The Economic Burden of Racial, Ethnic, and Socioeconomic Health Inequities

Health inequities have a very real and often deadly cost to human life, evidenced by the declining life expectancy of adults in the United States. These inequities also place an economic burden on communities and states across the country.

We analyzed the cost of racial, ethnic, and socioeconomic health inequities across the U.S. economy, quantifying how these disparities are just as deadly to the economy as they are to human life and wellbeing. It is imperative that policymakers at all levels continue investing resources in order to eliminate health inequities in the U.S. in order to save and improve lives and promote quality health for everyone.

The analyses found that the costs of racial, ethnic health, and socioeconomic inequities are unacceptably high and that policymakers on all levels must continue investing resources to eliminate these disparities in the US.

AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WV WI WY

Click on a state to view its data.

2019 Coronary heart disease death rate. Health inequity and disparity are illustrated for each of 6 racial and ethnic population groups. The baseline for health inequity (shown in blue) is the Healthy People 2030 equity goal. The baseline for health disparity (shown in orange) is the mean for the White population.
2019 Coronary heart disease death rate. Health inequity and disparity are illustrated for each of 6 racial and ethnic population groups. The baseline for health inequity (shown in blue) is the Healthy People 2030 equity goal. The baseline for health disparity (shown in orange) is the mean for the White population.

Table 1 from the Racial and Ethnic Health Report.

  • Abbreviations: BRFSS, Behavioral Risk Factor Surveillance System; MEPS, Medical Expenditure Panel Survey; NVSS, National Vital Statistics System.
  • Native Hawaiian and Other Pacific Islander samples in the MEPS for age-sex cohorts were too small to compute estimates for medical care spending and labor market productivity.
  • Because the study primarily focuses on the burden of health inequities for racial and ethnic minorities, state-level estimates were not computed for the White population using the BRFSS.

 

Cost, $ in billions

Outcome

American Indian or Alaska Native

Asian

Black

Latino

Native Hawaiian or Other Pacific Islander

Total health inequities for non-White populations

White

Total

MEPS and National NVSS Estimates

Excess medical care costs

2.8

4.9

42.0

25.4

 

75.1

183.3

258.4

Lost labor market productivity

4.7

0.9

31.5

22.0

 

59.1

90.0

149.1

Excess premature deaths

20.0

0.0

238.0

9.4

19.5

286.9

335.4

622.3

Total

27.5

5.8

311.5

56.8

19.5

421.1

608.7

1029.8

BRFSS and State NVSS Estimates

Excess medical care costs

3.5

4.6

36.8

31.3

0.6

76.8

 

 

Lost labor market productivity

3.3

3.6

33.2

40.3

0.6

81.0

 

 

Excess premature deaths

19.5

0.2

239.6

22.6

11.1

293.0

 

 

Total

26.3

8.4

309.6

94.2

12.3

450.8

 

 

Table 2 from the Racial and Ethnic Health Report. The bar graph is a visual representation of each number for purposes of comparison.

To compute excess medical care costs and lost labor market productivity, the authors computed states level estimates for 50 states and the District of Columbia (DC). State level prevalence rates for each race and ethnic group were computed using data from the 2016-2019 BRFSS. These rates were used to simulate medical care costs and labor market outcomes adjusting for age, gender, race, marital status, insurance status, education, family income, health status, health conditions and census regions of the country). Excess premature death costs were computed for each state and DC using state level data from National Vital Statistic System. GDP by states are published by The Bureau of Economic Analysis.

  • Abbreviations: BRFSS, Behavioral Risk Factor Surveillance System; MEPS, Medical Expenditure Panel Survey; NVSS, National Vital Statistics System.
  • Per-capita costs for each racial and ethnic group were computed by dividing the total economic loss for that group by the total population of each racial and ethnic group within their respective state.
  • State-level estimates for the White population were not computed because the study focused on burden of health inequities for racial and ethnic minority populations. The national per-capita estimate for the White population based on the MEPS estimate was $3098.
Total
State Total
AL 13741.2
AK 2253.9
AZ 7867.7
AR 4652.6
CA 39502.5
CO 4131.4
CT 2330.3
DE 1839.3
DC 3487.4
FL 27346.5
GA 21156.0
HI 4457.5
ID 1407.0
IL 29253.8
IN 6849.7
IA 1533.4
KS 3541.8
KY 4097.8
LA 15308.8
ME 280.6
MD 14412.7
MA 3637.0
MI 16074.9
MN 4620.2
MS 10290.0
MO 8673.9
MT 1367.2
NE 1483.7
NV 8748.2
NH 284.3
NJ 10287.3
NM 5933.5
NY 18750.5
NC 19817.3
ND 767.1
OH 14868.9
OK 7677.2
OR 1745.6
PA 14723.2
RI 1187.0
SC 12140.9
SD 1587.0
TN 11211.9
TX 40606.2
UT 2565.3
VT 47.4
VA 11606.4
WA 5161.2
WV 403.4
WI 4568.6
WY 229.5
American Indian or Alaska Native
State American Indian or Alaska Native
AL 9977
AK 17057
AZ 13247
AR 8550
CA 11240
CO 10274
CT 3769
DE 5585
DC 7480
FL 11504
GA 2176
HI 2428
ID 10335
IL 8295
IN 3586
IA 11168
KS 16676
KY 14348
LA 5651
ME 7232
MD 6228
MA 8850
MI 16615
MN 22096
MS 15517
MO 4577
MT 17314
NE 12245
NV 9571
NH 18509
NJ 3311
NM 12899
NY 3141
NC 10051
ND 15406
OH 6922
OK 12593
OR 10225
PA 13243
RI 9632
SC 4724
SD 20275
TN 13220
TX 6108
UT 9824
VT 9209
VA 2328
WA 17976
WV 10054
WI 10802
WY 10209
Asian
State Asian
AL 71
AK 164
AZ 398
AR 16
CA 634
CO 219
CT 353
DE 169
DC 197
FL 263
GA 325
HI 782
ID 71
IL 475
IN 192
IA 59
KS 263
KY 28
LA 53
ME 147
MD 649
MA 187
MI 156
MN 314
MS 74
MO 269
MT 245
NE 119
NV 641
NH 24
NJ 777
NM 171
NY 819
NC 300
ND 174
OH 101
OK 155
OR 346
PA 283
RI 148
SC 105
SD 29
TN 116
TX 130
UT 110
VT 143
VA 445
WA 511
WV 653
WI 160
WY 148
Black
State Black
AL 10254
AK 6490
AZ 5888
AR 9387
CA 7801
CO 6042
CT 5012
DE 7158
DC 10912
FL 6459
GA 6334
HI 1827
ID 2058
IL 9836
IN 10185
IA 9058
KS 9650
KY 9968
LA 9965
ME 814
MD 7190
MA 3770
MI 10202
MN 5579
MS 8801
MO 11790
MT 648
NE 7793
NV 9613
NH 816
NJ 7068
NM 5808
NY 4340
NC 7486
ND 411
OH 10022
OK 11100
OR 8321
PA 8940
RI 4198
SC 8929
SD 184
TN 9494
TX 6987
UT 3653
VT 362
VA 6575
WA 7205
WV 4108
WI 10636
WY 175
Latino
State Latino
AL 1494
AK 6461
AZ 1048
AR 857
CA 828
CO 2018
CT 855
DE 4086
DC 419
FL 1133
GA 687
HI 7073
ID 5621
IL 5136
IN 1268
IA 2526
KS 4803
KY 2681
LA 1222
ME 10095
MD 2472
MA 2177
MI 2761
MN 5012
MS 2145
MO 1063
MT 6365
NE 3082
NV 6725
NH 4819
NJ 914
NM 3300
NY 1326
NC 2619
ND 6070
OH 1295
OK 2452
OR 989
PA 2535
RI 5696
SC 680
SD 4133
TN 1365
TX 1501
UT 4723
VT 1709
VA 1126
WA 761
WV 3147
WI 612
WY 1754
Native Hawaiian or Other Pacific Islander
State Native Hawaiian or Other Pacific Islander
AL 1358
AK 604
AZ 20487
AR 2555
CA 35476
CO 12705
CT 3195
DE 11126
DC 443
FL 36384
GA 13201
HI 24017
ID 9728
IL 2710
IN 954
IA 1877
KS 3292
KY 25084
LA 6839
ME 6020
MD 1805
MA 3106
MI 578
MN 2410
MS 17241
MO 7056
MT 9739
NE 3119
NV 20712
NH 6078
NJ 1187
NM 3914
NY 33195
NC 17124
ND 590
OH 1151
OK 1032
OR 13064
PA 1017
RI 444
SC 1595
SD 1631
TN 549
TX 37993
UT 6968
VT 998
VA 16909
WA 21175
WV 5474
WI 512
WY 1348
Economic Burden per Capita in US Dollars for Racial and Ethnic Health Inequities in 2018
Location American Indian or Alaska Native Asian Black Latino Native Hawaiian or Other Pacific Islander
AL 9977 71 10254 1494 1358
AK 17057 164 6490 6461 604
AZ 13247 398 5888 1048 20487
AR 8550 16 9387 857 2555
CA 11240 634 7801 828 35476
CO 10274 219 6042 2018 12705
CT 3769 353 5012 855 3195
DE 5585 169 7158 4086 11126
DC 7480 197 10912 419 443
FL 11504 263 6459 1133 36384
GA 2176 325 6334 687 13201
HI 2428 782 1827 7073 24017
ID 10335 71 2058 5621 9728
IL 8295 475 9836 5136 2710
IN 3586 192 10185 1268 954
IA 11168 59 9058 2526 1877
KS 16676 263 9650 4803 3292
KY 14348 28 9968 2681 25084
LA 5651 53 9965 1222 6839
ME 7232 147 814 10095 6020
MD 6228 649 7190 2472 1805
MA 8850 187 3770 2177 3106
MI 16615 156 10202 2761 578
MN 22096 314 5579 5012 2410
MS 15517 74 8801 2145 17241
MO 4577 269 11790 1063 7056
MT 17314 245 648 6365 9739
NE 12245 119 7793 3082 3119
NV 9571 641 9613 6725 20712
NH 18509 24 816 4819 6078
NJ 3311 777 7068 914 1187
NM 12899 171 5808 3300 3914
NY 3141 819 4340 1326 33195
NC 10051 300 7486 2619 17124
ND 15406 174 411 6070 590
OH 6922 101 10022 1295 1151
OK 12593 155 11100 2452 1032
OR 10225 346 8321 989 13064
PA 13243 283 8940 2535 1017
RI 9632 148 4198 5696 444
SC 4724 105 8929 680 1595
SD 20275 29 184 4133 1631
TN 13220 116 9494 1365 549
TX 6108 130 6987 1501 37993
UT 9824 110 3653 4723 6968
VT 9209 143 362 1709 998
VA 2328 445 6575 1126 16909
WA 17976 511 7205 761 21175
WV 10054 653 4108 3147 5474
WI 10802 160 10636 612 512
WY 10209 148 175 1754 1348
US (overall) 12351 487 7797 1643 23225
Mean (SD) across states 10,281 (4,930) 262 (215) 6,614 (3,390) 2,856 (2,183) 8,976 (10,551)

Table 3 from the Socioeconomic Health Report.

  • Abbreviations: BRFSS, Behavioral Risk Factor Surveillance System; MEPS, Medical Expenditure Panel Survey; NVSS, National Vital Statistics System.
  • State-level estimates for adults with 4-year college or more were not computed because the study focuses on burden of health inequities for adults with lower educational attainment.

 

Cost, $ in billions

Outcome

Less than high school

High school / GED

Some College

Total health inequities for adults with <4-year college degree

4-year college degree or more

Total

MEPS and national NVSS estimates

Excess medical care costs

37.4

62.1

48.3

147.8

27.9

175.7

Lost labor market productivity

30.4

67.4

59.0

156.8

7.4

164.2

Premature death

175.9

455.4

4.5

635.8

0.0

635.8

Total

243.7

584.9

111.8

940.4

35.3

975.7

BRFSS and state NVSS estimates

Excess medical care costs

44.5

64.1

46.3

154.9

 

 

Lost labor market productivity

32.4

72.3

69.3

154.9

 

 

Premature death

178.9

457.0

12.9

648.7

 

 

Total

255.8

593.4

128.5

977.7

 

 

Table 4 from the Socioeconomic Health Report. The bar graph is a visual representation of each number for purposes of comparison.

  • Per-capita costs were computed by dividing populations of each education group for adults older than 25 years.
  • State-level estimates for adults with 4-year college or more were not computed because the study focuses on burden of health inequities for adults with lower educational attainment. The US per-capita estimate for adults with a 4-year college degree was $514.
Total Economic Burden
State Total Economic Burden
AL 28431
AK 2278
AZ 16484
AR 13210
CA 59463
CO 11203
CT 7380
DE 3523
DC 2710
FL 57230
GA 32384
HI 2727
ID 3974
IL 3974
IN 24224
IA 8749
KS 8264
KY 26132
LA 23145
ME 4621
MD 19037
MA 18343
MI 43710
MN 10209
MS 15561
MO 23704
MT 2689
NE 5220
NV 7864
NH 4443
NJ 20577
NM 7930
NY 36411
NC 48508
ND 1625
OH 47793
OK 16800
OR 10551
PA 43518
RI 2616
SC 42871
SD 2488
TN 36302
TX 71127
UT 5295
VT 1824
VA 22055
WA 19095
WV 6154
WI 14068
WY 1655
Less than High School
State Less than High School
AL 19194
AK 14804
AZ 7373
AR 15356
CA 3152
CO 6623
CT 5421
DE 10815
DC 14396
FL 8507
GA 11200
HI 4572
ID 8524
IL 7798
IN 12978
IA 9106
KS 8888
KY 21372
LA 19291
ME 14075
MD 11295
MA 6833
MI 20842
MN 7005
MS 18415
MO 16296
MT 13769
NE 7395
NV 4691
NH 12328
NJ 4691
NM 10816
NY 3631
NC 15833
ND 10014
OH 15706
OK 14731
OR 8785
PA 10217
RI 8464
SC 19954
SD 12145
TN 19082
TX 5815
UT 8100
VT 15049
VA 13246
WA 17037
WV 11318
WI 8827
WY 12029
High School / GED
State High School / GED
AL 16535
AK 10837
AZ 7945
AR 11448
CA 6280
CO 9653
CT 7241
DE 11418
DC 22430
FL 8069
GA 9355
HI 7085
ID 7586
IL 9352
IN 10643
IA 9145
KS 10306
KY 14738
LA 11145
ME 9423
MD 11857
MA 11836
MI 13225
MN 7426
MS 12321
MO 11165
MT 7683
NE 11884
NV 9662
NH 10819
NJ 8868
NM 11066
NY 6614
NC 14467
ND 8108
OH 11733
OK 11846
OR 8632
PA 9621
RI 7336
SC 25555
SD 8817
TN 14553
TX 10452
UT 6661
VT 7939
VA 8597
WA 7283
WV 6201
WI 7263
WY 8784
Some College
State Some College
AL 2391
AK 1944
AZ 1958
AR 1866
CA 1478
CO 1171
CT 1993
DE 2362
DC 2532
FL 1794
GA 2335
HI 1311
ID 1993
IL 1072
IN 1520
IA 1956
KS 2672
KY 2677
LA 2588
ME 2467
MD 2136
MA 1423
MI 1909
MN 1162
MS 3874
MO 2041
MT 1582
NE 1214
NV 1625
NH 2739
NJ 1800
NM 3587
NY 1846
NC 4223
ND 1131
OH 1839
OK 3305
OR 2499
PA 1997
RI 1791
SC 8374
SD 2124
TN 2845
TX 1337
UT 2228
VT 2572
VA 1287
WA 1993
WV 2850
WI 1946
WY 2309
Economic Burden per Capita for Education-Related Health Inequities for Each State and the District of Columbia in 2018
  Cost, $
Location Less than high school High school / GED Some college
AL 19194 16535 2391
AK 14804 10837 1944
AZ 7373 7945 1958
AR 15356 11448 1866
CA 3152 6280 1478
CO 6623 9653 1171
CT 5421 7241 1993
DE 10815 11418 2362
DC 14396 22430 2532
FL 8507 8069 1794
GA 11200 9355 2335
HI 4572 7085 1311
ID 8524 7586 1993
IL 7798 9352 1072
IN 12978 10643 1520
IA 9106 9145 1956
KS 8888 10306 2672
KY 21372 14738 2677
LA 19291 11145 2588
ME 14075 9423 2467
MD 11295 11857 2136
MA 6833 11836 1423
MI 20842 13225 1909
MN 7005 7426 1162
MS 18415 12321 3874
MO 16296 11165 2041
MT 13769 7683 1582
NE 7395 11884 1214
NV 4691 9662 1625
NH 12328 10819 2739
NJ 4691 8868 1800
NM 10816 11066 3587
NY 3631 6614 1846
NC 15833 14467 4223
ND 10014 8108 1131
OH 15706 11733 1839
OK 14731 11846 3305
OR 8785 8632 2499
PA 10217 9621 1997
RI 8464 7336 1791
SC 19954 25555 8374
SD 12145 8817 2124
TN 19082 14553 2845
TX 5815 10452 1337
UT 8100 6661 2228
VT 15049 7939 2572
VA 13246 8597 1287
WA 17037 7283 1993
WV 11318 6201 2850
WI 8827 7263 1946
WY 12029 8784 2309
US (overall) 9467 9982 2028
Mean (SD) across states 11,525 (4,843) 20,371 (3,363) 2,229 (1,113)

Table 5 compares data from both the Racial and Ethnic Health Report and the Socioeconomic Health Report.

  • The “Racial and ethnic health inequities” totals do not compute state-level estimates for the White population and adults with 4-year college or more because the study focuses on burden of health inequities for disadvantaged populations.
  • The “Education-related health inequities” fields are divided by the 2018 gross domestic product for each states and the nation, which are published by The Bureau of Economic Analysis.
Economic Burden of Racial and Ethnic and Education-Related Health Inequities
  Racial and ethnic health inequities Education-related health inequities
Location Total, $ in million Share of gross domestic product, % Total, $ in million Share of gross domestic product, %
AL 13741.2 6.12 28431 12.66
AK 2253.9 4.11 2278 4.15
AZ 7867.7 2.35 16484 4.92
AR 4652.6 3.58 13210 10.18
CA 39502.5 1.31 59463 1.97
CO 4131.4 1.10 11203 2.97
CT 2330.3 0.83 7380 2.64
DE 1839.3 2.40 3523 4.60
DC 3487.4 2.45 2710 1.90
FL 27346.5 2.58 57230 5.40
GA 21156.0 3.52 32384 5.38
HI 4457.5 4.77 2727 2.92
ID 1407.0 1.79 3974 5.05
IL 29253.8 3.32 3974 5.05
IN 6849.7 1.84 24224 6.52
IA 1533.4 0.80 8749 4.54
KS 3541.8 2.09 8264 4.87
KY 4097.8 1.94 26132 12.35
LA 15308.8 5.99 23145 9.06
ME 280.6 0.43 4621 7.07
MD 14412.7 3.45 19037 4.56
MA 3637.0 0.63 18343 3.19
MI 16074.9 2.99 43710 8.14
MN 4620.2 1.23 10209 2.72
MS 10290.0 8.89 15561 13.44
MO 8673.9 2.68 23704 7.33
MT 1367.2 2.75 2689 5.42
NE 1483.7 1.19 5220 4.18
NV 8748.2 5.18 7864 4.66
NH 284.3 0.33 4443 5.16
NJ 10287.3 1.62 20577 3.24
NM 5933.5 5.85 7930 7.82
NY 18750.5 1.10 36411 2.14
NC 19817.3 3.44 48508 8.43
ND 767.1 1.38 1625 2.92
OH 14868.9 2.16 47793 6.94
OK 7677.2 3.78 16800 8.27
OR 1745.6 0.72 10551 4.34
PA 14723.2 1.83 43518 5.42
RI 1187.0 1.94 2616 4.26
SC 12140.9 5.18 42871 18.29
SD 1587.0 3.02 2488 4.74
TN 11211.9 3.00 36302 9.72
TX 40606.2 2.23 71127 3.91
UT 2565.3 1.42 5295 2.93
VT 47.4 0.14 1824 5.34
VA 11606.4 2.13 22055 4.05
WA 5161.2 0.90 19095 3.31
WV 403.4 0.51 6154 7.77
WI 4568.6 1.33 14068 4.11
WY 229.5 0.58 1655 4.15
Total 12187.6 2086514.0 977675 4.69

Racial and Ethnic Health Report

What is the cost to the US economy of socioeconomic health inequities?

The economic burden in this category ranges from $421-$451 billion. Most of these inequities exist due to the exposure to economic, social, structural, and environmental risks and their healthcare access. The report measures the sum of excess medical care costs, lost labor market productivity, and excess premature death (before age 78) costs by race and ethnicity compared to health equity goals.

Socioeconomic Health Report

What is the cost to the US economy of socioeconomic health inequities?

The Socioeconomic Health Report found that the costs of socioeconomic health inequities are $940-$978 billion. Most of these costs were attributed to adults with a high school diploma. However, a disproportionate share of the expenses was attributed to adults with less than a high school education. The study was conducted to estimate the economic burden of socioeconomic health inequities in the US. The measures included excess medical care costs, lost labor market productivity, and excess premature death costs.

About the Tulane Institute for Innovation in Health Equity

The Tulane Institute for Innovations in Health Equity serves as a forum to promote scholarship advancing the reduction and elimination of preventable differences in the burden of disease. Health inequities impact a wide variety of demographic groups in not just the United States, but all over the world. The quest for health equity addresses both historical and contemporary injustices based on race, ethnicity, socio-economic status, gender, sexuality, disability status, and more.

The institute is comprised of centers, research projects, and individual researchers who explore unjust patterns in the distribution of disease that are avoidable and preventable. We work to enhance human health through engagement of disadvantaged communities and populations and to serve as a resource for education and training

If you are a member of the media looking for information about these reports, please visit our Media Inquiries page.

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