New York, Connecticut and Massachusetts rank among six states found to have better-than-average health system performance among all racial or ethnic groups.
A new analysis by the Commonwealth Fund finds racial health disparities exist in all 50 states. The report employs 25 indicators to evaluate states on health care access, quality, service use and health outcomes, and to detail racial disparities in each state's health care system.
Dr. David Radley, a senior scientist at the Commonwealth Fund, says the report was developed to help assess how past and current health policies impact people of different races and ethnicities. The goal is for policymakers and healthcare leaders to use the in-depth state-by-state data to identify inequities and create solutions to build a more equitable health system. Radley notes that in most states, health care systems best serve white residents.
"In almost every state health system performance experienced by Black people is lower than average," said Radley. "There are only six states... Rhode Island, Massachusetts, Maryland, Delaware, Connecticut and New York, where we see higher than average performance for black residents. The other thing to know is that in every state represented here, even the top performing states, Black people are faring substantially worse than the top performing group within the same state."
New York saw its Asian American, Native Hawaiian and Pacific Islander and white residents score in the 84th and 89th percentiles, respectively. But its Hispanic residents scored in the 54th percentile, followed by Black residents at the 52nd percentile.
Connecticut's Asian American, Native Hawaiian and Pacific Islander and white residents score in the 78th and 98th percentiles, with Hispanic residents scoring in the 55th percentile and Black residents in the 52nd percentile.
Massachusetts' Asian American, Native Hawaiian and Pacific Islander and white residents ranked in the 99th and 98th percentiles. Hispanic residents fell in the 75th percentile, and Black residents in the 69th percentile.
Laurie Zephyrin, senior vice president for advancing health equity at the Commonwealth Fund, points out that Black and Hispanic communities are further disadvantaged because they have fewer primary health care providers.
“And so it's really critical to address reimbursement to bolster the workforce, potentially considering loan repayment programs, for example, for providers that will come in and serve in minority majority communities. Also, it's important to expand the workforce to incorporate community health care workers, where we know the data just shows improved outcomes when integrating community health care workers into the health care system,” said Zephyrin.
Commonwealth Fund President Joseph Betancourt says the report should serve as a "call to action."
“There's no doubt that the U.S. healthcare system is not immune from the systemic inequalities of plague all facets of American society," Betancourt said. "Decades of policy choices at the federal state and local levels, combined with underinvestment inequity among local health care systems, has had a discriminatory impact and contributed to poor health outcomes for people of color.”
Zephyrin adds the plight of the uninsured cannot be ignored.
"When we look at the data about 25 million people in the United States that are still uninsured, and they're disproportionately people of color. And even for people who are uninsured, about a quarter of working age adults are underinsured. They're really facing high out of pocket costs and deductibles relative to their income, which really makes them not come in for care at all because they can't afford it,” Zephyrin said.
The Commonwealth Fund says policymakers at every level of government, along with leaders in health care, have many tools to make U.S. healthcare more equitable and to narrow persistent racial and ethnic disparities in health outcomes. The fund offers numerous recommendations including investing more in social services and strengthening primary care while ensuring universal, affordable, and equitable health coverage.
Zephyrin says the report shines a light on inequities. “I think one of the big takeaways, it's really an opportunity to resurface and really continue to prioritize the importance of this work, the importance of really seeing just, you know, firsthand with the data, the inequities that persist and the continued work that we need to do,” said Zephyrin.
Data for the 2024 State Health Disparities Report, published in mid-April, was gathered in 2021 and 2022. You can view the full report here.
