Everyone deserves the opportunity to live a healthy life, regardless of where they live, how much they make, or who they are.
Geographic, class, and racial disparities in health divide our country and make the vision of a healthy America impossible. Too many Americans lack adequate access to health care. Even more are in poor health because of inequities in community conditions, like income levels, racism, housing stability, access to nutritious food, neighborhood safety, public education, economic opportunity, and more.
Everyone deserves the opportunity to live a healthy life, regardless of where they live, how much they make, or who they are. Creating a truly healthy nation for all means securing universal health care coverage. It also requires investing in the community conditions that determine health.
- In the U.S., the all-cause mortality rate is 16% greater for African Americans compared to white Americans.
- Life expectancy differs based on income, with the richest 1% of men living an average of 14.6 years longer than the poorest 1%.
- In 2014, life expectancy at birth was 75.6 years for blacks and 79.0 years for whites, according to the CDC.
- Life expectancy varies widely based on neighborhood; in some parts of the country, life expectancy differs by as much as 20 years between towns only about five miles apart from one another.
A large body of research has shown that health outcomes are determined not only by access to health care, but also by social and community factors, what experts call community conditions. These community conditions include housing stability, access to nutritious food, public education, economic opportunity. Despite the U.S. spending more on health care than any other developed country, the health of Americans remains poor—in part because we are not investing enough in the community conditions that determine health from the start.
Racial/ethnic health disparities
Racism in our health care system and our society more broadly drives and maintains racial and ethnic health disparities. Black men are less likely to receive a colonoscopy, and black women are less likely to receive definitive breast cancer therapy, compared to white patients, which has led to persistent disparities in cancer death rates, the American Cancer Society reports. African-American, Native American, and Alaska Native women are about three times more likely to die from causes related to pregnancy, compared to white women in the United States. Access to vital prenatal and post-natal care is lower among women of color, which contributes to these outcomes. However, many women of color and their families have also reported that clinicians did not listen to their concerns during birth, leading to preventable deaths and near-misses.
Biases against racial and ethnic minorities persist in medical culture. For example, doctors rate black patients’ pain as lower than that of white patients. More black and Latinx people receive inadequate pain management compared with white counterparts. The false belief that African Americans have weaker lungs is even coded into medical device software. These myths put patients’ lives and health at risk.
Rural health care
The lack of primary care doctors in rural areas is immensely detrimental to the health of America’s rural residents, who already face significant socioeconomic, health, and transportation challenges. While 19.2 percent of the U.S. population lives in rural America, only 11.4 percent of physicians practice in rural locations. According to an analysis by 24/7 Wall Street, every state in America—even states with a high doctor-to-patient ratio—has at least one county in which there is no doctor.
Women living in rural areas are especially affected by lack of access to obstetric and gynecological care. Less than one half of rural women live within a 30-minute drive to the nearest hospital offering perinatal services. As of 2014, only 45% of rural counties had obstetric services, down from 54% in 2004.
California’s Health Care Paradox
In a disturbing paradox, increased state spending on medical treatment may actually be leading to worse health conditions for Californians. The Lown Institute’s analysis of California’s state budget from 2007 to 2018 finds that health care spending has skyrocketed, leaving fewer dollars to fund programs and services that support health and prevent illness at the community level.