Advancing Racial Equity In U S Health Care State Disparities

Leo Migdal

-Dec 3, 2025, 12:53 PM

advancing racial equity in u s health care state disparities

Dr. Reshma Chugani checks 7-year-old Zoe Oliver’s ears during a medical visit at Atlanta Children’s Clinical Center on September 29, 2023. Health care system performance varies widely by race and ethnicity, both within states and between states. Photo: Alyssa Pointer for the Washington Post via Getty Images Dr. Reshma Chugani checks 7-year-old Zoe Oliver’s ears during a medical visit at Atlanta Children’s Clinical Center on September 29, 2023.

Health care system performance varies widely by race and ethnicity, both within states and between states. Photo: Alyssa Pointer for the Washington Post via Getty Images Deep-seated racial and ethnic health disparities persist across the United States, even in states with otherwise high-performing health systems American Indians and Black Americans die at significantly higher rates from preventable and treatable causes than members of other racial and ethnic groups Deep-seated racial and ethnic health disparities persist across the United States, even in states with otherwise high-performing health systems Address for Correspondence: Wendy L Macias-Konstantopoulos, MD, Center for Social Justice and Health Equity, Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street Zero Emerson, Suite 3B, Boston, Massachusetts...

Email: wmacias@mgh.harvard.edu Received 2022 Aug 15; Revised 2023 Apr 17; Accepted 2023 May 24; Issue date 2023 Sep. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/ An overwhelming body of evidence points to an inextricable link between race and health disparities in the United States. Although race is best understood as a social construct, its role in health outcomes has historically been attributed to increasingly debunked theories of underlying biological and genetic differences across races.

Recently, growing calls for health equity and social justice have raised awareness of the impact of implicit bias and structural racism on social determinants of health, healthcare quality, and ultimately, health outcomes. This more nuanced recognition of the role of race in health disparities has, in turn, facilitated introspective racial disparities research, root cause analyses, and changes in practice within the medical community. Examining the complex interplay between race, social determinants of health, and health outcomes allows systems of health to create mechanisms for checks and balances that mitigate unfair and avoidable health inequalities. As one of the specialties most intertwined with social medicine, emergency medicine (EM) is ideally positioned to address racism in medicine, develop health equity metrics, monitor disparities in clinical performance data, identify research gaps,... In this critical review our aim was to (a) provide a synopsis of racial disparities across a broad scope of clinical pathology interests addressed in emergency departments—communicable diseases, non-communicable conditions, and injuries—and (b) through... For nearly two decades, the Commonwealth Fund has tracked health and health care in each state, seeking both to understand how the policy choices we make affect people’s health outcomes and to motivate the...

But assessing how well a state performs on average can mask the profound inequities that many people experience. This report evaluates disparities in health and health care across racial and ethnic groups, both within states and between U.S. states. We collected data for 25 indicators of health system performance, specifically focusing on health outcomes, access to health care, and quality and use of health care services for Black, white, Hispanic, American Indian and... We then produced a health system performance “score” for each of the five racial and ethnic groups in every state where we were able to make direct comparisons between those groups and between groups... (For complete details on our methods, see How We Measure Performance of States’ Health Care Systems for Racial and Ethnic Groups.)

Our hope is that policymakers, health system leaders, and community stakeholders will use this tool to investigate the impact of current and past health policies on different racial and ethnic groups and to take... Researchers found health system performance is worse for many people of color. Racial and ethnic disparities in health care are evident in every state, even those with robust health systems, according to a new analysis from the Commonwealth Fund. In the analysis from the organization, which is aimed at promoting equitable health care, researchers found health system performance is markedly worse for many people of color compared to white people. "Even among high performing states, we see significant disparities," Joseph Betancourt, M.D., President of the Commonwealth Fund, said in a report on the organization’s updated findings. Six states were found to have better-than-average health system performance among all racial or ethnic groups, including Rhode Island, Massachusetts, Connecticut, Hawaii, New Hampshire and New York.

However, even among these high-scoring health systems, racial disparities were observed. A new Commonwealth Fund report evaluates disparities in health and healthcare across racial and ethnic groups, both within states and between U.S. states. The authors collected data for 25 indicators of health system performance, specifically focusing on health outcomes, access to healthcare, and quality and use of healthcare services for Black, White, Hispanic, American Indian and Alaska... The report provides a health system performance “score” for each of the five racial and ethnic groups in every state to make direct comparisons between those groups and between groups in other states. In recent years, there has been a growing focus on addressing health disparities and advancing health equity.

This growth was spurred by incidents in 2020, including the COVID-19 pandemic, which highlighted the disproportionate impact of the virus on low-income people and people of color in the U.S. in addition to the police killings of George Floyd, Breonna Taylor, and others that increased attention to systemic racism that contributes to inequities such as health disparities. While the federal government can play a key role in addressing inequities, states also play a pivotal role, as they set policies, allocate resources, and administer many services and programs that are important for... Moreover, states have varying demographics, population needs, and political leadership, which may shape efforts to address health disparities and promote health equity. Efforts at the federal level are expected to shift under the Trump Administration, given that, during his first term, he took executive action to prohibit federal agencies and contractors from providing training addressing racism... As such, understanding state actions in this area may be of increasing importance.

This analysis focuses on current state efforts, many of which were implemented during or after 2020, to address health disparities and advance health equity based on a review of publicly available materials from all... In addition, case study interviews were conducted with 14 stakeholders in three states (California, North Dakota, and Michigan) to increase understanding of the factors contributing to success of these state initiatives, lessons learned, and... The case study initiatives reflect some of the broad themes of state-level activities identified through the analysis of publicly available materials and include states with varied geography, racial and ethnic demographics, and political leadership... This analysis shows that states with varying geography, demographics, and political leadership are pursuing work to address health disparities. However, states range in the level of commitment and resources focused on this work. While some states are taking more incremental steps, others have identified this work as a major cross-sector strategic priority, established dedicated infrastructure and resources to support this work, taken steps to empower and support...

As a result of these efforts, states have directed increased staff and resources to this work, established infrastructure and/or policies that facilitate community input to inform state decision-making and program implementation, increased funding to... In particular, the establishment of new infrastructure and policies to address disparities and advance equity may facilitate sustainability of this work amidst potential turnover in staff and leadership. Case study respondents highlighted factors that contributed to the success of initiatives and potential lessons for other states, including the presence of strong state leaders and champions, developing trusted and authentic relationships between the... This information may help inform state efforts to address health disparities and advance health equity by identifying potential strategies and approaches states may consider and factors that contribute to success. It is subject to limitations. While we sought to be comprehensive in our review, states may have activities underway that are not reflected in public-facing materials.

It is also possible that new activities have begun, concluded, or been retracted after our data collection period. Moreover, while this analysis provides greater insight into the range of state-reported activities to address health disparities and/or equity, it does not give insight into the effectiveness or outcomes associated with these actions. Future work examining the impacts of these efforts on state operations and disparities in health care and health outcomes will be important to help guide ongoing efforts to address health disparities and advance greater... Deep-seated racial and ethnic disparities in health care access, quality, and outcomes persist across all US states, a new Commonwealth Fund report finds. Part of the Fund’s ongoing series examining state health system performance, Advancing Racial Equity in U.S. Health Care: The Commonwealth Fund 2024 State Health Disparities Report, evaluates states on 25 measures of health care access, quality, service use, and health outcomes for Black, white, Hispanic, American Indian and Alaska Native...

Find out where your state ranks and how we can achieve more equitable healthcare systems in each state. Devna Bose, Associated Press Devna Bose, Associated Press Racial and ethnic inequities in health care are found in every state in the U.S. despite the passage of legislation intended to improve health outcomes for minorities and increased awareness of health care disparities over the past two decades, according to a new national report released Wednesday. The 300-plus-page document from the National Academies of Sciences, Engineering, and Medicine detailed how structural racism and people’s surroundings have contributed to worse health outcomes for minorities. It also offers recommendations and solutions to health care organizations and the federal government, like a more diverse workforce and adjusting payment systems to make health care more affordable.

WATCH: President Joe Biden and Bernie Sanders join forces to promote lower health care costs Dr. Georges Benjamin, executive director of the American Public Health Association and co-chair of the committee that wrote the report, said people of color in the U.S. are more likely to experience maternal and infant mortality, lower life expectancy and many chronic diseases.

Advancing Racial Equity In U S Health Care State Disparities

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