Health disparities in the U.S. are both persistent and, oftentimes, getting worse, according to a recent report from America’s Health Rankings. 

Released in June by the United Health Foundation, the disparities report and accompanying interactive website are based on decades of data on dozens of health-related measures, including social determinants.

At the national level, for example, the new report found “deep and persistent” disparities in mental and behavioral health by gender, educational attainment, and race and ethnicity. Other key findings included ongoing and growing disparities in maternal death rates, and widening gaps in food security. Black man looking downward

Overall, the report, which is based on data collected before the COVID-19 pandemic, found a strong link between education and health. Americans without a high school education face the greatest health, economic and social challenges, as well as the biggest health disparities. 

“The America’s Health Rankings Health Disparities Report is an excellent pre-pandemic baseline report for health and elected officials, and other stakeholders,” Georges Benjamin, MD, APHA executive director, said in a news release. “It provides actionable data that is relevant to leaders, not only in public health, but also across many sectors.” 

While the U.S. has made progress on a number of health measures, the report found that not all communities have benefited equally. For example, the nation’s overall uninsured rate dropped significantly within the past decade. However, the uninsured rate was still 3.5 times higher among people with only a high school degree, compared to college graduates, and three times higher among Hispanics and American Indian and Alaska Native people than among whites. 

Racial gaps were especially wide across states: For instance, between 2015 and 2019, American Indian and Alaska Native populations in Wyoming had an uninsured rate 24 times higher than white populations in Washington, D.C.

The nation also made progress on addressing deaths among Black infants, with rates declining in 22 states since the early 2000s. But the rankings report found that Black babies face the highest infant mortality rate in the nation, with a rate nearly three times higher than Asian and Pacific Islander babies. On maternal death, rates and disparities worsened.

Between 2015 and 2019, Black mothers faced a maternal mortality rate that was 3.4 times higher than Hispanic mothers. From 2005-2009 and 2015-2019, maternal mortality rates increased 22% among Black mothers, with 44 deaths per 100,000 live births. There was a 55% increase in deaths for white mothers, to 17 deaths per 100,000 live births, and a 23% increase for Hispanic mothers, to nearly 13 deaths per 100,000 live births.

Disparities in mental and behavioral health also worsened over the years for many groups. Researchers found that adults with less than a high school education had a rate of frequent mental distress that was 123% higher than college graduates. From 2017 to 2019, women experienced a 70% higher rate of depression compared to men.

The disparities report explores progress on a number of other social determinants of health, such as poverty, food insecurity, housing and pay gaps. Between 2015 and 2019, households headed by adults without a high school education had a nearly six times higher rate of food insecurity than households headed by someone with a college degree.

“That was one that really stood out for me,” said Judy Monroe, MD, president and CEO of the CDC Foundation. “And we know it only got worse during the pandemic.”

Monroe, a member of a national advisory committee that helped guide work on the new disparities report, said because the report lets users track progress over time and compare that progress to fellow states, it can be especially useful for bringing diverse stakeholders to the table and capturing the attention of policymakers. As a former state health official, she said the rankings data was often “incredibly motivating,” both for celebrating wins and for coalescing around entrenched problems and inequities. 

In addition to being a focal point for public health action, Monroe said the new disparities report also offers a roadmap for hospital and health systems to take action. 

“Sadly, the pandemic has been especially bad for health disparities,” Monroe told The Nation’s Health. “We need to take this data and lean in hard. It gives us a roadmap for focusing in and taking action, because if we don’t do that, things will only get worse.” 

For more information on the “America’s Health Rankings Health Disparities Report 2021” or to access its interactive website, both of which provide national and state-specific findings, visit

Photo: Image by Digitalskillet, courtesy iStockphoto