This year, for the first time, the foundation’s report took on a new focus. Titled “America’s Health Rankings Disparities Report,” the study documents the breadth, depth and persistence of health disparities in the U.S. to provide objective data to inform action for advancing health equity.
While previous reports have focused on the health of seniors, the health of women or on those who’ve served in the U.S. military, this year’s report focused on areas where one group has a disadvantage compared to another. The study’s results were broken down by all 50 states and the District of Columbia. In Minnesota, while some categories — including health insurance rates between rural and urban residents and low birthweights among white and Hispanic babies — show low rates of disparity, there was room for improvement in many other key areas.
Interested in learning more about the report, its methodology and results, I spoke with Rhonda Randall, DO, executive vice president and chief medical officer of UnitedHealthcare. Randall told me that she and her colleagues see the study’s results as a starting point, or a “call-to-action” for states to pinpoint possible areas for improvement.
“This report provides a baseline for all of us of where to start the conversation so we can decide where we can best put our efforts,” she said.
MinnPost: What inspired United Health Foundation to create a report focusing on health disparities?
RR: We wanted to look at the breadth and the persistence of health disparities, where are the disparities improving, where are they worsening, what they are representing. This report documents health disparities across the nation to provide objective data to inform action for advancing health equity.
MP: What sources do you use to gather your data?
RR: We gathered our data from four public reporting agencies. It is not United Health’s data. It is the nation’s data. The data sources for the report included the Centers for Disease Control and Prevention, the American Community Survey, the Current Population Survey Food Security Supplement and the National Vital Statistics System. Data was gathered across three time periods between 2003 and 2019. One of the things that was important in selecting our sources is that that data is reported at a state level and, for this report, at a sub-population level. We need to be able to isolate the answers to sub communities.
MP: Why was it important that the report focused on individual states?
RR: As we look at all 50 states, we wanted to be able to truly look at the breadth, depth and persistence of the disparities. Every state has areas where there are low rates of disparity. Every state follows the trends. When you take a comprehensive approach, you will see where things are going in the right direction and where things are going in the wrong direction as well.
MP: What are some of the health disparities that stood out when you took a closer look at Minnesota?
RR: For Minnesota, one of the major areas that we’ve been following for many years is low birthweight babies. Babies who are born underweight have higher rates of infant mortality and chronic disease. This is an important marker of disparity. In Minnesota, there is a low rate of disparity for infant mortality between white and Hispanic infants. It is below the national average.
One of the other areas to note here is that people living in metro vs. non-metro areas of the state have similar rates of health insurance. The uninsured rates are similar in rural and urban areas of Minnesota, which is not always the case in the rest of the country.
Another marker worth noting is the unemployment rate for Blacks in Minnesota, which went down 45 percent over the four years of our study. It was almost cut in half, from 14.6 percent unemployment to 8.1 percent. That shows some really nice progress.
MP: Those are positive measures. Can you tell me more about areas that show a need for improvement?
RR: For opportunities in Minnesota, one of the things we see is there is a high degree of disparity between Black and white children living in poverty. When we look at the white childhood poverty rate in Minnesota, which is the lowest for the races in the state, it is 6.6 percent for children ages 0-17. The group with the highest rate of childhood poverty in Minnesota is the Black population, with 36.9 percent of children between the ages of 0-17 living in poverty.
MP: This disparity is significant. Did your research uncover any measurable reasons for why it exists in Minnesota?
RR: The why is important. The reasons for this disparity are many. I can say that the impact of child poverty is far-reaching, lasting throughout a person’s lifetime. Chronic conditions like obesity, asthma, low birthweight babies are all associated with children living in poverty. Children living in poverty are also less likely to complete high school. Educational obtainment is really important.
MP: Your report really highlights the impact that these disparities have on the health of our state’s children. To see it highlighted this way feels significant.
RR: It is really important. We touched on the issue of low birthweight babies, but I’d like to go back to the issue of infant mortality. Here we are talking about babies who have died within their first year life. Generally Asian/Pacific islanders are the group that have the lowest rate of infant mortality nationally, with four deaths for every 1,000 live births. In Minnesota, that rate increased 54 percent during the study period, from 4.3 deaths per 1,000 live births to 6.6 deaths per 1,000 live births for babies under the age of 1.
MP: Does the report uncover the reason for this increase?
RR: The report doesn’t tell us the cause and effect. Across the nation, infant mortality rates have been decreasing. Nationally Asian infants have the lowest rate of infant mortality. Black infants have the highest. The report shows that in Minnesota, those disparities are closing. You don’t have as big a disparity between Asian/Pacific Islander and Black babies for infant mortality as you do nationally. It’s not because the numbers are improving for either group. It is because the numbers are increasing for Asian/Pacific Islanders.
MP: When you compare disparity rates in different states, do you see reasons some states are showing improvements in narrowing key health disparities like infant mortality?
RR: We do look at the research that tells us what works, and we generally find that states that have made improvements in some of these areas are states that have been looking closely at the results and asking the question, “What do we do about it?” These are states that are actively working to lessen health disparities.
We know that improving overall maternal health helps with infant mortality. When states focus on health improvements like decreasing rates of smoking and obesity in moms, and increasing access to prenatal care, they generally see improvement in both maternal and infant mortality rates. Also, when poverty rates decrease, mother and infant mortality rates also improve.
MP: You’ve mentioned educational obtainment as an overall measure of health. Can you tell me more about why the number of years a person spends in school has an impact on their physical health?
RR: I think the piece around education is such an important part of the story. We can see clearly that the trend over the 30 years that we’ve been collecting this information is that educational obtainment is an important social determinant of health. Over a lifetime, those who have higher education levels have higher incomes, higher health literacy, higher health insurance coverage. Research shows that they are more likely to make good health choices like not smoking and being physically active. Education is one lifestyle choice that communities and public policy leaders can really rally around.
In our research, we look at and compare overall health measures in those who haven’t finished high school, those who’ve finished high school, those who have completed some college and those with a college degree. With each increasing level of education, you see improvement in a person’s overall health.
Completing high school is an important marker. Nationally 12.1 percent of students did not finish high school. The state with the highest rate of high school graduates is Wyoming, where only 6.6 percent of high school students did not graduate.
MP: Were there any national health trends that surprised you and your colleagues as you assembled this report?
RR: Diabetes has been a trend we have been following over the 30 years of this report. We are very concerned that we continue see cases of diabetes increase across the nation. For years, there has been this notion that that the higher your level of education and income the less you are likely to get chronic diseases like diabetes, but now diabetes is on the rise among people who have a college education. Those cases are up 33 percent. That wasn’t a trend that we were expecting.
MP: Why do you think this is happening?
RR: With diabetes we know that there is a strong correlation between rising rates of obesity in our nation. That has an impact on all populations and education levels. It still affects those who only finish high school at greater levels, but the numbers are also up among those with a college education or higher.
MP: Did your study uncover any other notable national trends in health disparities?
RR: Our country has made some notable health improvements in recent years. But there are some other areas where the disparities are widespread. They continue to persist, and in some cases they’ve grown. The maternal mortality rate has grown nationally, and this really concerns us. It is unsafe to be pregnant or to have a baby in the United States. Our nation is worse in this category than most other developed nations.
Another area where we haven’t made significant gains is in mental health. And this data was collected pre-pandemic. We are concerned that in the years to come this trend will only continue to worsen. We expect to see all socioeconomic measures impacted by the pandemic. You may also see that the measures that were impacted by COVID may be hard to read immediately. The true impact won’t be clear for a number of years.