MINORITY HEALTH CARE DISPARITIES

Many of the diseases that are most prevalent among minority populations are preventable, raising hope among health care professionals that they can be rectified through better public health education and preventive care. The National Institutes of Health (NIH), an agency of the U.S. Department of Health & Human Services (HHS), has implemented the Minority Health and Health Disparities Strategic Plan 2021-2025 as part of the department’s efforts to chip away at minority health care disparities.

One goal of the NIH plan is to speed up the application of insights gained from clinical research into minority health care disparities to clinical practice and public health education. Among the factors being investigated are behavioral, biological, sociocultural, socio-ecological, and environmental characteristics that impact minority health disparities.

HOW HEALTH INEQUITIES IMPACT MINORITY POPULATIONS

Racial and ethnic minorities are disproportionately represented among essential workers and industries, placing them at higher risk of contracting COVID-19 and other infectious diseases, as the CDC reports. However, many other social, political, and economic factors contribute to the disparities in the provision of health services to minority groups.

• Discrimination

• Poor health care access and use

• Gaps in education, income, and wealth

• More crowded living conditions

Addressing the disparities focuses on improving access to primary care providers for children and adults in minority groups, promoting health literacy, and increasing funding to publicly funded health maintenance organizations (HMOs).

AFRICAN AMERICANS

The CDC notes that African Americans ages 18 to 49 are twice as likely to die from heart disease than white Americans, and African Americans ages 35 to 64 are 50% more likely to have high blood pressure than their white counterparts.

• Health coverage among African Americans has been boosted by the ACA, as The Commonwealth Fund reports. The percentage of uninsured African American adults declined from 24.4% in 2013 to 13.7% in 2016 before increasing to 14.2% in 2019.

• Chronic health conditions that have a greater impact on young African Americans than white people include high blood pressure (33% for ages 35 to 49 vs. 22% for white people), diabetes (10% vs. 8%), and stroke (7% vs. 4% for ages 50 to 64).

• Mental health issues are more prevalent among African Americans who live at or below the FPL, twice as many of whom report experiencing serious psychological distress than African Americans who live at twice the FPL or higher.

• Leading causes of death among African Americans are heart disease, cancer, and accidents.

LATINX/HISPANICS

The HHS states that only 50.1% of Latinx/Hispanics in the U.S. have private health insurance, the lowest rate of any ethnic or racial group. By comparison, 74.7% of non-Hispanic white people have private health insurance.

• Health coverage for Latinx/Hispanics increased as a result of the ACA, which saw the percentage of uninsured Latinos decrease from 40.2% in 2013 to 24.9% in 2018 before increasing to 25.7% in 2019, according to The Commonwealth Fund.

• Chronic health conditions among Latinx/Hispanics include higher rates of obesity than non-Hispanic white people, more instances of low birth weight infants, and more prevalence of diabetes. Puerto Ricans have higher rates of asthma, HIV/AIDS, and infant mortality.

• Mental health issues that Latinx/Hispanics are susceptible to include mental distress related to immigration and acculturation, as Mental Health America reports. Rates of serious mental illness and major depressive episodes are increasing for Latinos ages 18 to 49.

• Leading causes of death for Latinos are heart disease, cancer, and accidents.

ASIAN AMERICANS

While Asian Americans are less likely to live in poverty than the overall population (12.1% vs. 15.1%), certain subgroups have much higher poverty rates, including Hmong Americans (28.3%), Bhutanese Americans (33.3%), and Burmese Americans (35%).

• Health coverage among Asian Americans and Pacific Islanders (AAPIs) increased as a result of the ACA, according to figures compiled by the HHS. In 2013, 14.7% of the AAPI population was uninsured, but the number had decreased to 6.8% by 2019.

• Chronic health conditions that show a higher prevalence among Asian Americans than the general population include tuberculosis (16.7 incidence rate vs. 0.5 for white people), chronic obstructive pulmonary disease, hepatitis B, HIV/AIDS, smoking, and liver disease.

• Mental health issues are often untreated among Asian Americans because of the stigma attached to mental illness. Mental Health America estimates that 17.3% of Asian Americans will be diagnosed with a psychiatric condition at some point in their lives, yet Asian Americans are three times less likely to seek mental health treatment than other population groups in the U.S.

• Leading causes of death for Asian Americans are cancer, heart disease, and stroke.

HAWAIIANS AND OTHER PACIFIC ISLANDERS

The U.S. Census Bureau estimates that the median household income for NHOPIs in the U.S. was $66,695 in 2019, compared with $71,664 for white people. The number of NHOPIs living at or below the FPL was 14.8% in 2019, compared with 9% for white people.

• Health coverage rates for this population group are less than that for white people: 65.8% had private health insurance in 2019, compared with 74.7% of white people. The HHS notes that 12.3% of NHOPIs were uninsured in 2019.

• Chronic health conditions among NHOPIs are exacerbated by the group’s higher rates of smoking, alcohol consumption, and obesity than those of the general population. The TB rate for this group is 37 times higher than that for white people; hepatitis B and HIV/AIDS are also more common among NHOPIs.

• Mental health issues are less common among NHOPIs than in white people, including serious psychological distress in adults (10.1% vs. 12.7%) and major depressive episodes (3.5% vs. 8.5%). However, the HHS reports that suicidal thoughts, plans, and attempts increased sharply for Asian American and NHOPI young adults and adults ages 26 to 49 between 2009 and 2019.

• Leading causes of death for NHOPIs are cancer, heart disease, and stroke.

AMERICAN INDIANS AND ALASKA NATIVES

Cultural barriers, geographic isolation, and low incomes negatively affect the quality of health care available to AI/ANs. While 22% of AI/ANs live on reservations or other trust lands, 60% live in metropolitan areas — the lowest metropolitan percentage of any racial group, according to the U.S. Census Bureau. The median annual household income for AI/ANs was $49,906 in 2019, compared with $71,664 for white people.

AI/ANs have higher rates of mental illness and suicide than other population groups. They’re also more likely to be obese, experience substance abuse, and be victims of sudden infant death syndrome (SIDS). In addition to having higher rates of diabetes, liver disease, and teenage pregnancy, AI/ANs are nearly seven times more likely to contract TB than white people.

• Health coverage among AI/ANs increased following the passage of the ACA. In 2013, 26.9% of the AI/AN population was uninsured, decreasing to 19.1% in 2019. The HHS estimates that 51.9% of AI/ANs had private health insurance in 2019, while 42.1% relied on Medicaid or public health insurance.

• Chronic health conditions that are more prevalent among AI/ANs than in the general population include unintentional injuries; diabetes; obesity; SIDS; liver disease; hepatitis; and TB, which is seven times more common among AI/ANs than among white people.

• Mental health issues, including suicide and substance abuse, afflict AI/ANs at a greater level than other population groups. In 2019, suicide was the second leading cause of death among AI/ANs ages 10 to 34. The death rate from suicide among all AI/ANs is 20% higher than that of white people.

• Leading causes of death for AI/ANs are heart disease, cancer, accidents, liver disease, and cirrhosis.

RESOURCES ON MINORITY HEALTH CARE DISPARITIES

• American College of Surgeons, Health Care Disparities Resources — The site links to reports and publications that discuss the causes of disparities in health care for underserved populations and potential remedies to address the disparities.

• U.S. Department of Health & Human Services, Health Disparities Resources — Among the resources linked to are guides for medical school curricula, language access services, and cultural competency.