Rena Boss-Victoria has completed her DrPH and MPH from University of Texas School of Public Health and postdoctoral studies from University of Alabama School of Public Health Injury Control Center. She is the director/Chair of the Nursing Department at the first recognized Historical Black Colleges/Universities (HBCUs) in the Eastern Region of USA. She has built her professional career on a trajectory through practice to education to research to policy. The targeted outcomes were population health improvement and increased community capacity. Much of the work focused on increased access to quality health services for populations facing disparities. She has published and presented numerous papers and has been serving as an Editorial Board Chair.


Over the last few two decades, a plethora of studies have documented disparities in healthcare outcomes in communities of color. Consequently, a crescendo of knowledge about, symptoms of and potential solutions to close the gaps healthcare outcomes between communities of color as other communities who consistently experience higher healthcare outcomes has exponentially grown. Moreover, efforts of government and private agencies have grown significantly. The enactment of the American Affordable Care Act by the Congress of United States of American and signed in to federal law by President Barrack M Obama represented a very important set of changes in the healthcare delivery system in the U.S. The policy changes mandated by that law are still unfolding today. Unfortunately, identified gaps that were identified long ago still persist. In fact, in some cases, identified gaps have actually increased. The current paper is focused on an analysis of three major elements regarding healthcare outcomes with the context of social determinants of healthcare and disabilities outcomes. Those elements are: Activities of Daily Living Deficit (ADLD), Service Expectation Deficit (SED), and Confidence in Service Deficit (CISD).