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Report cites stubborn gaps between races in health care outcomes

Many of the reasons for the overall gap

Many of the reasons for the overall gap are outside the health care system, said Dr. Brian Harper, chief medical officer and vice president for equity and inclusion at the New York Institute of Technology in Old Westbury. Credit: New York Institute of Technology/Alexander Berg

Black New Yorkers receive better health care and have better health outcomes than their counterparts in most other states, but they still have far higher rates of infant mortality, preventable deaths and difficulty accessing care than white residents, a report released Thursday found.

The report, from the Commonwealth Fund, a Manhattan-based health care nonprofit, does not break down data by county, but experts said the same disparities exist on Long Island.

"What we see here on Long Island is a clear reflection of — if not worse — [health] outcomes in terms of the differences by race and ethnicity," said Martine Hackett, an associate professor of health professions at Hofstra University in Hempstead and an expert on health disparities.

The report found that Latino New Yorkers have lower rates of preventable deaths and of some diseases than whites. Yet Latinos are more likely to be uninsured than whites, Asians and Blacks, and they’re more likely to go without care because of cost, the report found.

The study examined health care outcomes, access and quality, and gave an overall score of 90 out of a maximum 100 to whites, 75 to Asians and Pacific Islanders, 56 to Latinos, and 53 to Blacks.

Better than national average

New York was one of only five states in which Black and Latino residents had better overall health care than the national average of all Americans.

Hackett said that’s in part because of greater access to health care in New York — the percentage of uninsured residents is lower, and Medicaid coverage is more expansive — and because New York has a higher-than-average income and educational level, and lower rates of obesity and smoking, all factors linked to better health care.

Yet, she said, even as health care outcomes have improved over the decades, "that gap between racial and ethnic groups basically remains the same."

Dr. K.C. Rondello, a clinical associate professor of public health at Adelphi University in Garden City, said "these reasons are deep-seated and chronic, and they reflect decades of inadequate funding and inadequate efforts in meeting the health care needs of people of color."

Among the starkest differences are in health outcomes. The rate of deaths that could have been prevented with more timely and effective care was more than double for Black New Yorkers — 139 per 100,000 people — than it was for white, Latino and Asian residents, who had rates of 68, 66 and 43, respectively.

Statewide, infant mortality for Blacks was 9 per 1,000 live births, compared with 4 for Latinos and 3 for whites and Asians.

State Health Department data from 2016 to 2018 shows that in Suffolk County, the infant mortality rate was 2.5 per 1,000 live births for whites but 9.4 for Blacks, In Nassau, it was 2.1 for whites and 7.4 for Blacks.

Hackett, co-founder of Birth Justice Warriors, an education and advocacy group that works to reduce Black infant and maternal mortality, said premature birth and low birth rate are the leading causes of infant mortality, and the stress that Black women face — including from unequal treatment — can impede the growth of the fetus and cause other physiological problems. She said Suffolk has taken steps to address the problem, but Nassau has not.

Dr. Lawrence Eisenstein, commissioner of the Nassau Health Department, said the agency has "done a dramatic amount of work" to address infant mortality, which is the top priority of its office of health equity. That includes convening symposiums and other discussions on the topic and providing prenatal vitamins and other nutritional support to pregnant women, he said.

The role of 'social determinants'

Many of the reasons for the overall gap are outside the health care system, said Dr. Brian Harper, chief medical officer and vice president for equity and inclusion at the New York Institute of Technology in Old Westbury.

"This is very challenging, because in order to see major improvement, you have to really improve on what we call the social determinants of health," said Harper, a former Suffolk County health commissioner. "When you look at things such as poverty and unemployment, residential segregation, environmental toxins, institutional racism — all of those things play a role in terms of the poor indices you’re going to see in minority communities."

Income and education help, yet even comparing, for example, Black and white people with identical incomes and educational levels, the white person is more likely to get better health care and have better outcomes, Harper said.

Dr. Laurie Zephyrin, vice president for advancing health equity at Commonwealth and a report co-author, said in a teleconference Wednesday that surveys have found that more than a third of Black and Latino adults reported that they or household members had faced discrimination in the health care system.

Harper said expanding health insurance coverage, providing more preventative and routine care to people of color, and investing more in social services are among changes that would help narrow the gap.

The disparities are why life expectancy is so much lower in communities of color, Harper said. For example, a census tract in mostly white and affluent Garden City has a life expectancy of 87.4, compared with 77.2 in two tracts immediately south, in Hempstead, which is mostly Black and Latino and has a much lower median income, according to a 2019 Associated Press analysis.

The data for the Commonwealth study was collected in 2019 and 2020, said David Radley, a senior scientist at the fund and a report co-author.

"In all likelihood, the pandemic has only exacerbated many of the inequities highlighted throughout the report," he said.