AJPH -- eLetters for Mitchell and Lassiter, 96 (12) 2093-2097

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COMMENTARY:
Dennis A. Mitchell and Shana L. Lassiter
Addressing Health Care Disparities and Increasing Workforce Diversity: The Next Step for the Dental, Medical, and Public Health Professions
Am J Public Health 2006; 96: 2093-2097 [Abstract] [Full text] [PDF]

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Funding Crisis for Title VII Diversity Programs: Alvin H Strelnick, MD, Paula N. O'Neill, MEd, EdD (12 March 2007)

Funding Crisis for Title VII Diversity Programs 12 March 2007

Alvin H Strelnick, MD,
Professor, Family & Social Medicine
Montefiore Medical Center/Albert Einstein College of Medicine,
Paula N. O'Neill, MEd, EdD
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Re: Funding Crisis for Title VII Diversity Programs

hstrelni{at}montefiore.org Alvin H Strelnick, MD, et al.

While we largely agree with the authors of your December 2006 Commentary, “Addressing Health Care Disparities and Increasing Workforce Diversity,” they failed to highlight the crisis of the impending elimination of major federal programs for enhancing diversity and filling the “pipeline” for minority health professionals authorized by Title VII of the Public Health Service Act--Health Careers Opportunity Programs (HCOPs) and minority Centers of Excellence (COEs).
For 30 years, HCOPs have succeeded at K-12, community and 4-year college, post-baccalaureate, and health professional school levels in recruiting minority and disadvantaged students, enhancing their academic skills, and supporting their preparation, entry, and graduation from schools of dentistry, medicine, pharmacy, public and allied health. Since 1987, COEs, based at schools of dentistry, medicine, and pharmacy, have conducted similar enrichment activities and assisted them in developing competitive applicant pools. COEs recruit and retain minority faculty, design and implement cultural competency and health disparities curricula, conduct research in minority health, and provide community-based clinical training for students among other programs.
Since their inception, some 459,036 underrepresented minority and disadvantaged students have participated in these two programs, 38% at K- 12 levels, 37% in colleges, 22% in health professional schools, and 3% at other levels. (1) Recent reviews of the literature have demonstrated their effectiveness. (2-4) A controlled study on post-baccalaureate pre-medical programs in California showed impressive results.(5)
Despite their history and demonstrated effectiveness, the President’s budget proposal for the last several years, including his February 2007 proposal for Fiscal Year 2008, eliminated all federal funding for COEs and HCOPs. Until 2005 Congress supported 34 COEs that received about $33.6 million and 74 HCOPs that received $35.6 million annually, but funding for both programs were cut dramatically for FY2006, 65% and 89%, respectively. In February 2007 Congress passed and the President signed a Joint Funding Resolution that funded both programs at their FY2006 levels, i.e., $11.9 million for 4 COEs and $4 million for 4 HCOPs. A 2006 survey of all COEs and HCOPs found that 83% would close without federal funding. (1) For Dental Centers of Excellence that means losing those at the University of Puerto Rico and University of Texas Dental Branch at Houston and San Antonio; only Meharry would survive.
Federal funding has been effective in making the institutional changes at academic health centers advocated by the authors. Unless the funding for COEs and HCOPs is restored, our workforce will become less diverse as our population becomes more so.
References:
1. Association of American Medical Colleges. Cuts to Title VII jeopardize progress in addressing health disparities among minority, underserved, and rural populations. Washington, DC: 2006. http://www.aamc.org/advocacy/lbirary/laborhhs./chopcoesurvey.pdf (Accessed March 7, 2007.)
2. Genshan S. Policy issues in dental work force diversity and community-based dental education: A report to the California Endowment, November 2004. http://www.calendow.org/reference/publications/pdf/workforce/TCE0101- 2005_Policy_Issues_.pdf (Accessed March 7, 2007)
3. Grumbach K, Munoz C, Coffman J, Rosenoff E, Gandara P, Sepulveda E. Strategies for improving diversity in the health professions. Center for California Health Workforce Studies, University of California, San Francisco. August 2005. http://www.calendow.org/reference/publications/pdf/workforce/TCE0802- 2003_Strategies_For_.pdf (Accessed March 7, 2007)
4. Saha S, Shipman SA. The rationale for diversity in the health professions. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, October 2006. http://bhpr.hrsa.gov/healthworkforce/reports/diversity/default.htm (Accessed March 7, 2007)
5. Grumbach K, Chen E. Effectiveness of University of California post-baccalaureate premedical programs in increasing medical school matriculation for minority and disadvantaged students. JAMA 2006;296:1079 -1085.