While high costs and varying quality of care affect all of us, they disproportionately impact people of color, non-English speaking residents, and low-income communities - creating racial and ethnic health disparities. For instance, the life expectancy for African-Americans is 73.3 years, five years shorter than it is for whites.  

Diabetes deaths by race underscore the extent of disparities in US health care.  Forty-eight African-Americans per 100,000 people die from complications caused by diabetes, compared to just over 22 deaths among whites.  While whites do have the lowest number of uninsured at 13% -- with the highest uninsured rate in the Hispanic community at 36% -- these disparities are the results of factors much greater than being insured or uninsured.  Insured and uninsured people of color are more likely than whites to receive sub-par care, experience worse health outcomes, and are less likely to receive routine or necessary care. 

The causes of health disparities are complex, systemic, and reflect the racial, class, and ethnic tensions that have for so long shaped American society and culture.  Factors include inadequate access to quality health care services, lack of racial and ethnic diversity in the health care workforce, a lack of cultural competency among providers, higher uninsured rates, toxics and poor environmental conditions such as lead-based paint, inadequate access to parks and recreation for physical activity, smog in inner cities, limited access to healthy foods, inadequate public support for providers serving low-income communities such as community health centers and safety net hospitals, low health literacy, and limited English proficiency. 

As recent reports by the National Women's Law Center (NWLC) have detailed, women similarly face unique challenges obtaining insurance and face greater challenges than men in affording care even with insurance.  Women earn lower wages, experience greater health insecurity and instability, and need more health care than men.  Yet, women face higher out-of-pocket costs as a share of their income, leading more women than men to avoid care because of cost. 

States are taking a leading role in working to eliminate health disparities, as the Opportunity Agenda and Families USA detail in Identifying and Evaluating Equity Provisions in State Health Care Reform.  While more needs to be done, the growing awareness of health disparities will help result in greater adoption of many key policy options described below.

While increased access to coverage will help all state residents, this is not enough to address the cultural, geographic, and institutional barriers to quality health care faced by people of color and low-income communities.  Reform must improve the cultural competency of providers, support the health care infrastructure and safety net, improve coordination among state and local health agencies, and create long-term planning so that quality and affordable health care is provided to all US residents regardless of personal characteristics and circumstances.  


The Opportunity Agenda and Families USA, supported by the Commonwealth Fund -- Identifying and Evaluating Equity Provisions in State Health Care Reform

National Women's Law Center (NWLC) -- Women and Health Coverage: The Affordability Gap, A Framework for Moving Forward, and Making the Grade on Women's Health

Institute of Medicine - Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care

Dartmouth Institute for Health Policy and Clinical Practice, funded by the Robert Wood Johnson Foundation - Disparities in Health and Health Care among Medicare Beneficiaries