It’s Time for California to Solve the Double Standard of Care

Illustration of five ladders, arranged tallest to shortest, leaning against a blue wall.

California is one of the most diverse places on the planet. One thing we all have in common is a deep desire for ourselves and our loved ones to be healthy, live to their full potential, and have productive, satisfying lives. That shared aspiration explains why the idea that everyone should have access to health care is such a universal value.

Unfortunately, we know some groups face barriers to high-quality care solely on the basis of their skin color or ethnic background. Although health care plays a small but essential role in a person’s overall health, the delivery system has an outsized role to play in addressing health disparities.

With that in mind, CHCF has just released its first California Health Care Almanac devoted to racial and ethnic health disparities across our state. The report tells us where in California people of color disproportionately face barriers to health care and bear a heavier burden of illness. It also reveals a pattern of harm that is especially devastating to the people in our Black communities.

By the Numbers

By 2040, people of color are expected to account for two-thirds of California’s population. That’s why addressing disparities they face today has such huge implications for California’s future.

The findings in the almanac include data on:

  • Life expectancy. The average life expectancy at birth in California was 80.8 years. It was lowest for Blacks at 75.1 years and highest for Asians at 86.3 years, an 11-year gap.
  • Health and insurance status. Latinos were most likely to report being in fair/poor health and have higher rates of uninsurance.
  • Access. About 1 in 5 Latinos lacks a usual source of care and is less likely to have a checkup. One in 6 Latinos also reported difficulty finding a specialist.
  • Quality. Black children and adolescents are much more likely to end up in the emergency room because of complications from asthma. Rates of preventable hospitalizations for Black adults were much higher than rates for other races/ethnicities.
  • Mental health. About 1 in 5 multiracial and Black adults reported depression compared to about 1 in 10 Asian adults.
  • Prevention. Latinos have the lowest rates of colorectal cancer screening. Black and Latina women were less likely than white and Asian women to have breast cancer diagnosed at an early stage.
  • Maternal health. Blacks fare worse on maternal/child health measures. They have higher rates of preterm births, low-birthweight babies, infant mortality, maternal mortality, and low-risk, first-birth cesareans.

With these data comes responsibility. Knowing these disparities exist should compel policymakers, health system leaders, providers, and consumer groups to act. We must keep working on broad improvements to make care more affordable, accessible, and effective. Addressing disparities around coverage, access, and quality is mainly the job of the health care system. Disparities in health outcomes require the health care system to be part of the solution and work in tandem with other sectors. In every case, all of us need to ask ourselves what unique challenges racial and ethnic groups face in getting the care and help they need, and then target improvement efforts to address those structural realities. Ultimately, eliminating disparities for communities of color will benefit all Californians.

Significant Progress

I am optimistic that California can solve these problems. Here are just a few examples of noteworthy progress.

  • In 2013, before the Affordable Care Act was implemented, there were major differences in the uninsured rate of white and Black Californians. Now, the uninsured rates for both groups are at historic lows, and there is no statistically significant difference between them. We know that coverage is a prerequisite to people having access to the care they need.
  • A decade ago, Kaiser Permanente launched the Equitable Care Health Outcomes Program, which uses a team-based, population health approach to reduce racial health disparities among its members. For Black members, the program’s goal was to improve hypertension control, which prevents heart attacks, strokes, and kidney disease. For Latino members, Kaiser focused on increasing screening for colorectal cancer, which is highly treatable if diagnosed early. After seven years, hypertension control levels for Black members had improved by 22%, and disparities between Black and white members were reduced by 71%. Colorectal cancer screening rates increased for Latino members by 20%, and disparities between Latino and white members decreased by 44%.
  • Health Net wanted to do something about disparities in maternal health — including high maternal mortality rates — for Black women in Los Angeles County. Health Net Medical Director Dr. Pooja Mittal devoted her recent CHCF Leadership Fellowship project to developing a pilot program (PDF) to provide doula services to pregnant Black women. (Continuously supporting women in labor improves outcomes during childbirth, research shows.) Dr. Mittal aims to have 150 women in the pilot. So far, 50 women have enrolled, and all 18 of the deliveries to date were healthy births. Health Net will begin to share preliminary results later this year.
  • Two years ago, California’s public hospitals launched a range of projects (PDF) to reduce racial and ethnic health disparities in five key areas: blood pressure control, colorectal cancer screening, diabetes care, heart disease, and tobacco screening and cessation. The effort was part of a five-year initiative within the Public Hospital Redesign and Incentives in Medi-Cal (PRIME) program. After one year, 12 of 17 public hospitals saw meaningful improvement in erasing disparities. For example, after identifying care gaps and conducting telephone outreach to patients in Spanish, the Central Valley’s Kern Medical persuaded more Latino patients to take aspirin to reduce their risk of heart attack and stroke. Arrowhead Regional Medical Center in San Bernardino County increased colorectal cancer screening for Latino males through a tailored educational campaign. Contra Costa Regional Medical Center in Martinez helped Black patients lower their blood pressure through a multifaceted program that the patients helped to design.

Leverage from Data

Progress is possible, but improvement efforts cannot succeed without data transparency. On that score, the state Department of Health Care Services has a large role to play. The department recently began publicly reporting on access and quality in Medi-Cal managed care by race and ethnicity. They should also use state data to focus targeted improvement efforts on specific populations and to work with health plans to do the same with their medical groups and community clinic partners.

Disparities won’t disappear overnight and change won’t happen on its own. Progress requires the entire health care system to demonstrate leadership, rigorousness, humility, and persistence. Count on CHCF to be an active partner in this vital effort.