A Framework for Eliminating Health Disparities
in the Commonwealth of Massachusetts

In 2006, as part of Massachusetts’ groundbreaking
Health Care Reform Law, the Health Disparities
Council (the Council) was established. Our mission
is to identify and recommend policies and actions to
eliminate racial and ethnic disparities in health and
healthcare outcomes and to achieve health equity
for all Massachusetts residents.

In order to guide this monumental and complex
mission, the Council has adopted a framework
which will assist us in planning, implementing,
and evaluating our future work. What follows is a
description of the framework, organized around six
objective areas that influence both access to healthcare
and personal health behaviors (See Figure):

Image: Figure entitled “Framework for Addressing Health Disparities”

1. Adopt Social Policies that Increase Equity
2. Promote Healthy Communities
3. Promote Institutional Transformation
4. Promote Provider Transformation
5. Promote Healthy Individual Behaviors
6. Improve Access to and Quality of Healthcare
and Health Outcomes

Each objective along with a scope of activity is
described below. Collectively, these objectives constitute
the framework for a comprehensive approach
to improving the health of and eliminating health
disparities among people of color.

1 Adopt Social Policies That Increase Equity
The residents of Massachusetts deserve to live
healthy, prosperous lives free from violence, racism,
want and disease. Society sets about constructing
and insuring those conditions for its members
through policies of its state and municipal governments.
The Council seeks to develop policies that
equitably improve the health of its residents, particularly
people of color in often socially disadvantaged
communities. These policies should increase access
to positive environmental conditions and provide
economic and educational opportunities for all ages
while permitting people to live in healthy housing
and neighborhoods. These policies must also respect
individual cultural, religious and ethnic systems of
behavior and belief.

2 Promote Healthy Communities
Community is the level of society at which people
live their daily lives. Community level supports to
health include adequate sources of healthy food, safe
neighborhoods and a built environment which promotes
physical activity. In addition, residents need
easy access to good jobs and schooling. Improving
community level access to health requires the establishment
of mechanisms for community input and
mobilization to guide the development of locally
relevant barrier-reduction strategies.

3 Promote Institutional Transformation
Institutions are places where we work, worship,
learn or receive treatment. These institutions are
accountable to meeting community needs and
contributing to societal and individual health.
Institutional transformation requires entities to
align their core values and deliver services to promote
health equity. Transformation includes, but is
not limited to, representation/diversity at all levels
within an institution, equitable pay and advancement,
increased access to and opportunities for
learning, bridging resources between communities
to overcome geographic and/or social isolation, and
equitable distribution of resources.

4 Promote Provider Transformation
Providers of healthcare services, including healthcare
institutions, healthcare educators, licensed healthcare
practitioners and others, have a direct impact
on health inequities and disparities. Provider transformation
includes incorporation of linguistically
and culturally competent licensed healthcare practitioners.
Cultural awareness and sensitivity in the
provider community must be advanced and permeate
throughout the delivery system to reduce disparities
and improve outcomes for all populations.

5 Promote Healthy Individual Behaviors
Healthy behavior does not occur in a vacuum. Factors
that impact individual health outcomes are present in
society and its communities and may be influenced
by individual knowledge and personally held beliefs.
Consequently, successful interventions that improve
individual health may first require implementation
of programs and policies that address health disparities
at the societal, community and institutional
levels. Through such interventions, individuals and
families should be afforded the proper tools to live
healthy lifestyles, access preventative care, treatment
of chronic disease and the education to make good
judgments about their health and healthcare.

6 Improve Access to and Quality of Healthcare and
Health Outcomes
Barriers such as health insurance, social stigma,
cultural competence and fractured delivery systems
contribute to the problem of disparities in healthcare.
Improving access to healthcare is dependent
on numerous factors including the availability of
appropriate clinical services, workforce competence,
financial payer mechanisms and geographic location.
Assessment of entities involved in healthcare delivery
(i.e. physical, mental, visual and dental) must
be conducted to increase existing levels of cultural
competency within the institution and among providers,
locate opportunities to reduce costs due to
duplication of efforts and improve health outcomes
among patient populations.