Health Disparities Target Women of Different Racial and Ethnic Groups
A decade after U.S. Surgeon General David Satcher called for the elimination of racial disparities in health, women of color in every state continue to fare worse than white women on a variety of measures of health, health care access and other social determinants of health, according to a new study by the Kaiser Family Foundation.
The report, "Putting Women's Health Care Disparities on the Map: Examining Racial and Ethnic Disparities at the State Level," documents the persistence of disparities on 25 indicators between white women and women of color, including rates of diseases such as diabetes, heart disease, AIDS and cancer, as well as insurance coverage and health screenings. It also documents disparities in the factors that influence health and access to care, such as income and education. Women of color fared worse than white women on most measures and in some cases the disparities were stark.
National statistics mask substantial state-by-state variation in disparities. The report moves beyond national figures to quantify where disparities are greatest, providing new information to help determine how best to combat the problem. The analysis also provides new state-level data for women of many racial and ethnic populations that are often difficult to obtain.
"This report demonstrates that disparities in health are not one problem but many and vary from state to state -- and that a variety of strategies will be needed if we hope to turn things around," said Kaiser President and CEO Drew Altman.
American Indian and Alaska Native Women Experience Some of the Greatest Challenges
Among different racial and ethnic groups, American Indian and Alaska Native women had among the worst outcomes on many health indicators, often twice as high as white women. The percentage of American Indian and Alaska Native women in serious psychological distress was more than 1.5 times that of white women. Native women exhibited the highest rates of smoking and cardiovascular disease and had considerably higher rates of access problems, such as not having a recent checkup and not getting early prenatal care. One in three American Indian and Alaska Native women lived in poverty, and the median household income for such women was less than half that of white women.
At the same time, the report reveals tremendous variation among states within racial and ethnic groups. For example, among white women, the rate of diabetes was 7.5 times as high in West Virginia (6.0%) as in the District of Columbia (0.8%). Among women who are Asian American, Native Hawaiian and other Pacific Islander,10% in Ohio had late or no prenatal care compared to 34% in Utah. Forty-three percent of Hispanic women in Oklahoma had not had a mammogram in the past two years, compared to 14.5% in Massachusetts.
"We conducted this study in an effort to shed light on the many challenges and the variety of experiences women of color face across the nation," said the Foundation's Cara James, the study’s lead author. "We hope that states can use this information as guidance in developing effective solutions to eliminating disparities."
Disparities Vary Among States
Many forces contribute to the levels of disparities in the states. The report examined underlying factors such as poverty levels and high school graduation rates that are often beyond the control of state health officials. It also looked at some factors that officials do have a hand in shaping, such as the scope of states' Medicaid programs, which can influence how many people have health coverage in a state.
The report illustrates that there are substantial gaps across the board in some states, whereas in other states the differences among racial groups are narrower. For instance, Virginia, Maryland, Georgia and Hawaii all had relatively small disparities between women of color and white women on health outcomes, health care access and the social factors that influence health outcomes and access. In contrast, disparities were larger in Arkansas, Indiana, Louisiana, Mississippi, Montana and South Dakota. In some states with relatively small disparities, such as Maine, white women and minority women were doing similarly well. In other states, such as Kentucky and West Virginia, they were doing similarly poorly.