FUNDING CRISIS IN TITLE VII DIVERSITY PROGRAMS

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Although we largely agree with Mitchell and Lassiter in their December 2006 commentary, “Addressing Health Care Disparities and Increasing Workforce Diversity,”1 they failed to highlight the crisis of the impending elimination of major federal programs for enhancing diversity and assuring adequate numbers of minority health professionals in the future as 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 recruiting minority and disadvantaged students, enhancing their academic skills, and supporting their preparation, entry, and graduation from schools of dentistry, medicine, pharmacy, public health, and allied health at the kindergarten through 12th grade, community and 4-year college, postbaccalaureate, and health professional school levels. Since 1987, COEs, based at schools of dentistry, medicine, and pharmacy, have conducted similar enrichment activities and assisted schools 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 the inception of these 2 programs, 459 036 minority and disadvantaged students have participated in them, 38% at K–12 levels, 37% in colleges, 22% in health professional schools, and 3% at other levels.2 Recent reviews of the literature have demonstrated their effectiveness.3–5 A controlled study on postbaccalaureate premedical programs in California showed impressive results.6 Despite the programs’ history and demonstrated effectiveness, the budget proposed by President Bush for the past 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 in total funding annually and 74 HCOPs that received $35.6 million in total funding annually, but funding for both programs was cut dramatically for fiscal year 2006, by 65% and 89%, respectively. In February 2007, Congress passed and the president signed a joint funding resolution that funded both programs at their fiscal year 2006 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.2 For dental COEs, this means losing those at the University of Puerto Rico and University of Texas Dental Branch at Houston and San Antonio; only Meharry Medical College’s COE would survive. Federal funding has been effective in making the institutional changes advocated by Mitchell and Lassiter at academic health centers. Unless the funding for COEs and HCOPs is restored, our workforce will become less diverse as our population becomes more so.