A new state-level scorecard on health equity data from the Commonwealth Fund paints a disturbing picture of disparities in health access and outcomes. The scorecard “exposes a range of deep-seated racial and ethnic healthcare inequities within all 50 states,” said David Blumenthal, M.D., president of the organization. “There's little doubt that the pandemic has exacerbated these inequities and other weaknesses in our healthcare system.”
The scorecard report looks at 24 measures of performance stratified for five racial and ethnic groups including Black, Latino, Native, Asian and white Americans. The data timeframes in the report vary by indicator, but generally reflect 2019 and 2020.
Health equity does not exist in any state, even those with stronger health systems, the report found. In every state, health system performance is markedly worse for many people of color when compared to white people. Only six states had above average performance for all racial and ethnic groups (for which data were available): Massachusetts, Connecticut, Rhode Island, New York, Hawaii, and Oregon. Some Midwest states like Minnesota and Wisconsin have historically performed strongly in the Commonwealth Fund State Scorecard series, but they report some of the largest racial inequities between groups. Others like Mississippi and Oklahoma show substandard performance for all groups, but still report sizable inequities within the state.
Health system performance among Black people is below average in most states and much worse than the best achieved in all states. Health system performance among Latinx/Hispanic people is below average in most states and much worse than the best achieved in all states
Speaking during a briefing for reporters, Blumenthal, former national coordinator for health IT, called the scorecard a comprehensive comparative analysis of how healthcare systems across the U.S. are functioning for people of color. It assesses how healthcare systems are doing when it comes to providing basic quality healthcare services, affordable and accessible care, and effective treatments and follow-up. “The scorecard explores the vital question: Are people of color having different experiences than white people within a state’s health system? Almost always, the answer is yes,” he said.
“There has hardly been a time I can recall when the value of examining states’ healthcare systems has been more apparent. As we have watched states take vastly different approaches to managing COVID-19, the very direct impact of different policy choices and approaches on people's lives and health has been made crystal clear,” he said. “In short, health policies matter to people's day-to-day lives. For generations, federal, state and local leaders have made policy choices that have produced worse health outcomes for people of color, including economics, oppression, residential segregation, and failing to invest in the places where people of color live and work. Policy decisions have also affected access to and quality of health services available to racial and ethnic groups. There is no question that healthcare services are an important source of observed inequities.”
Blumenthal said that structural racism has led to generations of disinvestment in communities of color, chief among the many factors contributing to these pervasive issues. “If we want to get the pandemic under control and mitigate longstanding injustices in our healthcare system and beyond, we need to dismantle the racist policies and practices that have led us here and create a truly equitable healthcare system.”
Six states — Massachusetts, Connecticut, Rhode Island, New York, Hawaii and Oregon — did stand out for having higher than average performance for all racial and ethnic groups measured, added David Radley, Ph.D., a senior scientist tracking health system performance at the Commonwealth Fund and a report co-author. These states also tend to have some of the smallest —albeit still evident — within-state disparities between the groups with the best and worst performance. “In other states like Minnesota, Michigan, and Wisconsin, the performance was particularly strong for white residents, but lacking among Black, Latino and Native Americans, as these states had some of the largest within-state disparities,” he said.
“Almost every state health system performance experienced by white people is better than the average performance achieved among people in all other groups,” he said. There are only a handful of states — for example, Maryland, Michigan, and Pennsylvania, — where some group other than white had higher performance. In each of these cases, the highest-performing group happened to be Asian Americans.
“Even in states with relatively strong performing health systems, people of color, particularly Black, Latino, and Native Americans, have higher mortality, less access to care and are more likely to receive lower quality care than white people,” Radley said.
“It is important to realize that these statistics translate to real people experiencing firsthand the impact of racial inequities on their health, their well-being in their lives,” said Laurie Zephyrin, M.D., the Commonwealth Fund’s vice president for advancing health equity and a co-author of the scorecard report. “As we all know, knowledge is power, and data like this that tells us a very specific story of how people of color are experiencing healthcare where they live can also be used to orient all of our work to create a more equitable healthcare system.”
Advancing health and racial equity in the healthcare system will require policies that confront the underlying structures that have brought us to this point, she added. “We need policies that ensure high-quality and affordable coverage as a really important first step,” Zephyrin said. She cited things like closing the Medicaid coverage gap in the 12 states that haven't expanded Medicaid, addressing postpartum coverage, strengthening primary healthcare, and improving the delivery of services by diversifying the healthcare workforce and supporting the community-based healthcare workforce as important first steps to take.
