Pushing the state to action: The Massachusetts health disparities council and office of health equity

It's been a learning experience. In 2006, the Massachusetts Health Disparities Commission released a report calling for a high-level, state Office of Health Equity which could work across governmental secretariats and departments to review their plans and recommend concrete actions to eliminate health disparities and promote health equity. That year, Massachusetts' groundbreaking Health Care Reform Law codified the commission into the state Health Disparities Council with a mission “to identify and recommend policies and actions to eliminate racial and ethnic disparities in health care and health outcomes and to achieve health equity for all Massachusetts residents.” It mandates 37 members drawn from the legislature and an array of state health officials and organizations. Many of the original commission's most active and ardent members were appointed to it. In 6 years, the Council has produced a 2 page, Framework for Eliminating Health Disparities. Its active membership has dwindled. The current administration has tucked an Office of Health Equity within its Department of Public Health. That office struggles for resources to produce a Commission-recommended “Health Disparities Report Card.” How has Massachusetts gone from a vibrant, pre-Health Reform, Health Disparities Commission with many plans and recommendations on ending disparities to a formalized but frozen Council that, despite desire and good will, cannot translate ideals into action? How would a small but high-level, legislatively mandated and funded Office of Health Equity situated outside of and “above” Public Health change the situation? What is the role of public advocacy in breaking the inertia?