Healthcare Resources

Healthcare Resources

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The Healthcare Resources dimension is constructed using four indicators: Primary Care, Mental Health Care, Dental Health Care, and the Health Uninsurance Gap, which capture racial disparities in access to essential healthcare services and insurance coverage across places.

Why is the Healthcare Resources Important to the Structural Racism and Discrimination (SRD) Index?

Healthcare resources are a critical pathway through which structural racism and discrimination shape unequal health outcomes1,2,3,4. Historical and ongoing inequities in insurance coverage, healthcare infrastructure, and provider availability have limited access to primary, mental, and dental healthcare services for Black communities2,5,6. These barriers contribute to delayed care, unmet health needs, and poorer health outcomes, reflecting systemic differences in how healthcare systems serve different populations7.

Disparities in healthcare resources also interact with other dimensions of structural racism captured in the SRD Index. Limited access to healthcare is closely linked to income inequality, housing instability, residential segregation, and environmental exposure, compounding health risks across the life course. As a result, unequal healthcare resources reinforce place-based and intergenerational health inequalities, making this dimension essential to understanding the broader impacts of structural racism and discrimination8.

How is the Healthcare Resources Calculated?

The Healthcare Resources dimension is calculated using four indicators: Primary Care, Mental Health Care, Dental Health Care, and Health Uninsurance Gap. For primary, mental, and dental health care, lower provider rates are used to indicate higher medical need; conversely, the Health Uninsurance Gap directly measures insurance gaps. To ensure comparability across counties, each indicator is standardized before being integrated into the index.

STEP 1: Indicator standardization

The primary care, mental health care, dental health care, and health uninsurance gap indicators are converted into Z scores after adjusting for outliers using top and bottom coding, following the SRD Index methodology.

STEP 2: Reversing the Z-Scores

The Z-scores for the primary care, mental health care, dental health care indicators are reversed so that a higher Z-scores of the reversed values contribute to higher values or scores of the SRD index.

The Z-scores for the health uninsurance gap were not reversed. A higher Z-score of health uninsurance gap contributes to a higher value or score of the SRD index.

STEP 3: Dimension score calculation

The Healthcare Resources Z score is calculated by taking the average of the four indicator Z scores:

Healthcare Resources Z score = (Z8 + Z9 + Z10 + Z11) / 4

where Z8 represents primary care, Z9 represents mental health care, Z10 represents dental health care, and Z11 represents health uninsurance gap

STEP 4: Ranking

The Healthcare Resources Z score are then converted into rank scores, where a higher score indicates a greater impact of racism and discrimination within this dimension.

References

  1. Egede, L. E., Walker, R. J., & Williams, J. S. (2024). Addressing structural inequalities, structural racism, and social determinants of health: a vision for the future. Journal of General Internal Medicine, 39(3), 487-491.
  2. Ahmed, A. T., Mohammed, S. A., & Williams, D. R. (2007). Racial discrimination & health: Pathways & evidence. Indian Journal of Medical Research, 126(4), 318-327.
  3. Yearby, R. (2018). Racial disparities in health status and access to healthcare: the continuation of inequality in the United States due to structural racism. American Journal of Economics and Sociology, 77(3-4), 1113-1152.
  4. Churchwell, K., Elkind, M. S., Benjamin, R. M., Carson, A. P., Chang, E. K., Lawrence, W., … & American Heart Association. (2020). Call to action: structural racism as a fundamental driver of health disparities: a presidential advisory from the American Heart Association. Circulation, 142(24), e454-e468.
  5. Price, J. H., Khubchandani, J., McKinney, M., & Braun, R. (2013). Racial/ethnic disparities in chronic diseases of youths and access to health care in the United States. BioMed research international, 2013(1), 787616.
  6. National Research Council, Board on Children, Youth, & Committee on Oral Health Access to Services. (2012). Improving access to oral health care for vulnerable and underserved populations. National Academies Press.
  7. Yamada, T., Chen, C. C., Murata, C., Hirai, H., Ojima, T., Kondo, K., & Harris III, J. R. (2015). Access disparity and health inequality of the elderly: unmet needs and delayed healthcare. International journal of environmental research and public health, 12(2), 1745-1772.
  8. Romanelli, M., & Hudson, K. D. (2017). Individual and systemic barriers to health care: Perspectives of lesbian, gay, bisexual, and transgender adults. American journal of orthopsychiatry, 87(6), 714.