The pandemic revealed entrenched health disparities that existed long before COVID-19, and a new report shows no state is immune.
While some do better than others, the comprehensive report of 2019 and 2020 data by The Commonwealth Fund found health equity doesn’t exist anywhere in the U.S.
The report, called the Health Equity Scorecard, showedhealth disparities in every state, even those with traditionally stronger health systems.
Researchers with the private foundation, which supports research on health issues, ranked states' care for five racial and ethnic groups: white, Black, Hispanic/Latinx, Asian American/Native Hawaiian/Pacific Islander and American Indian/Alaskan Native.
Theyused 24 data points to measure performance in health outcomes, access to care, quality and use of health care services.
“The scorecard explores a vital question: Are people of color having different experiences than white people within the same health care system?” said Dr. David Blumenthal, president of The Commonwealth Fund. “Almost always the answer is yes.”
The report found only six states had health care systems thatperformed above the national average for all racial and ethnic groups: Massachusetts, Connecticut, Rhode Island, New York, Hawaii and Oregon. However, white people still received better care in these states compared to people of color.
States where white residents received the best care in the country – like Minnesota, Maryland, and Connecticut – were also states where people of color received some of the worst care.
Even in Mississippi and Oklahoma, states with health care systems that historically performed poorly among all racial and ethnic groups, white patients still received far better care.
“States can learn from each other about what are the successes in other states, what can be done and what has worked, and how can we replicate this across state lines,” said Dr. Sara Bode, medical director of school health for Nationwide Children’s Hospital, who is unaffiliated with the report.
Some Midwest states, such as Minnesota and Wisconsin, have long had strong health care systems but reported some of the largest racial inequities between groups. Minnesota was the worst state for health outcomes among Latinx/Hispanic patients.
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States with some of the largest American Indian populations, including South Dakota, North Dakota, Montana and Wyoming, had the worst-performing health systems for these communities.
Researchers also examined premature mortality for racial and ethnic groups. In every state but Maine theyfound Black people were more likely to die early in life from conditions that are treatable with timely access to high-quality care.
“It is important to realize that these statistics translate to people,” said report co-author, Dr. Laurie Zephyrin, vice president of advancing health equity at The Commonwealth Fund. “Real people experiencing firsthand impact of racial inequities on their health, their well-being and their lives.”
Black people experienced the best health outcomes in Colorado and the worst in West Virginia. Latinx/Hispanic people had best health outcomes in Maryland and the worst in Montana. American Indian/Alaska Native health outcomes were best in California and worst in North Dakota.
The report's authors said health disparities existed after controlling for income.
"It's unfortunate that people are still surprised at this," said Linda Goler Blount, president and CEO of Black Women's Health Imperative. "At its core, these social determinants of health are racism and discrimination."
Health experts agree with study authors that the way to improve health equity is to ensure affordable, comprehensive health insurance for all, strengthen primary care, lower administrative burden for patients and invest in social services.
Blount added it's important that hospitals hire more physicians of color, as data showsBlack and Latinx/Hispanic patients have better outcomes when treated by doctors of similar race and ethnicity.
“The awareness stuff is great but unless we change the behavior of providers and the health care system and people in the workforce, we’re not going to see these numbers change,” she said. “We don’t need to describe it anymore, we need to change if we’re ever going to make progress.”
Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT.
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