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The Heckler Report: Reflecting on its beginnings and 30 years of progress

By Louis W. Sullivan, MD


I recently had the opportunity to participate in DHHS’ celebration recognizing the 30th anniversary of the release of what’s now referred to as “The Heckler Report.” The report was developed thanks to Secretary Margaret Heckler who recognized the “sad and significant fact… [that] there was a continuing disparity in the burden of death and illness experienced by Blacks and other minority Americans as compared with our nation’s population as a whole.” Secretary Heckler created the national platform that made the issue of minority health disparities a national issue – but I’d like to share a little of the history that led her to create the “Heckler Report” which has shaped minority health policy for the last 30 years.

Health Equity Summit on Capitol Hill, April 27, 2015Health Equity Summit(left to right): Dr. Satcher, Dr. Sullivan, Dr. Gracia, Dr. Pinn, Mr. Stokes

Walter Bowie (Dean, Tuskegee), Ralph Cazort, MD (Dean, Meharry Medical School), Anthony Rachal (Vice President, Xavier University) and I (Morehouse School of Medicine) founded the Association of Minority Health Professions Schools (AMHPS) in 1977. These four individuals came together with the purpose of working together to develop and promote programs that were (and remain) important to improving minority health status.

We were soon joined by the other health professions schools from the HBCUs (Drew, Florida A&M, Hampton, Howard, and Texas Southern). AMHPS now included colleges of medicine, dentistry, pharmacy and veterinary medicine. The common thread that bound us was our interest in creating more African-American health professionals in these fields. We soon added Latino, Hispanic American and Native American programs to our priorities.

“there was a continuing disparity in the burden of death and illness experienced by Blacks and other minority Americans as compared with our nation’s population as a whole.”

Secretary Margaret Heckler

In the early 1980s, we commissioned a study that was led by Dr. Ruth Hanft. The study entitled “Blacks and the Health Professions in the 1980s: A National Crisis and A Time for Action” was a concise report that clearly showed the shortage of minorities in the key medical professions. The health status of Blacks was worse than Whites and we needed greater support in order for that to change. We wanted to make this issue a national priority.

In March 1983, Al Haynes (Charles Drew), David Satcher (Meharry), Walter Bowie (Tuskegee) and I met with Secretary Heckler to inform her about the AMHPS study’s key findings. She was very positive and agreed to review the study closely and get back to us soon. As we left the meeting, we had mixed feelings because although we were well received, we weren’t sure if she really meant it.

But a month later, she let us know that she was setting up a Secretarial Taskforce lead by Dr. Thomas Malone, Deputy Director of the National Institutes of Health, and Dr. Katrina Johnson. Dr. Robert Graham (first administrator of HRSA) was a prominent member of the Taskforce. We were heartened by this development. And two years later in August 1985, Secretary Heckler released the “Report of the Secretary’s Taskforce on Black & Minority Health” that both affirmed our report and extended far beyond it.

Based on the report’s recommendations, DHHS’ Office of Minority Health was created by Secretary Heckler within a year and Dr. Herbert W. Nickens was appointed as the office’s first director. Creating OMH got a lot of attention and helped to set the tone. It began a cascade of Federal-level activities that focused the nation on minority health.

The Heckler ReportIn 1990, during my tenure as U.S. Secretary of Health and Human Services, I created the Office of Minority Health at NIH which first evolved into the Center for Minority Health and Health Disparities, then in 2010 with Congressional legislation, became the National Institute on Minority Health and Health Disparities (NIMHD).

And there are many other examples of the growing prominence of minority health, including the two seminal reports published by the Sullivan Commission and the Institute of Medicine (IOM) in 2004. We can’t ignore the disparities that still exist – such as the low percent of African American scientists who have received NIH research grants – but much has improved.

The Heckler Report was a significant historic touch point for the nation. That’s why it’s so appropriate that DHHS is celebrating its 30th anniversary. Whenever I see Margaret, she always reminds me that the AMHPS report and our meeting focused her on the issue of health equity. It’s good to be a part of the history that made this issue a national priority. With today’s U.S. demographics, these long-standing and recalcitrant disparities have become everyone’s issue, and not just a minority issue.

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