Racial and ethnic disparities in health care are found in every U.S. state, despite the passage of laws over the past two decades aimed at improving health outcomes for minorities and raising awareness of health care disparities, according to a new national report released Wednesday.
The more than 300-page document from the National Academies of Sciences, Engineering, and Medicine details how structural racism and people’s environments have contributed to worse health outcomes for minorities. It also offers recommendations and solutions to healthcare organizations and the federal government, such as a more diverse workforce and adjusting payment systems to make healthcare more affordable.
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Dr. Georges Benjamin, executive director of the American Public Health Association and co-chair of the committee that wrote the report, said Black people in the U.S. face higher rates of maternal and infant mortality, lower life expectancy and a number of chronic diseases.
“Inequities are rampant in our health care system, and if we address them, everyone will benefit,” Benjamin said.
Racism and bias on the part of health care providers also contributed to worse health outcomes, according to the report, which comes 21 years after the organization’s first report.
The committee behind the report suggested that practicing more physicians who come from diverse backgrounds and the communities they serve would improve many problem areas; studies show that people of color generally receive better care when they are treated by people who look like them.
Research also shows that language barriers persist in health care, and that training on how to manage prejudice and become more familiar with cultural issues does not lead to long-term improvements in health outcomes for minorities.
The report recommends that health care systems should work to strengthen relationships between patients and providers — so patients have a say in their treatment — and include important community voices.
“Health systems must work closely with the community to understand what their needs are, and engage them early and often,” Benjamin said.
Policies designed to close racial and ethnic gaps in access to health care have not been widely implemented, and there has been little oversight to ensure they are being implemented, the report said. It cited 10 states that have not yet expanded Medicaid under the Affordable Care Act, with legal challenges blocking widespread implementation of several provisions.
The report’s authors urge Congress, the U.S. Department of Health and Human Services, the National Institutes of Health and the Centers for Medicare & Medicaid Services to better coordinate their health care parity plans — which the report says are disparate — and to establish a federal oversight body to oversee implementation of these plans.
Other suggested steps include collecting better health care data at the federal level and providing more funding for research and programs that reduce racial and ethnic disparities.
Dr. Lisa Cooper, director of the Johns Hopkins Center for Health Equity and one of the report’s reviewers, said the quality of health care in the U.S. is not as good as in other high-income countries “because we have not addressed health inequities.” She said this has become even more evident during the COVID-19 pandemic.
“We will only make progress if we pay serious attention to this issue,” he said. “We are failing everyone in our health care system. It’s just that some groups of people are suffering more.”
Benjamin said the recommendations must be implemented, even if it takes years. If that doesn’t happen, people will continue to die “needlessly, unjustly,” he said.
