Data reported by the Colorado Health Institute often show disparities by income, education, and race/ethnicity. Evidence shows that these disparities are the result of structural discrimination that has been ingrained in society for generations. It is a mistake to attribute health disparities to individual behavior or group culture.
Research conducted by CHI and others shows a strong connection between income, education, and health outcomes. Money can buy access to more and higher quality medical care, safer neighborhoods, lower stress levels, and cleaner environments — all of which are powerful factors that influence health. To take a common example, the food that is most available and affordable in lower-income neighborhoods tends to be unhealthy, leading to higher rates of obesity and related diseases in these neighborhoods.
Education and wealth have close ties to race and ethnicity, with white Americans disproportionately more likely to enjoy higher incomes and education levels than Hispanic or Black Americans because of discriminatory policies that have blocked opportunities for education and wealth-building for people of color. However, health disparities persist by race and ethnicity even when controlling for income and education. For example, Black women with a college education are at higher risk for maternal death than white women who do not graduate from high school.
American history explains why this is so. Past and present policy choices have led inevitably to disparate health outcomes. Even before the country’s founding, white people enslaved Black people, and slavery was enshrined in the country’s constitution. After the Civil War abolished slavery, state and local governments adopted racist laws that kept Black people from building wealth and voting. Banks would not make loans to people of color, preventing them from building generational wealth through home ownership. The U.S. government pursued wars of conquest against the Indigenous population and later forcibly removed Native American children from their families in an attempt to assimilate them into white culture. Immigration laws targeted Asian people, and the federal government detained Japanese Americans in camps during World War II, robbing them of their homes, businesses, and freedom.
These policies left a legacy of trauma and dispossession. But racist policies and practices are still in force today. Black children are more likely to face harsh discipline in school. Zoning codes and discriminatory lending practices make it difficult for people of color to buy a house. In 2019, Colorado’s uninsured rate tripled for Hispanic children — most of whom were U.S. citizens — as their families avoided contact with clinics and government programs out of fear of the Trump Administration’s anti-immigrant practices.
We don’t cite these examples to make anyone ashamed of American history. We need to discuss this painful history because it explains the current state of health disparities. Understanding these disparities is the first step toward correcting them.
In the same vein, CHI shares data about health disparities not to shame individuals or groups, but to point out societal failings. Often, disparate health outcomes among races and income groups are the result of policy choices. Policies can be changed. Our mission at the Colorado Health Institute is to bring about that change by advancing policies that allow all people to enjoy healthier lives.