The COVID-19 pandemic has brought the issue of disparities in health and health care into sharp focus. The pandemic’s impacts have been uneven, with people of color bearing the heaviest burden in terms of negative impacts on health and well-being as well as economic impacts. However, health and health care disparities are not new. They have been documented for decades and reflect longstanding structural and systemic inequities rooted in racism and discrimination. While inequities in access to and use of health care contribute to disparities in health, inequities across broader social and economic factors that drive health, often referred to as social determinants of health, also play a major role. Using data to identify disparities and the factors that drive them is important for directing resources and efforts to address them and assessing progress toward achieving greater equity over time. To provide insight into the status of racial disparities in health and health care, this analysis examines how people of color fare compared to White people across measures of health coverage, access, and use; health status, outcomes, and behaviors; and social determinants of health. Where possible, we present data for six racial/ethnic groups: White, Asian, Hispanic, Black, American Indian and Alaska Native (AIAN), and Native Hawaiian and Other Pacific Islander (NHOPI). People of Hispanic origin may be of any race, but we classify them as Hispanic for this analysis. We limit other groups to people who identify as non-Hispanic. All differences described in the text are statistically significant. We use the most recent data available from a broad range of federal survey and administrative datasets, which largely represent experiences prior to the COVID-19 pandemic (see Data Sources). This analysis finds:
Together these data show that, prior to the pandemic, people of color fared worse compared to White people across a broad range of measures related to health and health care, particularly Black, Hispanic, and AIAN people. However, patterns vary across measures and there are variations in experiences within the broad racial and ethnic classifications used for this analysis. Many of these underlying disparities placed people of color at increased risk for negative health and economic impacts from the COVID-19 pandemic. Moreover, the pandemic has exacerbated many of these disparities and may contribute to widening disparities in the future. Data show that people of color are at higher risk for COVID-19 infection, hospitalization, and death compared to their White counterparts and have suffered more significant negative social and economic impacts. Despite being disproportionately affected by the pandemic, Black and Hispanic people have been less likely than White people to receive COVID-19 vaccines, although these differences have narrowed over time, and this gap has closed for Hispanic people. The data highlight the importance of efforts to address disparities in health and health care and show that it will be key for such efforts to address factors both within and beyond the health care system. Addressing these inequities is not only important for mitigating the disparate impacts of the COVID-19 pandemic but also for preventing further widening of disparities going forward. While these data provide insight into the status of disparities, ongoing data gaps and limitations hamper the ability to get a complete picture of disparities, particularly for smaller population groups. Further, data reported by these broad racial and ethnic categories often masks disparities among subgroups of the populations. As the share of people who identify as multiracial grows, it also will be important to develop improved methods for classifying and understanding their experiences. Going forward, reassessment of how data are collected and reported by race/ethnicity will be important for providing more nuanced understanding of disparities and, in turn, improved efforts to address them. Background: Racial Diversity within the U.S. TodayAs of 2019, 40% of the total population in the United States were people of color (Figure 2). This group included 19% who were Hispanic, 12% who were Black, 6% who were Asian, 1% who were American Indian or Alaska Native (AIAN), less than 1% who were Native Hawaiian or Other Pacific Islander (NHOPI), and 3% who identified as another racial category, including individuals who identified as more than one race. The remaining 60% of the population were White. The share of the population who are people of color has been growing over time, with the largest growth occurring among those who identify as Hispanic or Asian. Certain areas of the country, particularly the South, are more racially diverse than others (Figure 3). Overall, the share of the population who are people of color ranges from below 10% in Maine, Vermont and West Virginia to over half of the population in California, District of Columbia, Hawaii, Maryland, Nevada, New Mexico, and Texas. Most people of color live in the South and West, with more than half (59%) of the Black population residing in the South while, overall, nearly eight in ten Hispanic people live in the West (39%) and in the South (38%). Over three quarters of the NHOPI population (77%), almost half (47%) of the AIAN population, and 44% of the Asian population live in the Western region of the country. People of color are younger compared to White people. Hispanic people are the youngest population, with 33% below age 18, and 57% below age 34 (Figure 4). Roughly half of Black (49%), AIAN (49%), and NHOPI (51%) people are below age 34, compared to 44% of Asian people and 39% of White people.
Preventable Health Disparities Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by populations that have been disadvantaged by their social or economic status, geographic location, and environment.[1] Many populations experience health disparities, including people from some racial and ethnic minority groups, people with disabilities, women, people who are LGBTQI+ (lesbian, gay, bisexual, transgender, queer, intersex, or other), people with limited English proficiency, and other groups. Across the country, people in some racial and ethnic minority groups experience higher rates of poor health and disease for a range of health conditions, including diabetes, hypertension, obesity, asthma, heart disease, cancer, and preterm birth, when compared to their White counterparts. For example, the average life expectancy among Black or African American people in the United States is four years lower than that of White people.[3] These disparities sometimes persist even when accounting for other demographic and socioeconomic factors, such as age or income. Communities can prevent health disparities when community- and faith-based organizations, employers, healthcare systems and providers, public health agencies, and policymakers work together to develop policies, programs, and systems based on a health equity framework and community needs. Social determinants of health are the conditions in the places where people live, learn, work, play, and worship that affect a wide range of health risks and outcomes. Long-standing inequities in six key areas of social determinants of health are interrelated and influence a wide range of health and quality-of-life risks and outcomes. Examining these layered health and social inequities can help us better understand how to promote health equity and improve health outcomes.
A person’s social and community context includes their interactions with the places they live, work, learn, play, and worship and their relationships with family, friends, co-workers, community members, and institutions.[4] Interventions are critical to protecting the health and well-being of people who do not get the level of support they need to thrive from their social and community context. For example, children of incarcerated or detained parents may gain from their parents’ participation in reentry programs that assist with job placement or offer parenting support,[5] and lesbian, gay or bi-sexual high school students who are bullied would benefit from school-based programs to reduce violence and prevent bullying.[6] Social and community context also includes discrimination – or the unfair treatment of people or groups based on characteristics such as race, gender, age, or sexual orientation. Discrimination exists in many systems in society including those meant to protect well-being or health such as health care, housing, education, criminal justice, and finance.[7] Discrimination often has a negative effect on the people and groups who experience it and some people who belong to groups that historically have experienced discrimination, such as people with disabilities, people experiencing homelessness, and people who are incarcerated or detained. As a result, people who have experienced discrimination may be affected by layered health and social inequities. A growing body of research shows that racism has occurred for centuries at many levels in society in the United States and has had a negative impact on communities of color.[8] Racism is a system, supported and maintained through institutional structures and policies, cultural norms and values, and individual behaviors.[9] There are various forms of racism that—for more than 400 years—have defined and created most of the inequitable structures that exist in our society and lead to health inequities today. The three types of racism include:
Racism determines opportunity based on the way people look or the color of their skin. It also shapes social and economic factors that put some people from racial and ethnic minority groups at increased risk for negative mental health outcomes and health-related behaviors, as well as chronic and toxic stress or inflammation.[11],[12] Racism prevents millions of people from attaining their highest level of health, and consequently, affects the health of our nation.
People with disabilities and people from some racial and ethnic minority groups, rural areas, and White populations with lower incomes are more likely to face multiple barriers to accessing health care.[13][14] For example, structural barriers related to socioeconomic status, such as lack of insurance,[15] transportation, childcare, or ability to take time off work, can make it hard to go to the doctor. Cultural differences between patients and providers as well as language barriers affect patient-provider interactions and health care quality.[16] Inequities in treatment[17] and historical events, like the Tuskegee Study of Untreated Syphilis in the African American Male and sterilization of American Indian women without their permission, might also explain why some people from racial and ethnic minority groups do not trust health care systems and the government’s health-related guidance.[18],[19],[20],[21]
People from racial and ethnic minority groups are disproportionately affected by difficulties finding affordable and quality housing. The practice of redlining or denying mortgages among people of color – and as a result, access to public transportation, supermarkets, and health care – has contributed to segregation of cities in the United States. Although the U.S. Federal Government has enacted legislation since the 1970’s to reduce the segregation of cities,[22] this historical discriminatory practice has limited housing options among racial and ethnic minority groups to neighborhoods and residences that have school districts with inadequate funding, higher crime rates, and poorly resourced infrastructure. These conditions may make illnesses, diseases, and injuries more common and more severe among these groups. In addition, access to nutritious, affordable foods may be limited for these groups, and they may experience more environmental pollution within their neighborhoods.[23],24]
Not all workers have the same risk of experiencing a work-related health problem, even when they have the same job. Occupational health inequities are avoidable differences in work-related disease incidence, mental illness, or morbidity and mortality that are closely linked with social, economic, and/or environmental disadvantage, such as temporary work arrangements, socio-demographic characteristics (e.g., age, sex, gender identity, race, or class), and organizational factors (e.g., lack of worker safety measures, limited or no health insurance benefits).
People who have been historically marginalized, such as people from racial and ethnic minority groups, people with disabilities, and people with lower incomes, are disproportionately affected by inequities in access to high-quality education. [13][14] Policies that link public school funding to the tax base of a neighborhood limit the resources available in schools of lower income neighborhoods. This results in lower-quality education for residents of lower income neighborhoods, which can lead to lower literacy and numeracy levels, lower high school completion rates, and barriers to college entrance. In addition to educational barriers, limited access to quality job training or programs tailored to the language needs of some racial and ethnic minority groups may limit future job options and lead to lower paying or less stable jobs.
People from some racial and ethnic minority groups and other historically marginalized groups also face greater challenges in getting higher paying jobs with good benefits due to less access to high-quality education,[25] geographic location, language differences, discrimination, and transportation barriers. People with limited job options often have lower incomes, experience barriers to wealth accumulation, and carry greater debt. The historical practice of redlining and denying mortgages to people of color has also created a lack of opportunity for home ownership, and thus wealth accumulation, due to the inability to pass down property and build wealth. Such financial challenges may make it difficult to manage expenses, pay medical bills, and access affordable quality housing, education, nutritious food, and reliable childcare. CDC is transforming its public health research, surveillance, and implementation science efforts to expand beyond listing the markers of health inequities to identifying and addressing the drivers of these disparities. Through the CORE strategy, CDC is integrating health equity as a foundational element across our work – from science and research, to programs, partnerships, and workforce. As part of the initiative, OMHHE has adopted four CORE goals. OMHHE will facilitate and accelerate health equity principles’ adoption across CDC programs, policies, data systems, and funding structures. OMHHE is working to:
Potential Impact: National, state, local, tribal, and territorial public health staff will have a better understanding of health equity, the increased capacity to use data to integrate health equity into public health systems and interventions, and ultimately eliminate health disparities in the communities they serve. Goal in Action: CDC’s CORE Commitment to Health Equity Science and Intervention Strategy OMHHE/Office of Women’s Health will collaborate with partners to address and reduce the impact of gender discrimination and gendered racism in the workplace. OMHHE is collaborating with internal and external partners to:
Potential Impact: Systems changes will occur in the workplace, including workplaces that set the standard for gender equity best practices, that decrease experiences of gender discrimination and gendered racism, and ultimately, improve mental and physical health among people of all gender identities. Goal in Action: Evaluation of data on perceptions and experiences of gender discrimination and gendered racism in the workplace. OMHHE will mobilize partners to develop and implement strategies addressing health disparities and long-standing inequities including social determinants of health. OMHHE is providing guidance and support to partners who respond to public health needs to:
Potential Impact: CDC partners will be engaged and ready to respond to public health emergencies and address long-standing health inequities, health disparities, and structural and social determinants of health. Goal in Action: National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities OMHHE will transform the public health workforce to ensure diversity and health equity competencies in existing and future staff. OMHHE collaborates with internal and external partners to:
Potential Impact: National, state, local, tribal, and territorial public health agencies will have increased opportunity to support underserved undergraduate students and the current public health workforce with learning how to integrate health equity competencies into public health work. Ultimately, we will create a public health workforce that reflects the communities we serve and is responsive to the country’s changing demographics. Goal in Action: CDC OMHHE Student Programs You—as a community member or member of an organization—can join the effort to ensure that all people have equitable access to resources to maintain and manage their physical and mental health, including easy access to important information, goods and services, and affordable medical and mental health care. Community- and faith-based organizations, employers, healthcare systems and providers, public health agencies, policy makers, and others play a key part in promoting fair access to health, improving opportunity, and ensuring all communities can thrive. Communities can promote health equity by adopting policies, programs, and practices that:
Below are examples of additional actions that organizations and agencies can take to support health equity. Community and faith-based organizations can:
State, tribal, local, and territorial governments can:
[1] Office of Disease Prevention and Health Promotion. (2021, August 11). Healthy People 2020: Disparities. U.S. Department of Health and Human Services. Retrieved August 13, 2021, from https://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities. |