An assessment of state efforts to combat racial/ethnic health disparities: Case studies of Wisconsin, Texas, and Massachusetts

In the United States, vast racial/ethnic disparities in health outcomes persist both among and within states. Recognizing that state-based health and non-health policies, budgetary decisions, tax policies, income distributions, and political environments—not state demographics alone—contribute to, or mitigate, these disparities, this paper assesses state-initiated efforts to reduce racial/ethnic health disparities. It specifically focuses on the states of (1) Massachusetts, where racial/ethnic disparities are amongst the nation‘s lowest, (2) Wisconsin, where racial/ethnic disparities are amongst the nation‘s highest, and (3) Texas, where racial/ethnic disparities align closely with national averages. To systematically score each state‘s efforts, a Health Disparities Report Card System is developed and employed, which evaluates states based upon their minority health programs, data collection methods, data use, health disparities action plans, disparities-focused legislation, funding levels to disparities programs, other disparities-related programs and initiatives, health disparities research, timeliness of efforts, and numerous other factors. Results from the three individual case studies suggest that states with lower levels of health disparities (1) have higher report card scorings, meaning their efforts to address health disparities may be stronger, more comprehensive, and more closely match the suggested actions included on the report card, (2) tend to have a higher political prioritization of reducing health disparities, (3) exhibit lower levels of racial disparities within poverty rates, and (4) have been early actors in addressing health disparities. Based upon these findings, this paper develops a set of eight preliminary recommendations to states to best reduce racial/ethnic health disparities.