Racial Discrimination and Access to Care in Colorado

The CHAS shows that discrimination is a barrier to health access. People who identify as Black or African American or Hispanic/Latino were also more likely than white Coloradans to report skipping health care because of concerns about being treated unfairly, according to the CHAS.

While many people can experience discrimination within the health system, this report focuses primarily on people of color. It is well established that being treated unfairly and disrespectfully because of one’s race or ethnicity has far-reaching impacts, not limited to poor physical and mental health outcomes.(1) Additionally, meaningful and significant efforts are being made to improve health outcomes and reduce inequities among people of color, and these data help illustrate why this work is important and where more action is needed.

The CHAS findings offer new insight into recent experiences of discrimination in the health care system and their impact on people of color in Colorado. Taking action to ensure people of color in Colorado receive respectful, fair treatment regardless of their race, ethnicity, or culture is an urgent and necessary step for health care providers to improve health equity.

Health and Discrimination

Research indicates that experiences of discrimination can lead to a higher mortality rate, mental illness, cancer, hypertension, cardiovascular disease, obesity, and risky lifestyles.(2) 

Data from the CHAS also aligned with that research: Coloradans who skipped care due to fear of unfair treatment were much more likely to report poor health.

Coloradans who skipped care due to fear of unfair treatment were more likely to report poor or fair general health compared with those who did not skip care (41.2% compared with 11.2%). A similar trend was seen in poor mental health. Those who skipped care due to fear of unfair treatment were three times as likely to report poor mental health compared with those who didn’t skip care (46.6% compared with 15.6%).

More People of Color Reported Disrespectful Treatment or Lower Quality of Care Based on Race or Ethnic Background

In 2021, 4.2% of Coloradans ages 18 and older who got health care in the past year — about 148,000 people — reported that they were treated with less respect or received services that were not as good as others received.

More than one in three of those adults (35.2%, or about 52,000) were people of color — that is, people who identified as a race other than non-Hispanic/Latino white on the survey. This group includes people who selected Black or African American, Hispanic/Latino, Asian, Native Hawaiian or Other Pacific Islander, Middle Eastern or North African, American Indian or Alaska Native, or some other race. Small sample sizes prevented analysis by specific groups for this question.

Among people of color who reported being treated disrespectfully, a striking majority reported that ethnic background or culture (89.2%) or race (87.0%) were the reasons.

While people of color who answered the survey may also have reported that they experienced disrespectful treatment due to other aspects of their identities or life experiences, race and culture were the most commonly reported reasons among this group.

Among people of all races who reported being treated with less respect, income was the most common reason (58.3%), followed by ethnic background or culture (37.1%) and race (36.0%) (see Figure 1).

Note: Respondents reported other reasons for being treated with less respect, including disability, age, experience with violence or abuse, gender or gender identity, and sexual orientation. Due to small sample sizes, however, these reasons could not be reliably reported for the adult people of color sample. Respondents could also note more than one reason.

These data reflect that many people of color’s experiences in the health care system are shaped by centuries of racial discrimination. Unethical and racist science has perpetuated false beliefs and stereotypes about people of color among many providers.(3) Institutional and provider bias, structural racism, a history of dangerous experiments, and exploitive marketing have led to widespread mistrust in the health care system among many people of color.(4)

On a separate question on the 2021 CHAS, about 85,000 Coloradans reported needing care that was responsive to their race or ethnic background. Receiving culturally competent care was linked to higher satisfaction with care. (Read more: Diverse State, Diverse Needs.)

Addressing Discrimination in Health Care

The CHAS data in this brief make it clear that people of color experience discrimination within the health care system, an ongoing challenge that needs to be addressed.

Policymakers and providers are taking steps to reduce discrimination in the health care setting, including through recently passed legislation to advance this work. While that’s a good start, providers can take additional steps to promote more diverse and inclusive care. Download the brief to read:

• Promising approaches for providers
• Legislative action to encourage change

Conclusion

All Coloradans should be able to access health care without fear of being treated disrespectfully. But these CHAS data suggest that people of color in Colorado are having health care experiences tied to their race and ethnicity that can affect their health and access to care. These experiences are a manifestation of a long history of institutional and structural racism in the health care system. 

Building a more equitable health care system requires acknowledging and addressing this history and reducing racism and bias among providers. Culturally competent and equitable care can improve health equity and build trust between people of color and health care providers. 

Health care institutions, policymakers, educators, providers, and community-based organizations and funders all have a role to play in improving the experiences and health of Coloradans of color.