Nov. 18, 2021 -- Structural racism and “generations of disinvestment in communities of color” are driving “pervasive U.S. health inequities,” a new report finds.

Health systems across the country aren’t meeting the needs of people of color, according to the report from the Commonwealth Fund called “Achieving Racial and Ethnic Equity in U.S. Health Care: A Scorecard of State Performance.”

“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 live and work,” David Blumenthal, MD, president of the Commonwealth Fund, said during a briefing about the report.

Laurie Zephyrin, MD, MPH, vice president for advancing health equity at the Commonwealth Fund, said the root causes of the inequities have existed for centuries, and the pandemic has only made things worse.

“COVID-19 has unveiled for many the influence of structural racism on these disparities,” she said.

Lack of Community Investment Results in Unequal Health Outcomes

Blumenthal drew a connection between the lack of investment in communities to social determinants of health, including income, food, economic security, and unequal health outcomes for people of color across all 50 states.

Five racial and ethnic groups are included in the report: Black Americans, whites, American Indian/Alaska Natives, Asian American, Native Hawaiians, and Pacific Islanders, and Latinos.

Health outcomes, health care access, and quality and use of health care services are the three measures captured in the scorecard, which includes data from 2019 and 2020.

Additional findings from the scorecard include:

  • Health equity is nonexistent in any U.S. state. That’s a reality, even in areas that otherwise have strong health care systems, such as Washington D.C., Massachusetts, and Connecticut.

According to the CDC, in order to achieve health equity each person must be able to “attain his or her full health potential” and isn’t held back from achieving this outcome “because of social position or other socially determined circumstances.” The agency finds that health inequities can result in differences in length and quality of life; rates of disease, disability, and death; disease severity; and access to appropriate health care treatments.

  • Black, Latino, and American Indian and Alaska Native populations experience inferior health outcomes in U.S. health care systems, when compared to white patients.
  • Massachusetts, Connecticut, Rhode Island, New York, Hawaii, and Oregon fared better in the report, which means that racial and ethnic groups (where the data was available) had an above average performance.
  • Residents in Midwestern states, such as Minnesota and Wisconsin, are witness to some of the highest racial inequities among the groups studied. The report also found that, while residents of all races and ethnicities in Mississippi and Oklahoma have a substandard experience in the health care system, there are also health inequities in these states.

Blacks Are More Likely to Die from Preventable and Treatable Diseases

Black residents in most states are more likely to die early from preventable causes than white residents, according to the report. While they’re less likely to have access to high-quality care, Latino residents are less likely to succumb to preventable diseases than Black residents.

Diabetes is one condition that can be managed successfully through ongoing monitoring of blood glucose levels and medications. Still, health outcomes vary across races and ethnicities. The scorecard found that Black Americans and American Indians and Alaska Natives have a much greater chance of dying as a result of complications from diabetes.

Breast cancer, which is more likely to be diagnosed in later stages among Black women, is also considered treatable when it’s detected early. Black women are more likely to die as a result of breast cancer than women of other races and ethnicities.

Barriers such as poor insurance coverage, lack of a regular health care provider, and unaffordable medications can result in the ineffective treatment of conditions such as diabetes and high blood pressure, according to the scorecard.

The report’s recommends ensuring universal, affordable, and equitable health coverage; strengthening primary care and improving the delivery of services; reducing inequitable administrative burdens that affect patients and providers; and investing in social services.

Specific recommendations for supporting lower-income families can include access to unemployment compensation, in addition to the Earned Income Tax Credit and child tax credit programs, the researchers say. Other efforts by federal and state policymakers can include investments in childcare, food security, and targeted wealth-building programs.

The Commonwealth Fund, which published the first state scorecard in 2007, started publishing the report on a near-annual basis in 2014. According to a spokesperson, the 2021 report is the first to focus in depth on racial and ethnic gaps in the health care system.