A new health equity scorecard released today by the Commonwealth Fund finds deep-seated racial and ethnic health inequities in all 50 states and the District of Columbia — disparities that have been exacerbated by the COVID-19 pandemic.
Achieving Racial and Ethnic Equity in U.S. Health Care: A Scorecard of State Performance is a comprehensive examination of how health care systems are functioning for people of color in every state. Part of the Commonwealth Fund’s ongoing series examining individual state health system performance, the report uses 24 measures to evaluate each state on health care access, quality and service use, and health outcomes for Black, white, Latinx/Hispanic, American Indian/Alaska Native (AIAN), and Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations.
The health equity scorecard reveals that even among high-performing states, racial and ethnic health disparities can be dramatic. For example, Minnesota’s health care system, which has historically performed well in Commonwealth Fund state scorecard rankings, has some of the largest health disparities between white and nonwhite communities. Maryland, Massachusetts, and Connecticut are other traditionally high-scoring states where white residents receive some of the best care in the country but where quality of care is far worse for many populations of color. Similarly, in states like Mississippi and Oklahoma whose health care systems have historically performed poorly for both white and Black populations, white patients still received markedly better care.
In addition to showing how people of different races and ethnicities fare within each state, the Fund’s scorecard ranks how well each state’s health system is working for each racial and ethnic group. For instance, the health care system in California works better for Latinx/Hispanic people than the Texas health care system. In both Texas and California, however, the health system benefits white people more. Among states with large American Indian populations, South Dakota, North Dakota, Montana, and Wyoming have the worst-performing health systems for these communities while California’s system ranks at the top — though there are still wide disparities with other populations in the state.
Structural racism and generations of disinvestment in communities of color are chief among many factors contributing to pervasive U.S. health inequities, the authors note. As the COVID-19 pandemic has shown, people in many communities of color are more likely than members of white communities to live in poverty, to work in low-paying, high-contact industries, and to reside in high-risk living environments. Many Black, Latinx/Hispanic, and AIAN populations then face an unequal health system when they need to access care. They are less likely to have health insurance, more likely to face cost-related barriers to care and medical debt, and more likely to receive suboptimal care.
Health inequities are perpetuated and reinforced by each of these contributing factors — all of which have their roots in both past and current policies at the federal, state, and local levels. The authors suggest pursuing four broad policy goals to create an equitable, antiracist health system:
- Ensuring affordable, comprehensive, and equitable health insurance coverage for all
- Strengthening primary care
- Lowering administrative burden for patients
- Investing in social services.
Since health inequities vary across states, there are also opportunities for state programs to tailor interventions that address the unique needs of their communities.