How Minority Health Disparities Impact Patient Care
Medical care delivered within a healthcare facility doesn’t capture the whole picture of a person’s well-being.
Social determinants of health (SDoH) play a significant role in one’s health and welfare. The conditions and environments impact quality of life—both positively and negatively—and in the latter situation can contribute to health disparities. Although significant technological advances in care delivery and treatment have emerged in recent years, many factors outside care settings continue to influence health outcomes. The extent to which minority health disparities can affect care quality, total cost of care, and patient outcomes is greater than many providers and healthcare facilities understand. Being aware of the ways in which social determinants of health result in these disparities is a first step toward addressing health disparities in minorities and providing care that results in better patient outcomes.
Health equity is a shared responsibility
Healthcare systems are increasingly prioritizing SDoH. Achieving health equity requires everyone—including providers and payers—to be accountable for reducing minority health disparities by working within communities to address social determinants of health. To do that, they need robust tools that identify and tackle these disparities.
What are social drivers of health?
The Office of Disease Prevention and Health Promotion (ODPHP) focuses on five key social determinants of health:
- Economic stability: People with a steady income are less likely to live in poverty and more likely to have access to healthy foods, housing, and healthcare
- Education access and quality: People with more education live longer and tend to be healthier than those with less education.
- Healthcare access and quality: Getting the right care, in the right place, at the right time is essential for health. It reduces the risk of chronic disease, mental health issues, and mortality for vulnerable patient populations.
- Neighborhood: Living and working in a safe neighborhood environment reduces the risk that someone will experience harm from circumstances related to their surroundings, like violence or airborne contaminants.
- Social and community: Positive personal relationships and support structures improve overall health and well-being. They also combat negative health consequences from factors out of a person’s control, such as racism, discrimination, or bullying.
The real-world impact of SDoH
Many healthcare providers recognize that what happens outside of a clinic or hospital affects patients’ health and well-being. In the U.S., health disparities in under-resourced communities create wide gaps in several areas of healthcare.
Coverage and access to care
A 2021 report from the Kaiser Family Foundation (KFF) highlights some of the stark inequities in insurance and access to care. The Affordable Care Act reduced the number of uninsured people across all racial, ethnic, and income groups. But many gaps persist that make it hard for people to get affordable and convenient care.
For example, people of color are far more likely to be uninsured compared to white individuals. Additionally, low-income patients are less likely to have access to reliable transportation to get to and from appointments. People who live in rural communities and must travel long distances to get care also have more difficulty accessing regular care.
Minority communities have a higher prevalence of chronic disease compared to white communities, as outlined in a 2020 fact sheet from the Center for American Progress. Chronic conditions like asthma, diabetes, heart disease, high blood pressure, and obesity have serious implications on a person’s health and quality of life.
Social drivers of health can put people at higher risk of developing these diseases and make it harder to manage them. For example,
- People who live in communities with high levels of air pollution or high volume of substandard housing are much more likely to develop asthma.
- People who live in food deserts have limited access to grocery stores that sell fresh foods like fruits and vegetables. The lack of produce increases their risk of developing chronic conditions.
- People without access to convenient and affordable primary care providers or specialists may not seek care early enough to prevent chronic disease. They may also have difficulty managing chronic conditions.
Along with caring for physical health, providers must also address mental health challenges in patient populations and the care gaps that health disparities among minorities create. Many primary care providers recognize the importance of behavioral and mental health care and are incorporating it into each patient encounter. The COVID-19 pandemic recently brought mental health to the forefront for everyone. We saw its impact on physical well-being and identified significant gaps in the availability of this care. Beyond the current pandemic, SDoH can impact mental health in many ways, including:
- Post-traumatic stress from living in unsafe or violent neighborhoods
- Depression and anxiety from bullying or racial discrimination
- Stress from caring for a family member or loved one with disabilities
- Psychological strain for children with a parent who is incarcerated
Mortality and life expectancy
Without access to regular, high-quality healthcare, people of color are more likely to die from preventable causes. This is especially prevalent in infant deaths and maternal mortality rates.
The maternal mortality rate among white women is 13 per 100,000 live births. Mortality rates are more than double (30 per 100,000) for American Indian and Alaska Native (AIAN) and Native Hawaiian and Other Pacific Islander (NHOPI) women and more than three times as high for Black women (41 per 100,000).
Infant deaths are also indicative of minority health disparities. The national average of deaths per 1,000 live births is 5.6, but it varies widely by racial and ethnic group. AIAN, NHOPI, and Black infant mortality rates are about twice as high as those of whites, Asians, and Hispanics.
Quantifying the impact of SDoH on patients
One of the biggest challenges for healthcare providers and organizations is quantifying the impact of SDoH on patients and the effects of programs and other efforts to address SDoH on patient outcomes.
Getting specific data to understand the role SDoH play in health outcomes—and what you can do about it—requires the right datasets, analytic tools, and evaluation methodology. Together, these resources help give providers the ability to identify the right information, properly segment the data, and establish which patients are at highest risk and most in need of additional programs and services.
New NCQA standards to identify and address health disparities among minorities
The National Committee for Quality Assurance (NCQA) has a new Health Equity Accreditation Plus program to:
- Help organizations find health disparities among minorities
- Standardize processes to improve care quality for everyone
- Deliver appropriate services to specific populations based on SDoH factors and their health needs
Providers are increasingly held accountable for the overall health and well-being of their patients. The ability to identify people at higher risk, and focus outreach and care efforts to address SDoH, can significantly improve outcomes.
How it works in practice
Healthcare providers with a high volume of patients with asthma should capture and evaluate information on neighborhood-level factors that might increase asthma risk. That information is reflected in the RTI Rarity™ tool and the Local Social Inequity (LSI) score. Health Advance performs evaluations that helps providers analyze:
- Air pollution levels by zip code
- Outdoor air quality in specific neighborhoods or geographic areas
- Structural information about buildings, including the type, scale, and density
- Data on average age of housing to identify older buildings more likely to have issues with mold or asthma-related allergens
- Demographic data to locate populations with higher asthma incidence by ethnicity, occupation, or income level
With this information and our counsel, providers can better quantify risk. Providers can also proactively identify at-risk patients and offer preventive care. These preemptive measures result in better overall patient care and lower total cost of care. Clarifying the big picture is an essential step in reducing health disparities among minorities and at-risk patients.
RTI Health Advance offers the advisory services and tools providers need to address health disparities in under-resourced communities
We have significant expertise in designing quantitative and qualitative evaluations of SDoH approaches, assessing patients’ SDoH barriers, targeting interventions, stratifying outcomes across socioeconomic lines, and collaborating with community organizations to respond to patient needs.
Learn more about our health equity solutions.