Why are health disparities so stark in America right now? Dr. Rhonda Randall, Chief Medical Officer of UnitedHealthcare E&I, joins the podcast to explain.
The inaugural America's Health Rankings Health Disparities Report focuses on the inequalities in health care by race and ethnicity, gender, age, education and other measures. The report revealed an urgent need to address maternal mortality, mental and behavioral health and food insecurity in the United States. Why are health disparities so stark right now? Dr. Rhonda Randall, Chief Medical Officer of UnitedHealthcare E&I joins the podcast to explain.
Ira Apfel 00:05
Hello, and welcome to UnitedHealth Group’s Weekly Dose Podcast, where we'll get you up to speed on the latest trends shaping the future of health care. I'm your host Ira Apfel. This week we're talking about something we touched on a little bit in last week's episode, the inaugural America's Health Rankings Health Disparities Report. It's produced by the United Health Foundation, and you can read the whole document at www.americashealthrankings.org. As the name suggests, the report focuses on health disparities, the inequalities we find in health care by race and ethnicity, gender, age, education and other measures. According to the report, health disparities are particularly stark in America across racial and ethnicity, age and educational light. The report revealed an urgent need to address maternal mortality, mental and behavioral health and food insecurity in the United States, especially in the wake of the pandemic. Why are health disparities so stark right now? And what's been the response in the health care community? Dr. Rhonda Randall, Chief Medical Officer of UnitedHealthcare, Employer and Individual, is here to shed some light on the subject. Dr. Randall, welcome.
Dr. Rhonda Randall Thank you. Nice to be here.
Ira Apfel So I want to start by kind of setting the scene here and talking a little bit about health disparities. they existed before the pandemic. What were they like then? And what happened over the course of the pandemic that changed health disparities?
Dr. Rhonda Randall 01:38
Well, this report from America's Health Rankings is our inaugural health disparities report. And you're absolutely right, the data in this report comes pre pandemic. And it was very important for us to provide that baseline and also look at those trends over time. So this report looks at 30 different measures of our health very comprehensively from the environment, a community where we live, the behaviors that we're choosing as individuals that care we get when we go to the doctor or the hospital and ultimately outcomes. And we're able to look at the breadth of those disparities, how wide they are, how many different groups are experiencing them? how prevalent throughout the United States, the depth of the disparities, how wide the gaps are, so are they small gaps are the very significant gaps. And then the persistence, those trends over time is an important marker of what America's Health Rankings does. It's not just a snapshot, it's looking at the progress we've made both in the positive way and in the opportunities.
Ira Apfel 02:41
Now, I know that the United Health Foundation has produced America's Health Rankings for quite some time, roughly around 30 years or so that this health disparities report is a little different. Why did they decide to or why did you decide to switch it up just a little bit and focus so strongly on health disparities?
Dr. Rhonda Randall 03:05
Well, the America's Health Rankings platform contains over 140 different measures of our health. And you're absolutely right. for 31 years now, the annual report has been in existence that comes out every December, that report looks at more than 35 different measures of our health. And then, just about a decade ago, we started to look at a report on seniors, the health of people generally over the age of 65. And following that, we looked at the health of women and children, and then the health of those who've served in the US military. And in each of those reports in all of those 140 measures where the data has been available at a state level by subpopulations. That includes race and ethnicity that includes gender, that includes educational attainment, and includes geography, not only the states and where we live, but do we live in a metropolitan or a non-metropolitan area. And in each of those reports, we have been providing that disparity data, but we thought it was time to bring it all into one particularly around the conversations we've had over the last year and what we've seen happen with a pandemic, to bring some of the most respective measures where disparities exist into a single report.
Ira Apfel 04:16
So this gets to kind of a larger question, which I'm hoping you can answer, which is, what role does data play in in shaping the conversation about public health progress and challenges? I guess what I'm saying is, how is this health disparities report going to be used and who's going to use it?
Dr. Rhonda Randall 04:34
Well, the Super utilizers of population health reports have always been in the Public Health Officers in the state, State and Territorial Health Officers at that level. But more and more this has come into the light for individuals looking at this report for community leaders for business leaders, and employers looking at the data that's in this report as well. We want it to be used for a call to action. So it's Really important that this isn't just admire the problem. But this also shows us a baseline of where we start and the magnitude of what we're dealing with. It gives each state a good opportunity to look at where its strengths are, where its need for progress. And closing those gaps are and where they can make the most significant difference. states are often dealing with limited budgets. So if you need to understand where to make those investments, this data gives you that start of that conversation, and really helps you make better decisions.
Ira Apfel 05:32
Why does you know Health Foundation, and UHG do this and, and if anyone can access this in this in this data and this information, what is what are we doing as an organization that kind of makes it so crucial, and all encompassing?
Dr. Rhonda Randall 05:50
What we want the state to be available externally, it's been in the public domain throughout the course of its 31 years and running. And we want to provide those data driven insights so that we can help support better health outcomes. And that mission that we have, of helping people live healthier lives and helping the health system work better for everyone. It's important for the United Health Foundation, America's Health Rankings looks at this very comprehensively, we use the World Health Organization's definition of health, which is not just limited to our physical health, our emotional and behavioral health are important. You'll see national trends, but at a state level, you will find places where it's worse. And you'll find places where there's not much of a disparity at all. And there's a lot of learnings to happen on both of those ends.
Ira Apfel 06:37
So I want to dive in now to the health disparities report. And in like, in summary in large here, and you've provided a good example here from how one state uses one, measurement, one reading. But one of the biggest takeaways from the health disparities report that you want listeners to know,
Dr. Rhonda Randall 06:58
every time we look at any America's Health Rankings report, we see areas that we can be proud of the improvements that we've made, and we see areas where things are getting worse or that there's opportunity. So let's start with the positive news in in the disparities report, prior to the pandemic, access to care was improving across the states, the uninsured rate went down substantially went down by 37%. Their period measurement years were between 2010 to 2014 was the baseline and then we compared it in the years reported between 2015 and 2019. So in that period of time between 2010 and 2019, the uninsured rate in the United States went down 37%. That's something to pay attention to. Another thing that we saw was, although the rate of uninsured among American Indian and Alaskan Native populations in Wyoming, it was significantly higher than the uninsured population, the white populations in DC. So you see those differences between race and ethnicity and geography. So all those gains were not experienced equally. Another really good example, infant mortality rates, we made progress with infant mortality rates in the United States, those also continued to go down, it went down in 22 states between the measurement period year 2003 and 2006. And fast forward to 2015 to 2000. And in 2018. However, despite those national gains, we still see disparities between races, Black infants are almost three times more likely to have infant mortality experience infant mortality that is death before the first birthday 2.8 times higher than their Asian and Pacific Islander counterparts.
Ira Apfel 08:49
So a lot of good progress and a lot of things to work on. I'm curious, you know, you've been doing this now for a while, how long have you been overseeing this and kind of working with the American Health Rankings reports.
Dr. Rhonda Randall 09:03
I've been privileged to work with America's Health Rankings in the United Health Foundation on this suite of reports for around a decade. And it and looking at that over that period of time, you start to really see some of these highlights and trends. In fact, one of the really came out in this disparities report, and that's around educational attainment,
Ira Apfel 09:24
jumping on that a little bit more, what do you mean by educational attainment?
Dr. Rhonda Randall 09:27
So it's something that I've been observing, as I've been involved with a suite of reports now for quite some time. And we provide the data on the 140 different measures of health sliced by educational attainment when it's available. And you're starting to see a pattern that those who haven't completed high school versus those particularly those who have a college degree, but those who haven't completed high school versus those who have completed high school and the health measures over the course of their lifetime. So it was one of the things that we focus done in this disparities report, we saw differences between race and ethnicity, we saw differences between gender, we saw differences between geography, but we saw some pretty marked differences for educational attainment, and not finishing high school has ramifications to your health throughout the course of your lifetime. That that might not be as intuitive as you think. And it doesn't get as much attention in public health publications as it should. So I hope it brings the conversation to light mental health is a really good example of that those who have it finished high school, more likely to have experiencing poor mental health days, similar things that we're seeing with that measure around mental health, females are more likely to report higher rates of depression than their male counterparts.
Ira Apfel 10:49
And you know, you've been doing this now for 10 years. I'm wondering, was there anything in this report that surprised you either to the good or the bad? Where you said, Wow, I did not expect that.
Dr. Rhonda Randall 11:01
There wasn't anything that surprised me, because, you know, generally, trends don't change dramatically from one year to the next. But I'll tell you one, that not necessarily surprises me. But we've really got to do something about it. And you had some discussion with Dr. Huckaby earlier on maternal mortality, maternal mortality rates increased in the United States for all populations. And there's a significant difference between maternal mortality rates for Black mothers who have the highest rates of maternal mortality versus Hispanic mothers who have the lowest rates of maternal mortality, Black mothers 3.4 times more likely to die during pregnancy and immediate period after childbirth than their Hispanic counterparts with those rates went up for all populations, it went up 23% for Hispanics, 55% for whites, and 22% for Black mothers, so very much going in the wrong direction for a country like the United States.
Ira Apfel 12:04
Last question for you. What what's the bottom line from this health disparities report? what's the one takeaway or lesson you would like listeners to leave with?
Dr. Rhonda Randall 12:16
That it's a call to action. It's a call to action for us as individuals, it's a call to action for us to be leaders, in our homes, in our communities, at our in our workplaces. To share this data, I hope that those who are listening that may be already familiar with report, take it to the next level. I hope those of you who are listening and haven't been familiar with the report, go to America's HealthRankings.org. That's our website and play around with the data and information in your state in your community. And find nuggets in there something that you're passionate about. The data in this report is meant to be a call to action for all of us.
Ira Apfel 12:58
Well, Dr. Randall, thank you so much for being on the podcast today.
Dr. Rhonda Randall 13:02
Thank you for having me.
Ira Apfel 13:04
That's it for this episode of UnitedHealth Group’s Weekly Dose Podcast. Thanks for listening and have a great rest of your week.