Making Health Outcomes More Equal: What America Can Do

The topic of health is ever-present in our society; most of us are aware of at least some pressing issues with the American healthcare system, and many of us have lived to face them. In theory, we all agree that the care you get should not depend on your income, race, or ethnic background, but in reality, disparities continue to exist. 

A groundbreaking report titled ‘Unequal Treatment’ was released in 2003 to highlight the problems of equality our healthcare system faces. 21 years later, ‘Ending Unequal Treatment: Strategies to Achieve Equitable Health Care and Optimal Health for All’ has been released, detailing both the achievements that have been made and the steps that must be taken to end healthcare inequality once and for all. 

Overview of the 2003 'Unequal Treatment' 

The report, commissioned by Congress, found that minorities received lower-quality care than white patients, even after adjusting for access factors like insurance and income. These disparities were the same across a range of conditions, from cardiovascular disease to cancer and diabetes. All of these poor outcomes were driven by system factors, provider bias, and patient-provider interactions. The impact of these inequities was, and to some degree still is, profound, leading to poorer health outcomes and higher mortality rates among minority populations.

The report identified structural barriers, like unequal access to specialists and specialized care, alongside clinical factors, like stereotyping and poor communication. It emphasized that these inequities were reflective of broader societal inequities, ranging from socioeconomic status to discrimination. 

Recommendations included improving provider cultural competence, increasing minority representation in health professions, and strengthening data collection on disparities. The report aided policy interventions, like better financing for care.

Judging that inequities undermined the quality of health care and public trust, the report called for a strategy at several levels — systemwide reform, education, and community action — to minimize inequities, and believed that equal treatment was both a moral and pragmatic imperative to maximizing national health gain.

Insights from the 2024 'Ending Unequal Treatment' 

The report observed a minimal reduction in inequities over the two decades prior, with systematic defects remaining a driver of unequal outcomes. According to the report, minoritized populations have barriers such as restricted access to primary care, poorer quality of treatment, and increased chronic disease rates, in addition to broader societal determinants such as structural racism and economic inequality. 

The report also identifies the primary causes for gaps in the system as a lack of coverage by insurers, a shortage of specialists in vulnerable communities, and discrimination in the provision of care. The report critiques prior interventions with a record of success, like community health workers, but also condemns failure caused by unviable funding and policymaker backing. 

Recommendations include five goals: 1) expanding data collection, 2) ensuring equitable access, improving the quality of care, 3) expanding health equity research, and 4) addressing social determinants. It requires sustained federal commitment, increased reimbursement rates, and community-based solutions. 

In the end, the report concluded that health equity benefits everyone. The report is calling for a reimagined system prioritizing comprehensive, sustained strategies over incremental solutions to enable everyone to reach optimal health.

To enact such change, the report highlights the need for a skilled and diverse health workforce created by bringing more racially and ethnically diverse people into health care through courses like the dual degree nurse practitioner program.

Current State of Health Care Inequities

Both of these reports have had a lot to say about the state of health, but where exactly are we today? Long story short, improvement has been happening since 2003. Life expectancy for all Americans has increased, and the gap between whites and others is closing. 

Infant mortality: a pressing issue, considering America has had one of the highest infant mortality rates in the developed world, at 5.4 deaths per 1,000 live births, a figure that stood at 6.9 in 2003. Unfortunately, inequalities remain: Black and Native American infants face rates near 10 deaths per 1,000. These figures are just one example of a system where gains are real but uneven, with systemic barriers to accessing care. The slow narrowing of these gaps shows promise, but the pace underscores the need for more deliberate action.

Americas Healthy Future 

A lot has already been done to increase care for all, from Medicare and its subsequent expansions with the Affordable Care Act, which cut uninsured rates for Black and Hispanic adults by nearly half since 2013.

Both of these reports and the policies enacted as a result highlight how willing and capable the system is to change. But closing the final gaps requires more than expanded coverage—it requires dismantling the structural roots of inequity. Growing community health centers, expanding specialist access to underserved communities, and building stronger data to track disparities can drive equity. 

Achieving real equity takes sustained federal investment, community-level innovation, and solving social determinants like poverty and housing so that all Americans have an equal opportunity at health.