The State of Health Equity in the U.S.

Did you know the United States spends more per person on healthcare than all comparable countries – more than twice as much, yet does not reap the favorable health outcomes of other rich nations?

In 2021, according to the World Economic Forum, the U.S. spent an estimated $12,318 per person on healthcare — the highest healthcare costs per capita among the 38 member countries of the Organization for Economic Cooperation and Development (OECD). By comparison, Germany was the second highest-spending country with $7,383 in healthcare costs per capita, while the average for wealthy OECD countries, excluding the U.S., was only $5,829 per person. Such comparisons indicate that the U.S. spends a disproportionate amount on healthcare.

Disparities in Health Equity

Despite such large healthcare expenditures, many Americans lack sufficient health care and we’re far from attaining health equity: “the state in which everyone has a fair and just opportunity to attain their highest level of health” per the Centers for Disease Control and Prevention (CDC).

While the library of data that illustrates the scope of U.S health inequity continues to grow, we know this: location matters. In the last few years, the phrase “your zip code matters more than your genetic code” has become commonplace. In cities across the nation, the average life expectancy is 15-20 years shorter in low-income communities than those in more affluent communities. Rates of preventable, chronic and infectious diseases are higher in low-income neighborhoods and health gaps between low-income and affluent communities continue to widen. These disparities in health are founded on a complex interplay of racial/ethnic, economic, educational, and other social factors, and require changes at the individual, organizational, community, and policy level.

The Financial Cost of Health Inequity

According to Deloitte, health inequities cost approximately $320 billion in health care spending annually in the U.S. and could grow to $1 trillion or more by 2040. This increase in health care spending could cost the average American at least $3,000 annually, up from today’s cost of $1,000 per year, and this increase would more than likely have a greater impact on historically underserved populations.

In addition to the negative impact on outcomes and spending within the health system, health disparities can have broader consequences for the economy and quality of life. Health disparities account for roughly $42 billion in lost productivity per year, not including additional economic losses due to premature deaths.

Such financial waste negatively impacts individuals – and their employers. Addressing health inequities can help organizations improve the overall health of their workforces, lower healthcare-related expenses and improve productivity at the same time.

Factors Affecting Health Equity

In any discussion about health equity, the “social determinants of health” (SDoH) must be considered. These include conditions that exist in places where people live, learn, work, play and worship. Long-standing inequities in six key areas of SDoH are interrelated and influence a wide range of health and quality-of-life risks and outcomes. Examining these layered health and social inequities can help us better understand how to promote health equity and improve health outcomes.

  1. Social and Community Context

A person’s social and community context includes their interactions with the places they live, work, learn, play, and worship and their relationships with family, friends, co-workers, community members and institutions. For many, these contexts present huge barriers to personal health and well-being – making strategic interventions that provide indispensable support critical for those needing it. For example, children of incarcerated or detained parents may gain from their parents’ participation in reentry programs that assist with job placement or offer parenting support, and LGBTQ+ high school students who are bullied may benefit from school-based programs that reduce violence and prevent bullying.

  1. Healthcare Access and Use

People with disabilities, underrepresented racial/ethnic populations, rural citizens and white populations with lower incomes are more likely to face multiple barriers to accessing health care. For example, structural barriers related to socioeconomic status, such as lack of insurance, transportation, childcare, or ability to take time off work, can make it difficult to go to the doctor. Cultural and linguistic differences between patients and providers can negatively impact patient-provider interactions and health care quality. Inequities in treatment and historical events, like the U.S. Public Health Service Syphilis Study at Tuskegee and the involuntary mass sterilization of Native American women, help explain why some members of impacted racial and ethnic populations distrust health care systems and governmental health-related guidance.

  1. Neighborhood and Physical Environment

Many individuals within underrepresented racial/ethnic populations are disproportionately affected by difficulties in finding affordable and quality housing. The historical practice of redlining has not only impacted their ability to afford desirable housing (a key piece of the racial wealth gap), it’s negatively impacted access to public transportation, quality supermarkets (quality food), and nearby quality physical and mental health care. The segregation of neighborhoods has resulted in higher crime rates, poorly resourced infrastructure and higher rates of environmental pollution for many – all negatively impacting health.

  1. Income and Wealth Gaps

Many people within underrepresented racial/ethnic populations, LGBTQ+ and other historically marginalized groups face challenges in securing higher paying jobs with good benefits due to less access to high-quality education, language differences, discrimination, and transportation barriers. People with limited job options often have lower incomes, experience significant and generational barriers to wealth accumulation, and carry greater debt. Such financial challenges may make it difficult to manage expenses, pay medical bills, and access affordable quality housing, education, nutritious food, and reliable childcare.

  1. Workplace Conditions

Not all workers have the same risk of experiencing a work-related health problem, even when they have the same job. Occupational health inequities are avoidable differences in work-related disease prevalence, mental illness, or morbidity and mortality that are closely linked with social, economic, and/or environmental disadvantage, such as temporary work arrangements, socio-demographic characteristics (e.g., age, gender, gender identity, sexuality, race/ethnicity or class), and organizational factors (e.g., lack of worker safety measures, limited or no health insurance benefits).

  1. Education

Historically marginalized people, such as underrepresented racial/ethnic populations, individuals with disabilities, LGBTQ+ and those with lower incomes, are disproportionately affected by inequities in access to high-quality education. And, as higher education attainment is linked to higher paying employment, often including medical and dental insurance benefits, it’s clear that education has an impact on health.

How to Promote Health Equity

Everyone can play a role in ensuring that all people have equitable access to resources to maintain and manage their physical and mental health, including easy access to important information, goods and services, and affordable medical and mental health care. Non-profit organizations, businesses, health care organizations, public health agencies, policy makers and others play key roles in promoting and achieving health equity for all. Communities can promote health equity by adopting policies, programs, and practices that intentionally:

  1. Support equitable access to quality and affordable health and other social services (e.g., education, housing, transportation, childcare) and accessibility within these services.
  2. Recognize, respect, and support everyone in the community.
  3. Engage and leverage trusted messengers and community health workers to share clear and accurate information (tailored to a community’s languages, literacy levels, and cultures), and collect community input. It’s important to use clear, easy-to-read, accurate, transparent, and consistent information from a reputable source that is locally and culturally relevant in terms of language, messaging, tone, images, and format. Information should be suitable for diverse audiences, including people with disabilities, limited English proficiency, low literacy, or people who face other challenges accessing health information.
  4. Include community engagement efforts that can help build trust, promote social connection and strengthen partnerships between community members and public health organizations.

Of course, health care organizations play a key role. Those taking a proactive approach for developing sustainable DEI programs will be best positioned to improve health equity – and overall health care organizational performance. To improve health care for our nation’s increasingly diverse patient population, they should develop and implement organization-specific sustainable DEI strategies that:

  1. Enhance workplaces for all workers.
  2. Increase the diversity of workforces and board rooms to better match and understand the communities they serve.
  3. Increase workforce awareness of the uniqueness of all patients and colleagues and identify the barriers each may face to become healthier and more productive.
  4. Include reasonable and effective steps addressing any identified barriers.
  5. Include tracking, monitoring and reporting on the progress of the above efforts..