New York State has less severe racial and ethnic health inequities than other mid-Atlantic states, yet even so, a new analysis shows stark disparities for Black residents in access to care, the quality of care they receive and health outcomes.
The report, released last month by the Commonwealth Fund, assessed data based on 25 indicators of health care performance, including outcomes, access to health care and quality and use of health care services by race and ethnicity.
It was designed for health care leaders and state policymakers to identify and address inequities and to create targeted solutions.
New York was among six states found to have better-than-average health care system performance among all racial or ethnic groups.
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It received “worse than average” marks in just one category of the nonprofit research firm’s report: health quality for Asian Americans/Native Hawaiians/Pacific Islanders. This wasn’t an anomaly. Racial disparities were observed in every state, even those with high-scoring health care systems.
“This report demonstrates that if you don’t look under the hood, you won’t identify where you’re failing people and where you’re leaving people behind,” said Dr. Joseph Betancourt, president of the Commonwealth Fund, which seeks a high-performing, equitable health care system and has tracked health and health care in every state for almost two decades.
Kelly Marie Wofford has spent the first two years in her latest job laying the foundation for an office designed to serve those whose circumstances make it hard to lead their best lives in terms of health and well-being.
White New Yorkers have received the highest health system performance, scoring in the 89th percentile among all population groups nationally on the Commonwealth Fund report. Black residents experienced the lowest health system performance in the state, scoring in the 52nd percentile.
Many states performed poorly when it comes to the health of women, mothers and infants, with high and increasing rates of maternal and infant mortality and inequities in pregnancy-related outcomes for Black and American Indian/Alaska Native women. Things worsened during the pandemic. New York State performed better than average in this area, but health officials noted room for improvement.
Nora OBrien-Suric, president of the Health Foundation for Western & Central New York, said its foundation is focused on investing more in doula programs because research has shown better maternal health outcomes with low-income pregnant people who see doulas for prenatal care and childbirth.
New York ranked above the national average in percentages of residents with primary care physicians, the numbers of insured adults, those who receive mammograms, cervical cancer screenings or childhood vaccines.
An overall ranking for American Indians/Alaskan Natives in New York wasn’t available because of insufficient data. Yet the group had a higher rate than the national average of people who were uninsured, smoked and were obese. The health care quality for Asian Americans/Native Hawaiians/Pacific Islander populations was found to be “worse than average.”
Social determinants of health account for most differences in health outcomes between whites and people of color, says Dr. Timothy F. Murphy, director of the UB Community Health Equity Research Institute.
The quality of health care and access to it for Black New Yorkers was better than the national average but lower than that of white New York residents.
“Populations of color experience incredible health disparities,” said Dr. Timothy Murphy, director of the University at Buffalo Community Health Equity Research Institute, which was established in 2019 to research the causes of health inequities and develop and test solutions to eliminate health disparities in the region.
“So for example, in the City of Buffalo, a Black person dies 10 to 12 years younger than a white person,” Murphy said. “If we could solve all the health care access issues, for example, for African Americans in Buffalo, it’s estimated that would improve health outcomes by about 15%, which means if we’re really going to improve health outcomes, we have to address these broader social determinants of health.”
Those include poverty, housing, substandard housing and lack of education, he said. These factors can have a greater influence than genetics or access to health care services.
Pastor George Nicholas, CEO of Buffalo Center for Health Equity, talks about the need to turn the data into guided action to improve the health outcomes in communities that have been forced to live in substandard environments.
Researchers said achieving equity requires bold policy action. Numerous studies have shown that many patients of color contend with discrimination in health care settings and more often receive worse medical care than white patients, according to the report.
“Health care systems can have the opportunity to have strong reporting systems and reconciliation systems that center equity and providing accountability to ensure that there’s an easy way, for example, to anonymously or even transparently report situations involving racism or discrimination,” said Dr. Laurie Zephyrin, the Commonwealth Fund’s senior vice president for advancing health equity.
The researchers repeatedly urged broad policy goals that would ensure affordable, comprehensive and equitable health insurance coverage for all; strengthen primary care; reduce administrative barriers for patients and providers and increase investments in services such as housing and education.
“We know that in our systems, we have systemic racism and inequity in the way that care is delivered,” said OBrien-Suric. “And we know that people have implicit biases and this includes health professionals. So we’re trying to raise awareness about all of this and finding ways to not only inform people but educate people in public policy and to bring more quality affordable health care into areas that are lacking it.”
The foundation, she said, is advocating for policy and regulatory change that can improve health for white people and immigrants in rural areas, as well.
Along with New York, Massachusetts, Rhode Island, Connecticut and Hawaii had better-than-average health care performance for all groups. Oklahoma, Arkansas, West Virginia and Mississippi had health care scores below average among all groups.
The analysis was conducted using publicly available databases that reported outcomes from more than 328 million people during 2021 and 2022.
This story was produced through the New York & Michigan Solutions Journalism Collaborative, a partnership of news organizations and community groups dedicated to rigorous and compelling reporting about successful responses to social problems. The group is supported by the Solutions Journalism Network. The collaborative’s Health Equity Solutions Project focuses on potential solutions to challenges in health care.
