Beliefs about Health Care and Health Inequities in New Jersey

Differences in Health Equity Perceptions

In New Jersey—one the healthiest, wealthiest, most diverse states—residents with greater privilege and access to opportunities not only lead healthier lives but also are less likely to acknowledge that systemic factors including racism and discrimination contribute to poor health.

A recent poll among about 2,500 New Jerseyans by the Eagleton Center for Public Interest Polling at Rutgers University for the Robert Wood Johnson Foundation (RWJF) reveals significant differences in perceptions of health equity. Just as a combination of personal experiences, race, gender, income, education, location, and other factors determine health in New Jersey, so too do they influence public awareness and perception of health inequities and their causes.

Despite glaring health disparities along racial lines in New Jersey, only a third of those polled say they feel race and ethnicity have major influence on someone’s ability to lead a healthy life. Black residents (54%) are more likely to believe a person’s race or ethnicity significantly influences health, compared to white (30%), Hispanic (29%), and Asian (28%) respondents.

The poll results will guide RWJF’s work in its home state to raise awareness of the roles that racism, discrimination, and social and environmental health factors play in achieving and perceiving health equity. Such awareness is crucial to build consensus and garner public support for policies that combat inequity by eliminating racial and economic barriers to good health.

Key Findings

• Most New Jerseyans perceive unequitable healthcare access, but fewer than half (39%) feel racial discrimination interferes with New Jersey residents’ ability to get quality healthcare a “great deal” or a “good amount.”
• Women (81%) and urban residents (84%) are more likely than men and rural or suburban residents—by double digits—to say some people have a harder time accessing quality healthcare.
• Black residents (56%) are more likely to say racial discrimination affects access to quality healthcare either a “great deal” or “good amount” compared to White (36%), Hispanic (39%), and Asian residents (40%).
• Women (80%), Black residents (86%), and those living in urban areas (82%) are more likely than their counterparts—often by double digits—to strongly agree that all people should have the opportunity to lead a healthy life without disadvantages related to social position or other social determinants.
• Perceptions differ along demographic lines on the role of individual-level and societal factors on health. About 80 percent feel such individual factors as personal health practices (82%) and a steady, well-paying job (81%) are major influences, but similar numbers say the same about such societal factors including affordable healthcare (80%), access to healthy foods (79%), safe, affordable housing (77%) and one’s physical environment (76%).
• About 70 percent say quality childcare and education (72%), community safety (69%), access to safe and green spaces (67%), income (65%), and social support (64%) are major influences.
• About 40 percent say genetics and biology are major influence on heath, and a third say the same about race and ethnicity. Women, Black, and urban residents tend to believe individual factors—particularly race and ethnicity, and genetics and biology—are major influences.

Affordable Housing

Financial challenges (57%) are the most common barriers to safe, desirable housing, in addition to discrimination of any kind (10%), costs associated with safer areas (8%) and lack of housing availability (2%).
Women (24%), non-white, lower-income residents more likely to report housing barriers. Black (35%) and Hispanic (35%) residents are more than twice as likely as white (15%) and Asian (16%) residents to face housing barriers.

Birth Justice

Hispanic residents (26%) are more than four times as likely as white parents (6%), nearly four times as likely as Asian residents (7%), and about one-and-a-half times as likely as Black parents (16%) to rate prenatal care as “fair” or “poor.”
Black (30%) and Hispanic (30%) residents are nearly twice as likely as white residents (17%) and slightly more likely than Asian residents (23%) to believe the state’s pregnant population is treated inadequately or unfairly due to their race or ethnicity “all” or “most” of the time.

Public Health Preparedness

White residents (48%) are more likely than Black (40%), Hispanic (42%), and Asian (35%) residents to believe New Jersey’s health system was “not very” or “not at all” well-prepared for a public health emergency like COVID-19.
Nearly half feel their local health department was not as prepared as it should have been for a public health emergency. Hispanic residents (21%) are more likely to say their local health department was as prepared as it could have been or that nothing else could have been done to prepare for a public health emergency compared to white (14%), Black (13%), and Asian (13%) residents.

Conclusion

We can and must do better. Structural racism is not history. Unjust and unfair policies, practices, and norms underlie every aspect of society, enabling health inequities to persist despite medical advancements and investments intended to combat disparities.

Systems and societal structures must offer everyone a fair chance to live healthy lives. It’s time to look beyond a person’s race to ensure they are given the same opportunities as someone else a few miles away, living in a more desirable neighborhood.

The more people know about the causes of health disparities, the closer society will come to consensus needed to promote policies and practices that end those disparities. This is essential to the health and wellbeing of people who have endured generations of racial injustice, economic exclusion, and social marginalization.