Race, Inequality, and Health | KFF

Growing Mental Health and Substance Use Concerns and Racial and Ethnic Health Disparities

Drug overdose and suicide deaths have increased since the onset of the COVID-19 pandemic, with some groups particularly affected. These trends may lead to new and widening racial and ethnic disparities. For example, between 2019 and 2021, AIAN, Black, and Hispanic people experienced larger increases in drug overdose death rates than White people, resulting in the death rate for Black people surpassing that of White people by 2020. As of 2022, AIAN people had the highest suicide death rate, about one and a half times higher than the rate for White people.

Despite growing mental health concerns, people of color continue to face disproportionate barriers to accessing mental health care, including lack of health insurance coverage and financial and logistical barriers to accessing care, lack of a diverse mental health care workforce, the absence of culturally informed treatment options, and stereotypes and discrimination associated with poor mental health. Efforts to expand access to behavioral health should ensure that services address the cultural and linguistic needs of diverse populations.

The Dobbs Decision and Racial Disparities in Maternal Health

The decision to overturn the longstanding Constitutional right to abortion and elimination of federal standards on abortion access has resulted in growing variation across states in laws protecting or restricting abortion. These changes may disproportionately impact women of color, as they are more likely to obtain abortions, have more limited access to health care, and face underlying inequities that would make it more difficult to travel out of state for an abortion compared to their White counterparts. Restricted access to abortions may widen the already stark racial disparities in maternal health and have economic consequences associated with the direct costs of raising children and impacts on educational and employment opportunities. Women from underserved communities may also be at increased risk for criminalization.

Disparities in Coverage Following the End of Medicaid Continuous Enrollment Provision

The end of the Medicaid continuous enrollment provision may lead to widening disparities in coverage. Following the end of this provision, states have resumed Medicaid redeterminations, resulting in millions of enrollees being disenrolled from Medicaid. While the limited data available on disenrollments by race and ethnicity do not show large differences, people of color are more likely to be affected since they are disproportionately covered by Medicaid. Individuals with limited English proficiency and people with disabilities may also face increased challenges in completing the Medicaid renewal process, increasing their risk of coverage loss even if they remain eligible for coverage.

Impact of Evolving Immigration Policies on Immigrant Families

Immigrants face serious challenges in accessing health care, including high uninsured rates, affordability challenges, and linguistic and cultural barriers to care. Many lack sufficient information to understand how U.S. immigration laws affect them and their families, and immigration-related fears lead some to avoid certain activities, including participating in assistance programs for which they or their children may be eligible. The Biden Administration has reversed Trump Administration public charge regulations, but some immigrants still face uncertainty about their immigration status. Immigration-related fears may increase amid a growing focus on immigration enforcement and increasing anti-immigrant rhetoric.

Expanding Access to Health Coverage for Immigrants

Expansions in access to health coverage for immigrants could mitigate some of the challenges they face in accessing health care. States vary in the coverage they provide for their low-income population overall and immigrants specifically. Some states have expanded coverage for immigrants by taking up options available in Medicaid and CHIP, and some states have extended coverage to some groups regardless of immigration status through fully state-funded programs. In May 2024, the Biden Administration published new regulations that will extend eligibility for Marketplace coverage to DACA recipients.

Climate Change and Health Equity

Climate-related events have increasing impacts on health and health care, with disproportionate effects on historically marginalized and under-resourced groups. People of color, low-income people, and other marginalized or high-need groups face disproportionate risks due to underlying inequities and structural racism and discrimination. Residential segregation and historical policies have led to increased exposure to extreme heat and poor air quality for Black people in urban neighborhoods.

Racial and Ethnic Disparities in Access to Novel Drug Therapies and Technologies

People of color have higher rates of chronic diseases that may benefit from new medical advancements, but they may face increased barriers to accessing these drugs or therapies. Affordability challenges, lack of racial diversity in clinical trials, and underlying biases in clinical decision-making processes contribute to disparities in health.

SDGs, Targets, and Indicators

Source: kff.org