Report on Health Disparities Between Multiracial and Monoracial Populations in the United States: An Analysis Through the Lens of the Sustainable Development Goals

Executive Summary

This report analyzes health disparities between multiracial and monoracial populations in the United States, utilizing data from the Behavioral Risk Factor Surveillance System (2001–2012; N = 4,363,547). The findings reveal a significant challenge to achieving Sustainable Development Goal 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities). Despite often having a higher socioeconomic status, certain multiracial groups—specifically Black multiracial, American Indian or Alaska Native multiracial, and Other multiracial individuals—report poorer mental and physical health than their monoracial counterparts. This paradox highlights that economic progress alone is insufficient to close health gaps. The analysis systematically investigates four potential pathways explaining these disparities:

1. Socioeconomic Status (SES)
2. Early Life Adversity
3. Race-Related Experiences
4. Health Behaviors

The primary driver of health disadvantages across all multiracial groups is early life adversity, including family instability and adverse childhood experiences (ACEs). This finding directly links the goals of ensuring well-being (SDG 3) with the need for peaceful, just, and inclusive societies that protect children from violence and instability (SDG 16: Peace, Justice and Strong Institutions). Conversely, socioeconomic status and race-related experiences demonstrated unexpected suppression effects, indicating that they mask even greater underlying health disparities. These results underscore the necessity of policy interventions that move beyond economic factors to address the foundational social determinants of health, particularly the long-term impact of childhood conditions, to ensure no one is left behind in the pursuit of sustainable development.

Introduction: Health Disparities and the Sustainable Development Goals

The rapid growth of the multiracial population in the United States presents a critical new dimension for understanding and addressing health inequities, a central focus of the 2030 Agenda for Sustainable Development. This research directly confronts the objectives of SDG 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities) by investigating why multiracial individuals often experience poorer health outcomes compared to monoracial groups. A significant paradox emerges: many multiracial groups report worse health despite possessing higher socioeconomic status, challenging the conventional understanding that economic resources are the primary determinant of health. This study examines the complex social mechanisms that produce this inequality, focusing on non-socioeconomic pathways that are crucial for developing effective policies aligned with the SDGs.

Methodology

The analysis is based on a large, nationally representative dataset from the Behavioral Risk Factor Surveillance System (BRFSS) from 2001–2012, encompassing 4,363,547 respondents. Health outcomes were measured by self-reported days of poor mental and physical health. The study employed negative binomial regressions and Karlson-Holm-Breen (KHB) mediation tests to systematically evaluate four explanatory pathways for the observed health disparities:

• Socioeconomic Status: Measured by income, education, and employment.
• Early Life Adversity: Including parental divorce, childhood abuse, and household dysfunction (e.g., substance use, incarceration).
• Race-Related Experiences: Including perceived discrimination and frequency of thoughts about race.
• Health Behaviors: Including smoking, alcohol consumption, and physical activity.

This approach allows for a comprehensive decomposition of the factors contributing to health inequalities, providing nuanced evidence for targeted, SDG-aligned interventions.

Key Findings: Unpacking the Drivers of Health Inequality

The Paradox of Socioeconomic Status: A Challenge to SDG 1 and SDG 8

The findings reveal a complex relationship between socioeconomic status (SES) and health that complicates progress towards SDG 1 (No Poverty) and SDG 8 (Decent Work and Economic Growth). While these goals focus on improving economic well-being, this study shows that higher SES does not uniformly translate into better health for all populations.

• For Black multiracial and American Indian or Alaska Native (AIAN) multiracial individuals, higher SES was found to suppress, or mask, even greater health disparities. After controlling for their socioeconomic advantages, the health gap between these groups and their monoracial counterparts actually widened.
• In contrast, for Asian multiracial individuals, lower relative SES partially explained their poorer health outcomes compared to monoracial Asians.

This demonstrates that achieving economic goals is not a panacea for health equity. Without addressing other fundamental social determinants, economic gains may fail to produce the health and well-being outcomes envisioned in SDG 3.

The Critical Role of Early Life Adversity: A Link to SDG 3 and SDG 16

The most significant and consistent finding across all multiracial groups is the profound impact of early life adversity. This pathway proved to be the strongest mediator of health disparities, creating a direct link between the goals of SDG 16 (Peace, Justice and Strong Institutions) and SDG 3 (Good Health and Well-being).

• Differences in early life social conditions—particularly exposure to parental divorce, family instability, and adverse childhood experiences (ACEs) like domestic violence and household substance abuse—largely explained the poorer health outcomes among multiracial individuals.
• For Black multiracial individuals, accounting for early life adversity rendered the previously significant health gap statistically insignificant.
• For AIAN multiracial individuals, adjusting for early life conditions not only reduced but in some cases reversed the health disadvantage.

These results highlight that creating safe, stable, and nurturing environments for children (Target 16.2: End abuse, exploitation, trafficking and all forms of violence against and torture of children) is a fundamental prerequisite for ensuring healthy lives and promoting well-being for all at all ages (SDG 3).

Race-Related Experiences and Health Behaviors: Complex Factors in Achieving SDG 10

The investigation into race-related experiences and health behaviors yielded complex results, underscoring the multifaceted nature of inequality targeted by SDG 10.

• Race-Related Experiences: Contrary to expectations, experiences of racial discrimination showed a suppression effect. This suggests that accounting for discrimination actually increased the observed health gap, indicating that the current measures may not fully capture the unique stressors of “monoracism” or that other unmeasured factors are at play.
• Health Behaviors: The role of health behaviors was mixed. Risky behaviors like smoking and heavy drinking partially explained the health gap for some groups, while positive behaviors like regular exercise among multiracial individuals appeared to mask even larger underlying health problems.

This complexity signals that eliminating discrimination and promoting healthy lifestyles requires nuanced approaches that recognize the unique social positioning of multiracial individuals.

Discussion and Policy Implications for the SDGs

The findings of this report carry significant implications for policies aimed at achieving the Sustainable Development Goals, particularly for ensuring that progress on health and equality is inclusive of all populations.

Advancing SDG 3 and SDG 10: Beyond Economic Determinants

To effectively reduce health inequalities, policy must look beyond purely economic interventions. The paradox of worse health despite higher SES among multiracial groups proves that structural factors rooted in social and family life are powerful determinants of well-being. A true commitment to SDG 10.3 (ensure equal opportunity and reduce inequalities of outcome) requires addressing the social stressors that disproportionately affect multiracial families.

Prioritizing Early Life Interventions (SDG 16)

The overwhelming evidence pointing to early life adversity as a key driver of lifelong health disparities demands a policy focus on supporting children and families. Interventions should include:

• Strengthening support systems for interracial families, who may face unique stressors and reduced access to traditional kin networks.
• Integrating screening for ACEs into primary healthcare, especially for vulnerable populations.
• Investing in programs that reduce family stress and promote childhood well-being, directly contributing to the targets of SDG 16 and laying the foundation for SDG 3.

A Call for Disaggregated Data

This study reveals significant heterogeneity within the multiracial population. Treating multiracial individuals as a monolithic group masks critical differences in health outcomes and their underlying causes. To uphold the SDG principle of “leaving no one behind,” it is imperative that data collection and analysis efforts disaggregate data by specific multiracial subgroups. This will enable more precise, effective, and equitable policymaking.

Conclusion

This report identifies early life adversity as the primary mechanism driving health disparities between multiracial and monoracial populations in the United States. The findings challenge conventional, socioeconomically-focused frameworks for understanding health inequality and highlight the urgent need for a multi-faceted policy approach. To achieve the ambitious targets of the Sustainable Development Goals, particularly SDG 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities), interventions must address the deep-seated social and familial challenges that shape health across the life course. By focusing on the well-being of children and families (SDG 16), we can begin to dismantle the structural barriers that prevent an increasingly diverse society from achieving health equity for all.

Analysis of SDGs, Targets, and Indicators

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being: The article’s central theme is the investigation of health disparities, specifically focusing on “mental and physical health outcomes” among multiracial and monoracial populations. It directly examines factors like “poor mental and physical health days,” “chronic diseases,” and “substance use,” which are core components of ensuring healthy lives and promoting well-being for all.
• SDG 10: Reduced Inequalities: The study is fundamentally about inequality. It analyzes “health disparities between multiracial and monoracial groups” and seeks to understand the social mechanisms that produce these different outcomes. The research highlights how inequalities persist based on race and ethnicity, even when socioeconomic status is higher for some disadvantaged groups, directly addressing the goal of reducing inequality within a country.
• SDG 16: Peace, Justice and Strong Institutions: The article identifies “early life adversity” as a crucial factor in health disparities. This includes “adverse childhood experiences (ACEs)” such as “exposure to abuse, neglect, and household dysfunction.” This connects directly to SDG 16’s aim to end all forms of violence against children and create stable, just societies. The article links family instability and abuse to broader societal issues, which falls under the purview of this goal.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. SDG 3: Good Health and Well-being
   • Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
     
     Explanation: The article directly investigates “mental and physical health” by measuring “poor mental and physical health days.” It also discusses risk factors for non-communicable diseases, such as “obesity,” “smoking,” and “heavy drinking,” and their role in health disparities.
   • Target 3.5: Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol.
     
     Explanation: The study identifies “health behaviors” as a key pathway, noting that “multiracial individuals show higher rates of smoking and heavy drinking.” It also measures “household substance use” as a component of early life adversity, linking it to health outcomes.
   • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services…
     
     Explanation: The article touches upon access to healthcare by including “health insurance coverage” and “perceived treatment when seeking healthcare” as variables in its analysis, exploring whether differences in healthcare access and quality contribute to the observed health disparities.
2. SDG 10: Reduced Inequalities
   • Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.
     
     Explanation: The entire study is an analysis of health inequality based on racial identity (“multiracial-monoracial health disparities”). It examines how multiracial groups experience worse health outcomes, a key indicator of social exclusion, despite in some cases having higher socioeconomic status.
   • Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices…
     
     Explanation: The article investigates “race-related experiences” as a potential cause of health disparities, including the concept of “monoracism,” which it defines as “prejudice and discrimination specifically targeting multiracial people.” This directly relates to reducing inequalities of outcome that stem from discrimination.
3. SDG 16: Peace, Justice and Strong Institutions
   • Target 16.2: End abuse, exploitation, trafficking and all forms of violence against and torture of children.
     
     Explanation: The article finds that “early life adversity” is the most significant pathway explaining health disparities. It explicitly measures “adverse childhood experiences (ACEs),” including “physical abuse from parents,” “verbal abuse from parents,” and “witnessing violence between parents,” which are all forms of violence against children that this target aims to eliminate.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. For Target 3.4 (Promote mental and physical health):
   • Self-reported number of days mental health was not good in the past 30 days.
   • Self-reported number of days physical health was not good in the past 30 days.
   • Prevalence of obesity and other chronic health conditions.
   • Prevalence of household depression or mental illness.
2. For Target 3.5 (Strengthen prevention of substance abuse):
   • Smoking status (never, former, current occasional, current regular).
   • Rates of heavy drinking (defined as 2+ drinks daily for men, 1+ for women).
   • Childhood exposure to household members with alcohol problems or who used illegal drugs/misused prescription medications.
3. For Target 3.8 (Achieve universal health coverage):
   • Health insurance coverage status (insured vs. uninsured).
   • Perceived treatment when seeking healthcare (e.g., “same as other races,” “worse than other races”).
4. For Target 10.2 & 10.3 (Reduce inequalities and discrimination):
   • Disparities in the number of poor mental and physical health days between multiracial and monoracial groups.
   • Disparities in socioeconomic status (income, education, employment) across racial groups.
   • Self-reported experiences of race-related emotional or physical distress.
   • Frequency of thinking about one’s race as a measure of racial salience and potential stress.
5. For Target 16.2 (End violence against children):
   • Prevalence of Adverse Childhood Experiences (ACEs).
   • Self-reported rates of experiencing physical abuse from parents as a child.
   • Self-reported rates of experiencing verbal abuse from parents as a child.
   • Self-reported rates of witnessing violence between parents or adults in the household as a child.
   • Rates of parental divorce or family instability.

4. Table of SDGs, Targets, and Indicators

Source: nature.com