Report Shows Health Disparities by County, Demographics

March 27, 2018, 03:30 pm News Staff – After almost a decade of improvement, the percentage of babies in the United States born with a low birthweight rose to 8.2 percent in 2016 -- a 2 percent increase over 2014.

Social and Economic Disparities

First off, significant disparities in social and economic opportunities were seen across counties, with more than one out of every five youth in the bottom-performing counties not graduating from high school in four years. Additionally, the unemployment rate for adults in the bottom-performing counties (7.5 percent) was more than double that of adults in the top-performing counties (3.2 percent).

Overall, high-school graduation and unemployment rates were worse among counties in the Southeast, Southwest, Appalachian and Mississippi Delta regions. And among American Indian/Alaska Native, black or Hispanic youth nationally, one-quarter didn't graduate from high school in four years. In 2016, American Indian/Alaska Native and black adults had the highest unemployment rates (10.5 percent and 9.9 percent, respectively), while white and Asian adults experienced significantly lower rates of unemployment (4.2 percent and 3.5 percent, respectively).

Effects of Residential Segregation

"Decades of research on residential segregation illustrate the connection between place, race and health," the report noted. "The U.S. has a long history of racism and discriminatory policies and practices that have limited the opportunities of people of color in choosing where to live." And that residential segregation has had marked effects on health.

For example, black residents in smaller metropolitan or large urban counties faced greater barriers to health and opportunity than did white residents, according to the report's authors. The researchers found higher rates of child poverty, low birthweight and infant mortality among black children, youth and adults in these areas compared with whites.

In addition, high-school graduation rates and median household incomes among black residents in more segregated communities were lower than those of their counterparts in less segregated communities. This dichotomy was not seen for whites.

Data also showed that segregation patterns and limited opportunities for health care affect other racial and ethnic groups, as well. For example, compared with less segregated areas, rates of child poverty in more segregated counties are higher for black, American Indian/Alaska Native, Hispanic and Asian children, but not for white children.

Child Poverty Rates

Examining other trends for children in poverty, child poverty rates were highest in counties in the Southwest and Southeast regions, as well as those in parts of Appalachia, the Mississippi Delta and the Plains.

Rural counties had the highest child poverty rates (23.2 percent) overall, the report found, followed by large urban metropolitan areas (21.2 percent), smaller metropolitan areas (20.5 percent) and suburban counties (14.5 percent).

Child poverty rates for black and Hispanic children were worse across all types of counties, with the rates for children from these groups who live in suburban counties higher than for white children living in rural counties.

Teen Birth Rates

Finally, in some good news, teen birth rates have been declining across community types and in all racial and ethnic groups for more than a decade, and racial/ethnic gaps have narrowed. Hispanic teens saw the biggest improvement, with rates dropping from 77.7 births to 31.9 births per 1,000 females ages 15-19.

Teen birth rates were highest for counties in the Southwest and Southeast, as well as for counties in parts of Appalachia, the Mississippi Delta and the Plains regions. Whereas these areas saw little change in teen birth rates during the past decade, the East Coast and West Coast regions showed improvements.

Rural counties saw the highest teen birth rates (35.9 per 1,000), which were nearly twice the rates in suburban counties (18.5 per 1,000). And American Indian/Alaska Native (34.3 per 1,000), Hispanic (31.9 per 1,000) and black (28.1 per 1,000) teens consistently had birth rates twice as high as those for white or Asian teens.

"The time is now to address long-standing challenges like child poverty and residential segregation," said Julie Willems Van Dijk, Ph.D., R.N., director of County Health Rankings & Roadmaps, in the release. "This year's rankings are a call to action to see how these persistent health gaps play out locally, take an honest look at their root causes and work together to give everyone a fair shot at a healthier life."

Rankings Website Features

The County Health Rankings & Roadmaps website also features a What Works for Health section, which offers a database of nearly 400 evidence-based strategies to support local public health advocates in their communities.

Strategies are organized by topic areas to enable users to find what works best for their community, and each strategy is rated for its evidence of effectiveness and likely impact on health disparities.

The website also includes an Action Center with tips on how to get involved promoting public health in communities, as well as a section on Community Coaching that offers advice from actual community coaches to guide interested participants through the website's resources and offer tips on getting involved.

"As an organization committed to improving health and well-being, we can't tolerate the reality that some Americans don't have the same opportunity to be healthy because of where they live, how much money they make or the color of their skin," Besser said. "As a nation, we will be healthier and stronger together when we remove barriers to opportunity for everyone in America."

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