It’s been more than two years since the US Centers for Disease Control and Prevention declared racism a public health threat, and a new study gives a stark look at just how pervasive racial and ethnic disparities are in the United States.
Researchers tracked US mortality data across nearly two decades, breaking rates down by race and ethnicity and to the county level.
They found that Black and American Indian people had the highest overall mortality rates each year from 2000 to 2019, and that these groups also had the highest mortality rates for nearly all causes of death nationwide.
For a few causes of deaths – diabetes and kidney disease, maternal and neonatal disorders, and HIV/AIDS and sexually transmitted infections – mortality was consistently higher among the Black population than among the White population in nearly all counties for which data was available.
Mortality for HIV/AIDS and sexually transmitted infections was also consistently higher among American Indian and Alaska Native people than it was for White populations in nearly all counties, as was the rate for skin and subcutaneous diseases such as melanoma.
Of the 19 causes of death that were assessed, which encompass the vast majority of total deaths in the US, the only cause of death that was the highest for the White population was neurological disorders.
“When you look across these 19 causes, there are racial and ethnic disparities in mortality and there are also geographic disparities in mortality for every single cause,” said Laura Dwyer-Lindgren, an assistant professor at the University of Washington’s Institute for Health Metrics and Evaluation and study author. “The consistency of that overall finding – that these huge disparities are always there – really stuck out to me.”
In other words, the findings show that inequalities are not the exception, but the rule in the US.
Dwyer-Lindgren and fellow study authors write that this pattern points to “shared root causes” and “highlights the widespread, persistent, and substantial negative impact of systemic racism on health.”
Dr. Georges Benjamin, executive director of the American Public Health Association who was not involved in the study, points to four key factors that put certain racial and ethnic groups at a disadvantage when it comes to health in the US: differences in access to care, quality of care, personal health behaviors and broader social factors that can affect health.
“Racism is still fairly rampant within the health care system,” he said. “But with those four broad categories, most of the challenges get fixed when there’s a system where everyone is in and nobody is out – that is when prices are affordable so that people can actually pay for the care that they need and everyone is getting treated with the dignity and respect that they need.”
Disparities in maternal and neonatal mortality are a prime example of the health care system failing Black women in multiple ways, he said.
“That’s access to prenatal care. That’s access to things like adequate nutrition. That’s providers listening to their patients throughout the pregnancy, during the delivery and after,” Benjamin said.
While inequality was a consistent theme, the new study also found key nuances what those inequalities looked like – with a wide variety in the size and order of the gaps by cause and by location.
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“It highlights the complexity of what’s going on. The nature of the problem is a bit different depending on what population you’re looking at, what part of the country you’re looking at, and also what causes you’re considering,” Dwyer-Lindgren said. “I think that points to the need to have this kind of local data that allows people to pinpoint what the biggest challenges.”
Generally, mortality among Asian and Hispanic people was lower than it was for White people. But this doesn’t mean that these individuals don’t experience racism and its harms, the researchers said.
“The reasons for this finding are complex, and not fully understood,” they wrote. Individuals in these groups who migrated to the US may have some health advantages, and there are important differences within these groups by specific racial and national identities.
While the study assesses trends before the Covid-19 pandemic, experts say that events of the past few years put a spotlight on – and likely exacerbated – longstanding disparities.
“The time for intervention was yesterday. Every day that goes by without equitable health care, better programs, and new policies, the US records more unnecessary deaths, especially from diseases that are preventable,” said Ali Mokdad, professor of health metrics sciences and chief strategy officer of population health at the University of Washington.