The inaugural America’s Health Rankings Health Disparities Report provides a comprehensive portrait of the breadth, depth and persistence of disparities in health and well-being across the U.S. It captures key trends, successes and challenges to spark meaningful dialogue and action toward advancing health equity.

Over the past century, there has been significant progress towards improving health and well-being in communities across America. People are living longer; and eradication of polio, smallpox and other illnesses and breakthroughs in treatment have reduced morbidity and mortality. Access to health insurance and quality health care have made the difference in millions of lives, improving health outcomes, and reducing mortality.1, 2, 3
While the country has made great strides in health and health care over the years, health disparities persist by gender, geography, race and ethnicity and other factors, driven by systemic inequities in social, economic and environmental conditions people face. This continues to shorten lives and heighten the prevalence of acute and chronic conditions, profoundly impacting health and well-being.
Measures of longevity reveal the consequences of health disparities. Between 1959 and 2016, U.S. life expectancy at birth increased from 69.9 years to 78.9 years.4 However, in 2020, Black male life expectancy at 68.3 years was more reflective of the average American lifespan 60 years ago.
In communities across the country, “deaths of despair”—or deaths involving suicide, drug overdose or alcohol-related illnesses—have halted progress in improving life expectancy.4, 5 Tied to a growing epidemic of mental health and substance use disorders, as of 2014, deaths among working-age Americans increased, particularly for residents in high-poverty areas of upper New England, the Ohio Valley and Appalachia.4 Some of the largest increases in working-age mortality occurred among women and adults with less education.4
Deaths during the COVID-19 pandemic have also reduced average life expectancy by over a year, and further exposed and exacerbated longstanding health disparities. While the impact of COVID-19 has been widespread, American Indian/Alaska Native, Black, Hispanic and Native Hawaiian/Pacific Islander populations have faced higher age-adjusted rates of infection, severe illness and death compared to white and Asian Americans. And while many factors contribute to these differences, including their disproportionate representation as essential and frontline workers, recent reports have reinforced how underlying social and economic disadvantage in communities play an outsized role in COVID-19 disease and deaths.6

Defining Health Disparities

Over the last four decades, Healthy People—an initiative of the U.S. Department of Health and Human Services—has identified public health priorities to help individuals, organizations and communities across the U.S. improve health and well-being by eliminating health disparities and achieving health equity.
According to Healthy People, health disparities are “health differences that are closely linked with social, economic and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”
Health disparities largely stem from underlying inequalities in the conditions in which people are born, grow, live, work and age—referred to as the social determinants of health. Shaped by historic and contemporary policies, disparities in health and the determinants of health are often avoidable.

Health disparities are health differences that are closely linked with social, economic, and/or environmental disadvantage.

Advancing Health Equity

According to Healthy People, health equity is the “attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices and the elimination of health and health care disparities.” Progress toward achieving health equity is measured by “reducing and ultimately eliminating disparities in health and its determinants.”

Health equity is the attainment of the highest level of health for all people.

Why Health Equity Matters

Advancing health equity can help improve the well-being of people and communities across the nation, while saving lives and yielding economic benefits. Preventable and avoidable gaps in health contribute to the poor ranking of the U.S. on life expectancy, infant mortality and other health measures compared to other high-income countries, despite spending among the most on health care globally. The impact of these circumstances has both human and economic consequences. Inequities contribute to intergenerational transfers of disadvantage, limiting the economic mobility, opportunity and health of future generations.7 At the same time, estimates show that health disparities cost the U.S. economy as much as $1.24 trillion in excess medical spending and lost work productivity—costs that have only further grown amid the COVID-19 pandemic.

Report Objectives

The inaugural edition of America’s Health Rankings Health Disparities Report documents the breadth, depth and persistence of disparities, providing a comprehensive national and state-by-state portrait of health and well-being across the U.S prior to the COVID-19 pandemic. Building on 31 years of data and reporting from America’s Health Rankings, this new report uniquely highlights the constant and changing contours of disparities across gender, geography, race and ethnicity and educational attainment.
This report is intended for a broad range of national, state and local audiences such as policymakers, government officials, advocates and stakeholders across sectors including public health, health care, education, housing and others. The report’s objectives are to:
  • Provide objective data on the magnitude of health disparities for the nation, all 50 states and the District of Columbia across a breadth of indicators for health outcomes and the determinants of health by educational attainment, gender, geography and race and ethnicity.
  • Identify health disparity trends across multiple factors and subpopulation groups, highlighting where progress has been made in reducing disparities, where disparities have persisted and where they have grown.
  • Stimulate dialogue and action to address health disparities and advance health equity across multiple sectors and stakeholders.
As the nation emerges from the COVID-19 pandemic, the America’s Health Rankings Health Disparities Report can serve as an important resource to help national, state and community leaders identify and build on promising progress, while working to end longstanding disparities in opportunity, health and well-being for all Americans.

Breadth, Depth and Persistence of Health Disparities Across the U.S.

The America’s Health Rankings Health Disparities Report provides objective data that collectively demonstrate how deeply and widely entrenched health disparities are across the U.S. In doing so, the report identifies:
  • The breadth of health disparities, that is the existence of disparities across 30 health-related measures of core social and economic factors, clinical care, physical environment, health behavior and health outcomes.
  • The depth of health disparities, or the magnitude of disparities by educational attainment, gender, geography and race and ethnicity for the nation, all 50 states and the District of Columbia.
  • The persistence of health disparities, referring to where health disparities have remained despite progress or lack thereof, and where they have grown over time.

[1] Institute of Medicine. (2002). Care Without Coverage: Too Little, Too Late. Washington (DC): National Academies Press. DOI: 10.17226/10367
[2] Wilper, A.P., et al. (2009). Health Insurance and Mortality in US Adults. American Journal of Public Health, 99(12): 2289-2295. doi: 10.2105/AJPH.2008.157685
[3] Borgschulte, M. and Vogler, J. (2020). Did the ACA Medicaid Expansion Save Lives? Journal of Health Economics, 72(102333). https://doi.org/10.1016/j.jhealeco.2020.102333
[4] Woolf, W. and Schoomaker, H. (2019). Life Expectancy and Mortality Rates in the United States, 1959-2017. JAMA, 322(20): 1996-2016. doi:10.1001/jama.2019.16932
[5] Case, A. and Deaton, A. (2020). Deaths of Despair and the Future of Capitalism. Princeton (New Jersey): Princeton University Press.
[6] Karmakar, M., et al. (2021). Association of Social and Demographic Factors with COVID-19 Incidence and Death Rates in the US. JAMA 4, (1): e2036462. doi:10.1001/jamanetworkopen.2020.36462
[7] Davis, K., et al. (2014). Mirror, mirror on the wall, 2014 update: How the U.S. health care system compares internationally. The Commonwealth Fund. https://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror-wall-2014-update-how-us-health-care-system

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