Senate Democrats

Health Reform Must Address Health Disparities

Democrats are working to pass legislation that ensures quality, affordable health care for all Americans.  Substantial disparities exist in access to health care and insurance coverage and in health outcomes, reflecting the unique challenges these communities face.  Health reform legislation must address challenges, so that all Americans benefit from the positive results of health reform. 

About half of the nation’s uninsured are people of color. (B. Smedley, Health Affairs, 3/1/2008)  Because racial and ethnic minority populations are disproportionately uninsured, efforts to expand health coverage will prove critical for these communities.  However, simply insuring more people of color is not enough, as members of minority racial and ethnic groups face challenges in accessing health care and experience adverse health outcomes at higher rates than other communities.  This report outlines health disparities that must be addressed by reforming the delivery of care to these populations. 

Growing Population

People of color, including Hispanics, African Americans, Asians, Native Hawaiians and Other Pacific Islanders, and American Indians/Alaska Natives, constitute approximately one-third of the population. 

       Source: Kaiser Family Foundation, accessed 7/15/09

The U.S. Census projects that by 2050, people of color will make up more than half the population, with the proportion of Hispanics and Asians doubling compared to 2000 levels.

       Source: Kaiser Family Foundation, accessed 7/15/09

Given the projected growth of these communities as a percentage of the U.S. population, we must reduce health disparities people of color experience if we wish to improve health care in America and make it more sustainable.

Disparities Begin Before Birth

Prenatal Care

Racial and ethnic disparities in access to health coverage, access to health care, and health outcomes are apparent even before birth.  Nationwide, 83.2 percent of mothers receive prenatal care beginning in their first trimester. (Kaiser Family Foundation, accessed 7/13/09)  However, use of prenatal care varies widely by race, with 88.1 percent of non-Hispanic white mothers receiving care beginning in the first trimester, but just 76.1 percent of non-Hispanic black mothers and 77.3 percent of Hispanic mothers beginning prenatal care in the first trimester. 

Preterm Birth

Reduced access to prenatal care and other factors may lead to adverse pregnancy outcomes.  One such outcome is preterm birth, when babies are born before 37 completed weeks of pregnancy.  According to the March of Dimes, late or no prenatal care is a risk factor for preterm labor, and preterm babies are at risk for many newborn health complications, including respiratory problems and even death. (March of Dimes, January 2009

Premature babies are also at risk of long-term health complications, including mental retardation, cerebral palsy, lung problems, and vision and hearing loss, and some studies have found that very premature babies are at increased risk of diabetes, high blood pressure, and heart disease.  Nationwide, the preterm birth rate is 12.8 percent. (Kaiser Family Foundation, accessed 7/13/09)  However, non-Hispanic black mothers experience preterm births at a rate 50 percent greater than non-Hispanic white mothers, 18.5 percent as compared to 11.7 percent.  Hispanic mothers experience a 12.2 percent preterm birth rate, just under the national average.

Low Birthweight

Premature babies are at increased risk of low birthweight, defined as less than 5 pounds, 8 ounces.  Low birthweight babies generally experience increased risk of health complications as newborns, and some studies suggest low birthweight babies may experience increased rates of chronic diseases, such as high blood pressure, diabetes, and heart disease, as adults. (March of Dimes, May 2008)  While Hispanic and non-Hispanic white women have rates of low birthweight babies below the national average of 8.3 percent (7.0 percent and 7.3 percent, respectively), non-Hispanic black women experience a 14.0 percent rate of low birthweight babies. (Kaiser Family Foundation, accessed 7/13/09)

Infant Mortality

Premature birth is also the leading cause of infant mortality, and low birthweight is also a predictor of infant health and survival. (March of Dimes, 5/8/2006).  The rate of infant mortality in the United States is 6.9 deaths per 1,000 live births. (Kaiser Family Foundation, accessed 7/13/09)  However, racial and ethnic disparities in infant mortality follow similar patterns to other infant health predictors, with non-Hispanic whites and Hispanics experiencing lower infant mortality rates as compared to the national average (5.7 and 5.6 infant deaths per 1,000 live births, respectively).  Non-Hispanic blacks, however, experience an infant mortality rate more than twice that of whites and Hispanics, 13.6 infant deaths per 1,000 live births.

Life Expectancy at Birth

The health disparities described above contribute to a shorter life expectancy at birth for African Americans.  According to the Centers for Disease Control and Prevention, the life expectancy at birth for all races is 77.8 years, but African Americans’ life expectancy is much lower, 73.2 years, while Whites have a life expectancy at birth of 78.3 years. (National Center for Health Statistics, 2008)  

Given all the challenges that racial and ethnic minorities face even before reaching their first birthday, the health disparities that they experience as compared to the general population should come as no surprise.  In addition, higher rates of poverty, reduced access to health coverage, and reduced access to health care combine to exacerbate these disparities.

Greater Evidence of Poverty

Racial and ethnic minorities experience higher rates of poverty than Whites.  In 2006-2007, the Federal Poverty Level (FPL) for a family of four was $20,614 (2006) and $20,650 (2007).  While 17.2 percent of all Americans lived in poverty, Whites experienced a poverty rate of 11.5 percent, while poverty rates for Blacks and Hispanics were both more than double that rate, 32.2 percent and 28.4 percent, respectively.  The poverty rate for all other races was 19.4 percent. (Kaiser Family Foundation, accessed 7/13/09)

Access to Health Care Coverage

In addition to battling poverty, racial and ethnic minorities are disproportionately uninsured (B. Smedley, Health Affairs, March 2008).  In 2007, 16.8 percent of Americans under 65 years of age were uninsured. (National Health Interview Survey, S.R10_238.pdf" target= "_blank">2007)  However, the percentage of uninsured Hispanics, American Indians or Alaska Natives, and Native Hawaiians or Other Pacific Islanders was more than double that of non-Hispanic Whites, as indicated below.

Uninsured Persons Under Age 65, 2007

American Indian or Alaska Native

38.8 percent

Asian

15.4 percent

Hispanic or Latino

31.8 percent

Native Hawaiian or Other Pacific Islander

30.6 percent

Non-Hispanic Black

16.8 percent

Non-Hispanic White

12.6 percent

            Source: National Health Interview Survey, S.R10_238.pdf" target="_blank">2007

While the high cost of health insurance was the most frequently cited reason for not being covered by all racial and ethnic groups, minorities cited this barrier to coverage more frequently. (National Health Interview Survey, S.R10_238.pdf" target="_blank">2007)  Overall, 50.6 percent of Americans indicated they were uninsured because of the cost of insurance.  However, responses varied by racial and ethnic group, as illustrated below.

Persons Under Age 65 Citing Cost as Reason for Being Uninsured, 2007

American Indian or Alaska Native

53.3 percent

Asian

59.9 percent

Hispanic or Latino

57.6 percent

Native Hawaiian or Other Pacific Islander

*55.8 percent

Non-Hispanic Black

43.0 percent

Non-Hispanic White

47.5 percent

            Source: National Health Interview Survey, S.R10_238.pdf" target="_blank">2007

            *Relative standard error between 30-50 percent, estimates should be used with caution

Access to Health Care

Having health insurance coverage does not necessarily mean an individual has access to actual health care, but being insured makes it a lot easier to get care when you need it.  Given the higher rates of uninsured among racial and ethnic minorities as compared to non-Hispanic Whites, it is not surprising that these communities struggle to access health care.  Much larger percentages of all racial and ethnic minority adults ages 18-64 lack a usual source of care, as compared to non-Hispanic White adults. (National Center for Health Statistics, 2008)

Adults Age 18-64 with No Usual Source of Care, 2005-2006

American Indian or Alaska Native

21.9 percent

Asian

17.9 percent

Hispanic or Latino

35.1 percent

Native Hawaiian or Other Pacific Islander

*

Non-Hispanic Black

19.2 percent

Non-Hispanic White

14.8 percent

            Source: National Center for Health Statistics, 2008

            *Estimate not provided

In addition, members of all racial and ethnic minority groups were more likely than non-Hispanic Whites to report that they had not visited a doctor or other health care professional within the last year.  In fact, Hispanics were twice as likely as non-Hispanic whites to have gone 12 months without seeing a health care professional.

Adults with No Visits to a Doctor or Other Health Care Professional
Within the Past Year, 2007

American Indian or Alaska Native

29.7 percent

Asian

27.2 percent

Hispanic or Latino

33.6 percent

Native Hawaiian or Other Pacific Islander

*20.8

Non-Hispanic Black

20.7 percent

Non-Hispanic White

16.5 percent

            Source: National Health Interview Survey, S.R10_240.pdf" target="_blank">2007

            *Relative standard error between 30-50 percent, estimates should be used with caution

Health Status

Access to care is one of many factors that contribute to an individual’s health status. (Kaiser Family Foundation, January 2007)  Racial or ethnic minority groups (other than Asians) generally rate their health worse than non-Hispanic Whites.  While poor or low-income people have worse health outcomes than those with higher incomes across all races, differences are reduced but still persist when controlling for income.

Fair or Poor Health Status, 2007

American Indian or Alaska Native

14.0 percent

Asian

6.5 percent

Hispanic or Latino

9.4 percent

Native Hawaiian or Other Pacific Islander

*#4.2 percent

Non-Hispanic Black

12.7 percent

Non-Hispanic White

9.4 percent

            National Health Interview Survey, S.R10_238.pdf" target="_blank">2007

            *Relative standard error between 30-50 percent, estimates should be used with caution

            #Includes only estimate for those reporting “fair” health status

Chronic Conditions

Surprisingly, given disparities highlighted in health status and access to care, some racial and ethnic minorities fair better than non-Hispanic Whites with regard to chronic conditions.  Hispanics and Asians have lower rates of adults whose usual activities are limited due to one or more chronic condition, as compared to non-Hispanic Whites, non-Hispanic Blacks, and American Indians or Alaska Natives.

Adults Whose Usual Activities are Limited due to
One or More Chronic Conditions, 2007

American Indian or Alaska Native

15.1 percent

Asian

5.5 percent

Hispanic or Latino

7.4 percent

Native Hawaiian or Other Pacific Islander

*

Non-Hispanic Black

13.8 percent

Non-Hispanic White

13.2 percent

            Source: National Health Interview Survey, S.R10_238.pdf" target="_blank">2007

            *Estimate not provided

Racial and ethnic minorities tend to be disproportionately affected by chronic, debilitating diseases such as diabetes, obesity, cancer and AIDS. (Department of Health and Human Services, accessed 7/15/09)  To the extent that health reform focuses on reducing the incidence of chronic disease nationwide, members of these communities will benefit from such changes. 

Diabetes

Nationally, 10.1 percent of adults ages 20 and older have diabetes, but just 8.7 percent of non-Hispanic Whites have diabetes, compared to 15.3 percent of Non-Hispanic Blacks, and 15.1 percent of Mexican-Americans. (Centers for Disease Control and Prevention, accessed 7/13/09)  These disparities persist in the rate of mortality due to diabetes.  The nationwide mortality rate from diabetes is 24.6 deaths per 100,000 people, but twice as many non-Hispanic Blacks die due to diabetes as non-Hispanic Whites, with mortality rate of 47 for non-Hispanic Blacks and 22.5 for non-Hispanic Whites. (Kaiser Family Foundation, accessed 7/13/09)

Overweight and Obesity

Sixty percent of all American adults are overweight or obese, meaning they have a body mass index (BMI) greater than or equal to 25.0 kg/meters squared. (Kaiser Family Foundation, accessed 7/13/09)  Obesity rates vary by racial and ethnic group as follows:

Overweight and Obesity Rates for Adults, 2008

American Indian or Alaska Native

62.9 percent

Asian or Pacific Islander

37.7 percent

Hispanic

61.7 percent

Black

69.0 percent

White

59.5 percent

All Other Racial or Ethnic Groups

60.1 percent

Source: Kaiser Family Foundation, accessed 7/13/09

Cancer

Cancer deaths rates also vary dramatically by racial or ethnic group.  The nationwide death rate from cancer in 2005 was 184 per 100,000 individuals. (Kaiser Family Foundation, accessed 7/13/09)  Whites had a slightly lower cancer death rate, at 182.6 deaths per 100,000 and Blacks had a substantially higher cancer death rate of 222.7 per 100,000.  The data combines all other racial and ethnic groups into one category, which had a cancer death rate of 112.4 per 100,000.

HIV/AIDS

Health disparities among members of racial and ethnic minorities are particularly glaring when it comes to HIV/AIDS.  Nationally, there are approximately 15.2 cases of AIDS per 100,000 adults and adolescents. (Kaiser Family Foundation, accessed 7/13/09)  However, Blacks experience an AIDS case rate nearly ten times that of Whites, 60.1 compared to 6.7.  Hispanics and Native Hawaiians or Other Pacific Islanders have an AIDS case rate nearly three times that of Whites of 20.4. 

AIDS Case Rate per 100,000 Population, Adults/Adolescents, 2007

American Indian or Alaska Native

9.4

Asian

4.3

Hispanic or Latino

20.4

Native Hawaiian or Other Pacific Islander

20.5

Black of African American

60.1

White

6.7

Source: Kaiser Family Foundation, accessed 7/13/09

Reducing Health Disparities in Health Reform

As Congress works to pass legislation that ensures quality, affordable health care for all Americans, Senate Democrats are committed to reducing the disparities in access to health care and health coverage and in health status that exist between racial and ethnic minority populations and other Americans.  It is critical that all Americans benefit from the positive results of health reform. 

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