There also are longstanding disparities in health care. The Affordable Care Act health coverage expansions led to large gains in coverage across groups. Despite these gains, however, people of color and low-income individuals remain at increased risk of being uninsured Figure 3 , contributing to greater barriers to accessing health care. Further, starting in , coverage gains stalled and began reversing, reflecting a range of actions by the Trump administration, including decreased funding for outreach and enrollment assistance, approval of state waivers to add new eligibility restrictions for Medicaid coverage, and immigration policy changes that increased fears among immigrant families about participating in Medicaid and CHIP.
These coverage losses eroded some of the previous coverage gains under the ACA, particularly among Hispanic people , who already were at increased risk of being uninsured. Coverage losses have likely continued due to the COVID pandemic as people have lost jobs and experienced declining income. Beyond disparities in coverage, people of color and lower income individuals also receive poorer quality of care. Figure 3: People of color face longstanding disparities in health coverage. The higher rates of illness and death among people of color reflect increased risk of exposure to the virus due to living, working, and transportation situations, increased risk of experiencing serious illness if infected due to higher rates of underlying health conditions, and increased barriers to testing and treatment due to existing disparities in access to health care.
Beyond the direct health impacts of the virus, the pandemic has taken a disproportionate toll on the financial security and mental health and well-being of people of color, low-income people, LGBT people , and other underserved groups. As of late March , Black and Hispanic adults were more likely than White adults to report lack of confidence in their ability to make their next housing payment and to report food insufficiency.
Despite being disproportionately affected by the pandemic, as of April , Black and Hispanic people were less likely than White people to have received a COVID vaccine. Data across states show a consistent pattern of Black and Hispanic people receiving smaller shares of vaccinations compared to their shares of cases, deaths, and the total population, resulting in lower vaccination rates compared to their White counterparts.
While vaccination rates are increasing across all groups, the gaps in vaccination rates for Black and Hispanic people are persisting Figure 5. These disparities in vaccinations reflect the longstanding inequities that create increased barriers to health care for people of color and other underserved groups. Moreover, they leave people of color at increased risk for infection and illness and hinder efforts to achieve population level immunity.
Figure 5: Although vaccination rates are increasing across groups, Black and Hispanic people face persistent gaps. People of color and other underserved groups experience higher rates of illness and death across a wide range of health conditions, limiting the overall health of the nation. Research further finds that health disparities are costly. As the population becomes more diverse, with people of color projected to account for over half of the population by Figure 5 , it is increasingly important to address disparities.
Figure 6: People of color are projected to make up over half of the U. The COVID pandemic has exacerbated underlying disparities in health and health care and increased the importance of addressing them.
As such, prioritizing equity in COVID response efforts is not only important for mitigating the disproportionate impacts of the pandemic itself, but for protecting against even larger health disparities in the future. The Biden administration has identified racial equity, including health equity, as a key priority , which has been reflected in several recent agency actions.
Immediately after taking office, President Biden issued a series of executive orders and actions focused on advancing health equity.
The challenge of eliminating health disparities calls us to expand our ways of thinking about what to research and how to do it. Two approaches, interdisciplinary research and community participatory techniques, have shown exciting promise in reducing health disparities.
Moreover, community participatory projects have not only identified new solutions, but also improved buy-in by communities of both new and traditional health interventions Minkler, M. Community Based Participatory Research for Health. San Francisco: Jossey Bass.
Poorer health profiles and outcomes for African Americans and other minorities present not only a medical challenge, but also a moral mandate for the United States. In the states of the old South, this challenge and mandate are especially urgent. In Healthy People , it was to eliminate, not just reduce, health disparities. In Healthy People , that goal was expanded even further: to achieve health equity, eliminate disparities, and improve the health of all groups.
Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.
Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.
Over the years, efforts to eliminate disparities and achieve health equity have focused primarily on diseases or illnesses and on health care services. However, the absence of disease does not automatically equate to good health.
Powerful, complex relationships exist between health and biology, genetics, and individual behavior, and between health and health services, socioeconomic status, the physical environment, discrimination, racism, literacy levels, and legislative policies. Throughout the next decade, Healthy People will assess health disparities in the U. Census Bureau, American FactFinder.
American Community Survey. ACS demographic and housing estimates: [cited November 7].
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