A healthy California for all requires a health care system designed to redress, and not perpetuate, the inequities that too many Californians — especially Black Californians — face. Policymakers and health system leaders have a huge responsibility to understand the health care experiences of Black Californians and to transform the system to be more responsive to and effective at meeting their needs.

Health is a key value for Black Americans, who are among the most likely groups to say they always make their health a priority. But structural barriers in the health care system prevent them from achieving the health they actively seek. Black Californians experience disparities in care and outcomes despite having higher health insurance coverage rates (93%) than the state average.

The life expectancy at birth for Black Californians is 75.1 years — five years shorter than the state average and the lowest life expectancy of all racial and ethnic groups. Additionally, Black Californians have the highest rates of new colorectal, lung, and prostate cancer cases, and the highest death rates for breast, colorectal, lung, and prostate cancer. These outcomes cannot be explained away by factors like age, income, or education level. The health care system treats people differently — implicit biases and racism are known to exist at the levels of both the health care system and the individual provider.

Between 2011 and 2017, Black Californians were more than twice as likely as White Californians to undergo amputations related to diabetes — an outcome avoidable with better access to care and better disease management. Additionally, Black birthing people* fare worse on maternal and childbirth measures than birthing people of other races and ethnicities. These outcomes are not mere coincidences — they are the result of systemic failings in health care and other institutions.

The 2023 CHCF California Health Policy Survey found nearly 7 in 10 Black Californians (69%) experienced negative interactions during health care visits (e.g., having a provider assume something about them without asking; having a provider talk down to them or not treat them with respect), compared to 54% of Californians overall. The good news is that two-thirds of Californians overall believe it is extremely or very important to reduce differences in health care quality between racial and ethnic groups. It is incumbent on California, working at all levels and across systems, to break down entrenched barriers to quality health care for Black Californians.

CHCF is working to advance Black health equity in two ways:

• Addressing Anti-Black racism in California health systems
• Supporting work to improve Black birth equity

* We use the term “birthing people” to recognize that not all people who become pregnant and give birth identify as a woman or a mother.