Racial and Ethnic Health Disparities Exist in Every State, Report Finds

While racial and ethnic health disparities have and continue to exist, the scope has not been well documented or quantified. Now, a new Commonwealth Fund report is demonstrating just how deep some of these health inequities run.

“There’s a historical perspective that plays into why we want to do the report… We know that in every state and nationally, people of color tend to have worse [health] outcomes than White people,” David C. Radley, PhD, MPH, senior scientist at the Commonwealth Fund, told Verywell. “They face experience low quality of care and access barriers that many White people don’t have. It was important to be able to quantify that.” 

The report found that racial and ethnic disparities in the healthcare system exist in every U.S. state. How dramatic those disparities are varied. For example, Minnesota ranked third as having the largest disparities between White and Black, Latinx, Hispanic, Asian American and Native Hawaiian/Pacific Islander, and Native American communities (AANHPI). Meanwhile, Mississippi demonstrated the lowest performance for all groups.

“Some of the states—Minnesota and Wisconsin, for example, have performed traditionally very well—those states actually had some of the largest racial inequities between groups," Jesse Baumgartner, MPH, research associate at the Commonwealth Fund, told Verywell. "Overall, state numbers can mask some real divergent underneath and that’s what we found, particularly a few states that we would historically think of as having stronger health systems."

How Were the Scores Calculated? 

To score each state’s performance, Radley and his team collected national data sets from the American Community Survey, Behavioral Risk Factor Surveillance System, Centers for Medicare and Medicaid Services, and statistics from the Center for Disease Control (CDC) for 24 indicators of health system performance. These indicators were then grouped into three performance domains: 

1. Health outcomes
2. Healthcare access
3. Quality and use of healthcare services 

In this report, health outcomes were defined by the mortality rates and prevalence of health-related issues. Under the health outcomes domain, the researchers found:

• Black people and American Indian and Alaskan Native (AIAN) people are more likely to die early than White people from treatable conditions. 
• Black and AIAN people are more likely to die from diabetes complications than AANHPI, Latinx/Hispanic, and White people. 
• Black women were more likely to be diagnosed later and die from breast cancer—a disease that’s treatable when detected early—than White women.

Researchers also looked at healthcare access, which they defined as the disparity in access to care between White and minority populations. Under this domain, the researchers discovered: 

• While the Affordable Care Act expanded coverage, state uninsurance rates were higher for Black, Latinx/Hispanic, and AIAN adults compared to AANHPI and White adults.
• In most states, White people were less likely than other Black and Indigenous people, and communities of color to face cost-related barriers. 

Lastly, the quality and use of healthcare services are the disparities in the quality of care and a population’s access to primary care, emergency services, and preventative care. The researchers found that: 

• Black Medicare beneficiaries are more likely than White beneficiaries to be admitted to the hospital or seek emergency department care for conditions that are usually managed through primary care. 
• Black, AIAN, and Latinx/Hispanic adults are less likely to receive their annual flu shot when compared with AAHPI and White adults. 

Based on the overall scores, each racial and ethnic group received a percentile score, with number one indicating worst health system performance and 100 representing the best.

For example, California received a score of 50 for the Latinx and Hispanic population whereas Florida received a 38. This indicates that California’s health system performs slightly better for the Latinx and Hispanic population than Florida does. 

The results show that all health systems still have room to improve. 

Catalyzing Policy Change 

Ultimately, Radley and Baumgartner hope this report will be used as a tool to catalyze policy change.

“What we want to do with a report like this is shed light on exactly how much disparity there is, across states and within states and health equity," Radley said. "I think the report does a good job of doing that. And so the goal of this report is to inform policymakers, the media, public, on the state of the world.” 

To bridge the gap, the report suggests that there needs to be universal, affordable, and equitable health coverage for all people. Nearly 30 million people in the U.S. remain uninsured, which impacts people of color disproportionately.

The authors say there needs to be stronger primary care and delivery of services with better access for communities of color. There also needs to be an investment in social services to address issues that can interfere with health—such as affordable housing, public transportation, early childhood development, and affordable higher education.

Moving forward, they hope it will start as a jumping-off point for states and federal authorities to classify data based on racial and ethnic groups.

“There’s a lot of different subpopulations and places of origin. There are not monolithic groups,” Baumgartner explains. “The real hope here is that this is the jumping-off point, states have the ability to collect more detailed data to dig deeper into specific trends at a health system level, levels that we could never get to with just federal data.”

Once more data becomes available in the coming years, Radley and Baumgartner plan on continuing to dive in and create actionable steps.