Health Disparities Persist Among Children: Opportunities for the ACA

By Tara Mancini

While Minority Health Month draws to a close this week, the just released “National Healthcare Disparities Report,” from the Agency for Health Care Quality illustrates the urgency for dedicating more attention to the issue. Mandated by Congress, the 2011 report is the ninth to be issued.  Overall, the report finds that access to health care did not improve for most racial and ethnic groups from 2002 through 2008. Below, I highlight some findings specific to racial and ethnic disparities in child and maternal health.

Infant mortality rates, often considered a good indicator of the overall health of a nation, gives reason for pause.  The 2009 data indicate that African American infants had the highest infant mortality rate for babies with very low birth weight (less than 1500 grams) at 267 per 1,000 live births compared to the rates of all other racial/ethnic groups and to the national average (245 deaths per 1,000 births). Comparing the rate of maternal deaths, the gap between African American and White women has continued to grow larger.

One of the new measures added in 2011 to track the effectiveness of care is the percentage of children ages 0-17 who received a wellness check-up in the past 12 months.  Using 2009 data, the most recent that is available, the report indicates slightly more promising results for African American children, who received wellness check-ups at the highest rate, 83.5 percent, compared to both the national average (77.9 percent) and children of all other races/ethnicities. American Indians and Alaskan Natives received wellness visits at a rate lower than any other racial group -71.8 percent – and Hispanics had a lower rate than non-Hispanics, 74.9 versus 78.8 percent.

Overall, there was little difference in the percentage of children who had a wellness visit within the last 12 months based on private or public insurance, 80.8 percent versus 80.5 percent.  Yet, it is noteworthy that children of most racial and ethnic groups with public health insurance coverage were more likely to have had a wellness visit when compared to the average for their racial or ethnic group.  The increase was most dramatic for Hispanics, American Indians, and children of multiple races – each group’s rate increased by at least four percentage points: 79.3, 76.9, and 84.2, respectively.

Immunizations are another crucial aspect of preventative care, but in 2009, the national average of children ages 19-35 months who received all of their recommended vaccines was only 63.6 percent.  White children received vaccinations at the highest rate of any racial group, 65.3 percent, followed by 62.3 percent of Asian children, 61.9 percent of American Indian and Alaskan Native children, 58.5 percent of African American children and 56.9 of multi-racial children. Native Hawaiian and Pacific Islander children had the lowest rate, with just 53.7 percent. Hispanics children received all recommended immunizations at a higher rate when compared to non-Hispanics, 67.1 versus 62.2 percent.

It is important to remember that the data contained in this report predates the passage of the Affordable Care Act, which contains many provisions to reduce barriers to care.  HHS used those provisions as the basis for its Action Plan to Reduce Health Disparities among racial and ethnic minorities.  As my colleagues pointed out last month, the ACA is already helping to maintain or improve access to preventative services for more than half of America’s children.  The data is not disaggregated by race and ethnicity, but the ACA equirement to improve the collection of demographic data presents us with another opportunity to tackle the question of where health disparities remain.