Racial and Ethnic Health Disparities What State Legislators Need to Know Racial and Ethnic Health Disparities: What State Legislators Need to Know

Racial and Ethnic Health Disparities What State Legislators Need to Know Racial and Ethnic Health Disparities: What State Legislators Need to Know The National Conference of State Legislatures is the bipartisan organization that serves the legislators and staffs of the states, commonwealths and territories. NCSL provides research, technical assistance and opportunities for policymakers to exchange ideas on the most pressing state issues and is an effective and respected advocate for the interests of the states in the American federal system. Its objectives are: • To improve the quality and effectiveness of state legislatures. • To promote policy innovation and communication among state legislatures. • To ensure state legislatures a strong, cohesive voice in the federal system. The Conference operates from offices in Denver, Colorado, and Washington, D.C. Printed on recycled paper. © 2013 by the National Conference of State Legislatures. All rights reserved. ISBN 978-1-58024-709-2 National Conference of State Legislatures l 2 Racial and Ethnic Health Disparities: What State Legislators Need to Know mericans are living longer, healthier lives than ever before because of social, Health outcomes include public health and medical technology advances. Not every community benefits whether a disease or Aequally from these improvements, however. Persistent and well-documented condition gets better or health disparities exist between various racial and ethnic populations, even when ac- worse, what the costs of counting for economic status. Health disparities—differences in health outcomes care are, and how satisfied among groups—often are driven by the social conditions in which people live, learn, patients are with the care work and play. In the United States, these differences are caused by a complex array of they receive. It focuses factors, which makes it impossible to devise a single policy solution for all instances of not on what is done for health inequality. patients, but what results This brief provides state legislators with an overview of health disparities that affect from what is done. various ethnic and racial minorities, existing strategies used to address them, and policy Source: http://myhealthoutcomes. options for lawmakers to consider that may offer effective solutions to these issues. com/faqs/3000 Social Determinants of Health Factors influencing health may be biological, socioeconomic, psychosocial, Social Determinants of Health behavioral or social in nature. Scientists generally recognize the following five Social determinants of health determinants of health for a population.1 include social and physical environments, available health • Biology and genetics (e.g., gender and age). services, and structural and so- cietal factors that affect people’s • Individual behavior (e.g., alcohol abuse, unhealthy diet, lack of exer- overall health. cise, injection drug use [needles], unprotected sex and smoking). • Social environment (e.g., discrimination, income and gender). • Physical environment (e.g., physical conditions where a person lives, works, goes to school and plays). • Health services (e.g., access to quality health care, having a usual source of care, and having or not having health insurance). On average, medical services rendered by a doctor, clinic or hospital determine about 20 percent of a patient’s overall health, according to a study by the University of Wisconsin Population Health Institute— other studies have found this percentage to be even less. About 80 percent of people’s health is the result of socioeconomic status, physical environment, health behaviors and biology. Thirty percent of overall health, for example, is determined by individual lifestyle choices and behavior, such as smoking, excessive alcohol use, poor diet, lack of exercise and unsafe sexual activity. In the past, much of the money invested in and strategies used to address health disparities centered on clinical services. More recently, policymakers also are turning to innovative models to address the social determinants of health. National Conference of State Legislatures l 3 Racial and Ethnic Health Disparities: What State Legislators Need to Know It is important to recognize that the determinants of health do not occur in isolation of each other, however. Therefore, a continual challenge for lawmakers in discussing the social determinants of health is which, if any, policies can make a difference. Education practices that improve reading comprehension and high school completion rates, for instance, can help people manage their health. In addition, health varies with education; people with higher education levels experience better health. Policies that ensure healthy food is available for purchase and create safe communities for citizens to walk and bike also can have a long-term effect on health, as another example. Access to Quality Care One of the most noticeable health inequities between whites and minorities in the United States is insurance coverage. In 2011, the U.S. Department of Health and Human Services found whites were uninsured at a much lower rate (11.7 percent) than African Americans (20.8 percent) or Hispanics (30.7 percent). Of the nation’s 47 million uninsured, half are of minority backgrounds, although they represent only one-third of the U.S. population. Lack of insurance contributes to disparities in both access to health care and quality of care. Medicaid’s Role in Increasing Access for Uninsured racial and ethnic minority popu- Ethnic and Racial Minorities lations face multiple challenges in accessing health care; they often experience lower qual- One way for states to address health disparities is to improve access to ity care and are less likely to receive preven- health coverage on families and individuals. Most uninsured minori- tive care and routine medical check-ups.2 The ties work, but do not have employer-sponsored health insurance Agency for Healthcare Research and Quality coverage. The recent recession further exacerbated the problem that found that race and ethnicity were the sec- a disproportionate number of minorities have to access insurance. ond and third leading indicators, after lack of According to the Kaiser Commission on Medicaid and the Uninsured, insurance, in determining which Americans 28 percent of African Americans and 38 percent of Hispanic Americans were unable to receive or experienced delays in reported losing a job during the downturn. As a result, more minori- receiving necessary health care, medication or ties enrolled in Medicaid for their health insurance coverage. Between dental care. Uninsured minorities also are less 2007 and 2009, Medicaid added 1.4 million African American and likely to have a usual source of care (a facility 2.5 million Hispanic beneficiaries. In total, 27 percent of both African where one receives care regularly) and therefore American and Hispanic American populations rely on Medicaid. are more likely to resort to more costly ambula- 3 The Affordable Care Act provided two primary paths to increasing tory care facilities such as emergency rooms. health coverage for the uninsured: providing subsidies for private In 2006, for example, emergency room visits insurance purchase through health insurance marketplaces for people by African Americans were almost twice those with incomes between 100 percent and 400 percent of federal pov- made by whites.4 Less available access to nearby erty guidelines; and expanding Medicaid to cover virtually all Ameri- preventive care and usual care is an important cans with incomes up to 138 percent of poverty. When the June 2012 factor that contributes to health disparities Supreme Court Ruling made the Medicaid expansion optional, it left among Americans. the expansion decision up to individual states. States’ decisions about the Medicaid expansion will affect their insurance coverage rates for For some racial and ethnic minority people, a people with incomes below the poverty level. language barrier also affects health care access and quality. A study by the University of Mis- souri found that people who speak English were significantly more likely to have a usual source of care (82.3 percent) than those who speak Spanish (63.2 percent) or another language (71.9 percent).5 Spanish speakers were more than eight times as likely to never have had their blood pressure checked and almost twice as likely to never have had their cholesterol checked.6 National Conference of State Legislatures l 4 Racial and Ethnic Health Disparities: What State Legislators Need to Know The Aging of Minorities The population of minorities over age 65 is expected to expand rapidly in the future. Between 2010 and 2020, the proportion of elderly Americans who belong to a minority group will increase from 20 percent to 24 percent.7 There were 1.4 million elderly Asian Americans in 2010; in 2050, that number will grow to 7.6 million. The number of African-American elderly will expand from 3.3 million to 9.9 million in the same time period, and Pacific Islanders and American Indians will grow from 235,000 to almost 1 million. The most dramatic change will occur with Hispanics, where the elderly population will expand from 2.9 million to 17.5 million.8 Minorities in Rural Communities Rural Americans face disparities in health compared to their urban peers, and for minorities in rural areas, these disparities are even more pronounced. Rural minorities experience higher rates than their peers of illness and death from conditions such as asthma,

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