Marginal health equity for Black Californians suggests slow road ahead

It’ll take California longer than it’s even been a state—and longer than the US has been a nation—to close the racial health disparity and other gulfs in equity for Black folks, according to a report from the Black Policy Project, which looks at equity within the state.

Given the slow rate of improvement Black Americans have seen in equity since 2000, it would take 248 years to close the outcomes gap, the report showed. By comparison, the US has been a nation for 246 years; California has been a state for 174.

These findings come as the US healthcare industry takes a pulse check on its health equity progress. Health equity work has been underway at many institutions for decades, but the rise in value-based care contracts, plus the disparities laid bare during the pandemic and America’s overall racial reckoning, has accelerated those efforts in the past four years.

This latest report, the “State of Black California,” published by the Black Policy Project out of the UCLA Ralph J. Bunche Center for African American Studies, follows up on a similar report completed in 2007. The 2024 iteration shows that despite modest progress, US healthcare is still staring down steep racial equity problems.

The report uses the “Equality Index” to assess whether Black people “experience equal conditions with other ethnic groups, particularly whites,” the report authors explained. The Equity Index looks at numerous social outcome data, including health, and serves up a baseline score of 1.00 established by White Californians.

Overall, the report shows some improvement for Black people in California, with socioeconomic outcomes improving by 21.7 percent based on census data from 2000 to 2020. Still, it’s been a slow road to equity. In 2000, the Equity Index score for Black people was 0.66. By 2020, the number rose modestly to 0.69, or a 4 percent climb.

“According to that rate of change, closing the racial gap between Black and white Californians would take over 248 years,” Michael Stoll, faculty director of the Black Policy Project and author of the report, said in a press release.

What’s more, Black Californians’ 0.69 on the Equity Index (0.69) is still 30 percent lower than that of all racial minority groups. For Latinos, the 2020 Equity Index score was 0.72; for Indigenous Californians, it was 0.74; and for Asian Pacific Islanders, it was 1.14.

Zooming in on the Health Index, which represents 15 percent of the total Equity Index score, the score for Black people in 2020 was 0.69, which means their health outcomes were a little more than two-thirds those of White people. For Latinx people, the score was 1.08; for Asian people, it was 1.51; and for Indigenous people, it was 0.81.

The low Health Index score for Black people was largely driven by the stark difference in the age-adjusted death rate across racial demographics, the researchers indicated.

The age-adjusted death rate accounts for 65 percent of the Health Index score, and for Black people in California in 2020, it was 853 per 100,000 people. The death rate for White people was 667 per 100,000 people, yielding a 0.75 White/Black death rate ratio.

“The death rate data shown here were collected before the COVID-19 pandemic, which disproportionately affected the Black community,” the researchers stressed. “These numbers are likely much rosier than would be the case if the data covered the period that included the pandemic.”

The report also focused on infant death rates, which the medical industry already knows are higher among Black people than White people. This report adds to that literature, reporting that the Black infant death rate was 9 per 1,000 live births, compared to 3.2 per 1,000 live births among White people. That adds up to a 0.35 White/Black infant death ratio, the researchers said.

The report indicated serious inequities across numerous other social categories, many of which affect health. Social determinants of health like income, housing stability, educational attainment, justice-involvement, and civic engagement were all documented in the report.

“These findings are meant to guide the development of new solutions and to build upon successful programs,” Stoll said. “Although there is a long way to go, the data shows that with investment and action, the lives and socioeconomic outcomes of Black Californians can significantly improve.”