Trends in Health Equity in the United States by Race/Ethnicity, Sex, and Income, 1993-2017

Authors: Frederick J. Zimmerman, Nathaniel W. Anderson
Publication Year: 2019
Last Updated: 2019-10-04 09:54:02
Journal: Journal of the American Medical Association
Keywords: Health equity, social determinants of health, health inequality, health justice, Behavioral Risk Factor Surveillance System (BRFSS)

Short Abstract:

Importance  Health equity is an often-cited goal of public health, included among the 4 overarching goals of the Department of Health and Human Services’ Healthy People 2020. Yet it is difficult to find summary assessments of national progress toward this goal.

Question  Has health equity improved or worsened during the past 25 years in the United States among working-aged adults?

Findings  Using data from more than 5.4 million respondents to the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System, this study found that from 1993 to 2017, the black-white gap showed significant improvement. However, measures of health equity and health justice declined over time, and income disparities worsened.

Meaning  Meaningful progress on health equity in the United States will require greater effort, new approaches, or both.

Abstract:

Importance  Health equity is an often-cited goal of public health, included among the 4 overarching goals of the Department of Health and Human Services’ Healthy People 2020. Yet it is difficult to find summary assessments of national progress toward this goal.

Question  Has health equity improved or worsened during the past 25 years in the United States among working-aged adults?

Main Outcomes and Measures  Health equity was assessed separately for each of 2 health constructs: healthy days—the average of physical and mental healthy days over the previous 30 days—and general health in 5 categories, rescaled to approximate a continuous variable. For each health construct, average health was calculated along with 4 measures of health equity: disparities across 3 income groups; black-white disparities; health justice—a measure of the correlation of health outcomes with income, race/ethnicity and sex; and a summary health equity metric.

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