Support and Resources for Addressing Health Inequity and Inequality in the US

The United States may be a land of opportunity, but when it comes to health and health care, too many people are left behind. Inequities related to race, gender, income and other factors are widespread and lead to gross disparities in health status and even life expectancy. Addressing these disparities is essential to improving the wellbeing of people in marginalized communities. Many advocacy organizations, health care providers and policymakers are working on reducing health disparities to improve equity and health outcomes. The implications of health inequities go far beyond individuals to impact society as a whole.

People often use the terms “inequality” and “inequity” interchangeably, but these terms have important differences. “Health inequalities” are differences in health status between groups, such as higher rates of certain conditions in one ethnic group compared to another. “Health inequities” refer to disparities that result from societal factors and structures, sometimes called “social determinants of health.” Both concepts are related and need to be addressed. For people without health insurance, accessing care can be difficult if not impossible. In turn, going without needed medical care can lead to poor health outcomes. Being uninsured is an inequity that leads to unequal health status.

Health inequities are the result of a range of non-medical factors, often called “social determinants of health.” These factors include socioeconomic status, education, employment, housing and local community environments — all of which are interrelated. People living in poverty, for example, have less access to quality education, may have fewer economic opportunities and may live in worse housing conditions. People in unstable housing may have more difficulty getting or keeping a job, and people without jobs are more likely to be uninsured. This vicious cycle of inequity isn’t merely a set of unfortunate circumstances. Rather, many people in poverty face systemic discrimination, and people of color routinely face bias and discrimination.

The roots of health disparities run deep, but there are many people and organizations working to reduce inequities and inequalities. For example, government policies can expand access to health insurance, which can help improve access to care and reduce disparities. Nonprofit agencies work with individuals to help them access the care they need while also working to raise awareness about these experiences to try to reduce disparities for whole segments of the population.

Federal, state and local government agencies can play a major part in addressing health inequities and disparities. Some of the most meaningful advances in health equity have come through government policies to expand insurance coverage, protect vulnerable people from discrimination and fund services for people who need them most.

Nonprofit organizations and private institutions play important roles in addressing health disparities. Countless community-based organizations and health care providers offer programs to address non-medical barriers to health. These programs address everything from housing improvements and food to transportation and employment. Health insurers also increasingly offer programs to address social determinants of health.

Families USA is a national, non-partisan, nonprofit organization dedicated to expanding access to high-quality, affordable health care and improved health for all. One of its focus areas is health equity, on the principle that “no one should face barriers to a healthy life because of who they are or where they live.” The organization works to achieve its mission by conducting policy analysis and advocacy. It also partners with organizations representing people of color, people with disabilities, people in rural areas and others to shape a policy agenda that addresses inequities and social determinants of health.

A national nonprofit and advocacy organization, Community Catalyst's mission is “to build the power of people to create a health system rooted in race equity and health justice and a society where health is a right for all.” The organization works toward a vision where everyone has what they need to be healthy and refers to equity as its “north star.” Community Catalyst advocates for reducing medical costs, expanding health coverage and benefits and making sure people can access trusted health care providers. Specific initiatives include work to expand Medicaid coverage and improve Medicaid benefits, raise state and national standards for private and public health insurance providers, and reduce limitations on access to health care providers, among others.

The Institute for IHI is a nonprofit organization dedicated to health care quality and safety. IHI argues that “there can be no progress on quality without equity.” It offers health equity programming, including white papers and courses for health care professionals to guide health care organizations to improve health equity in their institutions and communities.

The AHA developed this framework to guide hospitals and health systems to become more equitable and inclusive. The initiative includes an assessment tool that health care organizations can use to understand their current performance on health equity measures. It also offers tools and resources for improving patient care, organizational policies, leadership and governance.

Many national and local health insurers have created programs to reduce health disparities. For example, Humana’s Bold Gold program focuses on reducing food insecurity, isolation and loneliness and transportation barriers for its members. The Blue Cross Blue Shield Association, the association of independent Blue Cross Blue Shield companies, launched an initiative to reduce maternal health disparities, with steps such as expanding postpartum coverage and enabling access to birthing centers, doulas and nurse midwives. Because health insurers benefit when their members are in good health, most now have programs to tackle some form of disparity that worsens member health.

Everyone should be able to get high-quality health care delivered with respect. That’s not always the case. If you’re struggling to get the health care and coverage you need because of your identity or where you live, you can and should advocate for yourself. But you don’t have to go it alone. Know where and how to find help, resources and information to arm yourself with and the tools you need to overcome barriers.

Health care information may seem dense, confusing and overwhelming. But the more you know, the more power you have. If you can get informed about your rights and options, you’re more likely to get what you need. Just knowing what questions to ask can give you authority and help you get support you might not get otherwise.

For people with limited financial resources, free or subsidized health insurance is available on the Health Insurance Marketplace. It doesn’t hurt to apply and see what subsidies you may be able to get. There are also community-based providers around the country that receive funds to provide free or lower-cost health care services. Don’t go without care or coverage — research resources for affordable options.

Depending on who you are, you may face extra barriers or have specific needs when it comes to your health and health care. For example, transgender people can face burdensome expenses if their insurance won’t cover gender-affirming care. Or, if you’re in a same-sex couple, you may have extraordinary expenses associated with starting a family. Plan and budget for your needs and seek support from organizations dedicated to helping people in your situation afford the care they need and deserve.

It may be easier said than done, but working with health care providers you trust can make a huge difference in the care you get. You’ll be more comfortable opening up about your needs and concerns, which will help your providers help you. Finding a provider who shares your racial identity may improve trust, according to research that shows patients feel better about the quality of care they receive when they get that care from a provider of the same race or ethnicity. But you may not need to see a provider who looks like you or shares your background to get the best care; other research shows that diverse care teams provide better care, even if the provider you see doesn’t come from your background.

No matter who you are, you are not alone. There are people like you and people who care about you out there working to make sure you get the health care you need and deserve. Community-based organizations exist to advocate for and support all kinds of people. Research the nonprofits in your area. The hospital or clinic where you get care may also know who can help.

One of the most important ways to make sure you get the health care you need is to make sure you have high-quality health insurance. Too many people, though, lack affordable coverage. According to KFF, 27.5 million nonelderly adults in the United States were uninsured in 2021. People of color were most likely to be uninsured. Most uninsured people were in families with at least one full-time worker, with household incomes below 400% of the federal poverty level, or about $58,000 per year for an individual. Many earn less than 200% of the federal poverty level.

Despite the availability of reasonably affordable insurance options, the majority of people who are uninsured cite the cost of coverage as the main reason. Uninsured people were more than twice as likely to report trouble paying medical bills and may wind up going without care as a result. But there may be health insurance options if you know where and how to look.

From research and policy organizations advocating for improvements to community-based organizations that directly help people from marginalized communities access care and other services, countless local, state and national organizations exist to improve health equity. Just a snapshot of available resources includes:

• Commonwealth Fund: The Commonwealth Fund supports independent research and publishes high-quality reports on health care access, quality and equity. Its mission is to promote a high-performing, equitable health system that focuses on improving access and quality for vulnerable populations.
• Urban Institute: The Urban Institute is a nonprofit research organization that publishes data to advance equity. Among its focus areas is federal health care reform, along with several other social determinants of health, such as housing, education and economic mobility.
• Deloitte Health Equity Institute: An arm of the global firm Deloitte, the Deloitte Health Equity Institute aims to address disparities in the drivers of health, racism and structural flaws in the system. It publishes research reports, playbooks and data dashboards and tools to advance health equity.
• AMA Center for Health Equity: The American Medical Association’s Center for Health Equity works to embed equity across AMA activities. It publishes guides and resources for medical professionals to improve awareness and practice of health equity principles and strategies.
• Patient Advocate Foundation: The Patient Advocate Foundation is a national nonprofit organization that provides case management and financial support to people with chronic and serious illnesses. It publishes consumer-friendly resources and a financial resources directory.
• Patient Access Network Foundation: The National Patient Access Foundation was founded as an advocacy organization alongside the direct support organization, Patient Advocate Foundation. It advocates for health system reforms to protect patient rights and partners with other advocacy groups and community-based organizations to create programs that improve access to and quality of care for all.
• Community Catalyst: Community Catalyst is a national nonprofit organization dedicated to creating a health care system rooted in racial equity and health justice. It produces guides and other resources to help consumers manage their health care and supports advocacy efforts to advance health policy for better coverage and access to care.
• Black Mamas Matter Alliance: The Black Mamas Matter Alliance is a national, nonprofit network of Black women-led organizations focused on ensuring Black women can thrive before, during and after pregnancy. The organization’s work includes advocacy, research and cultural shifts for Black maternal health, rights, and justice.
• National Center for Cultural Competence: A program of Georgetown University, the National Center for Cultural Competence provides national leadership on cultural and linguistic competency in health and mental health care delivery, administration, education and advocacy. It provides training and consulting to organizations and publishes research, tools and resources to promote cultural and linguistic competency.
• The Cross Cultural Health Care Program: The Cross Cultural Health Care Program is dedicated to serving as a bridge between communities and health care organizations to advance culturally and linguistically appropriate health care. It provides training and consulting to support culturally competent communication and practices within health care institutions.
• Eidos LGBTQ+ Health Initiative at the University of Pennsylvania: The Eidos LGBTQ+ Health Initiative, housed in the University of Pennsylvania’s School of Nursing, connects community leaders, researchers, academics, business leaders, investors and entrepreneurs to improve LGBTQ+ health. It conducts research, education and community engagement “to further the sustained wellbeing of the LGBTQ+ community.”
• Center for Excellence in Transgender Health: Part of the University of California San Francisco, this center provides training and education and conducts research to advance health equity for transgender and gender non-binary communities. It publishes studies, resources and guides to help providers and others effectively support transgender and non-binary patients.
• LGBTQ+ Healthcare Directory: The LGBTQ+ Healthcare Directory is a free, searchable database of doctors, medical professionals and other health care providers in the United States and Canada who are knowledgeable and sensitive to the unique health needs of LGBTQ+ people. It is a project of the Tegan and Sara Foundation and GLMA – Health Professionals Advancing LGBTQ+ Equality.
• Allies for Reaching Community Health Equity: This organization produces events and materials to help advocates and public health practitioners advance health equity in their communities.
• Health Equity Tracker:The Health Equity Tracker from the Satcher Health Leadership Institute at Morehouse School of Medicine gathers and provides detailed data on health outcomes by race, ethnicity, sex and other factors. The Tracker aims to address health disparities by providing policymakers, community leaders and researchers with the data they need to make informed decisions to achieve health equity and justice for all.