Report details and key findings

For the report, researchers analyzed 25 metrics that track healthcare access, outcomes, and quality of care for five racial/ethnic groups in each U.S. state. Data was taken from CDC, CMS, and the U.S. Census Bureau between 2020 and 2022, making it the first Commonwealth report to analyze health disparities and include data from the COVID-19 pandemic.

Overall, the researchers found significant health disparities nationwide, with Black, Hispanic, and Native Americans having worse outcomes than white or Asian Americans. These disparities were also observed in states that had above-average health system performances for all racial groups, such as Connecticut, Hawaii, New Hampshire, New York, and Rhode Island.

"Health equity does not exist in any state in the U.S.," said David Radley, a senior scientist at the Commonwealth Fund and one of the report's authors.

The researchers also found that Black and Native Americans had higher numbers of premature deaths from preventable causes than other racial/ethnic groups. Rates of preventable, premature deaths were higher for Black populations in nearly every state.

Premature death rates were also higher for Black populations in nearly every state. However, premature death rates were higher for both Black and white populations in six states: Arkansas, Mississippi, Louisiana, Tennessee, Kentucky, and Missouri.

Among Native Americans, the highest rates of premature deaths were in South Dakota, Wyoming, Montana, and North Dakota.

There also continue to be large disparities when it comes to access to care. In almost every U.S. state, Black, Hispanic, and Native residents have higher uninsured rates than white or Asian residents. Hispanic and Black Americans also have much higher uninsured rates than other groups in states that have not expanded Medicaid.

Across all the racial/ethnic groups, Hispanic Americans are the most likely to be uninsured and to go without care due to cost.

Commentary

According to Siobhan Wescott, an Alaska Native physician and professor of American Indian health at the University of Nebraska Medical Center, the report's "findings shine light through the many holes in the U.S. health care system, especially for those who have brown or Black skin."

"It's time to reconsider our priorities or reports like this will be commonplace," she said.

To improve health equity in the United States, leaders at the Commonwealth Fund encouraged both governments and healthcare providers to invest in initiatives targeting disparities. These initiatives include strengthening primary care services in underserved communities, reducing administrative burdens for patients and providers, and boosting access to social services.

"There are deep historical references and policies that create these inequities. If one is trying to solve those inequities outside the healthcare system and really driving the economic engine and the healthcare support into these low-income communities, that will have a significant effect," said Laurie Zephyrin, a physician and SVP of the Commonwealth Fund.

The Commonwealth Fund also recommended that states expand access to Medicaid and Affordable Care Act plans. According to Sara Collins, VP for healthcare coverage and access at the Commonwealth Fund, several states have expanded Medicaid in recent years, including Missouri, Nebraska, and Oklahoma, and she expects health outcomes to improve as a result.

"Insurance coverage is a key part of this," Zephyrin said. "25 million people in the U.S. are still uninsured and they are primarily people of color."

Overall, Joseph Betancourt, president of the Commonwealth Fund, said he hopes the report will encourage states to analyze their own health disparities, understand regional differences, and learn how to improve from other states.

"If you don't look under the hood, you won't identify where you’re failing people and where you’re leaving people behind," Betancourt said.

Advisory Board's health equity resources

For insights on how to improve your organization's health equity efforts, check out these Advisory Board resources:

This research outlines four ways leaders can scale the impact of their health equity goals, as well as increase accountability throughout their organization. Similarly, this guide explains how organizations can move from a pledge to action on health equity, and provides actionable steps for CEOs.

To measure health equity at your organization, we offer both a cheat sheet and a conversation guide. These resources will help you set principled priorities, boost accountability, and address expectations from stakeholders.

This featured page can also help you find more research and insights on specific problems related to health equity, such as workforce challenges, data collection, behavioral health, and more. (McFarling, STAT, 4/18; Goldman, Axios, 4/18; Hartnett, Modern Healthcare, 4/18; Radley et al., Commonwealth Fund, 4/18)