Health Disparities Overview

11/16/2020

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Health disparities—inequities in the quality of health, health care and health outcomes experienced by groups based on social, racial, ethnic, economic and environmental characteristics—persist across the nation.      

Many factors contribute to health disparities, including genetics, access to care, poor quality of care, community features (e.g., inadequate access to healthy foods, poverty, limited personal support systems and violence), environmental conditions (e.g., poor air quality), language barriers and health behaviors. These social, economic and environmental conditions where people live, learn, work and play are known as social determinants of health.

Communities of color, populations with a lower socioeconomic status, rural communities, people with cognitive and physical disabilities and individuals who identify as LGBTQ are often disproportionately exposed to conditions and environments that negatively affect health risks and outcomes and lead to higher rates of health disparities. For example, Americans living in rural areas are more likely to die from unintentional injuries, heart disease, cancer, stroke, chronic lower and respiratory disease than their urban counterparts.

These health disparities account for significant costs to states and communities. According to a 2018 study by the W.K. Kellogg Foundation and Altarum, health disparities cost $42 billion in lowered productivity and $93 billion in excess medical costs each year.

Even when income, health insurance and access to care are accounted for, disparities remain. Disproportionately poor health outcomes – in areas such as infant mortality, life expectancy and prevalence of chronic disease—reveal differences by race and ethnicity independent of other factors. For example, Black people have higher rates of high blood pressure and tend to develop this diagnosis at an earlier age than other racial groups. Similarly, Black and Hispanic people are more likely to suffer strokes

COVID-19

The COVID-19 pandemic has highlighted health disparities across groups based on social, racial, ethnic, economic and environmental characteristics. For example, some members of ethnic and racial minority groups have a higher chance of getting COVID-19 and of experiencing the severe and longer-lasting impacts of the virus. Health care system discrimination, higher uninsured rates, higher rates of employment in essential work settings with minimal or no paid sick days, and increased likelihood of reliance on public transit and crowded housing situations increase COVID-19 exposure to racial and ethnic minority groups that experience lower educational and income levels. Further impacts of the COVID-19 pandemic can be found here.

State Policy Options

Given the various determinants of health and interactions among the factors that influence health disparities, no single policy solution exists to address or eliminate them all. Experts recommend pursuing multiple angles, including policies both in and outside of the health care arena, and considering a combination of policies and strategies to address various determinants. Policymakers seeking to address health disparities may wish to consider the following strategies to determine the most appropriate policies for their states.

Address barriers in access to care

Examine factors leading or contributing to disparities in access to care, such as lack of insurance coverage and challenges navigating the health care system. Consider strategies to remove barriers or pilot new models of paying for and delivering care that address disparities. These state strategies may include supporting community health centers or other facilities reaching underserved communities, using telehealth as a way to improve access and extend providers’ reach, and promoting the use of community health workers or navigators to support patients. In addition, patient-centered medical homes, which aim to improve coordination of care, may help address social determinants of health.

Examine health care workforce needs and consider ways to develop the workforce

Evaluate backgrounds and languages spoken among the existing health care workforce and how those align with the communities being served. In addition to the health care workforce (whose members typically serve individuals), consider examining public health workers (those who focus on community and population health, such as through health screenings and immunizations). Assess other gaps in the workforce, such as geographic distribution or number of Medicaid providers in the community. Look at ways to address gaps and strategies that may fit the state’s needs, such as cultural and linguistic competency standards, recruitment and retention efforts, and pipeline programs for students from underserved communities. For example, the South Dakota Department of Health offers health care providers multiple trainings, webinars, continuing education and self-assessment materials on health equity and cultural competency. 

Support data collection efforts and use data to analyze needs

Work with state officials in public health, minority health, rural health and Medicaid offices when possible to learn more about existing data collection efforts and data needs within the state. Consider ways the state can support data collection around gaps in health care, health care workforce shortages and disparities experienced by specific populations. Use existing data to focus state efforts and resources. For example, the Maryland General Assembly passed legislation in 2004 to establish the Office of Minority Health and Health Disparities, which is active in sharing minority health trend data with stakeholders and engaging minority populations in state health programs. 

Convene stakeholders and support partnerships across sectors

Collaborate with other stakeholders to discuss health disparities in the state, current activities and ways to leverage efforts and existing funding mechanisms. Involve nongovernmental groups, community- and faith-based organizations, schools and other sectors outside of health to promote innovative solutions. Reach out to people who are experiencing the greatest health disparities to ask about their barriers and challenges and involve them in discussions about strategies. Connecticut’s Office of Health Equity, for example, established the Connecticut Multicultural Health Partnership in 2008. This partnership between the state department of public health and public and private partners in the community facilitated work to identify and address health disparities. Similarly, Alabama’s Office of Minority Health strives to engage diverse communities to promote minority presence and participation in health planning and policy formation.

Consider Disparities Using a Social Determinants of Health Lens

Analyze the external factors in the social, economic and environmental landscape that may affect health and health disparities in the state. For example, look at health disparities that exist within the context of other factors like education and income. Along these lines, the 2020 Health Improvement Plan published by the Oklahoma Department of Public Health focuses significantly on how social determinants of health shape the state’s health disparities. Consider policies that may address social determinants as a way to improve health for communities experiencing disparities. Colorado’s Office of Health Equity is charged with implementing strategies to address the varying causes of health disparities, including the economic, physical and social environment.

State Policy Actions

A compilation of health disparities legislation through 2020 is in the process of being updated. Coming soon -  a table of 2021 Introduced and Enacted Health Equity Legislation.

Please note that NCSL takes no position on state legislation or laws mentioned in linked material, nor does NCSL endorse any third-party publications; resources are cited for informational purposes only.

Health disparities are the culmination of a complex array of factors and determinants. Policy can play a key role in addressing its systemic reach in society. While the health care field has traditionally served as the primary setting for policy solutions, aligning other community stakeholders or community resources to create a framework for addressing social determinants of health is key. Eliminating health disparities will likely require a cohesion of multiple strategies, but successful efforts have the potential to increase life expectancy, quality of life and reduce health care spending by millions of dollars.

Additional Resources

NCSL Resources:

External Resources:

Please note that NCSL takes no position on state legislation or laws mentioned in linked material, nor does NCSL endorse any third-party publications; resources are cited for informational purposes only.

Community Health Workers
Patient-Centered Medical Home
Medicaid and Access to Care
Community Collaborations for Health Equity
COVID-19 and Health Disparities