Racial Disparities and Life Expectancy: A State-by-State Examination
Nazleen Bharmal, MD, MPP, is an alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program. She is an internal medicine physician and health services researcher at the University of California, Los Angeles.
I was introduced to the connection between racial and health disparities during medical school and residency working with underserved populations, where I witnessed the large impact local environments have on health and health care. While I had worked on some of these issues through community-based organizations, the Robert Wood Johnson Foundation Clinical Scholars program was my first experience conducting research on racial and health disparities.
In our study published in a special “Bridging the Gap between Research and Health Policy” edition of Health Services Research, we explored the patterns of racial disparity in life expectancy at the state level, specifically examining both the absolute and relative context of life expectancy between blacks and whites compared with their national life expectancy. We were particularly interested in state-level differences given that health policy is a growing concern of state governments, and because control of Medicaid coverage and generosity of public health insurance benefits varies greatly among states.
As expected, we found that blacks lived fewer years than whites in every state, though the disparity was heterogeneous across states. However, we were surprised to learn that states with smaller gaps in racial disparity were not the result of black populations living longer, but conversely, due to white populations with shorter life expectancy compared to the national average. We also found that states with large differences, while often driven by black populations living fewer years, may not make a significant contribution to the racial disparity in life expectancy at the national level. Eliminating the disparity in states with large black populations has the greatest impact nationally, even if the racial difference is modest.
In terms of the societal implications of our work, we argue that federal and state health policies that simply concentrate on the black-white difference in a geographic region may miss important opportunities to improve overall population health or significantly reduce disparity at the national level.
Our results suggest that federal and state agencies could consider new ways to measure and track health disparities since many disease prevention and health promotion initiatives are identified and monitored by magnitudes in a health disparity. These agencies could also consider both the relative and absolute differences in life expectancy as they fund targets for regional interventions, evaluate health program outcomes, and compare disparities at the local and national levels.
This work is an initial description of geographic variations in health disparities. Our future work in this area may examine the contribution of major causes of death on state-level disparities and understanding patterns and prevalence of racial/ethnic disparities in major cities. Other areas for research include examining state or local policies that may potentially be impacting the heterogeneous patterns of health disparity in life expectancy, and designing appropriate interventions at the policy level.
Learn more about the study here.