The National Academies of Sciences Engineering and Medicine on Wednesday said law and policy changes aimed at eliminating health disparities have made slow and uneven progress improving racial inequities over the past 20 years.
The Ending Unequal Treatment report found that people of color in 2024 are still disproportionately uninsured, underutilizing care services and underrepresented in the healthcare workforce. The report is funded by the National Institutes of Health and Agency for Healthcare Research and Quality and is a follow up to the academies' 2003 study on pervasive inequities in care access, coverage and treatment between patients of color and their white peers.
Related: How health inequity maps out across America
“We’ve made progress in a lot of areas, but it's been inconsistent and we've had some regression in those outcomes,” said Dr. Georges Benjamin, co-chair of the National Academies of Sciences Engineering and Medicine’s report authoring committee.
Life expectancy marginally improved for some ethnic groups during the past two decades, but it dropped for others, according to the report. Life expectancy for white individuals increased slightly from 77.2 years in 2003 to 77.5 years in 2022. Similarly, life expectancy for those who are Black inched up from 72.4 years in 2003 to 72.8 years in 2022.
In contrast, life expectancy for the Hispanic population slid from 80.3 years in 2006 to 80.0 years in 2022 and American Indian and Alaska Native life expectancy dropped from 71.8 years in 2019 to 67.9 years in 2022.
Here are some persistent care inequities and the impacts on communities of color, according to the academies' report.
1. Higher rates of cardiovascular disease, diabetes
Cardiovascular disease is the leading cause of death across the country, and disparities have remained virtually unchanged since the National Academies of Sciences Engineering and Medicine’s 2003 study.
The rates of cardiovascular disease remain highest among Black individuals, followed by Native Hawaiian and Pacific Islander populations, according to the report. White people and American Indian and Alaska Native individuals have the next highest rates.
“We've made substantial improvement as a field improving cardiovascular health with medications and other things, but there are many people that still aren't benefiting from the best hard science that we have,” Benjamin said.
People of color also fare worse when it comes to other serious conditions like cancer, COVID-19 and diabetes. In 2023, 13.6% of American Indian and Alaska Native adults had diabetes, followed by 12.1% of Black adults, 11.7% of Hispanic adults, 9.1% of Asian adults and 6.9% of white adults.
The report recommended federal agencies and health systems research and implement interventions around structural racism and health-related social needs to tackle the disparities. Additionally, the Office of Management and Budget should “more aggressively enforce” required data collection on patients’ race, ethnicity, tribal affiliation and preferred language, the report said.
2. Less access to primary care, clinical services
Minority groups are less likely than white populations to have a primary care provider, according to the report. Similar to data from two decades ago, people of color are still more likely to report that a facility or hospital is their usual source of care, rather than an individual clinician.
Primary care is an important avenue to manage chronic diseases, access preventative services and reduce emergency department visits.
Widespread inequities also exist in certain populations’ access to outpatient specialty care, mental healthcare and substance use disorder services. In 2023, only 35% of Black and Hispanic adults reported receiving substance use disorder treatment, compared to 51% of white adults.
3. Differences in uninsured rates
Uninsured rates have declined for all populations since the National Academies of Sciences Engineering and Medicine’s last report, although disparities in coverage between ethnic groups remain.
Compared with nearly 7% of White adults, 19% of American Indian and Alaska Native adults were uninsured in 2022, according to the report. Hispanic adults were close behind with 18% uninsured, followed by 13% of Native Hawaiian and Pacific Islander adults and 10% of Black adults.
In 2000, 13% of white people were uninsured, compared with 23% of Black people, 35% of Hispanic people and 24% of individuals from other ethnic groups.
For minority populations, the expansion of Medicaid has significantly narrowed racial and ethnic disparities in coverage, the report found. Rates of Medicaid use in Black and Hispanic communities are double white individuals' use rate.
The report suggested states continue to expand Medicaid and Congress works to establish payment policies for Medicaid on par with Medicare.
4. Lack of diversity among nurses, physicians
The healthcare sector has made progress in training and hiring more clinicians of color, although white people still disproportionately outnumber other ethnic groups in the clinical workforce.
Nearly 40% of physicians identify as a person of color, compared with 9% of physicians in 2000. About 20% of registered nurses are people of color, up from 12% of nurses in 2000.
The report found a number of barriers to building a diverse workforce, including socioeconomic burdens, a lack of adequate mentoring and access to educational programs, systemic racism and limited support systems for medical students.
To recruit and retain more clinicians of color, the industry should focus on reducing overly restrictive scope-of-practice limitations while allowing more frequent collaboration with colleagues across disciplines, the report said. It also recommended providing flexible working hours, competitive salaries and opportunities for ongoing professional development and leadership.
5. Positive community-based care interventions
One bright spot over the past 20 years has been the evidence showing positive outcomes from community-based care programs, according to the report.
Hundreds of providers and health systems partnered with community-based organizations to work on improving mental health literacy, reducing hospital readmissions, helping patients navigate available care resources and delivering substance abuse interventions.
Community-based care programs prioritize issues impacting minority group by sending clinicians into neighborhoods, as well as integrating residents and policymakers in traditional settings, the report said.
“We made a big deal about bringing community into this conversation, recognizing that we deliver healthcare not in isolation of the community, but for and within the community,” Benjamin said. “All of government ought to be working to address these social determinants so that people can receive the optimal healthcare that they need.”
