Broadly measured, Connecticut does better than most other states in terms of the overall health and wealth of its residents: The state boasts the second highest median family income in the country and it ranks fourth in terms of health outcomes — a composite measure that takes into account access to healthcare, disease burden and behavior among others. The statistics, however, don’t tell the whole story; when it comes to health, there are significant health disparities between racial and ethnic population groups.
According to the Connecticut Department of Health’s 2009 Health Disparities Report, residents who identify as black or African American have the highest premature death rates in the state for all causes. Incidence rates of infectious diseases including HIV/AIDS and other sexually transmitted disease are significantly higher for black and Hispanic residents than for whites.
Ongoing debates about health care reform are trying to address these issues and others, but have centered on expanding health care coverage to the uninsured with an emphasis on revamping the health insurance industry. These efforts are commendable. However, problems with the health care system only account for a portion of the health gap between minorities and whites. Some of this disparity must be attributed to underlying, contextual factors, including disparate educational attainment and living environments. Thus, the desired outcome of better health for all citizens may not materialize if direct efforts to eliminate disparities beyond access to coverage are not made.
A 2007 article in The American Journal of Public Health showed that the number of deaths that could be averted by correcting inequality in education was greater than the number attributable to medical advances. The disparities in Connecticut are particularly acute: 32 percent of Hispanics and 19 percent of African Americans have less than a high school diploma, compared to only 9 percent of whites. Thus, the article suggests that encouraging people to remain in school and closing the achievement gap could have an impact on health. In part, this benefit from higher-level education comes from an increase in earning power and an ability to obtain jobs that are more likely to provide comprehensive health insurance for their employees. In addition, through education, individuals are better able to make wise choices when faced with options that put their health at risk.
Similarly, the environment influences the way people live their daily lives and their health. A study conducted among children in Massachusetts showed that distance to the nearest fast-food restaurants was inversely associated with body mass index, while density of fast-food restaurants was directly correlated with BMI. The same study found that distance to schools and subway stations, amount of open space and density of subway stations were inversely associated with BMI. These data indicate that certain environments — that promote healthy lifestyles — are more conducive to limiting obesity and its attendant complications.
With the advent of health care reform, there has to be a complementary and concerted effort to improve the health of disadvantaged populations and reduce other disparities. While some may say these initiatives will be too expensive, or that choosing to take on the problem alongside health care reform is more than we can handle, evidence demonstrates that the current health care system burdened health disparities is unsustainable — the Congressional Budget Office estimates that we will spend a quarter of GDP on health care within 15 years. For comprehensive health reform to be achieved, we need to have our priorities right.
Cel Ezeani is a master’s candidate at the School of Public Health.