The Texas Office of Minority Health, currently the Office for the Elimination of Health Disparities (OEHD), was created by the 73rd Texas Legislature in 1993 as part of House Bill 1510 to facilitate an increasing focus on the distinct health care needs of minority populations in Texas. The functions of the office, as promulgated in the bill, were to:

• Assume a leadership role in working with federal, state and private groups and agencies to develop minority health initiatives and
• Maximize the use of existing resources for this purpose without duplicating current efforts in this area.

With the passage of House Bill 2292, 78th Legislative Regular Session in 2003, the Texas Legislature called for the creation of OEHD. It’s primary focus is to optimize the health and wellness of Texas residents by developing and strengthening systems and services to monitor, analyze and assess the health needs of underserved populations throughout the state. OEHD was established in 2004 to bring greater focus to health disparities statewide across service systems.

With the passage of House Bill 1396, during the 80th Legislative Regular Session, the Texas Legislature transferred the OEHD from the Texas Department of State Health Services to the Texas Health and Human Services Commission (HHSC). The relocation to HHSC has afforded OEHD the opportunity to apply an integrated approach and to partner with other health and human services agencies. This includes oversight to all HHSC agencies, including the Texas Department of State Health Services, the Texas Department of Aging and Disability Services, the Texas Department of Assistive and Rehabilitative Services and the Texas Department of Family and Protective Services.

To provide leadership and guidance throughout HHSC and to assist the state in improving the health status of special and underserved populations.

Service Purpose:
To reduce health disparities among special or underserved populations across Texas. This will be achieved by:

• Providing technical assistance throughout the Texas Health and Human Services Commission to ensure health disparities are addressed in all agency services,
• Providing leadership to internal and external partners through the collaborative development of health policies and programs established to eliminate health disparities and
• Promoting cultural competency, research, health literacy and evaluation of health promotion and disease prevention program activities.

The core functions of the office are to:

• Identify internal and external partners, resources and opportunities for collaboration and coordination of health disparities efforts in Texas,
• Identify “best practices” and work with research and policy institutions to develop and promote evidence-based intervention strategies and research initiatives for addressing health disparities, and
• Provide internal and external consultation, training, education, and technical assistance on health disparities, cultural competency, health literacy and strategic planning.

In 2006, OEHD initiated the HDI, a project that monitors progress toward eliminating the health status gap in Texas. HDI establishes a baseline for HHSC’s efforts to eliminate racial and ethnic disparities in health. Although current data are presented by race and ethnicity to describe the health status gaps, race/ethnicity alone is not a cause of a particular health condition or status. The HDI project will account for the real causes that affect health disparities. The goal of HDI is to identify relevant public health indicators available from existing HHSC databases to provide an overall picture of community health. The HDI initiative will stimulate research aimed at reducing health disparities.

The HDI initiative incorporates the Community-Based Participatory Research (CBPR) model. CBPR is a partnership approach designed to answer the question of how community stakeholders are empowered to identify effective and efficient solutions to health problems. To address disparities and develop stable, mutually beneficial relationships with community-serving agencies, the HDI project is guided by community participatory principles and will grow directly out of identified recommendations and goals of the community.

These sessions provide professional, structured training and education regarding “best practices,” as well as guidance on successful application of evidence-based interventions and policies to HHSC staff. Other trainings are available on various health disparities topics, such as cultural competency and health literacy.

In March 2008 the Summit, a biennial event, will be held at the Texas State Capitol. This year’s Summit theme is “African Americans Moving in the Right Direction” and will feature educational presentations and strategic plans to address health disparities in Texas.

These projects are varied and range from coalition building to outreach and education activities. Regional projects are based on the needs of the regions and are responsive to community input. OEHD coordinates with Regional Staff located across Texas to implement projects. In 2007, OEHD Regional Staff conducted two community outreach presentations on health literacy in Westway, Canutillo (El Paso County). OEHD Regional Staff also coordinated six presentations at Presidio High School.

OEHD maintains a database with more than 3,000 community-based organizations, researchers and professionals. OEHD periodically sends information to database members about minority health issues, statewide meetings, conferences and funding opportunities. Since the transfer, the OEHD database has increased by 25,000. This has drastically expanded the number of contacts to whom the office can relay information.

Created by the Texas Legislature in 2001, the HDTF offers recommendations to assist the HHSC in accomplishing the following goals:

• Eliminate health and health access disparities in Texas among multicultural, disadvantaged, and regional populations, and
• To reorganize HHSC programs to eliminate those disparities.

In August 2005, Hurricane Katrina devastated the Gulf Coast region. As many as one million evacuees from Louisiana, Mississippi and Alabama relocated across the United States, the largest dislocation in United States history in the last 150 years. Texas was the recipient of more than half of this evacuee population. Twenty-six days after Katrina, Hurricane Rita struck the Texas/Louisiana coasts. In the days before Rita made landfall, millions once again evacuated to east Texas and western Louisiana. Thousands of these displaced residents will not be able to return to their place of residence for many years, both because of the catastrophic damage and the lack of resources to return and rebuild. Most likely, the majority of this group will become permanent residents in Texas. For this reason, it is extremely important not to view this historical event as a periodic, defined disaster with a return to normalcy. Instead, the actual result of these catastrophes will be long lasting for the state of Texas, drastically affecting current health and social service systems in ways that have not yet been fully realized.

In September 2005, OEHD received funds from the federal Office of Minority Health (OMH) to provide education, guidance and outreach to Displaced Louisiana and Texas Residents (DLRs). The goal of these funds was to assist these new and displaced residents in accessing emergency and ongoing health and human services in Texas. To ensure that these activities were responsive to the needs of DLRs, OEHD coordinated a meeting in December 2005 with representatives from the Louisiana Department of Health and Hospitals, City of New Orleans Health Department and a New Orleans community-based organization. OEHD then sent out a survey to 271 health and social service providers in Texas to determine the immediate needs of service providers and displaced residents. Sixty-one providers responded to the survey; about 10 percent indicated that they did not serve any DLRs. Through this assessment process, OEHD began developing the following activities:

• An outreach and education campaign to assist DLRs, especially those in need of HIV care services, in navigating the new service delivery system in Texas,
• An extensive navigational guide that details a wide variety of health and social services specifically available for DLRs in Texas and
• Cultural competency training to health and social service providers in Texas that are assisting DLRs.

Outreach and Education Campaign

OEHD has collected several educational and informational items for a new Resource Clearinghouse. The location will have a laptop for access to research articles and funding information. Additionally, the clearinghouse will have brochures and other educational items for distribution to the agency and the community.

Since September 2007, OEHD staff in Austin conducted four trainings and workshops. “Taking the First Steps toward Cultural Competency” was taught to staff at the Texas Department of State Health Services (DSHS). This training lasts 90 minutes and focuses on incorporating a cultural competency initiative in one’s program or clinic. In addition, “Taking the First Steps toward Cultural Competency” was taught to DSHS, HIV/STD staff. Finally, “Issues in Cultural Competency,” a day-long workshop, was taught to DSHS staff in Nacogdoches, Texas.

OEHD awarded a contract to Interlex, a media advertising agency, to develop a culturally-appropriate print media campaign that targets DLRs in Houston and East Texas. The campaign’s goal was to encourage and instruct DLRs on how to access state and federal health and social services in Texas. The public information campaign, which began in July 2006, targets African-American media, churches and faith-based organizations by developing culturally-sensitive ads and purchasing media spots in newsletters and community newspapers. The campaign also targets zip codes in Houston and East Texas with the highest reported number of DLRs and displays educational posters at convenience stores in the area.

OEHD completed and distributed a culturally appropriate navigational guide that provides a comprehensive listing of federal and state health and social services that are available in Texas. The tabbed guide has visual and tactile cues for identifying important sections. The guide uses the same imagery from the awareness campaign, reinforcing the same motivational messages. Each page presents a call to action, reminding the reader that they are empowered to seek access to health care. A separate section of the navigational guide specifically focuses on services for HIV and sexually transmitted diseases in Texas. With continued funding, OEHD will update and distribute the Navigational Guide every two years.

In Texas, reducing and eliminating health disparities requires the efforts of a multidisciplinary team of researchers, public health, substance abuse and mental health staff and community and organizational stakeholders who can investigate and provide a better understanding of the role of behavioral, biological and socioeconomic variables. No one program and/or project can adequately address every factor that may contribute to health disparities. Investigation will educate OEHD about how these variables intertwine and will lead to informed development of policies and interventions to address health disparities, including those in mental health and substance abuse.

To achieve this goal, OEHD created and supports a state collaborative of stakeholders addressing health disparities. In addition, OEHD also supports HHSC programs by providing a link between state and local communities to address health disparities, strengthening the infrastructure to address health disparities and emphasizing health promotion and disease prevention. The collaborative program, Texas State Partnership to Address and Eliminate Health Disparities, is a five-year project to reduce health disparities in Texas by strengthening relationships to determine evidence-based policy and prevention program strategies.

The partnership focuses on the following three core areas:

• Conducting a needs assessment to determine barriers to public health and health care and potential solutions,
• Enhancing and supporting the community-based collaborative to recommend, test, inform and reform proposed strategies and
• Creating and supporting a process for diffusion of ongoing technical assistance regarding health disparities information, research and strategies.

To ensure these outcomes and provide guidance, the project has an external evaluator who provides an assessment of the process determines the effectiveness of proposed interventions/policies and estimates the impact on health disparities in Texas.

In 2007, OEHD partnered with the Department of State Health Services HIV/STD Program to plan and conduct a social marketing campaign targeting African American women who are HIV positive or at high risk of infection. The campaign promotes the benefits of HIV medical care, medication adherence and risk-reduction counseling through the development and distribution of culturally-relevant media. It was designed to reach African-American women in areas with the most severe health disparities, evidenced by rate and incidence captured in epidemiological data, including Austin, Dallas, Fort Worth, Corpus Christi and their surrounding areas. The materials developed included restroom ad panels, posters, pamphlets, transit ads, print ads, radio public service announcements and SMS (text) messaging. Local stakeholders were enlisted to provide input on development of campaign materials, as well as to disseminate materials at the community level. Several local agencies have expressed interest in distributing campaign materials and incorporating the materials into existing prevention outreach activities.

OEHD partners with TMF, a nonprofit organization of licensed physicians, to offer cultural competency training to healthcare providers throughout the state of Texas. This training teaches providers in Texas about patient perspectives, values and behaviors to provide the best care possible for a culturally and racially diverse patient population. Cultural competency has emerged as a strategy to reduce health care disparities by teaching health care professionals how to meet the social, cultural and linguistic needs of their patients.

(As of Dec. 2007)

Year	Federal	State	Private
FY 2007	$287,203	$321,000	None
FY 2008	$175,000	Pending	None
FY 2009	$175,000	N/A	None

OEHD has four professional staff members including one director and three program specialists. Each program specialists focuses on one of the following: coordinating activities for Texas State Partnership to Address Health Disparities activities, working with OEHD Regional Staff or working with the Health Disparities Task Force.

The Statewide Health Disparities Task Force operates with nine seats.

OEHD Regional staff members throughout the state of Texas coordinate with OEHD to conduct health disparity activities and eight regional projects.

• OEHD Biennial Report to the 80th Texas Legislature, 2007
• The Health Disparities Task Force Report to the Texas Legislature, 2006
• Final Report of Recommendations for Health Disparities Index, Scope and Indicators, 2006
• Addendum: Compilation of Responses Regarding the Final Report of Recommendations for Health Disparities Index, Scope and Indicators, 2006
• Health Disparities/Community Electronic Health Record Consensus Meeting Report, 2006
• The Health Disparities Task Force Report, 2004

Prepared by National Association of State Offices of Minority Health (NASOMH)