Health inequities continue to persist in the US

In 2003, NASEM released a groundbreaking report called "Unequal Treatment," which explained that structural racism was rampant throughout the U.S. healthcare system and that people of color received worse care — regardless of their income, social status, or education.

Now, over 20 years after that original report, NASEM has released a follow-up titled "Ending Unequal Treatment." In the new report, NASEM found that people of color are still disproportionately uninsured, underutilizing care services, and underrepresented in the healthcare workforce.

Although uninsured rates have decreased for all populations since the original 2003 report, there are still disparities in health coverage. In 2022, 19% of American Indian and Alaska Native adults were uninsured, followed by Hispanic adults at 18%, Native Hawaiian and Pacific Islander adults at 13%, and Black adults at 10%. In comparison, almost 7% of white adults were uninsured.

Currently, people of color still have higher rates of many health conditions, such as cardiovascular disease and diabetes, than white people. Black Americans have the highest rates of cardiovascular disease, followed by Native Hawaiians and Pacific Islanders. American Indian and Alaska Native adults also have the highest rates of diabetes at 13.6%, followed by Black adults at 12.1%.

Minority groups are also less likely to have access to care compared to white populations. Similar to what was found 20 years ago, people of color are less likely to have a primary care provider and more likely to report that their usual source of care is a facility or hospital instead.

Although there has been progress in increasing diversity in the healthcare workforce across the past 20 years, there is still a disproportionate number of white workers compared to other racial/ethnic groups. According to the report, some barriers to building a diverse workforce include socioeconomic burdens, a lack of access to educational programs and adequate mentoring, systemic racism, and limited support systems for medical students.  

"Twenty years later, it is clear that our nation has not made enough progress," said Victor Dzau, president of the National Academy of Medicine.

Separately, Georges Benjamin, co-chair of NASEM's report committee, said that "We've made progress in a lot of areas, but it's been inconsistent and we've had some regression in those outcomes."

Recommendations for addressing health inequities

According to the report's authors, racial and ethnic inequities continue to be "fundamental flaws" in the U.S. healthcare system. To address these issues, the authors made several recommendations, including establishing a pathway for everyone to have affordable health insurance, reimbursing Medicaid providers at the same rate as Medicare providers, and increasing funding for the Indian Health Service.

Other specific recommendations include:

• HHS should ensure its programs collect and report data on race and ethnicity for both patients and healthcare workers, with monitoring by the Office of Management and Budget
• Healthcare systems should allocate more funding to help  health equity solutions, including patient navigators and community health workers
• HHS should set clear, enforceable standards on health equity so health systems will be held accountable for implementing solutions
• Federal research on health inequities, structural racism, health-related social needs, and more should be expanded
• HHS' Office of Civil Rights should receive better funding so it can enforce existing but underused laws against discrimination

"Many of the tools needed to reach these goals are already available and need to be fully used," said committee co-chair Jennifer DeVoe, professor and chair of family medicine at Oregon Health & Science University.

Although health equity researchers welcomed the new recommendations, some said they did not go far enough. Researchers noted that health inequities are not only related to the healthcare system, but also to larger social problems, such as housing inequality, lack of access to fresh food, and inequities in educational opportunities.

"The recommendations all have merit but they don't go far enough because they don't address structural racism as an underlying cause of health disparities," said Louis Penner, a health disparities researcher and professor emeritus in the department of oncology at Wayne State University.

The report’s authors summed up the state of health inequity in the United States by saying, "The United States likes to see itself as the world's standard bearer of excellence in health care. Yet when compared to other industrialized nations, we are not the exemplars we believe we are."

Advisory Board's health equity resources

For insights on how to improve your organization's health equity efforts, check out these Advisory Board resources:

• This  research  outlines four ways leaders can scale the impact of their health equity goals, as well as increase accountability throughout their organization.
• Similarly, this  guide  explains how organizations can move from a pledge to action on health equity and provides actionable steps for CEOs.
• To measure health equity at your organization, we offer both a  cheat sheet and a  conversation guide. These resources will help you set principled priorities, boost accountability, and address expectations from stakeholders.
• This expert insight highlights why hospital and health system leaders are prioritizing social determinants of health (and why you should do the same).  
• This  featured page can help you find more research and insights on specific problems related to health equity, such as workforce challenges, data collection, behavioral health, and more.

(Owens, Axios, 6/27; McFarling, STAT, 6/26; Devereaux, Modern Healthcare, 6/26)