Report: Racial Health Inequities Persist in U.S.

States Have Large Racial Disparities in Health Care Equity, Study Finds

‘We don’t really see health equity anywhere in the country,’ says the lead author of a new study from the Commonwealth Fund.

By Steven Ross Johnson
Nov. 18, 2021,

The report by the Commonwealth Fund found racial and ethnic inequities in every state for Black, Latino, American Indians and Alaskan Native residents.(GETTY STOCK IMAGES)

Racial and ethnic health inequities are pervasive throughout the U.S., according to a new analysis that found some of the widest disparities occur within states known for having high performing health care systems.

A new report released on Thursday by the Commonwealth Fund, a private foundation that aims to improve health care systems for the most vulnerable, assessed the performance of the health system in all 50 states and the District of Columbia on health care access, quality of care, and health outcomes for racial and ethnic minority residents.

The report evaluated state health system performance for Black, white and American Indian/Alaskan Native residents, as well as for Asian American, Native Hawaiian, Pacific Islander and Latino populations using 24 data indicators grouped into three areas: health outcomes, health care access, and quality and use of health care services. Racial and ethnic inequities were found in every state for Black, Latino, American Indians and Alaskan Native residents.

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“We don’t really see health equity anywhere in the country,” says study lead author, David Radley, a senior scientist for tracking health system performance for the Commonwealth Fund, adding the racial and ethnic health care gap is much wider than previously thought.

Health system performance for white residents scored above the national average in all but three states – Mississippi, Oklahoma and West Virginia. In those states that scored below average, health system performance was much lower for non-white residents compared to white residents.

Health care coverage, preventable deaths, and rates of health care utilization and preventive care services like breast cancer screenings were some of the factors used to calculate state health system performance scores.

Only six states had health systems that scored above the national average for all racial and ethnic groups studied – Oregon, Rhode Island, Hawaii, Massachusetts, Connecticut and New York. Yet large disparities were also found in those states, where health system performance for white residents was scored the best of any group except in Massachusetts, where it was slightly higher among Asian American, Native Hawaiian and Pacific Islander residents.

Some of the largest racial health disparities were found in states with health systems that have historically received high grades. In Minnesota, the health system ranked third in the country by the Commonwealth Fund in its most recent edition of its annual Scorecard on State Health System Performance released in 2020. Yet the state’s health system only scored in the 36th percentile out of 100 for Black residents, 24th for its Latino population, and in the 6th percentile for American Indian and Alaskan Native residents in the new equity report.

Similarly, Iowa ranked fourth in the U.S. for overall health system performance, according to the 2020 Commonwealth Fund state scorecard, yet scored well below the national average on performance for Latino and Black residents, according to the equity analysis.

“When you look at state averages, you’re really masking what’s going on beneath the surface,” Radley says. “It takes this deeper dive to see exactly where and for who the system is performing better and where the system is not performing as well.”

Speaking to reporters on Wednesday, Commonwealth Fund President Dr. David Blumenthal said people of color are having vastly different experiences than white residents within the same health system, which has led to a range of deep-seated inequities.

Blumenthal said health care disparities have only been exacerbated by the COVID-19 pandemic, which has disproportionately impacted people of color. Latino, Black, American Indian and Alaskan Native people are at least twice as likely as white people to die from COVID-19, with American Indian and Alaskan Native residents more than three times as likely to be hospitalized from the disease, according to an Oct. 8 research brief by the Kaiser Family Foundation.

Blumenthal said narrowing the ethnic and racial health gap will require health policies aimed at expanding health care access and addressing socioeconomic factors like poverty, food insecurity and housing instability that can negatively impact health outcomes.

“Health policies matter for peoples’ day-to-day lives,” Blumenthal said. “For generations, federal, state and local leaders have made policy choices that have produced worse health care outcomes for people of color.”