Why This Work Matters
A healthy California for all requires a health care system designed to redress, and not perpetuate, the inequities that too many of our fellow Californians face. There is a huge responsibility for policymakers and health system leaders to understand the health care experiences of Black Californians and to reform 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 their fullest potential for health. 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 prostate, colorectal, and lung 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 both at the level of the health care system and at the individual provider level.
Between 2011 and 2017, Black Californians were more than twice as likely as non-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 2021 CHCF California Health Policy Survey found about half of Californians think it’s “harder” or “much harder” for Black residents than for White residents to get the care they need. Among those Californians, large majorities agree that the state government, health insurance plans, hospitals, and individual health care providers have a “very large” or “large” amount of responsibility for addressing racial and ethnic health inequality in health care. It is incumbent on California, working at all levels and across systems, to break down entrenched barriers to quality health care.
Generalized approaches to improve health care will neither be robust nor swift enough to control and eliminate disparities, which is why CHCF is investing specifically in Black health equity. Most of CHCF’s work is focused on improving care for Medi-Cal enrollees, but the disparities in care and outcomes that Black Californians face cross insurance types. With that in mind, CHCF will work to end Black health inequities across public and commercial systems. (According to the 2017 California Health Interview Survey, 54% of Black Californians have private health insurance and 31% are enrolled in Medi-Cal.)
CHCF is committed to listening to and centering the voices of Black Californians in this work. We are partnering with Black-led organizations to understand the health care experiences of Black Californians, build data transparency and accountability around equitable care, and promote the participation, advancement, and retention of Black people in the health care workforce. We are also creating a Black Health Equity Advisory Group composed of academics, policymakers, providers, and community advocates to guide our development of this work.
A summary of CHCF’s portfolio of Black health equity projects can be found below.
Understanding the Health Care Experiences of Black Californians
- Evitarus, a Black-owned public opinion research and public policy consulting firm in Los Angeles, is conducting qualitative research among a diverse sample of Black Californians to understand their experiences of racism and its impact on their health care. This project will identify 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 improve their health outcomes. (In process)
- The Conversation: Between Us, About Us, is a public information campaign to provide Black communities with credible information about the COVID-19 vaccines. Developed by KFF, the Black Coalition Against COVID-19, and Rhea Boyd, MD, MPH, the campaign features Bay Area comedian W. Kamau Bell in an open, honest conversation with Black doctors, nurses, and researchers. CHCF cofounded the campaign with KFF, the Commonwealth Fund, Sierra Health Foundation, and YouTube. (March 2021)
Building Transparency and Accountability
- The National Committee for Quality Assurance is developing 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. (In process)
Cultivating a Diverse Health Workforce
- The Urban Institute is conducting 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 will build on the work of the California Future Health Workforce Commission and recommend investments that could advance patient-provider race concordance in California. Shena Ashley, PhD, will lead the Urban Institute team, which also includes Kimá Joy Taylor, MD; LesLeigh D. Ford, PhD; and Faith Mitchell, PhD. (In process)
- CHCF contributed to a scholarship and debt relief fund at the Charles R. Drew University of Medicine and Science, a Historically Black Graduate Institution in South Central Los Angeles that is designated as a minority-serving institution by the US Office for Civil Rights. The scholarships will be based on documented need and continued good academic performance and will help ease the impact of financial burden on medical students of color. (David Carlisle, MD, PhD, president and CEO of Charles R. Drew University, serves on the CHCF board of directors. He was not involved in CHCF’s decision to fund the scholarships.)
For information, please contact Katherine Haynes.