Nearly 40 Years of Advancing Health Equity
The Report of the Secretary's Task Force on Black and Minority Health (commonly referred to as the Heckler Report) was released nearly 40 years ago and mobilized the U.S. Department of Health and Human Services' (HHS) efforts to eliminate health and health care disparities.
This timeline highlights key milestones and activities related to health equity since 1985.
Health Equity Timeline
The Secretary's Task Force releases its Report on Black and Minority Health, also known as the Heckler Report. It served to mobilize HHS efforts to eliminate health and health care disparities.
Office of Minority Health
Congress creates the Office of Minority Health (OMH) within HHS in response to the Heckler Report. OMH is dedicated to improving the health of racial and ethnic minority populations through the development of health policies and programs that will help eliminate disparities. The creation of OMH paved the way for agencies throughout HHS to establish their own Offices of Minority Health.
OMH Resource Center
HHS OMH launches its Resource Center, which provides minority health literature, research, and referrals for consumers, community organizations, and health professionals. The Resource Center offers a variety of evidence-based information resources, including access to online document collections, database and funding searches, and customized responses to requests for information.
CDC Office of Minority Health
The HHS Centers for Disease Control and Prevention (CDC) establishes the CDC Office of Minority Health, now the CDC Office of Health Equity, which exists to ensure health equity is embedded in an all-of-public health approach to overcoming persistent health disparities and health inequities across a range of population groups that disproportionately experience poor health outcomes.
Americans With Disabilities Act
Congress passes the Americans with Disabilities Act (ADA). The ADA is a wide-ranging civil rights law that prohibits, under certain circumstances, discrimination based on disability.
Healthy People 2000
HHS releases Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Healthy People 2000 was the second iteration of the Healthy People initiative, and it has been followed by Healthy People 2010, 2020, and 2030. The Healthy People initiatives detail a comprehensive, nationwide, 10-year health promotion and disease prevention agenda. One of three goals in Healthy People 2000 was the reduction of health disparities.
Healthy People 2010
HHS releases Healthy People 2010. One of its overarching goals was to eliminate health disparities rather than simply reduce them.
National CLAS Standards
HHS OMH releases the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care to improve health care quality and advance health equity.
Minority Health and Health Disparities Research and Education Act
Congress passes the Minority Health and Health Disparities Research and Education Act. This Act supports biomedical and behavioral research on minority health and health disparities, medical training for minorities and others, and the study and collection of data regarding minorities and other populations.
Executive Order 13166
President Clinton issues Executive Order 13166, titled Improving Access to Services for Persons with Limited English Proficiency, regarding improving access to services (provided by Federal agencies or their grantees) for individuals with limited English proficiency (LEP). The Executive Order requires Federal agencies to examine the services they provide, identify any need for services to those with LEP, and develop and implement a system to provide those services so those with LEP can have meaningful access to them.
National Center on Minority Health and Health Disparities
The Minority Health and Health Disparities Research and Education Act establishes the National Center on Minority Health and Health Disparities (NCMHD) at the National Institutes of Health (NIH). Now an Institute, the National Institute on Minority Health and Health Disparities’ mission is to lead scientific research to improve minority health and reduce health disparities.
LEP Guidance from the HHS Office for Civil Rights
The HHS Office for Civil Rights (OCR) issues Guidance to Federal Financial Assistance Recipients Regarding Title VI and the Prohibition Against National Origin Discrimination Affecting Limited English Proficient (LEP) Persons to ensure individuals with LEP have meaningful access to HHS funded programs. Title VI of the Civil Rights Act of 1964 requires recipients of Federal financial assistance to take reasonable steps to make their programs, services, and activities accessible by eligible persons with LEP.
Eliminating Health Disparities in the United States
The HHS Health Resources and Services Administration (HRSA) publishes the report Eliminating Health Disparities in the United States, which outlines HRSA’s strategies for eliminating the unequal burden of disease experienced by many populations.
First National Healthcare Disparities Report
The HHS Agency for Healthcare Research and Quality (AHRQ) releases the first annual National Healthcare Disparities Report. This annual report, now part of the National Healthcare Quality and Disparities Report, measures trends in effectiveness of care, patient safety, timeliness of care, patient centeredness, and efficiency of care.
The Institute of Medicine publishes Unequal Treatment, which found that a large and consistent body of research underscores the existence of disparities and offered recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, cross-cultural education, and other arenas.
Second LEP Guidance from the HHS Office for Civil Rights
To assist Federal agencies in carrying out Executive Order 13166, HHS OCR issues revised Guidance to Federal Financial Assistance Recipients Regarding Title VI and the Prohibition Against National Origin Discrimination Affecting Limited English Proficient (LEP) Persons. It set forth the compliance standards that recipients of Federal financial assistance must follow to ensure that their programs and activities normally provided in English are accessible to persons with LEP and thus do not discriminate on the basis of national origin in violation of Title VI's prohibition against national origin discrimination.
Think Cultural Health
HHS OMH launches Think Cultural Health, a website featuring information, continuing education opportunities, resources, and more for health and health care professionals to learn about culturally and linguistically appropriate services, or CLAS. Think Cultural Health is dedicated to advancing health equity at every point of contact and promoting culturally and linguistically appropriate services.
In the Nation's Compelling Interest
The Institute of Medicine publishes In the Nation's Compelling Interest, which considers the benefits of greater racial and ethnic diversity, and identifies institutional and policy-level mechanisms to garner broad support among health professions leaders, community members, and other key stakeholders to implement these strategies.
Setting the Agenda for Research on Cultural Competence in Health Care
HHS OMH and AHRQ collaboratively released Setting the Agenda for Research on Cultural Competence in Health Care. Research topics examined included language assistance interventions; cultural competence education and training; and racial, ethnic, and linguistic concordance.
National Leadership Summit for Eliminating Racial and Ethnic Disparities
HHS OMH convenes 2,000 experts and stakeholders at the National Leadership Summit for Eliminating Racial and Ethnic Disparities.
National Partnership for Action to End Health Disparities
HHS OMH leads the creation of the National Partnership for Action to End Health Disparities to mobilize a nationwide, comprehensive, community-driven, and sustained approach to combating health disparities and to move the nation toward achieving health equity.
Medicare Improvements for Patients and Providers Act of 2008
Congress passes the Medicare Improvements for Patients and Providers Act of 2008. MIPPA requires that the Office of Inspector General conduct a study examining Medicare provider and plan compliance with OCR's LEP Guidance.
Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement
The Institute of Medicine releases the report Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement, which underscores the importance of REAL data collection to identify, examine, and ultimately address health disparities.
The Affordable Care Act
The Patient Protection and Affordable Care Act of 2010 passes. It reauthorizes OMH, establishes Offices of Minority Health within six HHS agencies, and re-designates the NIH National Center on Minority Health and Health Disparities as the National Institute on Minority Health and Health Disparities.
Section 1557 of the Affordable Care Act extends Federal civil rights laws prohibiting discrimination on the basis of race, color, national origin, gender, disability or age to any health program or activity receiving Federal funds; any program or activity administered by an executive agency; or any entity established under Title I of the Act.
Healthy People 2020
HHS releases Healthy People 2020 with an expanded health disparities goal to achieve health equity, eliminate disparities, and improve the health of all groups.
Strategic Plans to Reduce Health Disparities
HHS OMH leads two complementary strategic plans to reduce health disparities: the HHS Action Plan to Reduce Racial and Ethnic Health Disparities and the National Stakeholder Strategy for Achieving Health Equity, the most comprehensive Federal commitments to date for eliminating disparities in health and health care. The HHS Action Plan provided a framework for departmental agencies and offices to streamline and institutionalize programmatic and policy efforts, as well as promote integrated approaches and evidence-based programs, so that all Americans have the chance to live the healthiest lives possible. The National Stakeholder Strategy provided a common set of goals and objectives for public and private sector initiatives and partnerships to help racial and ethnic minorities – and other underserved groups – reach their full health potential.
CDC Health Disparities and Inequalities Report
The HHS CDC releases the first periodic CDC Health Disparities and Inequalities Report – United States, 2011. The report highlighted health disparities by sex, race, and ethnicity, income, education, disability status, and other social characteristics in the U.S. The report also provided analysis and reporting of the recent trends and ongoing variations in health disparities and inequalities in selected social and health indicators.
Executive Order 13166
The Attorney General announces the Federal Government's renewed commitment to language access obligations under Executive Order 13166, Improving Access to Services for Persons with Limited English Proficiency.
Implementation Guidance on Data Collection Standards
HHS issues Implementation Guidance on Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability Status. The guidance presents a set of uniform data collection standards for inclusion in surveys conducted or sponsored by HHS as required by Section 4302 of the Affordable Care Act. The guidance aims to improve the ability of the public health and healthcare systems to identify and track disparities in health and health care, understand their correlates and consequences, and facilitate greater accountability for reducing them.
National CLAS Standards
HHS OMH releases the enhanced National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care. The Standards establish a blueprint for health and health care organizations to implement and provide culturally and linguistically appropriate services. The Standards are intended to advance health equity, improve quality, and help eliminate health disparities.
HHS Language Access Plan
The HHS Language Access Plan defines HHS’ language access policy across ten elements, identifying specific steps HHS agencies should take to provide meaningful access to individuals with limited English proficiency (LEP) to HHS-conducted programs and activities, in accordance with Executive Order 13166.
Nondiscrimination in Health Programs and Activities
This final rule implements Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs and activities. The final rule clarifies and codifies existing nondiscrimination requirements and sets forth new standards to implement Section 1557. HHS OCR also issues a summary of the final rule.
HRSA Health Equity Report
The HHS Health Resources and Services Administration (HRSA) publishes a Health Equity Report that presents a comprehensive analysis of HRSA’s program efforts in reducing health disparities and promoting health equity.
Scientific Achievement Plan
The National Institute on Minority Health and Health Disparities (NIHMD) established the Scientific Advancement Plan to improve health equity by advancing the science of minority health and health disparities.
Healthy People 2030
HHS releases Healthy People 2030 with an increased focus on health equity, social determinants of health, and health literacy.
Minority Health Social Vulnerability Index
OMH and the CDC launch the Minority Health Social Vulnerability Index (SVI) to enhance existing resources to support the identification of racial and ethnic minority communities at greatest risk for disproportionate impact and adverse outcomes due to the COVID-19 pandemic.
Executive Order 13985
Executive Order 13985, titled Advancing Racial Equity and Support for Underserved Communities Through the Federal Government, directs the federal government to revise agency policies to account for racial inequities in their implementation.
Presidential COVID-19 Health Equity Task Force
Executive Order 13995, titled Ensuring an Equitable Pandemic Response and Recovery, establishes the Presidential COVID-19 Health Equity Task Force, whose mission is to provide specific recommendations to the President of the United States for mitigating inequities caused or exacerbated by the COVID-19 pandemic and for preventing such inequities in the future.
HHS Health Equity Action Plan
In response to Executive Order 13985, HHS publishes the HHS Equity Action Plan, which describes actions HHS can take to advance health equity and institutionalize a focus on health equity, highlighting five key HHS activities as examples.
CMS Framework for Health Equity
The HHS Centers for Medicare & Medicaid Services publish the Framework for Health Equity 2022-2032. The framework aims to further advance health equity, expand coverage, and improve health outcomes for the more than 170 million individuals supported by CMS programs. It sets the foundation and priorities for CMS’s work strengthening its infrastructure for assessment, creating synergies across the health care system to drive structural change, and identifying and working to eliminate barriers to CMS-supported benefits, services, and coverage.
Executive Order 13166
The Attorney General announces the Federal Government’s renewed commitment to language access obligations under Executive Order 13166, Improving Access to Services for Persons with Limited English Proficiency.
Executive Order 14091
Executive Order 14091, titled Further Advancing Racial Equity and Support for Underserved Communities Through the Federal Government, builds upon previous equity-related Executive Orders by extending and strengthening equity-advancing requirements for agencies, and positions agencies to deliver better outcomes for the American people.