Early Death Racial Disparity - Ages 65-74 in Alabama

Alabama

Certain historically marginalized racial and ethnic groups are more likely to have earlier onset and more severe disease, as well as higher disease-specific mortality. According to the Centers for Disease Control and Prevention (CDC), inequities in the social determinants of health are driven mainly by the negative effects of interpersonal and structural racism, placing communities of color at risk for poor health outcomes. Additionally, chronic stress due to racial discrimination or interpersonal racism may result in psychological distress and increases in adverse health behaviors.

Understanding racial and ethnic disparities in mortality among older adults requires historical and socioeconomic context. Structural racism — the interaction of institutions, social forces and ideologies that may determine the availability of community resources based on their racial and ethnic composition — contributes to racial inequities in health and premature death among seniors. Aspects of life impacted by structural racism include social determinants of health, such as: 

• Housing, transportation and neighborhood environment.
• Education, job opportunities and income.
• Language and literacy skills.
• Violence and discrimination. 

While not the direct cause of death, these social factors often play a large role in how and why a person dies. Research indicates that health disparities are costly and contribute to increased medical care costs, productivity losses and additional economic burdens due to premature deaths every year. In 2018, the total economic burden of racial and ethnic health disparities in the United States was estimated at $451 billion, or $1,377 per person.

According to America’s Health Rankings analysis, the largest disparities in premature death by race and ethnicity are among:

• Black older adults, who have the highest early death rate. Multiracial older adults have the lowest rate. The premature death rate of Black older adults is 2.9 times higher than that of multiracial older adults, and 1.5 times higher than that of white older adults. 
• Hawaiian/Pacific Islander older adults, who have an early death rate 2.5 times higher than that of multiracial older adults and 1.3 times higher than that of white older adults.

To address racism and its effect on health, comprehensive and upstream solutions are needed at the systemic and institutional levels. Interventions that improve the quality and accessibility of social factors such as housing, income, employment and education can potentially improve health. To address health disparities, the CDC supports programs that target aspects of the social determinants of health, address barriers to accessing care or focus on populations facing disparities. Examples of how these programs are implemented across the U.S. include:

• The National Center for Chronic Disease Prevention and Health Promotion works with American Indian/Alaskan Native communities to develop culturally competent and community-supported public health services and surveillance. Their programs include establishing Tribal Epidemiology Centers and helping tribal communities gain access to traditional fresh produce.
• The National Breast and Cervical Cancer Early Detection Program helps increase cancer screening, diagnostic and treatment services among those who are uninsured by providing community navigators and partnering with local agencies for outreach.
• The National Diabetes Prevention Program provides structured lifestyle change programs both in person and online to prevent Type 2 diabetes among high-risk groups.
• The Community Health Workers for COVID Response and Resilient Communities initiative provides financial support and assistance to community health workers, who are established and trusted in their communities and can liaise effectively with health and social services institutions. This initiative works to stop the spread of COVID-19 and promote health equity while better supporting the communities most impacted by the pandemic. 

The Centers for Medicare and Medicaid Services has also released an updated framework with the aim of promoting health equity, broadening health coverage and improving health outcomes for those covered under Medicare, Medicaid, CHIP and the Health Insurance Marketplaces. 

According to Healthy People 2030, promoting healthy choices is not enough to eliminate health disparities. They suggest that public health organizations collaborate with partners in other sectors like education, transportation and housing to improve the conditions in people's social, economic and physical environments.

Healthy People 2030 has multiple national overarching goals related to preventing premature death and eliminating racial disparities, including:

• Attaining healthy, thriving lives and well-being free of preventable disease, disability, injury and premature death.
• Eliminating health disparities, achieving health equity and attaining health literacy to improve the health and well-being of all.
• Creating social, physical and economic environments that promote attaining the full potential for health and well-being for all.

Bailey, Zinzi, Natalia Linos, and Mary T. Bassett. “Inequities in the Mortality Rates of Older Americans—Race, Sex, Place, and Time.” JAMA Network Open 3, no. 8 (August 3, 2020): e2012437. https://doi.org/10.1001/jamanetworkopen.2020.12437.

“CMS Framework for Health Equity 2022–2032.” Baltimore, MD: Centers for Medicare & Medicaid Services, 2022. https://www.cms.gov/files/document/cms-framework-health-equity-2022.pdf.

Henning-Smith, Carrie, Ashley M. Hernandez, Marizen Ramirez, Rachel Hardeman, and Katy Kozhimannil. “Dying Too Soon: County-Level Disparities in Premature Death by Rurality, Race, and Ethnicity.” Policy Brief. Minneapolis, MN: University of Minnesota Rural Health Research Center, March 2019. http://rhrc.umn.edu/wp-content/files_mf/1552267547UMNpolicybriefPrematureDeath.pdf.

Krieger, Nancy. “Discrimination and Health Inequities.” In Social Epidemiology, 2nd ed., 17–62. Oxford, New York: Oxford University Press, 2014. https://doi.org/10.1093/med/9780195377903.003.0003.

Williams, David R. “Miles to Go before We Sleep: Racial Inequities in Health.” Journal of Health and Social Behavior 53, no. 3 (September 2012): 279–95. https://doi.org/10.1177/0022146512455804.

Williams, David R., Jourdyn A. Lawrence, and Brigette A. Davis. “Racism and Health: Evidence and Needed Research.” Annual Review of Public Health 40, no. 1 (April 1, 2019): 105–25. https://doi.org/10.1146/annurev-publhealth-040218-043750.

Williams, David R., and Selina A. Mohammed. “Racism and Health II: A Needed Research Agenda for Effective Interventions.” The American Behavioral Scientist 57, no. 8 (August 1, 2013). https://doi.org/10.1177/0002764213487341.

Williams, David R., and Valerie Purdie-Vaughns. “Needed Interventions to Reduce Racial/Ethnic Disparities in Health.” Journal of Health Politics, Policy and Law 41, no. 4 (August 2016): 627–51. https://doi.org/10.1215/03616878-3620857.