Racial Health Disparities Worsened Over 20-Year Period

November 18, 2020 - Racial health disparities have only gotten worse in the past twenty years, new data shows, despite Congressional and research efforts to better understand and mitigate disparities.

The study, published in JAMA Network Open, showed that poor health indicators among Black patients have gotten worse since the turn of the new millennium. For Hispanic patients, diabetes, hypertension, and uninsurance disparities have worsened.

These results come after a two-decades-long push to address racial health disparities, the researchers from the Columbia University Irving Medical Center reported. In 1999, Congress requested the then Institute of Medicine (now known as the National Academy of Medicine) to allocate $35 billion in funding over 20 years to assess and address racial health disparities.

That funding resulted in over 16,000 research projects looking at racial health disparities and the health inequities causing them, the researchers said. That is a far cry from the $12 million Congress had previously allocated to investigate the issue.

But nevertheless, racial health disparities have persisted, the researchers found. In an assessment to look into whether the funding, coming as a part of the Minority Health and Health Disparities Research and Education Act of 2000, actually made a dent in disparities, the researchers found racial health disparities are in fact getting worse.

The research team combed through just shy of 5 million records from the Behavioral Risk Factor Surveillance System from between January 1999 and December 2018. Records belonged to individuals over age 45 who identified as either Black, Hispanic, or White.

The researchers looked at different poor health indicators, like occurrence of chronic illness, physical inactivity, uninsured status, and overall poor health.

By and large, poor health indicators deteriorated for Black patients at a higher rate than they did for White people, indicating that racial health disparities between the two races grew.

“Despite substantial Congressional funds directed at reducing health disparities during the last 20 years, we found worsened disparities for most diseases among Black adults compared with White adults but fewer disparities among Hispanic adults in comparison with White adults,” the researchers said.

Black patients saw improvement in physical inactivity and uninsured status, but otherwise saw worsening health status for chronic illnesses like hypertension, diabetes, asthma, and stroke.

In other words, the difference in wellness and health between White and Black patients grew.

“Our findings add to the literature documenting that policy choices have not resulted in the sought-after reductions in Black-White health disparities in the United States,” the team explained. “Several possible reasons include the fact that the National Academy of Medicine projects were funded primarily to assess the consequences of health disparities and to draft policy statements. Interventions were less emphasized.”

These results were less pronounced when looking at Hispanic populations, although still striking. The gap between White and Hispanic patients became smaller when looking at coronary heart disease, stroke, kidney disease, asthma, arthritis, depression, and physical inactivity. This means the racial health disparities between White and Hispanic people with regards to these issues improved.

But there were some areas where disparities between White and Hispanic people grew. For Hispanic patients, diabetes, hypertension, and uninsurance disparities have worsened.

These findings come even after the Affordable Care Act (ACA) increased access to private health insurance and, in some states, Medicaid. With that, patients saw increased access to preventive screenings, which may have closed some of the disparities observed in the study.

But it didn’t account for improvement everywhere, the team acknowledged.

“Several of the chronic diseases that showed the worst trends over time in our data were eligible for screening through ACA policies, suggesting that promoting screening alone will be insufficient to reduce disparities,” they noted. “It may also be the case that there has been no return on investment in these policies and others implemented during the past 20 years and that accurately curving the trajectory of chronic disease will take more time.”

Social determinants of health, discrimination in healthcare, and other social issues may also need attention before racial health disparities can close, the team posited.

These results come as the healthcare industry becomes laser-focused on racial health disparities. The COVID-19 pandemic has shone a light on prevailing racial health disparities, something the researchers said should prompt future research.

Investigations may look into how decades of racial health disparities sowed the challenges seen during the pandemic.

But ultimately, the medical industry needs to remain focused on efforts to address health disparities in order to create an overall healthier population in the future.

“Progress can be challenging and slow,” the researchers concluded. “We encourage researchers to look to the successes thus far in the areas of physical inactivity and arthritis, which will allow us to advance our national health equity mission.”