Health care systems in every state have racial and ethnic disparities, according to a new report.
Researchers from The Commonwealth Fund, a private, nonprofit foundation, found these disparities are rooted in long-standing racist policies and exacerbated by the COVID-19 pandemic.
“The scorecard finds that health equity does not exist in the U.S.,” said co-author David C. Radley, Ph.D., senior scientist at the Commonwealth Fund. “Even in states with relatively strong-performing health systems, people of color, particularly Black, Latino and Native Americans, have a higher mortality, less access to care and are more likely to receive lower quality care compared to White people.”
The group compiled data from 2019 and 2020 on 24 indicators of health system performance, including several specific to children such as rates of infant mortality, uninsured children, pediatric preventive care and childhood vaccination. These indicators were grouped into one of three categories — health outcomes, health care access and quality/use of health care services.
The data show that in most states, health system performance is above average for White people and below average for Black and Latinx people.
In some states like Minnesota, Michigan and Wisconsin, health system performance was strong for White people but not for Black. In other states like Oklahoma, Mississippi and West Virginia, health system performance was weak for all races but worse for Black residents. Disparities persisted even in states where performance was better than average for all races like Connecticut, Hawaii, Massachusetts, New York, Oregon and Rhode Island.
The study also found people who are Black or American Indian/Alaska Native (AI/AN) are more likely to die prematurely from treatable conditions in most states compared to the average across all groups.
For example, diabetes complications and infant and maternal mortality rates are higher for both groups. Breast cancer death rates are significantly higher among Black women than other women.
Looking at access to care, authors of the report attributed improvements in insurance coverage to the Affordable Care Act. However, 12 states have not expanded Medicaid eligibility, and these states have significant Black and Latinx populations.
Latinx adults in almost every state have higher than average rates of being uninsured, which in some cases is due to barriers related to immigration, according to the report.
Authors of the study said the inequities are rooted in long-standing public policies.
“For generations, federal, state and local leaders have made policy choices that have produced worse health outcomes for people of color, including economic suppression, residential segregation and failing to invest in the places where people of color live and work,” said Commonwealth Fund President David Blumenthal, M.D. “These and other factors have contributed to social determinants of health such as income, food, and housing security and education that significantly affect health outcomes for people of color.”
Authors said the COVID-19 pandemic highlighted existing inequities, worsened social determinants of health and strained the health care system.
“If we want to get the pandemic under control and mitigate long-standing injustices in our health care system and beyond, we need to dismantle the racist policies and practices that have led us here and create a truly equitable health care system,” Dr. Blumenthal said.
The Commonwealth Fund laid out four broad policy goals to address inequities in health care:
- ensure universal, affordable and equitable health insurance coverage,
- strengthen primary care and improve delivery of services,
- reduce inequitable administrative burdens affecting patients and providers, and
- invest in social services.
Authors also noted the positive impact they have seen from some federal/state partnerships that address children’s health such as the Children’s Health Insurance Program and Vaccines for Children program.
Addressing racism is a priority for the AAP. In a 2019 policy statement, it detailed the significant impact of racism on child and adolescent health and laid out strategies to help pediatricians combat it in their practices, the workforce, communities and in research.
“Achieving decisive public policies, optimized clinical service delivery, and community change with an activated, engaged, and diverse pediatric workforce is critically important to begin untangling the thread of racism sewn through the fabric of society and affecting the health of pediatric populations,” according to the policy.