Dennis P. Andrulis

• Ph.D., MPH
• University of Texas at Austin

With support from The California Endowment and W.K. Kellogg Foundation, Texas Health Institute developed and administered the Marketplace Health Equity Assessment Tool (M-HEAT) to measure California’s progress toward advancing health equity in its marketplace. Health equity is defined as the attainment of the highest level of health for all people....

With support from the Connecticut Health Foundation and W.K. Kellogg Foundation, Texas Health Institute developed and administered the Marketplace Health Equity Assessment Tool (M-HEAT) to measure Connecticut’s progress toward advancing health equity in its marketplace. Health equity is defined as the attainment of the highest level of health for a...

With support from Sierra Health Foundation, Texas Health Institute in collaboration with La Familia Counseling Center and other community partners developed and administered a survey to identify perceptions and experiences of health care access barriers among South Sacramento’s newly insured and uninsured. Administered in four languages across seve...

The purpose of this Policy Brief is to take stock of the ACA’s progress in advancing health equity—that is, the opportunity for all to achieve optimal health. This brief examines the promise, impact, and forward-looking opportunities of the ACA in advancing health equity. It builds on an extensive body of work that Texas Health Institute researcher...

In some states, like California, a critical backbone to systems transformation is the Section 1115 Medicaid Waiver’s Delivery System Reform Incentive Payment (DSRIP) program. This brief documents DSRIP and related experiences in Massachusetts, Texas, New York, Oregon, Vermont, and Colorado.

A growing body of evidence suggests that low-income, racially, and ethnically diverse populations are especially susceptible to the adverse effects of climate change, often facing greater morbidity and mortality than the general population. Our 2012 climate change report suggests that many vulnerable communities are at risk of facing the “perfect s...

The Affordable Care Act (ACA) requires that each state’s navigator program for its health insurance marketplace consider culture and language in outreach and enrollment. Despite this intent, data suggest that a majority of eligible non-white and limited English proficient individuals are not enrolling for reasons including lack of awareness, lack o...

Given nearly half of those eligible for coverage through health insurance marketplaces will be individuals of diverse racial/ethnic heritage, monitoring how marketplaces work to educate, reach, and enroll these populations is critical to assuring success. Early enrollment data suggest that states are already facing significant challenges. For examp...

The report focuses on one of the services central to the success of state marketplaces—navigator and in-person assister programs to educate and enroll racially, ethnically, and linguistically diverse populations. Based on a review of peer-reviewed publications, federal regulations, state-based reports on enrollment, and key informant interviews, th...

Since the enactment of the Affordable Care Act, the Texas Health Institute has been monitoring the implementation progress of over 60 provisions intended to advance health equity across five priorities: health insurance exchanges; health care safety net; workforce support and diversity; research, data, and quality; and public health and prevention....

Background: A growing body of evidence suggests that low income, minorities and other populations are especially susceptible to the adverse effects of climate change events. However, research has not focused specifically on related threats and state or local response to them. This report for the first time establishes a multi-state baseline invento...

This report provides a synthesis of research documenting racial and ethnic disparities in morbidity and mortality associated with the 2009-2010 H1N1 pandemic, exploring their underlying root reasons and providing a path forward for integrating diversity and equity into pandemic planning and response.

The study represents a unique effort, which for the first time, brings together many levels of information on health, climate and socio-cultural factors drawing on research, data analysis, Geographic Information Systems (GIS) mapping, policy review and one-on-one interviews with state and local government leaders, academicians, and community-based...

The 2009 H1N1 Pandemic reaffirmed the disproportionate burden of morbidity and mortality faced by racially and ethnically diverse populations in emergency events. The rate of H1N1 related deaths was four times higher among American Indians/Alaska Natives than all other groups. African Americans and Latinos were also more likely to die or be hospita...

As the population of the United States grows more culturally diverse, so does the significance of achieving equity in health care. The Affordable Care Act (ACA) of 2010, offers for the first time in almost 50 years, an unprecedented opportunity to advance this objective. As identified in our July 2010 report, Patient Protection and Affordable Care...

The Affordable Care Act of 2010 creates both opportunities and risks for safety-net providers in caring for low-income, diverse patients. New funding for health centers; support for coordinated, patient-centered care; and expansion of the primary care workforce are some of the opportunities that potentially strengthen the safety net. However, decli...

Racially/ethnically diverse communities suffer a disproportionate burden of adverse outcomes before, during and after a disaster. Using California as a locus of study, we sought to identify challenges and barriers to meeting the preparedness needs of these communities and highlight promising strategies, gaps in programs, and future priorities. We c...

the populations of almost all megacities and their trajectory of historical and projected growth have required expansion beyond what were original city limits—a growth that has led to considerable urban sprawl. Although this adaptation has included incorporating nearby areas into the city, in many locations it has also led to major if not explosive...

Hurricane Katrina, and the more recent H1N1 Influenza Pandemic, awakened the nation to the deep-rooted patterns of socioeconomic and racial/ethnic disparities that exist in preparing for and responding to communities. A growing body of literature cites that a myriad of factors outside the public health system, and within the broader social, politic...

Time and time again, racial/ethnic minorities are disproportionately affected by public health emergencies. While Hurricane Katrina prompted attention to this issue, pervasive disparities in mitigation, preparedness, response and recovery remain. This was evident, yet again, following the 2009 H1N1 Pandemic as racial/ethnic minorities were more lik...

Health care reform bills passed by both the House and Senate demonstrate a commitment from legislators to reduce racial/ethnic disparities in health and health care through federal policies. In addition to broad health insurance market reforms which have been the focal point of the health care debate, both bills contain a number of less publicized...

Extensive evidence has documented a legacy of neglect in meeting the needs of culturally diverse communities during public health emergencies. Historic fragmentation among public/private sector agencies has contributed to these disparities by thwarting consensus on addressing needs and on working collaboratively with diverse communities through eff...

The study compared the nation as a whole and fourteen regions selected for participation in the RWJF Aligning Forces for Quality initiative (Cincinnati, Cleveland, Detroit, Humboldt County, Kansas City, Maine, Memphis, Minnesota, Seattle, Willamette Valley, Western Michigan, Western New York, Wisconsin, and York County, PA). We compiled regional st...

As the population of the United States continues to grow more racially and ethnically diverse, so too, does the significance of achieving equity in health and health care. Leading health reform bills in the 111th Congress have offered for the first time in almost 50 years, an unprecedented opportunity to achieve greater access to affordable and hig...

Introduction The experiences of racially/ethnically diverse residents and communities in the US in the wake of the wildfires in California, Hurricane Katrina, and other disasters have shown the serious if not fatal lack of their effective engagement in response to these events, confusion around access to and provision of emergency care, and failure...

Emergency Preparedness and Diversity Initiatives of the Center for Health Equality (CHE) at the Drexel University School of Public Health CURRENT PROJECTS National Consensus Panel on Emergency Preparedness and Cultural Diversity. With support from the HHS Office of Minority Health, CHE developed a national panel of experts to provide guidanc...

Each year, the Society for Academic Emergency Medicine, the American College of Emergency Physicians, and the American Board of Emergency Medicine co-sponsor an educational session at the Association of American Medical Colleges Annual Meeting. The 1997 session was entitled “Emergency Department Initiatives to Improve the Public Health,” and includ...

Dennis Andrulis, Professor at Drexel University, will provide an overview of the declining status of public hospitals in the largest urban areas in the United States. The specifics of this presentation will include the trends in public hospitals and other hospitals in the 100 largest cities and suburbs - in the context of the changing safety net ro...

The tragedy of Hurricane Katrina in New Orleans confirmed that effective implementation of public health preparedness programs and policies will require compliance from all racial and ethnic populations. This study reviews current resources and limitations and suggests future directions for integrating diverse communities into related strategies. I...

To understand the interrelationship of literacy, culture, and language and the importance of addressing their intersection. Health literacy, cultural competence, and linguistic competence strategies to quality improvement were analyzed. Strategies to improve health literacy for low-literate individuals are distinct from strategies for culturally di...

An analysis of trends in hospital use and capacity by ownership status and community poverty levels for large urban and suburban areas was undertaken to examine changes that may have important implications for the future of the hospital safety net in large metropolitan areas. Using data on general acute care hospitals located in the 100 largest cit...

For decades, health care in the urban United States has been a study in contrasts. Hospitals in many U.S. cities are renowned for providing the best quality of care in the world. The term centers of excellence has come to represent mostly urbanbased academic medical centers and other facilities that have developed a reputation for providing emergen...

During the 1990s, increasing attention was focused on longstanding racial and ethnic disparities in health and health care. New research and experiences from the front lines documented the extent of these differences, their costs to individuals and society, and the role the health care system plays in perpetuating them. As evidence continued to mou...

We examined the progress of the nation's 100 largest cities and their surrounding suburban areas toward achieving Healthy People 2000/2010 goals for two measures of infant health: low birth weight (LBW) and infant mortality (IM). Using data from the National Center for Health Statistics, we compared 1990 and 2000 urban and suburban LBW and IM rates...

The heightened awareness of substantial racial and ethnic disparities in health outcomes has major implications for how healthcare providers effectively manage health conditions among diverse populations. This report identifies five dimensions that address the major causes of disparities that can exert significant influence over the success and qua...

This report profiles the 2000 status of and changes (since 1990) in rates of health and health-related measures for racially and culturally diverse populations living in the 100 largest U.S. cities and their suburbs. Data came from the U.S. Census Bureau and Centers for Disease Control and Prevention to identify patterns in race/ethnicity, foreign...

Urban communities continue to face formidable historic challenges to improving public health. However, reinvestment initiatives, changing demographics, and growth in urban areas are creating changes that offer new opportunities for improving health while requiring that health systems be adapted to residents' health needs. This commentary suggests t...

Without Abstract

Many health care professionals have sustained an almost single-minded conviction that disparities in access to health care across socioeconomic groups are the key reason for the major discrepancies in health status between wealthy persons and poor persons. Others, however, have argued that a host of factors work to create major impediments and that...

Judging from the social and health measures considered in this article, Newark and Jersey City face similar challenges as other large cities. For Newark, the challenges are more extreme. The high rates of poverty and violence, coupled with a low rate of high school graduation and a large number of single parent households bode ill for the city. The...

The crisis facing the health care system in Los Angeles County has threatened to engulf a critical part of the city's and the area's essential services—trauma care provided at the Los Angeles County+University of Southern California (LAC+USC) Medical Center. Though averted at this time, it should serve as a clarion call to communities across the co...

To compare utilization and financing of inpatient care for persons with the acquired immunodeficiency syndrome (AIDS) (as defined by the Centers for Disease Control) and those with "other HIV [human immunodeficiency virus]-related illness." A mailed survey of the members of five national organizations representing public, teaching, children's, comm...

To evaluate factors influencing emergency physician staffing patterns in an important subset of US hospitals. Survey of emergency department directors and hospital administrators. Member institutions of the National Association of Public Hospitals and the Council of Teaching Hospitals. Of 498 hospitals enrolled, two mailings and telephone follow-up...

To assess the extent and distribution of hospital and emergency department crowding nationally. The research design consisted of a mailed questionnaire disseminated in the fall of 1988 to the member institutions of the National Association of Public Hospitals (NAPH) and the Council of Teaching Hospitals (COTH). Study participants included hospital...

From the early days of its recognized occurrence, AIDS has been per­ ceived as posing tremendous threats, burdens and challenges to human beings. Individuals, societies and, in a global point of view, mankind are affected by the effects of the HN infection, the nature and extent of which is still unclear in many ways. In the beginning only biomedic...

In 1987, the National Public Health and Hospital Institute conducted a national survey of 623 acute-care hospitals to obtain information relating to inpatient and outpatient care for persons with acquired immunodeficiency syndrome (AIDS). Two hundred seventy-six hospitals reported treating persons with AIDS; the average length of stay was 16.8 days...

The National Association of Public Hospitals and the Association of American Medical Colleges' Council of Teaching Hospitals conducted a detailed survey on hospital care to patients with acquired immunodeficiency syndrome (AIDS) in major US public and private teaching institutions in 1985. The 169 hospitals treating patients with AIDS that responde...

The National Association of Public Hospitals and the Association of American Medical Colleges' Council of Teaching Hospitals conducted a detailed survey on hospital care to patients with acquired immunodeficiency syndrome (AIDS) in major US public and private teaching institutions in 1985. The 169 hospitals treating patients with AIDS that responde...

The public sector has paid a major portion of the hospital bill for acquired immunodeficiency syndrome (AIDS) patients. According to our national estimates of AIDS inpatient hospital costs, private insurance covered approximately 17 percent of the $ 380 million bill for 1985, with public funds paying most of the remainder. Medicaid, by far, represe...

The present study examined the attitudes and perspectives of Division 27 (Community Psychology) members toward training roles and issues. Surveys sent to Division members focused upon: (a) background and demographic data; (b) past and present academic and employment characteristics; (c) relevance of community psychology to present employment; (d) c...

The federal government already is involved deeply in medical care in this country, and is becoming more and more involved in the development, assessment, diffusion, regulation, and use of medical technologies. More regulation is inevitable because the problems are not going to disappear and because the government has limited alternatives to deal wi...

Acknowledgments We acknowledge,and thank the Robert Wood Johnson Foundation and our program officer, Laura Leviton, for support of this report and the Social and Health Landscape of Urban and Suburban Americaproject. Wealso thank Angela Romano