Still Striving for the Mountaintop: Achieving Health Equity for African Americans

Racial and ethnic health inequities remain pervasive across most state health systems*. For most states where data is available, when compared to their Non-Hispanic White counterparts, Black and American Indian/Alaskan Native people are more at risk to die early** (PDF | 653 KB) from treatable and preventable conditions; suffer serious pregnancy-related complications or death; die from heart disease or cancer; and are at greater risk for the onset of diabetes. The evidence is clear that there are deeply rooted inequities in health care across and within states* (PDF | 2.9 MB). These inequities should generate a call for health equity action (PDF | 4.7 MB).

Achieving health equity is a critical goal for behavioral health services. Equal access to high quality and affordable behavioral health services and support is the right of all individuals, regardless of race, age, ethnicity, gender identity, disability, socioeconomic status, sexual orientation, sex characteristics, or geographical location. While this mountain may be a difficult one to climb, addressing health equity requires leadership, collaboration, and support for sustainability. In January 2021, the Biden-Harris Administration issued White House Executive Order 13985. The presidential directive amplified the human costs related to racism, chronic poverty, and other disparities, and ordered the federal government to advance an ambitious, whole-of-government equity agenda. During Black History Month in 2023, President Biden reaffirmed federal commitment to equity and signed a second Executive Order, Further Advancing Racial Equity and Support for Underserved Communities Through the Federal Government directing the federal government to continue and expand the equity priorities for each American, including rural communities, communities of color, Tribal communities, LGBTQI+ individuals, people with disabilities, women and girls, etc.

The Substance Abuse and Mental Health Services Administration’s Office of Behavioral Health Equity (OBHE) coordinates efforts to reduce disparities in mental and/or substance use disorders across populations. OBHE’s mission is to advance equity in behavioral healthcare by tailoring public health and service delivery efforts that promote mental health, prevent substance misuse, provide treatments, and facilitate supports to foster recovery for racial, ethnic, and sexual, gender minority populations and communities. While the work of achieving overall health equity for African Americans as a people has been and continues to be aspirational, we cannot deny the progress that has been made in the public health and mental health infrastructure, national awareness, through legislation, and program services. Here are just a few major milestones that have advanced health equity for African Americans and other marginalized groups:

1915
National Negro Health Week begins in response to findings by the Tuskegee Institute that amplified the poor health status of African Americans in the early part of the 20th Century.

1986
The U.S. Department of Health and Human Services’ Office of Minority Health was created and is one of the most significant outcomes of the 1985 Secretary’s Task Force Report on Black and Minority Health. The creation of the office lent itself to the emergence of minority health disparities as an issue of national significance.

2003
The Healthcare Equality and Accountability Act was introduced to improve minority health and healthcare and eliminate racial and ethnic disparities in health and healthcare.

2009-Present
To address disparities in behavioral health care, the National Network to Eliminate Disparities in Behavioral Health (NNED) was formed with support from SAMHSA, the National Institutes of Health/National Institute on Minority Health and Health Disparities, The Annie E. Casey Foundation***, in partnership with the National Alliance of Multi-ethnic Behavioral Health Associations. With a network of more than 1,500 community-based organizations, the NNED is operated by SAMHSA’s OBHE and invites community-based organizations or agencies, and individuals addressing mental health or substance use disparities, with a strong focus on diverse communities, to become NNED Members.

2018-Present
The Historically Black Colleges and Universities Center for Excellence in Behavioral Health (HBCU-CFE) was established by SAMHSA for the purpose of recruiting students to careers in the behavioral health field to address mental and substance use disorders, provide training that can lead to careers in the behavioral health field, and/or prepare students for obtaining advanced degrees in the behavioral health field. A goal of the HBCU-CFE is to increase the number of HBCU students prepared to enter the behavioral health field by assisting students with continuing their education in behavioral health.

2020-Present
The African American Behavioral Health Center for Excellence was established with support from SAMHSA as one of three Centers of Excellence to develop and disseminate training and technical assistance for healthcare practitioners on issues related to addressing behavioral health disparities.

This year is a new opportunity to lessen the burdens of health disparities and expand implementation of proven health equity strategies. There also are opportunities to expand the reach of health equity in public policy, community development, workforce development, and program services to name a few. Black History Month is a month to reflect on the advances people of African descent have made in America. There have been many. But collectively, America has not erased the tragic impact of racially driven health inequities. The march toward the mountaintop continues onward. Let’s go!

To learn more about HHS’ Equity Action Plan visit https://www.hhs.gov/equity/index.html#eap.

Resources

• African American Behavioral Health Center for Excellence: The African American Behavioral Health Center of Excellence (CoE) is a national CoE funded by SAMHSA, located within the National Center for Primary Care, Morehouse School of Medicine.
• Historically Black Colleges and Universities Center for Excellence in Behavioral Health (HBCU-CFE): The Center for Excellence emphasizes education, awareness, and preparation for careers in mental and substance use disorder treatment including addressing opioid use disorder treatment, serious mental illness (including First Episode Psychosis), and suicide prevention. The mission of HBCU C.A.R.E.S. is to raise awareness of and offer access to behavioral health fields for diverse students.
• National Network to Eliminate Disparities in Behavioral Health: NNED is a network of community-based organizations focused on the mental health and substance use issues of diverse racial and ethnic communities.
• Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health (PDF | 4.7 MB): This workbook from the Centers for Disease Control and Prevention is for public health practitioners and partners interested in addressing social determinants of health to promote health and achieve health equity.
• SAMHSA’s Office of Behavioral Health Equity: OBHE advances behavioral health equity by reducing disparities in racial, ethnic, LGBTQI+, and other under-resourced communities across the country by improving access to quality services and supports that enables all to thrive, participate, and contribute to healthier communities. OBHE was established in accordance with Section 10334(b) of the Patient Protection and Affordable Care Act of 2010.
• White House Executive Order 13985: Advancing Equity and Racial Justice Through the Federal Government: President Biden signed Executive Order 13985 which charged the federal government with advancing equity for all, including communities that have long been underserved.
• White House Executive Order 14091: Further Advancing Racial Equity and Support for Underserved Communities Through the Federal Government: President Biden signed Executive Order 14091 to build upon previous equity-related Executive Orders by extending and strengthening equity-advancing requirements for agencies, and it positions agencies to deliver better outcomes for the American people.

*The Commonwealth Fund’s 2020 Scorecard on State Health System Performance provides an assessment of the 50 states and the District of Columbia on 49 measures of access to health care, quality of care, service use and costs of care, health outcomes, and income-based health care disparities.

**The Century Foundation is one of the oldest public policy research institutes in America. Their featured 2019 report, Racism, Inequality, and Health Care for African Americans (PDF | 653 KB), widely examines the state of health care coverage for African American populations and highlights the social factors impacting their health outcomes, including disparity risks.

*** The Annie E. Casey Foundation is included as recognition of their role in supporting the creation of NNED.