State budget eliminates NC’s Office of Health Equity

By Rachel Crumpler

More than 30 years after North Carolina became one of the first states to establish an Office of Minority Health and Health Disparities, state lawmakers have eliminated the standalone office dedicated to reducing gaps in health outcomes.

A provision on page 250 of the state’s new 600-plus page budget bill, signed into law July 7 by Gov. Josh Stein, eliminates the office, also known as the Office of Health Equity. Now all of the office’s “authority, functions, powers, and duties” will be transferred to the N.C. Department of Health and Human Services’ Division of Public Health.

Former directors of the office and health equity researchers say dismantling the standalone office could weaken North Carolina’s efforts to reduce persistent health disparities. The change comes as Republican lawmakers in North Carolina — and across the country — have increasingly sought to end diversity, equity and inclusion initiatives. 

Barbara Pullen-Smith, the office’s inaugural director, told NC Health News the office’s work is just as important as when it was first created.

“I don’t see how there will be this dedicated focus on the differences and the disparities,” she said. “That’s what’s going to be lost, and that’s a shame. To me, that’s just going backwards.”

Documenting disparities in health outcomes

The office was created in response to growing recognition of how health outcomes differed among populations. A landmark 1985 federal report was the first to examine and document health gaps between white and minority populations, leading to the creation of an Office of Minority Health within the U.S. Department of Health and Human Services in 1986.  

North Carolina soon followed with its own analysis. In 1987, the State Center for Health Statistics published a report documenting wide disparities in illness and death experienced by minority populations. In response, a state work group convened and recommended creating an Office of Minority Health to coordinate statewide efforts to help address gaps in health outcomes.

In 1992, the North Carolina General Assembly allocated $190,000 to establish the Office of Minority Health and a 15-member Minority Health Advisory Council.

“[The Office] was created to lead the charge to address those significant differences between racial and ethnic minorities and the majority population,” Pullen-Smith, who led the office for 19 years, said. “It was all based on data, and data has always been our friend.”

“We never excluded any population. We just focused on those areas based on the data where populations were having the greatest negative impact.”

Though the office initially focused on racial and ethnic disparities, it broadened its work to also address health disparities tied to geography, disability status, socioeconomic status and other factors.

Over the past three decades, the office has engaged faith-based organizations, local nonprofits, county health departments, tribes and others to reduce barriers to health care access and improve health outcomes in communities across the state. 

The office’s vision reads: “All North Carolinians can achieve a higher level of health and a shared well-being, regardless of race, ethnicity, disability, sexuality, gender identity, socioeconomic status or other differences.”

The office’s staff of 10 will not lose their jobs, but will transition to the Division of Public Health, according to DHHS spokesperson Hannah Jones.

Jones said in a statement that while it is “disheartening to see the change in organizational structure,” the department is working to implement the legislation in a timely manner.  

“Everyone in North Carolina deserves access to affordable and appropriate care, and the work of OMHHD helps close gaps and improve health outcomes across all communities,” Jones said.

Data, community-driven

Pullen-Smith built the office from the ground up around two key principles: use data to identify differences in health outcomes and then partner with community stakeholders to address them.

When she became director, the State Center for Health Statistics only broke data into “white” or “minority,” which Pullen-Smith called “unacceptable.” 

Improving how the state collected and reported race and ethnicity data became one of her first priorities. As a result, categories expanded to include African American/Black, Hispanic/Latino, American Indian and Asian/Pacific Islander. 

“It just was one of the most important first steps,” Pullen-Smith said. “I wanted to make sure that each population could see themselves in the data.”

Those data improvements also laid the groundwork for North Carolina’s first health disparities report card in 2003, a report that has been periodically updated, most recently in 2024.

Pullen-Smith said the reports help gauge progress and strategize how best to intervene to reduce differences in health outcomes among different groups of people.

Better data was only part of the approach. The office also focused on partnering with community stakeholders and removing barriers they identified.

For example, as North Carolina’s Spanish-speaking population grew in the 1990s, the office established a language access line that allowed health departments without bilingual staff to connect with an interpreter in real time, because the language difference presented a significant barrier to care.

Cornell Wright, who led the Office of Minority Health and Health Disparities for seven years from 2015 to 2022, said building trust through community partnerships remained a key component of the office’s work. The legacy of government-sponsored experiments like the 40-year Tuskegee Syphilis Study, where Black men were left untreated for the infection even as researchers knew how to cure them, has left many in minority communities less trusting of medical professionals. 

“The biggest thing about that office is that it really dove into community and helped in so many different ways through its programming, through its policies, through its subject-matter expertise in making sure that the people were seen, heard and valued — and also given a chance to not just survive, but thrive,” Wright said.

Wright pointed to the North Carolina Minority Diabetes Prevention Program he helped create in 2017, which is in operation today. The program provides screenings and yearlong lifestyle coaching to communities disproportionately affected by prediabetes. An estimated 2.7 million North Carolinians have prediabetes, one-third of them from racial and ethnic minority groups, according to DHHS data. 

The office’s community relationships especially paid off during the COVID-19 pandemic, Wright said.

While state health officials worked to rapidly distribute vaccines, the Office of Minority Health and Health Disparities focused on addressing often-overlooked barriers to care — including transportation, work schedules and distrust of the medical system.

Early in the pandemic, there was a wide gap between Black and white vaccination rates. However, by August 2022 — about a year and a half after the first vaccine was administered in the state — North Carolina had closed the gap by leveraging data and trusted community messengers to prioritize equity in its distribution plans. People around the country took notice, including the White House. 

“We were that trusted voice when it came to communities of color, minority communities,” Wright said. 

Pushback to health equity

After the disproportionate effect of COVID on minority populations — and the racial flashpoint of the murder of George Floyd — the federal government and many states invested more heavily in health equity initiatives and research aimed at better understanding factors driving disparities. 

The Biden administration issued executive orders to advance health equity, including one that outlined equity as a priority for the federal government.

In recent years, however, health equity initiatives have increasingly become entangled with Republicans’ efforts to eliminate diversity, equity and inclusion actions and programs.

President Donald Trump began his second term by signing executive orders terminating DEI-related initiatives, offices, equity action plans and equity-related grants and contracts across the federal government. As a result, major restructuring followed at federal health agencies, including partial or complete layoffs at HHS’ Office of Minority Health, CDC’s Office of Health Equity and the Office of Women’s Health.

The rollback of focused efforts to address health disparities, including the termination of research funding, has worried health advocates, who believe the cuts could contribute to worse health outcomes.

North Carolina’s Republican-led legislature has also recently passed — over Stein’s vetoes — several new laws prohibiting DEI initiatives and practices from state government, K-12 public schools and public higher education.  

In addition to the elimination of the standalone Office of Health Equity, lawmakers also cut the N.C. Department of Administration’s Office for Historically Underutilized Businesses in the new state budget. 

The office of Senate leader Phil Berger and House Speaker Destin Hall did not respond to a request for comment asking why the Office of Health Equity was eliminated. 

The budget provision also prohibits DHHS or the governor from creating any “separate division, office or section” to perform any of the functions of the Office of Health Equity without authorization from the General Assembly.

Angelo Moore, executive director of the Center of Excellence for Integrative Health Disparities and Equity Research at North Carolina A&T University, said the elimination of the standalone office is disappointing, even as the work will purportedly continue in the reorganized structure.

“The purpose of having individuals and organizations that really focus on health disparities is so it gets the attention that it needs, so the population gets the attention that they need, so the resources are being put at places where people need them,” Moore said. “I ask the question: Why take them away? When you have individuals that have poor health conditions, somebody’s going to pay for it.”

Gaps remain

The Office of Health Equity’s most recent health disparities analysis report, released in 2024, made it clear that the work to close health gaps is far from finished.

The report identified six key health disparity categories to address: social drivers of health; access to health care; chronic disease; communicable disease; mental health, substance use, suicide and violence prevention; and health across the lifespan.

Within each category, the report identifies certain metrics and priority populations where the Office of Health Equity saw the greatest opportunity to make an impact within three to five years. Among them are disproportionately high prostate cancer mortality among Black men, elevated overdose death rates among American Indians and firearm-related hospitalization rates that are much higher among Black residents.

Wright, who currently serves as a health equity advisor, said directing limited public health resources toward populations with the greatest needs is a core principle of public health and a cost-effective approach.

“An important piece of being a public health practitioner is to figure out what the issue or the need is and then to try to solve it,” Wright said. “You can’t just do a one-size-fit-all cookie cutter approach.”

Moore said improving overall population health starts with addressing the communities that are experiencing the poorest health outcomes.

“Oftentimes, in health disparities, we find particular populations that have worse health conditions, bring our attention to it, and we develop interventions that help that population,” he said. “Also those interventions help other populations as well. Everybody benefits.” 

“Administrations will come and go, but we really need to focus on what the people need, which hasn’t changed,” Moore said. “Health disparities in communities are ongoing.”

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