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                <name>query/</name>
                <summary>Health Disparities</summary>
                <description>
                </description>

                <author>Maria Baron</author>
                <company>NJDOH Center for Health Statistics</company>
                <versions>
                        <version>
                                <number>1.0</number><date>July 17, 2009</date><who>Maria</who><description>initial release</description>
                        </version>
                        <version>
                                <number>1.1</number><date>July 9, 2015</date><who>Maria</who><description>updated for HNJ2020 Foundation Health Measures</description>
                        </version>
                        <version>
                                <number>1.2</number><date>9/30/15</date><who>Maria</who>
                                <description>Made each section expandable/collapsible instead of a whole page of expanded text</description>
                        </version>
                        <version>
                                <number>2.0</number><date>4/12/18</date><who>Maria</who>
                                <description>Overhauled</description>
                        </version>
                </versions>
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        <TITLE>Health Disparities</TITLE>
        
        <CONTENT>
                Click a bar to expand or collapse its content.
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                <TITLE>Introduction</TITLE>
                        <CONTENT>
                        <table id="disparity"><td>Reducing health disparity among New Jerseyans is an overarching goal of the New Jersey Department of Health (NJDOH).</td></table>

                        <br/>
                        A <b>health disparity</b> is "a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion."<span class="SmallerFont"><sup><a href="#ref1">1</a></sup></span><br/>
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                <a name="hnj"></a>
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                <TITLE>Healthy New Jersey</TITLE>
                        <CONTENT>
                        <!--a href="http://nj.gov/health/chs/hnj2010u05/index.shtml" target="_blank" title="Go to HNJ2010 Update 2005 page">
                        <img src="view/image/home/HNJ2010.jpg" style="float:left; vertical-align:text-top; margin:0; margin-right:15px; height:100px;" title="HNJ2010" alt="HealthyNJ2010"/></a-->

                        <!--a href="http://nj.gov/health/accreditation/sha2010.shtml" target="_blank" title="Go to SHA2010 page">
                        <img src="view/image/home/SHAcover.jpg" style="float:right; margin:0; margin-left:15px; height:200px;" title="SHA2010" alt="SHA2010"/></a>

                        <a href="http://nj.gov/health/chs/hnj2020/about/history/index.shtml#2" class="Bold" target="_blank">Healthy New Jersey 2010: A Health Agenda for the
                        First Decade of the New Millennium</a> was planned in the late 1990s and released in June, 2001.
                        Following the federal <a href="http://www.healthypeople.gov/2010/" target="_blank">Healthy People 2010</a> initiative,
                        Healthy NJ 2010 established the elimination of disparities in health outcomes based on race 
                        and/or ethnicity as one of its two overarching goals, the other being increasing the quality
                        and length of healthy life.  To that end, every objective that is measured based on individuals 
                        had data and targets for each race/ethnicity for which data were available at the 
                        time the baselines were established in 2000.  In many cases, data systems were not collecting data
                        by race/ethnicity or were collecting a limited set of races/ethnicities (e.g., White, Black, 
                        and Other).  Also, for some objectives, the number of events for a particular
                        racial or ethnic group was too small to calculate a reliable rate.  As data collection systems improved their race and ethnicity data collection and as some racial/ethnic populations increased in New Jersey, more data were added to Healthy NJ 2010 as can be
                        seen in the <a href="http://nj.gov/health/chs/hnj2020/about/history/hnj2010u05.pdf" class="Bold" target="_blank">Healthy New Jersey 2010 Update</a>
                        published in May, 2005.  The Center for Health Statistics also produced a report specifically
                        addressing health disparities called <b>
                        Healthy New Jersey 2010: Assessing Progress by Race and Ethnicity</b> in July, 2008.  
                        Healthy NJ 2010 objectives were tracked through conclusion as indicators 
                        within the NJSHAD system.  The final assessment of Healthy NJ 2010 was published in 2014 as 
                        <a href="http://www.nj.gov/health/chs/hnj2020/sha2010.shtml" class="Bold" target="_blank">New Jersey State Health Assessment 2010</a>.

                        <br/><br/-->
                        
                        <a href="http://nj.gov/health/chs/hnj2020/about/intro/index.shtml" class="Bold" target="_blank">Healthy New Jersey 2020</a> (HNJ2020) is the state's version of the federal <a href="https://www.healthypeople.gov/" class="Bold" target="_blank">Healthy People 2020</a> initiative, which sets national objectives for improving the health of all Americans.
                        <br/><br/>
                        HNJ2020 is used for <a href="http://www.nj.gov/health/chs/hnj2020/about/sh_assessment/index.shtml" class="Bold" target="_blank">State Health Assessment</a> (SHA) and is also the <a href="http://www.state.nj.us/health/chs/hnj2020/about/sh_improvement_plan/index.shtml" class="Bold" target="_blank">
                        State Health Improvement Plan</a> (SHIP).  As of April, 2018, the 2018 SHA is undergoing edits based on a public comment period in January and February.  The 2018 SHIP is in the planning stage and will focus on the SHA's six priorities for 2018-2020:
                        <a href="http://nj.gov/health/chs/hnj2020/about/intro/index.shtml" target="_blank" title="Go to HNJ2020 page">
                        <img src="view/image/home/HNJ2020.png" style="float:right; vertical-align:text-top; margin:0; height:100px;" title="HNJ2020" alt="HealthyNJ2020"/></a>
                        <ul>
                                <li>Improve access to health services</li>
                                <li>Improve birth outcomes</li>
                                <li>Increase childhood immunization rates</li>
                                <li>Reduce heart disease and stroke</li>
                                <li>Reduce obesity</li>
                                <li>Improve mental health and substance abuse outcomes</li>
                        </ul>
                        <br/>
                        One of Healthy People's four <a href="https://www.healthypeople.gov/2020/About-Healthy-People" target="_blank">overarching goals</a> is to "achieve health equity, eliminate disparities, and improve the health of all groups."  In order to measure progress toward that goal, <a href="http://nj.gov/health/chs/hnj2020/documents/objectives/allobjtable.pdf" target="_blank">every HNJ2020 objective</a> based on person-level data has data and targets 
                        for the four largest racial/ethnic groups in the state -- Whites, Blacks, Hispanics, and Asians.  When a single year of data does not provide enough events 
                        to calculate reliable rates for all racial/ethnic groups, three-year averages are used, if available.  
                        For some objectives, three years of data combined still do not include enough events to 
                        calculate statistically reliable rates and are indicated as such in HNJ2020 documents.  
                        For some data sources outside of NJDOH, data are not available for all HNJ2020
                        racial/ethnic subgroups.<br/><br/>  
                        All HNJ2020 objectives are being tracked as 
                        <a href="indicator/CatHNJ2020.html">indicators</a> within the NJSHAD system. <br/> 
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                <a name="priority"></a>
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                <TITLE>Priority Areas</TITLE>
                        <CONTENT>
                        New Jersey P.L.2004, c.137 established the <a href="http://www.njleg.state.nj.us/2004/Bills/PL04/137_.HTM" class="Bold" target="_blank">Eliminating Health Disparities Initiative</a> 
                        in the <a href="http://nj.gov/health/omh/index.shtml">Office of Minority and Multicultural Health</a> (OMMH) 
                        and set forth priority areas for OMMH to develop and implement a comprehensive, coordinated plan to reduce 
                        health disparities between White and racial and ethnic minority populations in the State.<br/><br/>

                        The <a href="indicator/CatDisparity.html">health disparity priority areas</a> are:
                                <ul>
                                        <li>asthma</li>
                                        <li>breast, cervical, prostate, and colorectal cancer screening</li>
                                        <li>cardiovascular disease</li>
                        <a href="indicator/CatDisparity.html" title="Go to Disparity Priority Areas index">
                        <img src="view/image/home/inequality.png" style="float:right; vertical-align:text-top; margin:0;margin-left:15px; margin-right:150px; height:120px;" title="Health Inequity symbol" alt="HealthInequity"/></a>
                                        <li>diabetes</li>
                                        <li>hepatitis C</li>
                                        <li>HIV/AIDS</li>
                                        <li>immunizations (adult and child)</li>
                                        <li>infant mortality</li>
                                        <li>injuries (accidental) and violence</li>
                                        <li>kidney disease</li>
                                        <li>obesity</li>
                                        <li>sexually transmitted diseases</li>
                                </ul>
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                <!--a name="strategic"></a>
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                <TITLE>Strategic Plan to Eliminate Health Disparities</TITLE>
                        <CONTENT>
                        <a href="http://nj.gov/health/chs/documents/re_coding_standard.pdf" target="_blank" title="Go to coding guidelines page">
                        <img src="view/image/home/codingguidelines.png" style="float:right; vertical-align:text-top; margin:0; margin-left:15px; margin-bottom:15px; height:120px;" title="Race and Ethnicity Coding" alt="RECodingGuidelines"/></a>
                        In 2007, NJDOH released its <b>Strategic Plan to Eliminate Health Disparities in New Jersey</b>.  
                        The plan set a targeted agenda
                        for the reduction of health disparities among minority populations.  One of the goals
                        was to standardize the collection and reporting of race/ethnicity data across the Department,
                        so the Center for Health Statistics was charged with creating coding guidelines 
                        for the collection and dissemination of race and ethnicity data by programs 
                        within NJDOH.  The resulting guidelines were published in December, 2007, 
                        in a document titled <b>
                        Race and Ethnicity Coding Guidelines for the New Jersey Department of Health 
                        and Senior Services and its Grantees</b>.  Consistent with the 
                        <a href="https://www.whitehouse.gov/omb/information-for-agencies/federal-register" target="_blank">1997 OMB-15 directive</a>, 
                        it provides a description of the mutually exclusive race and ethnicity categories and also
                        provides guidance on how to collect data on primary language spoken in the home.
                        The Guidelines establish the gold standard by which all NJDOH race and ethnicity data should
                        be collected and disseminated.
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                <a name="clas"></a>
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                <TITLE>Cultural Competency</TITLE>
                        <CONTENT>
                        New Jersey is a racially, culturally, and ethnically diverse state. More than one-fifth of New Jersey residents are foreign-born and nearly one-third speak a language other than English at home and of those, only 60% feel they speak English very well.<span class="SmallerFont"><sup><a href="#ref2">2</a></sup></span>
                        <br/><br/>
                        This rich diversity presents a challenge to health professionals. Diverse populations bring different attitudes, expectations, beliefs, and communication styles to each health encounter. Health professionals must be sensitive to these complex issues if they are to be successful.<span class="SmallerFont"><sup><a href="#ref3">3</a></sup></span>
                        <br/><br/>
                        <a href="http://nj.gov/njsncc/index.shtml" target="_blank" title="Go to NJSNCC">
                        <img src="view/image/home/njsncc.png" style="float:left; vertical-align:text-bottom; margin:0; margin-right:20px; height:100px;" title="NJSNCC" alt="NJSNCC"/></a>
                        The Office of Minority and Multicultural Health offers health professionals many cultural competency resources, including the <a href="http://nj.gov/health/ommh/documents/clas_standards.pdf">National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care</a>, known as "CLAS Standards."  There are 15 CLAS Standards, however the first one serves as the frame and essential goal of the other fourteen:  "Provide effective, equitable, understandable, respectful, and quality care and services that are responsive to diverse cultural health beliefs and practices, preferred language, health literacy, and other communication needs."<span class="SmallerFont"><sup><a href="#ref4">4</a></sup></span>
                        <br/><br/>
                        The <a href="http://nj.gov/njsncc/index.shtml" class="Bold" target="_blank">New Jersey Statewide Network for Cultural Competence</a> is a broad-based network to advance culturally competent practices in New Jersey.
                        </CONTENT>
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                <!--a name="immigrants"></a>
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                <TITLE>Newest New Jerseyans</TITLE>
                        <CONTENT>
                        <a href="http://nj.gov/health/chs/documents/newest_new_jerseyans.pdf" target="_blank" title="Go to Newest NJans page">
                        <img src="view/image/home/newestnewjerseyans.png" style="float:left; vertical-align:text-top; margin:0; margin-right:15px; height:175px;" title="Newest New Jerseyans" alt="Newest New Jerseyans"/></a>
                        Published in February, 2011, <b>
                        The Health of the Newest New Jerseyans</b> updates health care providers statewide
                        on the health status and behaviors of New Jersey's growing foreign-born population. The report 
                        includes important demographic information and geographic trends related to this population, 
                        compares select health outcomes and behaviors of state residents by race/ethnicity and 
                        nativity status, and examines the impact of duration of U.S. residence on foreign-born 
                        residents' health.<br/><br/><br/><br/><br/><br/><br/>
                </CONTENT>
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                <a name="data"></a>
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                <TITLE>Data addressing Health Disparities in New Jersey</TITLE>
                        <CONTENT><br/>
                        <h2>NJSHAD Community Dashboard</h2>
                                <a href="community/snapshot/Builder.html">Dashboards of health indicators</a> for Asians, Blacks, Hispanics, and Whites compared to statewide and national rates for:
                                <a href="community/snapshot/Builder.html" title="Go to community dashboard builder"><img src="view/image/home/snapshoticon.png" style="float:right; vertical-align:text-bottom; margin:0; margin-left:20px; margin-right:150px; height:100px;" title="Community Reports" alt="Community Dashboard icon"/></a>
                                <ul>
                                        <li>Birth and Infant Health</li>
                                        <li>Healthy New Jersey</li>
                                        <li>Leading Causes of Death</li>
                                </ul>
                                <br/>
                                
                        <!--a href="indicator/CatLHI.html" title="Go to LHI page">
                        <img src="view/image/home/LHI.png" style="float:right; vertical-align:text-top; margin:0; margin-top:-15px; margin-left:15px; height:90px;" title="Leading Health Indicators" alt="Leading Health Indicators"/></a>
                        <h2>Leading Health Indicators</h2>
                                As a group, the <a href="indicator/CatLHI.html">Leading Health Indicators</a> 
                                from Healthy New Jersey 2020 reflect the major health concerns in New Jersey for the decade 2011-2020.
                                <br/><br/-->
                                
                        <h2>NJSHAD Indicator Reports</h2>
                                Most or all of the <a href="indicator/Introduction.html">NJSHAD indicator reports</a>
                                in the following topic areas have one or more views by race/ethnicity:
                                <ul>
                                        <li>Behavioral Risk Factor Survey (BRFS)</li>
                                        <li>Birth and Infant Health</li>
                                        <li>Cancer</li>
                                        <li>Child and Adolescent Health</li>
                                        <li>Healthy New Jersey 2020</li>
                                        <li>Infectious and Communicable Diseases</li>
                                        <li>Injury and Violence</li>
                                        <li>Maternal and Child Health Epidemiology (MCH Epi)</li>
                                        <li>Mortality and Leading Causes of Death</li>
                                        <li>Nutrition, Physical Activity, and Obesity</li>
                                </ul>
                                <br/>
                                
                        <h2>NJSHAD Custom Data Queries</h2>
                                Datasets in the <a href="query/Introduction.html">NJSHAD query system</a> 
                                that have race and/or ethnicity among the variable choices are:
                                <ul>
                                        <li>Births</li>
                                        <li>Deaths</li>
                                        <li>Infant Deaths and Fetal Deaths</li>
                                        <li>Inpatient Hospital Discharges and Emergency Department Visits</li>
                                        <li>Behavioral Risk Factor Survey: includes data related to arthritis, asthma, 
                                                cardiovascular health, cancer screening, diabetes, diet and exercise, health care access and coverage, immunizations, overweight and obesity, substance use, and more</li>
                                        <li>Pregnancy Risk Assessment Monitoring System: includes data for before,              during, and after pregnancy, as well as infant health issues like breastfeeding and safe sleep</li>
                                        <li>STD Incidence</li>
                                </ul>
                                <br/>

                                <h2>Other Data Sources</h2>
                                More data related to race and ethnicity for these topics are available at their respective websites.
                                <ul>
                                        <li><a href="http://www.nj.gov/health/fhs/chronic/asthma/in-nj/" target="_blank">Asthma</a></li>
                                        <li><a href="http://www.state.nj.us/health/ces/cancer-researchers/surv-research/" target="_blank">Cancer</a></li>
                                        <li><a href="http://www.nj.gov/health/fhs/chronic/diabetes/" target="_blank">Diabetes</a></li>
                                        <li><a href="http://www.nj.gov/health/hivstdtb/hiv-aids/statmap.shtml" target="_blank">HIV/AIDS</a></li>
                                        <li><a href="http://www.nj.gov/health/fhs/maternalchild/outcomes/mortality-reviews/" target="_blank">Maternal Mortality</a></li>
                                        <li><a href="https://www.state.nj.us/humanservices/dmhas/publications/surveys/" target="_blank">Middle School Risk and Protective Factor Surveys</a></li>
                                        <li><a href="http://lwd.state.nj.us/labor/lpa/dmograph/est/est_index.html" target="_blank">Population Demographics</a></li>
                                        <li><a href="http://www.nj.gov/health/fhs/maternalchild/outcomes/prams/" target="_blank">Pregnancy Risk Assessment</a></li>
                                        <li><a href="http://www.nj.gov/health/hivstdtb/stds/stats.shtml" target="_blank">Sexually Transmitted Disease</a> (STD)</li>
                                        <li><a href="http://www.nj.gov/education/students/yrbs/" target="_blank">Student Health Survey of High School Students</a></li>
                                        <li><a href="http://www.nj.gov/health/fhs/tobacco/" target="_blank">Tobacco Control</a></li>
                                        <li><a href="http://www.nj.gov/health/hivstdtb/tb/" target="_blank">Tuberculosis</a> (TB)</li>
                                </ul>                   
                </CONTENT>
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                <a name="info"></a>
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                <TITLE>Information about Health Disparities in New Jersey</TITLE>
                        <CONTENT>
                        <ul>
                                <li>The <a href="http://www.state.nj.us/health/ommh/" class="Bold" target="_blank">Office of Minority and Multicultural Health</a> is leading the effort to reduce and eventually eliminate the gaps in health status between 
                                New Jersey's minority and multicultural communities and in the state as a whole.</li>
                                <br/>
                                <li>The <a href="http://www.state.nj.us/health/fhs/" class="Bold" target="_blank">Division of Family Health Services</a> administers programs addressing 
                                <a href="http://www.nj.gov/health/fhs/maternalchild/" class="Bold" target="_blank">maternal, infant, and child health</a>; <a href="http://www.state.nj.us/health/fhs/wic/" class="Bold" target="_blank">WIC</a>; and <a href="http://www.state.nj.us/health/fhs/sch/" class="Bold" target="_blank">Special Child Health and Early Intervention Services</a> (SCHEIS).
                                SCHEIS has information about <a href="http://www.nj.gov/health/fhs/nbs/bloodspot/" class="Bold" target="_blank">sickle cell disease</a> which disproportionately affects some minority groups.</li>
                                <br/>
                                <li>The <a href="http://www.state.nj.us/health/fhs/chw/" class="Bold" target="_blank">Office of Community Health and Wellness</a> includes the Office of Nutrition, Fitness, and Tobacco Control as well as <a href="http://www.nj.gov/health/fhs/chronic/" class="Bold" target="_blank">Chronic Disease Programs</a> for conditions such as asthma, diabetes, and stroke, which disproportionately affect some minority groups.</li>
                                <br/>
                                <li>The <a href="http://www.nj.gov/health/aids/" class="Bold" target="_blank">Division of HIV, STD, and TB Services</a> uses its resources to help 
                                community-based networks deliver high-quality, comprehensive services that meet the 
                                language and cultural needs of the people they serve.</li>
                                <br/>
                                <!--li><a href="http://www.state.nj.us/health/ommh/resources/" class="Bold" target="_blank">Cultural Competency</a>
                                among health professionals means respecting and adapting to different attitudes, expectations, beliefs and communication styles among diverse populations.</li-->

                                <li><a href="http://www.state.nj.us/health/ohs/" class="Bold" target="_blank">Occupational Health and Workplace Safety</a>
                                provides information on OSHA, Right to Know, workplace injuries, hazardous exposures, and more, as well as several documents in Spanish.</li>
                                <br/>
                                <li>The Department of Human Services' <a href="http://www.state.nj.us/humanservices/doas/home/nutrition.html" class="Bold" target="_blank">
                                Senior Nutrition Programs: Promising Practices  for Diverse Populations</a> is a directory of programs intended to bridge the cultural divide and offer assistance to seniors of all backgrounds, including those with limited English skills.</li>
                        </ul>   
                        </CONTENT>
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                                <br/>
                                <hr/>
                                <div class="SmallerFont">
                                        <a name="ref1"></a>1. US Department of Health and Human Services. The Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020. <a href="http://www.healthypeople.gov/sites/default/files/PhaseI_0.pdf">Phase I report: Recommendations for the framework and format of Healthy People 2020</a>. Section IV: Advisory Committee findings and recommendations. Page 28. 10/28/08
                                        <br/>
                                        <a name="ref2"></a>2. US Census Bureau, 2016 American Community Survey 1-Year Estimates, retrieved from <a href="https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml">American Fact Finder</a> on 4/12/18.
                                        <br/>
                                        <a name="ref3"></a>3. NJDOH Office of Minority and Multicultural Health, <a href="http://nj.gov/health/ommh/resources/">Cultural Competency Resources</a> webpage. 4/12/18.
                                        <br/>
                                        <a name="ref4"></a>4. NJDOH Office of Minority and Multicultural Health, <a href="http://nj.gov/health/ommh/documents/clas_policy_practice.pdf">Cultural Competence CLAS Policy and Practice</a> circular. 1/1/17.
                                        <br/>
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