Report: Alabama has poor health system performance, stark health care disparities

A new Commonwealth Fund report found Alabama has some of the starkest health disparities between racial and ethnic groups in the Southeast. The infant mortality rate among Black Alabamians is three times higher than that of whites. (Stephanie Nantel/Getty Images)

Alabama has some of the most severe disparities in health care outcomes among racial groups, according to a new report.

The state ranked 44th out of the 50 states and the District of Columbia on overall health system performance, according to a Commonwealth Fund report published last week. Alabama only did better than Tennessee, Kentucky, Wyoming, Arkansas, Oklahoma and West Virginia.

White Alabamians experienced the highest health system performance and had a score in the 61st percentile among all population groups nationally. Hispanic Alabamians ranked in the 8th percentile. Black Alabamians ranked 27th.

The study also found that while white Alabamians have better health outcomes than Black or Hispanic Alabamians, they trail health outcomes for white Americans overall. 

Rob Green, spokesperson for ADPH, said in a statement the department “is committed to addressing health disparities and promoting health education for all Alabamians.” He said the department strives to ensure everyone has access to resources and the information to make informed decisions regarding their health.

“We will continue to work towards improving health outcomes through partnering with other organizations, providing community outreach, and offering services in communities all across the state,” he said.

The study analyzed 25 metrics aimed to assess the state of health care delivery and outcomes across the United States, including health indicators, health care accessibility, and the quality and utilization of health care services.

Among the parameters assessed were premature deaths under the age of 75 from preventable and treatable illnesses; mortality rates from conditions such as breast cancer; rates of health insurance coverage; utilization of primary care services and access to preventive health care interventions like vaccinations.

Researchers generated a “health system performance” score ranging up to 100 for each racial and ethnic group within each state and ranked states based on these scores.

Alabama’s racial and ethnic health disparities were more severe than other states. In Louisiana, which ranked immediately above Alabama at 43, white people ranked in the 63th percentile, but Black and Hispanic Louisianians ranked 31 and 21, respectively.

The disparities are starkest when it comes to the infant mortality rate.  While infant mortality is ticking down in the state, that has been driven by a drop in white infant mortality, which reached an all-time low in the state in 2021. Black infant mortality tripled.

The report also identifies barriers to health care access such as lack of insurance coverage, high out-of-pocket expenses, and shortages of health care providers and facilities in these communities.

Additionally, the report attributes poorer health conditions in communities of color to various factors, including poverty, environmental pollution, elevated crime rates, and limited access to green spaces.

The Alabama Department of Public Health has identified several factors that can lead to poor health outcomes, such as food deserts; lack of transportation, education and employment opportunities; limited access to health care and unsafe neighborhoods.

To address these disparities, the report recommended the state take a comprehensive approach, with policies aimed at expanding health care coverage and access to broader social determinants of health, including affordable housing, child care and public transportation.

Jennifer Harris, health policy advocate at Alabama Arise, said her biggest takeaway from the report is that people in Alabama lack access to health care.

About 128,000 Alabamians are in a “coverage gap,” according to KFF. Because the state has not expanded Medicaid, people in the coverage gap make too much to qualify for traditional Medicaid and too little to qualify for subsidized Affordable Care Act plans offered in the marketplace.

“This, unfortunately, has meant that some people are no longer here with us. We hear stories from their families, about how they wait too long to have a screening when they knew something was wrong, or don’t seek the care that they may have needed because of their fear that they would not be able to pay for it,” Harris said.

Expanding Medicaid, she said, is part of the puzzle to overcome health inequalities in Alabama. She said officials also need to work to put more green spaces in communities of color, which would allow children to move more and avoid chronic illness. Harris said racism and sexism can create biases that keep decisions from being made that could start to address the issue.

“When you have so many systems that have been broken down, and you’re not finding what connects them, to help them build up and be better, then you have a major problem. That’s why we often see Alabama on the lower end of a lot of these lists, it’s because we’re not connecting key components,” she said.

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