In the Wake of National Health Reform: Will Health Inequities Be Eliminated?

By Smedley, Brian D. | National Urban League. The State of Black America, January 1, 2011 | Go to article overview
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In the Wake of National Health Reform: Will Health Inequities Be Eliminated?

Smedley, Brian D., National Urban League. The State of Black America

The 2O1O mid-term election has important implications for the nascent health reform law: the House Leadership has vowed to repeal and replace the Patient Protection and Affordable Care Act (ACA), which President Obama signed into law only seven months prior to the November 2O1O election. In reality, it will be extremely difficult for House Republicans to repeal and replace the Act, which would require Senate consent and the President's signature. But Republicans will wield other powerful tools to limit dramatically the ACA's size and scope while at the same time establishing a legislative framework for a more market-based approach to the financing and delivery of healthcare.

What are the implications of this shift in political power in Washington for the health equity movement? The movement's proponents seek to ensure that all people in the United States- regardless of race, ethnicity, geography, or social class- enjoy equal opportunities for good health. Will the ACA prove beneficial in this effort? This essay will assess the potential of the ACA to address health inequities, particularly their root causes, which are largely outside of the healthcare arena. I use the term health inequities because it describes the poorer health status of many communities of color relative to national averages and asserts that these differences are unacceptable because they are avoidable.


Racial and ethnic health inequities persist from the cradle to the grave. Some U.S. racial and ethnic minorities experience a disproportionate burden of poor health across a host of health measures, ranging from infant mortality to life expectancy as well as most chronic and infectious diseases. African Americans, American Indians, and Pacific Islanders face some of the most persistent and pervasive inequities relative to whites.1 For example, while the life expectancy gap between African Americans and whites has narrowed slightly,2 African Americans still can expect to live 6-1O fewer years than whites and face higher rates of illness and mortality.3

In terms of lives, this gap is staggering: An analysis of 1991 to 2OOO mortality data concluded that, had mortality rates of African Americans been equivalent to that of whites in this time period, over 880,000 deaths would have been averted." And while some racial and ethnic groups, such as some Hispanics and Asian Americans, have better overall health status than national averages, they suffer disproportionately from some diseases, such as diabetes, cancer, and liver disease and tend to experience poorer health outcomes the longer they and their descendente live in the United States.5

The causes of racial and ethnic health inequities are complex and multifactoral. Socioeconomic differences are the most significant factor, given the strong correlation between socioeconomic status and health. People at every ascending step in the socioeconomic grathent generally have better health than those even a step below.6 Given the disproportionate representation of many racial and ethnic minorities in lower socioeconomic tiers, socioeconomic inequality is a major factor contributing to health inequalities. Health behaviors also certainly play a role- some racial and ethnic minorities, for example, report being less physically active than whites- but these health behaviors are often shaped by neighborhood context.

Many public health researchers believe that the fundamental mechanism underlying these inequities is residential segregation, which powerfully shapes health resources, risks, and life opportunities. Racial and ethnic minorities are more likely than whites to live in segregated, high-poverty communities, communities that have historically suffered from a lack of health care investment. Many of these communities also face a host of health hazards- such as high levels of air, water, and soil pollution and a glut of fast food restaurants and liquor stores - and have relatively few health-enhancing resources, such as grocery stores where fresh fruits and vegetables can be purchased, or safe parks and recreational facilities where residents can exercise or play.

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In the Wake of National Health Reform: Will Health Inequities Be Eliminated?


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