Racial disparities put further strain on primary care

 Racial disparities put further strain on primary care

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Racial disparities in healthcare access, quality and outcomes are still prevalent across the United States, reflected notably in the sharp racial divide in premature deaths, according to the Commonwealth Fund’s 2024 State Health Disparities Report.

The study assessed data from racial and ethnic groups, including Black, Hispanic, American Indian/Alaska Natives (AIAN), and Asian American, Native Hawaiian and Pacific Islander (AANHPI) populations across 25 different measures encompassing healthcare access, quality, service utilization and health outcomes.

Even in states known for high-quality healthcare  among them Massachusetts, Minnesota and Connecticut  many people of color experience significantly inferior quality of care.

Elevated poverty rates, increased pollution and crime levels, limited access to green spaces, and a lack of affordable, quality healthcare options were contributing factors, while the COVID-19 pandemic exacerbated existing disparities.

Commonwealth Fund report coauthor Arnav Shah pointed to Massachusetts, where the Black population had the lowest performance score in the state.
He explained this was driven by disparities between the black population and the Asian and White populations in measures like treatable and preventable deaths before age 75.

The report also analyzed rates of obesity, potentially avoidable emergency departments for older adults, rates of flu and pneumonia vaccination, and the percentage of children with preventive care visits.

Among the most concerning findings was the stark racial divide in avoidable deaths, with higher rates among American Indian and Black populations.

“By definition these types of deaths are considered to be treatable or preventable by timely health care interventions like cancer screenings and vaccinations,” Shah said. “Many of these can be achieved through having access to a strong primary care system.”


Shah noted the primary care system across the U.S. is already strained because there are too few providers.

“This is especially true in many communities with high concentrations of Black and Hispanic people,” he said. He said the primary care system can be strengthened by creating incentives (e.g., loan forgiveness or medical school tuition assistance) for more medical students to choose primary care as a specialty.

“Other improvements could be made through increasing reimbursement rates for primary care providers relative to other medical specialties and augmenting the primary care workforce with physician assistants, nurse practitioners, and other types of community health workers,” Shah explained.


Addressing health inequity is both a social and economic imperative, with the National Institutes of Health estimating that race and ethnicity disparities in the United States cost upwards of $400 billion annually.

David Radley, coauthor of the Commonwealth report, agreed more needs to be done to develop healthcare workforce that is well equipped to handle different communities. “This might mean more investment to get providers into communities in the most need, as well as working to ensure healthcare workers reflect the cultural and language of the communities they serve,” he said.

He said reports like Commonwealth’s can help get conversations started, as well as help people from different states identify benchmarks and a common understanding.

“Ultimately, state policy and healthcare leaders need to acknowledge the disparities noted here as a problem that deserves attention and be willing to invest resources and time to help address,” Radley said. “They also need to talk to each other.”

He noted there are several organizations that promote these types of collaboration between state leaders.

These include the National Academy for State Health Policy (NASHP), the National Association of Medicaid Directors (NAMD), the Center for Evidence-Based Practices (CEBP) and the Institute for Healthcare Improvement (IHI).

A February 2023 study in Health Affairs suggested improving maternal outcomes could be achieved through the development of surveys with disaggregated race and ethnicity data.

The report emphasized the importance of understanding disparities among racial and ethnic groups to address issues such as premature mortality rates.

Email the writer: nathaneddy@gmail.com

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