'Pervasive' racial and ethnic inequities exist across all state health systems, Commonwealth Fund analysis finds

Healthcare systems are failing people of color in every state, with health outcomes and access to quality care among people of color worse than for white people, according to a state-by-state analysis by the Commonwealth Fund. 

Health system performance is above average for white people in most states, the analysis found. Only in three states is it below average for all ethnic and racial groups—West Virginia, Oklahoma and Mississippi—but even in those, Black, Latino and American Indian/Alaska Native populations fare far worse than whites.

Meanwhile, health system performance among Black and Hispanic populations is below average in most states. Even in states with high health system performance for all racial and ethnic groups—Massachusetts, Connecticut, Rhode Island, Hawaii, Oregon and New York—there are still sizable gaps in care for Black and Latino communities, the analysis found. 

"Racial and ethnic disparities in health outcomes and health care are pervasive both across and within states. Transformative change will depend on policy and practice changes to make access to care more equitable and to ensure equal treatment in the delivery of care," the report authors wrote.

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The analysis also found that across most states, Black and American Indian/Alaska Native people are more likely to die early in life from treatable conditions, with the mortality rate being highest for both groups in Mississippi. And in fact, some states that have historically received high State Scorecard rankings revealed some of the largest racial inequities between groups. 

“The scorecard finds that health equity does not exist in the U.S.,” said David Blumenthal, M.D., president of the Commonwealth Fund, in a call with reporters Wednesday. In nearly every state, healthcare is better for white people.

The Fund used 24 metrics from its State Scorecard to examine health system performance in each state by race and ethnicity. The groups studied include Black, white, American Indian/Alaska Native, Asian/Pacific Islander and Hispanic. The fund relied on a variety of data for 2019 and 2020 but noted that data is limited. 

The analysis also found that among data that was available, state uninsured rates were generally higher among Hispanic adults. 

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These inequities are driven by structural racism and social determinants that affect health outcomes, Zephyrin said in the call with reporters. She also emphasized that these findings are not a surprise.

“Knowledge is power and data like this tells us a very specific story,” Zephyrin said. She suggested that this data should be used to tailor and improve healthcare professionals’ work for the needs of their specific populations. Data collection, too, needs to improve to better identify and close care gaps, she said. 

To combat these realities, the authors of the analysis recommend policy solutions including expanding insurance coverage, which helps improve upon inequities, strengthening primary care, lowering the administrative burden that exists for patients and investing in social services.