Addressing Anti-Black Racism in California Health Systems

Why This Work Matters

According to the 2020 California Health Insurance Survey, 64% of Black Californians have private health insurance and 24% are enrolled in Medi-Cal. Most of CHCF’s work is focused on improving care for Medi-Cal enrollees, but Black Californians face disparities in care and outcomes regardless of the type of health insurance they have.

Our Approach

Generalized approaches to improve health care will neither be robust nor swift enough to control and eliminate disparities, which is why CHCF is investing to end Black health inequities across public and private systems.

CHCF is committed to centering the voices of Black Californians in this work, which is founded on listening to Black Californians and measuring equity in health care. We are working to build accountability for equitable care by fostering health care equity measurement and reporting; to promote equity in delivery systems by improving policies and practices; and to equip Black Californians with information and tools to advocate for equitable care for themselves and their communities.

A summary of CHCF’s portfolio of projects to improve health care systems for Black Californians can be found below.

Project Highlights

Building Accountability for Equitable Care

The National Committee for Quality Assurance (NCQA) developed racial equity quality measures that state Medicaid programs (and potentially other purchasers) can integrate into accountability programs. Measurement can help illuminate how well health systems are serving Medicaid enrollees by race, provide data transparency, and ultimately help drive improvement. The first report in this project describes the current state of use and application of health quality measures among state Medicaid programs. NCQA also developed a health equity measurement framework that state Medicaid programs can use to measure accountability in health plan managed care contracting. The final report was an examination of peer-reviewed and gray literature uncovering four methods for measuring equitable care. (March 2023)
The RAND Corporation conducted research to understand the interaction between race and patient safety. This study resulted in key recommendations for integrating racial health equity into hospital patient safety policies and practices. (August 2022)
It also paved the way for an ongoing project that will develop a tool to assess racial equity in patient safety systems. (Ongoing)

Promoting Equity in Delivery System Policies and Practices

The California Health Care Safety Net Institute, in collaboration with the National Equity Project and subject matter experts, will convene a Community of Practice among California’s public health systems that is designed to advance health systems in their efforts to systematize equitable care. (Ongoing)
Artificial Intelligence (AI) is entering health care and can only be as equitable and ethical as it as its creators make it. The National Academy of Sciences is working with multi-sector experts to create an AI Code of Conduct, which will guide the use of AI in health care and bio-sciences with the goal of ensuring equitable innovation. (Ongoing)
The Urban Institute is convening multi-sector experts to review progress in health equity in the 20 years since the Institute of Medicine published Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. The experts will analyze what worked and what didn’t, and the Urban Institute will produce a series of publications with the aim of recommending ways to accelerate progress toward health equity. (Ongoing)
Thalamus, a cloud-based Software-as-a-Service company and creator of the premier platform for hospital residency application and interview management, conducted research to measure growth and attrition at key stages of the transition from undergraduate medical education to residency training for newly minted physicians in California. The CHCF-funded analysis focused on Black and Latino/x physicians with an eye toward increasing recruitment and retention of physicians who are underrepresented in medicine in California. (April 2023)
Additionally, based on its observations of inequities in residency matching, Thalamus established a 501(c)(3) organization to award scholarships to cover the costs of competing for residency placement. CHCF is proud to support that effort as well. (2022)
The Urban Institute conducted a comprehensive review of historical and current programs designed to encourage people of color, especially Black people, to enter the health professions, persist in professional training, and remain and advance in the health professions. This research built on the work of the California Future Health Workforce Commission and recommends investments that could advance patient-provider race concordance in California. Watch a recording of Urban Institute’s webinar summarizing the findings of the research. The Urban Institute team included Kimá Joy Taylor, MD; LesLeigh D. Ford, PhD; Eva H. Allen, MPP; and Faith Mitchell, PhD. (June 2022)
- Based on the work of Urban Institute, Mathematica is working on policy recommendations for improving the diversity of California’s health workforce. (Ongoing)

Engaging and Equipping Black Californians to Advocate for Equitable Care

EVITARUS, a Black-owned public opinion research and public policy consulting firm in Los Angeles, conducted qualitative and quantitative research among a diverse sample of Black Californians to understand their experiences of racism and its impact on their health care. This project identified policy actions and practice changes at the clinical, administrative, and training levels that policymakers and health system leaders can take to eliminate the impact of racism on Black Californians’ experiences in health care and to improve their health outcomes. A Black Health Equity Advisory Group composed of academics, policymakers, providers, and community advocates guided our development of this work. Read the final report. (October 2022)
- Additional fact sheets spotlighting the experiences of Black women with Medi-Cal, Black Californians with mental health conditions, Black Californians who identify as LGBTQIA+, and Black Californians with disabilities were published in 2023 and 2024. A publication on Black men’s engagement with health care is also forthcoming. (Ongoing)
The Conversation / La Conversación, is a public information campaign to provide Black and Latinx communities with credible information about the COVID-19 vaccines. Co-created by KFF and Rhea Boyd, MD, MPH, and supported by a range of partners, the initial video featured Bay Area comedian W. Kamau Bell in an open, honest conversation with Black health care workers. As vaccine availability and guidance has evolved, subsequent videos have featured Latinx health care workers answering common questions in English and Spanish, pediatricians providing information about the vaccine for children, and maternity care workers providing information about the vaccine and pregnancy. (2022)

Learn More

For more information, please contact Katherine Haynes.

Advancing Black Health Equity