Racial Divides Persist in U.S. Health Outcomes

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Data from a variety of sources show that health outcomes for African-Americans often fall short of those for white populations, a persistent reality that can be attributed to multiple factors such as socioeconomics and geography.

In February, for example, a study that looked at young people with diabetes documented that African-Americans were more likely to have complications associated with the disease. And in October 2017, the American Heart Association noted that African-Americans are not seeing gains from wider reductions in incidences and deaths linked to cardiovascular disease.

Community leaders and policymakers have analytical tools at their disposal to examine the circumstances that play a role in people’s health. That information then can be used to assess proposed public or private development projects and to encourage decisions that help narrow these divides. The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, recognizes that health outcomes are driven by a range of factors beyond genetic makeup and individual behavior. The project seeks to illuminate those connections to ensure that everyone has the opportunity to be healthy.

This work launched with a focus on increasing use of health impact assessments (HIAs), a flexible, data-driven approach to identify the health consequences of individual policies and develop practical strategies to enhance the benefits and minimize adverse effects. Now the project is building on that foundation to ensure that health considerations routinely factor into policy and business decisions, with an emphasis on ensuring that these decisions take into account the health of populations and communities that have the worst outcomes.

These approaches could help improve outcomes over the long term and boost health more broadly. At this point, however, significant divides remain and can be exemplified by recent statistics from the District of Columbia. A July 2016 report prepared for the district’s Commission on African American Affairs found that black men in the nation’s capital live nearly 15 fewer years than white men in the city, and that black women live nine fewer years than white women.

Compared with the white population, African-Americans suffer from a greater incidence of chronic diseases that lead to higher death rates, according to the 2016 report. For example, coronary heart disease and strokes kill blacks at twice the rate of whites. Deaths tied to complications from diabetes are six times more likely in the African-American community.

Nationally and in the district, maternal mortality is also higher among black women than white. In the United States, black women die in pregnancy and childbirth at 2.5 times the rate for white women, while black children face a mortality rate 1.5 times that of white children.

Looking at health through a wider lens

Many factors contribute to these avoidable gaps, but the definition of health has traditionally been too narrow, making it difficult to reduce the divides. The Health Impact Project and others are working to change that by highlighting the range of circumstances that play a role in individual or community health.  

Each year, the University of Wisconsin Population Health Institute releases County Health Rankings, showing where the best and worst health outcomes exist across the country. The institute has identified multiple factors that affect health outcomes, including education, employment, income, and family and social support. When examining outcomes such as length and quality of life, analysts say that social and economic circumstances can have a greater impact than access to and quality of clinical care, or specific health behaviors.

Because these factors are so critical to health outcomes, the Health Impact Project invests in partnerships to work across disciplines such as economic development and planning to make sure that health is factored into all levels of government and business decisions. In February, the project awarded eight grants to organizations across the country to help boost community health through the use of HIAs.

As part of its effort to promote routine consideration of health impacts, especially in communities where persistent gaps exist, the Health Impact Project recently announced funding and technical assistance to five organizations to incorporate health into all decision-making. This approach seeks to help those working in public and private sectors to understand the effect of their actions on community health, because health is much more than medical coverage and care.

A healthy life should be within reach of all in this country. When historian James Truslow Adams articulated the notion of an American Dream in 1931, he said: “Life should be better and richer and fuller for everyone, with opportunity for each according to ability or achievement.” The same should be true for health.

Stacey Millett directs the Health Impact Project.