health problems, and (6) development of more complete data on minority health problems and increased research efforts. Page 1 GAO/HRD4O-14OF’S Minority Health Information 8 I* B-239933 I Our objective was to obtain information specifically requested by the Objectives, Scope,and Subcommittee.As discussedwith Subcommitteestaff, we obtained Methodology information on the following: l whether OMH had written goals, objectives, and strategic plans and whether these were specifically developed for Asian Americans and Pacific Islanders, blacks, Hispanics, and Native Americans; . the yearly funding levels for minority health activities, the amount of funds and staff devoted to each of the four targeted minority popula- tions, and whether OMH believes its resourcesare sufficient to address the needsexpected to result from future increasesin the Hispanic and Asian American populations; . OMH'S general activities and those specifically targeted for each of the four minority populations, the number of grant applications received and the number of grants awarded, and whether any applications or grants were for a specific group; and l whether grantee performance is evaluated, the results of any evalua- tions, and what efforts OMH has made to increase grant applications for any of the four targeted groups that may not be well represented among applicants. The information provided in this fact sheet is basedprimarily on data provided by OMH, which, for the most part, we did not verify. We supple- mented the information OMH provided through interviews with key pro- gram officials and reviews of budget, staffing, and grant documents. We did not obtain written comments from HHS on the information contained in this fact sheet. However, we discussedthe information with OMH offi- cials and incorporated their comments where appropriate. We per- formed our work from April to May 1990. overall goal is to improve the health status of Asian Americans Summary OMH'S and Pacific Islanders, blacks, Hispanics, and Native Americans. How- ever, at this time, OMH doesnot have specific short-term and long-term goals or objectives for each of these groups, nor does it have strategic plans for its activities. A strategic plan is being developed and is expected to be completed in early fiscal year 1991. OMH'S budget and staff for fiscal year 1986 was $1.9 million and 11 staff members. The administration has requested an increaseto about $19.6 million and 30 staff members for fiscal year 1991.OMH believes that these 1991 proposed increaseswill provide sufficient resourcesto addressthe needsresulting from the expected increasesin minority Page 2 GAO/HRD-90-140FS Minority Health Information B-282822 populations. Officials noted there are many other sourcesof HHS funds addressing minority health. For example, the Public Health Service as a whole, of which OMH is a part, has $664 million targeted to minority populations in fiscal year 1990. OMH says that it does not allocate staff to specific minority groups, nor does it have major activities or programs that serve any one of the four minority populations. OMH'S position is that it attempts to achieve a bal- anced representation among all four minority populations in the pro- grams it supports. OMH has two general grant programs to fund health-related activities for minority populations. Since OMH was established in December 1985, it has received 881 grant applications and awarded 64 grants under these two programs. Our analysis showed that while most grant applications did not specify a minority group that was to be served, most grants awarded were for a specific minority group. Blacks were the largest group served, and Hispanics were the next largest. Although OMH monitors grantee performance through reports and site visits, OMH has not conducted an overall evaluation of grantee projects. An OMH-contractedevaluation of 6 of 12 completed grants has shown \ that the projects had mixed results in achieving the desired program goals. OMH considersprojects to be successfulif (1) they reach the targeted minority population(s), (2) grantee organizations remain in existence and continue project activities after the grant period, and (3) grantees are able to secure funds from other sourcesafter OMH funding ends. OMH has not determined the extent that specific minority groups are rep- resented in its grant programs, but believes that all four minority popu- lations are being well represented. Detailed information on the goals, resources,and activities of OMH is pro- vided in sections 1 to 4 of this fact sheet. We are sending copies of this fact sheet to other interested House and SenateCommittees and Subcommittees;the Secretary of Health and Human Services;the Director, Office of Management and Budget; and other interested parties. We will also make copies available to others on Page 3 GAO/HRD9O-14OF3 Minority Health Information B-239933 request. Should you have any questions concerning this fact sheet, please call me at (202) 2756196. Other major contributors to this fact sheet are listed in the appendix. Sincerely yours, Mark V. Nadel Associate Director, National and Public Health Issues Page 4 GAO/HR.D-90.14OFS Minority Health Information Page 5 GAO/HRD-9044OFs Minority Health Information , Contenti Letter Section 1 8 OMH Goals, Objectives, and Strategic Plans Section 2 10 Funding and Staffing Public Health Service Funding for Minority Health 11 Levels Section 3 12 Grant Applications and Awards Section 4 14 Grant Evaluations and Assistance to Prospective Grantees Appendix Appendix I: Major Contributors to This Fact Sheet 16 Tables Table 2.1: Office of Minority Health Funding and Staffing 10 (Fiscal Years 1986-91) Table 2.2: Public Health Service Sourcesof Minority 11 Health Funding (Fiscal Years 1987-91) Table 3.3: Office of Minority Health Grant Applications 13 and Awards Serving Specific Minority Populations (Fiscal Years 1986-90) Abbreviations AIDS acquired immunodeficiency syndrome HHS Department of Health and Human Services OMH Office of Minority Health PHS Public Health Service Page 6 GAO/HRD!40-140FS Minority Health Idormation .* Page 7 GAO/HRD-9@14OFB Minority Health Information Section 1 OMH Goals,Objectives,and StrategicPlans ’ As described in various program documents,OMH'S overall goal is to improve the health status of Asian Americans and Pacific Islanders, blacks, Hispanics, and Native Americans. At this time, however, OMH does not have specific goals for each of these groups. The office is cur- rently developing a minority health strategic plan, This draft plan has not established specific goals for the target groups. OMH says such goals will be established, if necessary. OMH'S objectives, as published in the December12, 1986, Federal Reg- ister, are to . establish near-term and long-range objectives for HHS health activities for minority populations; . develop reporting and monitoring requirements for these objectives; . organize and plan activities to meet minority health needsand monitor the HHS budget to assure an appropriate share of funds is devoted to minority health problems; l provide technical assistanceto states and the public and private sectors to assure minority health issuesare addressed; . serve as a resource to promote, investigate, develop, and implement innovative health care models for minority populations; . conduct, review, and develop strategies to improve the availability and accessibility of health professionals to minority communities; . conduct, sponsor, and facilitate conferenceson minority health; . assurethat steps are taken to improve data sourcesand integrate data systems reflecting minority populations; and . facilitate research and foster public awarenessof factors affecting minority health. OMH does not have a written strategic plan at this time, but is expected to complete one in fiscal year 1991. In 1987, OMH awarded an initial con- tract to ROWSciences,Inc., to provide technical and administrative assistancein developing the strategic plan for minority health. The cumulative contract costs total about $1.4 million. The objectives of the planning effort are to develop an agendathat all nnsagencies,as well as other components of the health community, can use to improve minority health and provide OMH with a means to evaluate progress. At about the time of the initial contract award, OMH established Health IssuesWorking Groups to determine the level of HHS'S minority health activities relating to six health problem areas and three cross-cutting Page 8 GAO/HRD-90-14OFY.S Minority Health Information Section 1 OMH Goals, Objectives, and Strategic Plans areas identified in the Secretary’s task force report.’ The working groups developed an inventory of federal minority-related programs for each of the areas of concern for minority health. Using the information developed by the working groups and the recom- mendations of the Secretary’s task force, in June 1989 the contractor prepared a draft strategic plan. OMH is in the processof providing the draft plan to nonfederal technical experts for review and comment. After the expert comments are received, OMH plans to publish a notice of the plan in the Federal Register in August 1990 to solicit public com- ments before finalizing the plan in early fiscal year 1991. The draft plan established an overall goal of reducing the disparity in health characteristics that exist between the minority and general popu- lations by improving minority accessto all levels of health care. To accomplish this, the plan proposes short-term, medium-term, and long- term goals. Short-term goals are those for which activity might be com- pleted in 1991; medium-term goals might be completed by 1992, and long-term goals might be completed by 1995 or later. Examples of these goals are increasing professional awarenessof cardiovascular disease and stroke among minorities (short-term); encouraging inclusion of information on cancer screening and minority risk factors for cancer in health promotion materials (medium-term); and developing outreach and education programs to increase minority use of prepregnancy and prenatal health care (long-term). The draft plan doesnot establish specific goals for each of the four targeted minority groups. However, OMH says that if the comments received on the plan indicate a need to do so, such goals will be established. ‘The six health problem areas are cardiovascular disease and stroke; diabetes; cancer; substance abuse; homicide, suicide, and unintentional injuries; and infant mortality. The three cross-cutting areas are development of minority demographic data, minority needs in health education and health professions, and access to health care services and financing. Since the task force met, AIDS has been added as the tenth minority health concern. Page 9 GAO/HRD-BO-140FS Minority Health Information Section 2 l?tmdingand Staffiig Levels From fiscal year 1986 to fiscal year 1990, OMH'S annual budget increased from $1.9 million to about $8 million. During this sameperiod, its staffing level increased from 11 to 17. For fiscal year 1991, the adminis- tration has requested an increaseto approximately $19.6 million and to 30 OMH staff members. OMH says that its staff are not assignedto specific minority population issues.Instead, OMH stated that staff are assignedby functional program area (that is, program development, external coordination, internal coor- dination, and program management),and all staff perform work related to each of the targeted minority groups. The populations of Hispanics, Asian Americans and Pacific Islanders, and blacks are all projected to increase in the next several years. The President’s fiscal year 1991 budget request provides OMH with an increase of $11 million and 13 additional staff members.OMH believes that these increaseswill be sufficient to addressthe needsresulting from the expected increasesin minority populations. This is becauseOMH funding represents a relatively small component of the total HHS resourcesdevoted to improving minority health. Principal responsibility for all programs that provide health services for minorities rests with several other Public Health Service and HHS agencies. OMH funding and staffing for fiscal years 1986-91are shown in table 2.1. Table 2.1: Office of Mlnority Health Fundlng and Staffing (Fiscal Years 1986-91) Dollars in thousands Fiscal years 1986 1987 1988 1989 1990 1991 Actual Auth. Actual Auth. Actual Auth. Actual Auth. Actual Est. Actual Est. Dlrease amount staff amount staff amount staff amount staff amount staff amount staff Health problem areasa $1,914 11 $3,000 11 $2,872 11 $2,964 11 $3,946 14 $15,442 25 AIDS education and prevention 0 0 0 0 1,436 0 3,416 2 4,010 3 4,058 5 Total $1,914 11 $3,000 11 $4,308 11 $6,380 13 $7,956 17 $19,500 30 ‘includes funding for AIDS to community health coalitions to address the risk factors of this disease among minority populations. Source: Office of Minority Health, HHS. Page 10 GAO/HRD90-140FS Minority Health Information Section 2 Funding and Staffing Levels Although HHS does not maintain separate data on its total funding for Public Health Service minority health problems in general or individual minority populations, Funding for Minority the Public Health Service has categorized its expenditures for minority Health health activities. This information is included in supplementary budget data submitted with the Public Health Service’sfiscal year 1991 budget justification. Examples of Public Health Service minority health activities include programs to reduce cardiovascular diseaseand diabetes in blacks, His- panics, and Native Americans; information and education programs for minorities on sexually transmitted diseases,including AIDS; and child- hood lead-poisoning prevention. However, OMH said that other HHS agen- cies, such as the Health Care Financing Administration and the Social Security Administration, do not identify the amount of funds targeted for minority health activities. The Public Health Service’sfunding of minority health activities for fiscal years 1987-91is shown in table 2.2. Table 2.2: Public Health Service Sources of Minority Health Funding (Fiscal Years Dollars in thousands 1987-91) Fiscal years Agency 1987 1988 1989 1990(Est.) 1991 (Est.) National Institutes of Health $255,235 $292,250 $339,397 $373,249 $410,364 Alcohol, Drug Abuse and Mental Health Administration 13,531 15,984 58,245 88,930 86,053 Health Resources and Services Administration 41,250 45,850 47,389 48,097 164,578 Centers for Disease Control 55,386 61,560 87,427 125,766 129,351 Office of Assistant Secretary for Healtha 33,313 6,839 16,219 11,622 23,485 Agency for Health Care Policy and Research 2,500 2,663 951 4,930 4,930 Indian Health Service 0 0 800 992 1,013 Total $401.215 $425.146 $550.420 $653.586 $819.774 aOMH funding amounts are included with the Office of Assistant Secretary for Health. Source; Supplementary budget data submitted with the Public Health Service’s fiscal year 1991 budget justification. Page 11 GAO/HRD-90-140FS Minority Health Information Section 3 0 Grant Apphations and Awards OMH stated that it doesnot have major activities or programs that serve any particular one of the four minority populations. OMH'S position is that it attempts to achieve a balanced representation among all four minority populations in its programs. However, under OMH'S two general grant programs, most of the grants awarded serve a specific minority group. Blacks and Hispanics represented the largest groups served. OMH funds health-related activities that cover the targeted minority groups through two general grant programs, the Minority Community Health Coalitions Demonstration Grants (coalition grants) and Minority AIDS Education/Prevention Grants (AIDSgrants). Grants awarded under these two programs are for education and prevention programs for the minority health problem areas. Under the coalition grants program, OMH provides funds to community coalitions to help reduce the leading causesof excessdeaths in minority populations, as identified in the HHS Secretary’s 1986 Task Force Report on Black and Minority Health and in recognition of the severity of the AIDS problem. These grants provide funding for Z-year projects to plan and implement innovative programs to reduce the diseaserisk factors in the four minority populations. Under the AIDS grants program, OMH provides funds to organizations serving minority populations for use in providing AIDS prevention infor- mation and education to minority populations. Grants under this pro- gram are awarded for 3 years. For a variety of purposes, OMH has also entered into (1) interagency agreementswith other federal agenciesand (2) contracts with private organizations, such as health organizations, collegesand universities, and professional groups. For example, OMH co-sponsorsconferencesand workshops on AIDS and other minority health problems. For the period October 1, 1986, through April 30, 1990, OMH received 881 grant applications under its coalition grants and AIDS grants pro- grams. OMH did not have its own breakdown of what group(s) each application was to serve. Our review of information. provided by OMH of the organizations submitting grant applications showed that in most cases,the information did not specify the minority group that was to be served. Of the 881 applications OMH received, we identified 166 that would serve one or more specific minority groups. Even though OMH information on most grant applications was not spe- cific, most grants actually awarded were intended to serve a specific minority group. From October 1986 through April 1990, OMH awarded 64 grants; 64 of these were to serve a specific minority group and the Page 12 GAO/HRD-99-149lW Minority Health Information Section 3 Grant Applkationa and Awards remaining covered multiple groups. The number of grants applied for and awarded, as well as the number and amount of grants awarded to serve specific minority groups for that period, are shown in table 3.3. Table 3.3: Office of Minority Health Grant Applications and Awards Sewing Dollars in thousands Specific Minority Populations (Fiscal Grant awards Years 1986-90) Grant Group(s) served application8 Number Amount pe& group 23 $3,431 Hispanic :: 16 2,362 Asian American/ Pacific Islander 1,033 Native American :7 96 1,198 Subtotal 156 54 8,024 Two to three groups Black/Hispanic 8 6 938 Black/Native American 1 1 136 Black/Hispanic/Asian American/Pacific Islander 1 1 169 Subtotal 10 8 1,243 All four groups served or specific aroutx unknown 715a 2 313 Total 881 64 $9,580 Note: Data are through April 30, 1990, and no new grants have been awarded to date in fiscal year 1990. OMH has committed funds amounting to $1.9 million for 3-year AIDS Education/Prevention Grants that were awarded in fiscal years 1988 and 1989. aOn the basis of information OMH provided, GAO could not determine whether these applications were intended to serve a specific group. Page 13 GAO/HRD-90.140FS Minority Health Information ProspectiveGrantees OMH said it managesgrant achievementsthrough quarterly and final reports, which grantees must submit, as well as visits to grantee sites. For ADS grants, which are awarded for 3 years, OMH staff also conduct evaluations of performance by requiring grantees to apply annually to continue their projects. During the period October 1986 through April 30, 1990, OMH staff made 67 site visits to monitor grantee perform- ance.OMH officials report that they have never terminated a grant prior to completion of the grant period becauseof poor performance. OMH has not conducted an overall evaluation of grantee performance. However, to obtain an indication of the successof its projects, in 1988 OMH contracted for an evaluation of 6 of the 12 grants that had been completed. OMH considers projects to be successfulif (1) they reach the targeted minority population(s), (2) grantee organizations remain in existence and continue project activities after the grant period, and (3) grantees are able to secure funds from other sourcesafter OMH funding ends. The contractor’s evaluation showed that OMH projects had the fol- lowing mixed results: l Although all six projects resulted in a heightened awarenessby the targeted population of minority health problem areas and associated risk factors, not all of the projects were able to assessthe level of knowl- edge(or attitudes) and practices of their targeted populations con- cerning particular diseases. l Although all six projects experienced difficulty in locating funding to continue the projects, all but one project continued to function following the end of the OMH funding. OMH is currently reviewing the contractor’s evaluation report in relation to each grantee’s final report. OMH has not conducted any specific review regarding the issue of minority representation in its grant programs. OMH believes that all four minority populations seemto be well represented among the large num- bers of grant applications submitted to OMH and, therefore, such a review has not been conducted. The office reports that it has provided technical assistanceto minority organizations to increase their knowl- edge of funding sourcesand to improve their grant application submis- sions so that they may better compete for federal and other funds. OMH said that in fiscal years 1988 and 1989, it held a series of regional training workshops to help minority organizations better compete for OMH and HHS funding. Over 600 individuals attended these sessionsin fiscal year 1989. Page 14 GAO/HRLb90-14OFs Minority Health Information Page 16 GA0/HRD90440FS Minority Health Information Appendix I Major Contributors to This Fact Sheet Janet L. Shikles, Director, Health Financing and Policy Issues, Human Resources (202) 275-5451 Division, &b&-t B. Jojokian, Assistant Director Rodney E. Ragan,Assignment Manager Washington, DC. Benjamin F. Herr, Jr., Evaluator-in-Charge (108782) Page 16 GAO/HRD9&1~Fs Minority Health Information - ___I---__. --.___.-___ _____- ~l”-ll-.-__- ._^“---. _-^“-l-----ll- Ii.S. Gt~ut~rid Acctounl.iug Office Post, Office Box 60 I5 (hithwsburg, Maryland 20877 ‘l‘lw first five copies of each report iwe fret*. Additiouid copit++ are w2.00 tw~tl.
Minority Health: Information on Activities of HHS's Office of Minority Health
Published by the Government Accountability Office on 1990-06-06.
Below is a raw (and likely hideous) rendition of the original report. (PDF)