The nation has not made much practice in improving health equity, despite the strides made in treatment and technology over 25 years. (Image: Chris Nicholls/ALM)
The United States has seen a worrisome lack of progress in health equity over the last 25 years, according to a new study from the Journal of American Medical Association.
The report's authors note that health equity—the concept that all Americans should have the same opportunity to be as healthy as possible, regardless of factors such as personal wealth or ethnicity—is often stated as a major public policy priority. For example, it is one of four major goals of the U.S. Department of Health and Human Services' Healthy 2020 initiative. Despite that, there have been few measurements of progress toward the goal of health equity.
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“It is difficult to find summary assessments of the extent to which national or state-level progress toward this goal is being made,” the report said. “Without such summary measures, it is difficult to track performance toward health-equity goals.”
Millions of records; mixed results
This study used de-identified data from almost 5.5 million Americans over the 25-year time period, looking at two main measurements: total healthy days over the last month, and general health in five specific categories.
Several findings were notable. For example, the data showed that income disparities in health increased over the study's time period. On the other hand, disparities in health between African American and white Americans decreased over the past two-and-a-half decades. “Black-white disparities were small and trending slightly downward over time for both outcomes. Over the 25-year period, the black-white gap showed significant improvement,” the report said.
When looking at the category of health justice—a measure of health outcomes independent of race, sex, or income—the findings were more mixed, the report said. “Health justice decreased generally throughout the period for healthy days, with a modest improvement from 2012 to 2015, gains that were erased by 2017.”
25 years of standing still?
The report concludes that the nation has not made much practice in improving health equity, despite the strides made in treatment and technology over 25 years.
“The results of this study show a worrisome lack of progress on health equity during the past 25 years in the United States,” the researchers wrote. “Although there are some differences across conceptualizations of health equity, and small differences across the 2 concepts of overall health, the overall pattern is one of stagnation mixed with unambiguous decline.”
A clear area of concern is the geographic and income-related disparities, which are growing worse, according to the report. “From 2001 to 2014, income disparities in life expectancy increased, and an analysis of disparities in life expectancies across counties found that they have been increasing since 1980 and were correlated with county-level racial/ethnic proportions and income,” the study said. “Also similar is an analysis of education-related disparities in mortality across states, which found wide differences across states, coupled with an overall pattern of minimal progress.”
The study noted that there are some limitations to the analysis, due to data shortcomings. However, the authors added, the consistency of their findings add to the strength of the overall conclusions.
The authors also called for more study of the issue and better tracking of health equity measurements. “The country as a whole must work harder to promote health equity if the often-stated goals of improving health equity are to be met,” the report said. “The analysis here hints that increasing income disparities may be associated with stagnant health equity. If this is in fact the case, policies that reduce the prevalence and penalties associated with poverty would be a clear starting point to improving health equity.”
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