The Committee will carry out this charge guided by integrated core values that permeate the Committee's deliberations and are reflected in its work. The Committee views these core values as an inseparable whole that cannot be divided into individual parts. Each core value articulated here derives its vitality from its context among the others, and any effort to single out one or another would therefore undercut the structural integrity of the entire framework.
In formulating its core values, the Committee is endeavoring to adopt and promote the perspective of health care professionals and advocates who enter into an area where they are no longer experts. The Committee feels it is necessary to risk being the "student" and to give up command and control in order to share ideas and strategies for building accountability with the minority communities it represents. In addition, these core values endeavor to reflect this country's unique legal and political relationship with Indian tribal governments that includes engaging in regular and meaningful consultation and collaboration with tribal officials to develop Federal policies that have tribal implications, and are responsible for strengthening the government-to-government relationship between the United States and Tribal Nations.
SEVEN CORE VALUES
- Health for the Common Good: pursuing the status of a healthy American nation
includes access to improved health status and quality health care for all U.S.
The World Health Organization defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." (Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 1946).
Achieving the status of a healthy nation, which includes a focus on improved health status and quality care for all, requires a national plan that ensures that the costs and benefits are shared as public good, with everyone contributing according to their means and receiving services based on their needs. The protection and improvement of the health status of the nation is the primary goal of effective and equitable health care. Such a system ensures that the pursuit of profits does not interfere with any community's equal access to health and quality health care.
The Committee's deliberations and recommendations reflect the key provisions on prevention and wellness of the Patient Protection and Affordable Care Act of 2010 (H.R. 3590) that include strategies for: developing more affordable and accessible preventive services; improving community prevention; improving critical aspects of oral health; and building and maintaining a more robust public health system.
- Cultural Humility: redressing power imbalances that exist between minority
communities/Tribal Nations and health providers, health systems, and government.
The Committee endorses the concept of "cultural humility" which incorporates a lifelong commitment and active engagement to redress the power imbalances in physician-patient dynamic, and to developing mutually beneficial and non-paternalistic partnerships with communities on behalf of individuals and defined populations. The Committee believes that cultural humility should extend to redressing the power imbalances that exist particularly between minority communities/Tribal Nations and health providers, health systems, and government. More specifically, as the Administration, Congress, and DHHS proceed with the implementation of health reform, a serious and concerted effort should be made to develop, plan, and implement health and health care policies and programs that reflect a genuine cultural humility and responsiveness towards minority communities and Tribal Nations.
- A Patient-Centered Approach to Improving Population Health and Achieving
Health Equity: advancing and implementing the concept of patient-centeredness
that considers individuals' needs as they impact improving health status, providing
quality health care and achieving health equity.
In its deliberations and recommendations, the Committee will reflect the thinking behind provisions of H.R. 3590 that address the development of a national strategy to improve health outcomes, efficiency, and patient-centered care for all Americans. It is the Committee's firm belief that the ultimate goal of national health reform is the improvement of the health status of all populations through developing and implementing effective prevention and public health, care strategies, and research priorities that reflect the diversity of the U.S. Public health programs and care strategies must take into account diverse cultural values, beliefs, and practices as they affect the health status of all communities and Tribal Nations. In addition, the Committee wholeheartedly endorses research that considers differences in effectiveness of treatment and services across subpopulations including racial and ethnic minorities.
The Committee believes being patient-centered is at the core of health equity which exists when all individuals and populations have equal opportunities for good health. Accordingly, the Committee endorses health system strategies that advance health equity by tailoring care to meet individuals' needs and ensuring that care does not vary in quality based on personal characteristics such as race, ethnicity, gender, language barriers, geographic location, and socioeconomic status.
- Accountability for the Health and Health Care of Minority Communities and
Tribal Nations: promoting compliance with existing laws, regulations, and financing
systems affecting health and health care of minority communities and Tribal Nations
with an emphasis
- on societal responsibility for advancing health and quality health care for these communities and
- on the specific responsibilities of DHHS in this regard.
The Committee believes that there is communal accountability which considers enforcement of laws and regulations as a tool but not the sole, or even primary, strategy for providing effective public health and quality health care for all. Included in this communal accountability are the critical elements of sufficient and effective resources and systems of financing to provide quality and equitable health care for all.
The Committee, however, also believes that DHHS has a particular and unique responsibility to U.S. minority communities and Tribal Nations affected by national health and health care policies and programs. In administering these health and health care programs authorized by the Congress and supported by the Administration, DHHS not only has the role of responsible and competent steward of public resources but must exercise special vigilance in protecting and advocating for the interests of these communities. This special vigilance is demonstrated by DHHS developing, implementing, and monitoring programs and initiatives that promote health and improve the quality of health care for minority communities with the goal of eliminating disparities and achieving equity in the U.S. health system. In addition, the Committee recognizes that the Federal delivery of health services and funding of programs and research to maintain and improve the health of American Indian and Alaska Natives (AI/AN) are consonant with the Federal government's historical and unique legal relationship with federally recognized Indian Tribes.
- Respect for the Diversity of U.S. Communities: understanding and placing value
on diversity of our populations in the health care system, including among other
factors race, ethnicity, culture, language, sexual orientation, and age.
A culture of diversity embraces acceptance and respect. The Committee understands that each individual is unique and recognizes individual differences, which can be along the dimensions of race, ethnicity, gender, sexual orientation, socio-economic status, age, physical/mental abilities, religious beliefs, political beliefs, or other ideologies. A culture of diversity is about understanding ourselves and each other and moving beyond simple tolerance to embracing and celebrating the richness of each individual. While diversity can be about individual differences, it also encompasses institutional and system-wide behavior patterns.
- A Diverse and Competent Health Care Workforce: developing a diverse
workforce to improve the health status and provide quality care for all communities
and for addressing health disparities.
The Committee believes that developing a diverse workforce in all organizations requires human resources programs that recruit, orient, and train staff to provide culturally and linguistically appropriate care. This has particular importance in building and maintaining a robust public health system with effective prevention programs to protect the public's health. A genuinely diverse workforce includes strategies that move an organization's care programs beyond cultural sensitivity (i.e., "I mean well") toward cultural competency (i.e., "I am doing well for the patient") and the elimination of health care disparities. Critical to creating and sustaining a diverse workforce are executive leadership teams and governance bodies that are representative of, and responsive to, diverse communities. The goals of achieving improved health status and equitable health care for diverse communities should be part of an organizational environment; reflected in policies and practices; supported with effective operational and administrative infrastructures; and be a key element in determining organizational effectiveness.
- Effective Engagement of Diverse Communities: viewing communities and Tribal
Nations not just as recipients or consumers of health care, but rather as equal
partners in improving health status and providing quality care for all.
The Committee recognizes that genuine and effective community partnerships require accurate assessment of needs and genuine engagement. Health care organizations need to develop and maintain open dialogues with communities through interactions with trusted community/Tribal Nation leaders and members to identify key issues and effective strategies for improving the public's health and access to available community resources. Effective community engagement goes beyond mere dialogue and assures community influence in developing policies and practices that affect individuals' and communities'/Tribal Nations' health and well-being. This is in accordance with DHHS' Tribal Consultation Policy (2005) that directs all of its components to establish a process to ensure accountable, meaningful, and timely input by Tribal officials in developing policies that have a significant effect on federally recognized tribes.