oversight

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)

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




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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




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