All Health Is Local: Health Outcomes Differ by Race and Location
“In U.S. health care, it’s not only who you are that matters, it’s also where you live.” So say the authors of a new study on the uneven quality of health care and the resulting health disparities along racial and geographic lines. A report from the Center for American Progress released last year detailed community-level strategies for evening out racial and ethnic health disparities, a tactic that is now even more relevant, given the new data on geographic differences.
Research has shown for years that minorities face greater risk of complications from heart disease, diabetes, and other common afflictions. Treatable risk factors such as hypertension, low physical activity, tobacco use, infrequent access to care, and obesity are more prevalent among African Americans, American Indians, and Alaska Natives, Hispanics, and Native Hawaiians and Pacific Islanders than among white Americans.
But this report, from the Dartmouth Atlas Project and Robert Wood Johnson Foundation, shows that where you live can also play a determining factor in the care you receive.
Researchers examined Medicare claims for evidence of disparities by race or location and indeed found evidence of both. Blacks, for example, face a risk of leg amputation—a severe complication of peripheral vascular disease and diabetes, which typically results from years of suboptimal care—that is four times greater than whites.
But the rates varied even more starkly by region. The rate of leg amputation for blacks in Mississippi, Louisiana, and South Carolina was found to be about 6 per 1,000. In Colorado and Nevada, it was less than 2 per 1,000. Even the rates for whites in the three southern states—about 1.3 in 1,000—were more than double that of the two western ones.
Other research has also pointed to the importance of location, and specifically the exposure to health risks associated with living in poor neighborhoods, as a factor in health disparities. A recent article in the journal Health Affairs highlighted the link between disadvantaged neighborhoods and detrimental health outcomes such as lower life expectancies. Roughly 76 percent of black children and 69 percent of Latino children living in large metropolitan areas live in neighborhoods that have higher poverty rates than those found in the neighborhoods of the worst-off white children. Many of the states with the highest poverty rates are also located in the South, contributing to the wide disparities in health outcomes seen across state lines.
Health policy leaders are increasingly recognizing the importance of controlling risk factors to reduce disparities. One solution is community programs that work to modify risky health behaviors and risk factors themselves. The Center for Disease Control and Prevention’s Racial and Ethnic Approaches to Community Health, or REACH 2010, and the Department of Health and Human Services’ Office of Minority Health’s two grant programs —Community Programs to Improve Minority Health and the State Partnership Grant Program to Improve Minority Health—have effectively reduced racial and ethnic disparities in targeted subpopulations.
Initial policy steps to reduce disparities even further include increasing and leveraging funding for community programs, increasing the infrastructure capacity for these programs to expand and take hold, and allocating funding for an office of minority health for each state, territory, and district. Other strategies should include improving health providers’ performance—a particular focus of The Robert Wood Johnson Foundation’s new $300 million, three-year initiative intended to narrow the racial and geographic disparities at the community level.
These steps need to be taken sooner rather than later—calculations show, for example, that there would have been 85,000 fewer black deaths overall in the year 2000 alone if health disparities had been eliminated in the 20th century. Live are being lost every day, and there’s no time to waste.