Racial and ethnic disparities in health and health care remain a persistent challenge in the United States. The COVID-19 pandemic’s uneven impact on people of color drew increased attention to inequities in health and health care, which have been documented for decades and reflect longstanding structural and systemic inequities rooted in historical and ongoing racism and discrimination. KFF’s 2023 Survey on Racism, Discrimination, and Health documents ongoing experiences with racism and discrimination, including in health care settings. While inequities in access to and use of health care contribute to disparities in health, inequities across broader social and economic factors that drive health, often referred to as social determinants of health, also play a major role. Using data to identify disparities and the factors that drive them is important for developing interventions and directing resources to address them, as well as for assessing progress toward achieving greater equity over time.
This analysis examines how people of color fare compared to White people across 64 measures of health, health care, and social determinants of health using the most recent data available from federal surveys and administrative sets as well as the 2023 KFF Survey on Racism, Discrimination, and Health, which provides unique nationally-representative measures of adults’ experiences with racism and discrimination, including in health care (see About the Data). Where possible, we present data for six groups: White, Asian, Hispanic, Black, American Indian or Alaska Native (AIAN), and Native Hawaiian or Pacific Islander (NHPI). People of Hispanic origin may be of any race, but we classify them as Hispanic for this analysis. We limit other groups to people who identify as non-Hispanic. When the same or similar measures are available in multiple datasets, we use the data that allow us to disaggregate for the largest number of racial and ethnic groups. Future analyses will reflect new federal standards that will utilize a combined race and ethnicity approach for collecting information and include a new category for people who identify as Middle Eastern or North African. Unless otherwise noted, differences described in the text are statistically significant at the p<0.05 level.
We include data for smaller population groups wherever available. Instances in which the unweighted sample size for a subgroup is less than 50 or the relative standard error is greater than 30% — which are outside of what we would typically include in analysis like this — are noted in the figures, and confidence intervals for those measures are included in the figure. Although these small sample sizes may impact the reliability, validity, and reproducibility of data, they are important to include because they point to potential underlying disparities that are hidden without disaggregated data. For some data measures throughout this brief we refer to “women” but recognize that other individuals also give birth, including some transgender men, nonbinary, and gender-nonconforming persons.
Social Determinants of Health
RACIAL DISPARITIES IN SOCIAL AND ECONOMIC FACTORS
Social determinants of health are the conditions in which people are born, grow, live, work, and age. They include factors like socioeconomic status, education, immigration status, language, neighborhood and physical environment, employment, and social support networks, as well as access to health care. There has been extensive research and recognition that addressing social, economic, and environmental factors that influence health is important for advancing health equity. Research also shows how racism and discrimination drive inequities across these factors and impact health and well-being.
Black, Hispanic, AIAN, and NHPI people fare worse compared to White people across most examined measures of social determinants of health (Figure 31). Experiences for Asian people are more mixed relative to White people across these examined measures. Reliable or disaggregated data for NHPI people are missing for a number of measures.
WORK STATUS, FAMILY INCOME, AND EDUCATION
Across racial and ethnic groups, most nonelderly people live in a family with a full-time worker, but Black, Hispanic, AIAN, and NHPI nonelderly people are more likely than White people to be in a family with income below poverty (Figure 32). While most people across racial and ethnic groups live in a family with a full-time worker, disparities persist. AIAN (68%), Black (73%), NHPI (77%), and Hispanic (81%) people are less likely than White people (83%) to have a full-time worker in the family. In contrast, Asian people (86%) are more likely than their White counterparts (83%) to have a full-time worker in the family. Despite the majority of people living in a family with a full-time worker, over one in five AIAN (25%) and Black (22%) people have family incomes below the federal poverty level, over twice the share as White people (10%), and rates of poverty were also higher among Hispanic (17%) and NHPI (16%) people.
Black, Hispanic, AIAN, and NHPI people have lower levels of educational attainment compared to their White counterparts. Among people ages 25 and older, over two thirds (69%) of White people have completed some post-secondary education, compared to less than half (45%) of Hispanic people, just over half of AIAN and NHPI people (both at 52%), and about six in ten Black people (58%) (Figure 33). Asian people are more likely than White people to have completed at least some post-secondary education, with 74% completing at least some college.
NET WORTH AND HOME OWNERSHIP
Black and Hispanic families have less wealth than White families. Wealth can be defined using net worth, a measure of the difference between a family’s assets and liabilities. The median net worth for White households is $285,000 compared to $44,900 for Black households and $61,600 for Hispanic households (Figure 34). Asian households have the highest median net worth of $536,000. Data are not available for AIAN and NHPI people.
People of color are less likely to own a home than White people (Figure 35). Nearly eight in ten (77%) White people own a home compared to 70% of Asian people, 62% of AIAN people, 55% of Hispanic people, and about half of Black (49%) and NHPI (48%) people.
FOOD SECURITY, HOUSING QUALITY, AND INTERNET ACCESS
Black and Hispanic adults and children are more likely to experience food insecurity compared to their White counterparts. Among adults, AIAN (18%), Black (14%), and Hispanic (12%) adults report low or very low food security compared to White adults (6%) (Figure 36). Among children, AIAN (24%), Black (21%) and Hispanic (15%) children are over twice as likely to be food insecure than White children (6%). Data are not available for NHPI adults and children.
People of color are more likely to live in crowded housing than their White counterparts (Figure 37). Among White people, 3% report living in a crowded housing arrangement, that is having more than one person per room, as defined by the American Community Survey. In contrast, almost three in ten (28%) NHPI people, roughly one in five (18%) Hispanic people, 16% AIAN people, and about one in ten Asian (12%) and Black (8%) people report living in crowded housing.
AIAN, NHPI, and Black people are less likely to have internet access than White people (Figure 38). Higher shares of AIAN (12%), and Black and NHPI people (both at 6%) say they have no internet access compared to their White counterparts (4%). In contrast, Asian people (2%) are less likely to report no internet access than White people (4%).
TRANSPORTATION
People of color are more likely to live in a household without access to a vehicle than White people (Figure 39). About one in eight Black people (12%) and about one in ten AIAN (9%) and Asian (8%) people live in a household without a vehicle available followed by 7% of Hispanic and NHPI people. White people are the least likely to report not having access to a vehicle in the household (4%).
CITIZENSHIP AND ENGLISH PROFICIENCY
Asian, Hispanic, NHPI, and Black people include higher shares of noncitizen immigrants compared to White people. Asian and Hispanic people have the highest shares of noncitizen immigrants at 25% and 19%, respectively (Figure 40). Asian people are projected to become the largest immigrant group in the United States by 2055. Immigrants are more likely to be uninsured than citizens and face increased barriers to accessing health care.
Hispanic and Asian people are more likely to have LEP compared to White people. Almost one in three Asian (31%) and Hispanic (28%) people report speaking English less than very well compared to White people (1%)(Figure 41). Adults with LEP are more likely to report worse health status and increased barriers in accessing health care compared to English proficient adults.
EXPERIENCES WITH RACISM, DISCRIMINATION, AND UNFAIR TREATMENT
Racism is an underlying driver of health disparities, and repeated and ongoing exposure to perceived experiences of racism and discrimination can increase risks for poor health outcomes. Research has shown that exposure to racism and discrimination can lead to negative mental health outcomes and certain negative impacts on physical health, including depression, anxiety, and hypertension.
Black, AIAN, Hispanic, and Asian adults are more likely to report certain experiences with discrimination in daily life compared with their White counterparts, with the greatest frequency reported among Black and AIAN adults. A 2023 KFF survey shows that at least half of AIAN (58%), Black (54%), and Hispanic (50%) adults and about four in ten (42%) Asian adults say they experienced at least one type of discrimination in daily life in the past year (Figure 42). These experiences include receiving poorer service than others at restaurants or stores; people acting as if they are afraid of them or as if they aren’t smart; being threatened or harassed; or being criticized for speaking a language other than English. Data are not available for NHPI adults.
About one in five (18%) Black adults and roughly one in eight AIAN (12%) adults, followed by roughly one in ten Hispanic (11%), and Asian (10%) adults who received health care in the past three years report being treated unfairly or with disrespect by a health care provider because of their racial or ethnic background. These shares are higher than the 3% of White adults who report this (Figure 43). Overall, roughly three in ten (29%) AIAN adults and one in four (24%) Black adults say they were treated unfairly or with disrespect by a health care provider in the past three years for any reason compared with 14% of White adults.