Widespread health care disparities revealed: Hardships for minority kids start at birth

Black and Hispanic children receive universally worse medical care than their white peers, starting from the moment they’re born and spanning across all specialties, according to a comprehensive five-year review.

Researchers reviewed hundreds of studies that looked at racial disparities and health inequities from January 2017 to July 2022, adjusting for insurance status, family’s socioeconomic status and preexisting health conditions.

They found widespread racial and ethnic disparities in care, treatment and health outcomes across all pediatric specialties, including neonatology, primary care, emergency medicine, critical care, surgery, mental health, developmental disabilities, endocrinology and palliative, or end-of-life, care, according to the study published Wednesday in The Lancet Child & Adolescent Health.

“From the very earliest moments of life, there are pervasive inequities in the quality of healthcare received by children in the USA,” said Natalie Slopen, assistant professor of sociology and behavioral sciences at Harvard University who led the research review. “Racism profoundly impacts not only children’s health but also people’s health into adulthood.”

The study found Black and Hispanic kids consistently received lower-quality neonatal care compared with white infants. In primary care, researchers also found poorer communication between healthcare providers and nonwhite children, youth and families.

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Researchers saw differences in wait times, how providers determine who gets care first and suspected child abuse evaluations for nonwhite kids who come to the emergency room. The widest disparities were in pain management, where nonwhite kids were found to be less likely to receive painkillers for a broken arm or leg, appendicitis or a migraine than white children were.

Black, Hispanic and Asian American children who received end-of-life care were more likely to die in the hospital compared with white children. Hispanic kids were more likely to receive medically intense care during their last days of life.

“It’s an impressive compilation of the mounting data that demonstrates that inequities in healthcare delivery are pervasive,” said Dr. Monika Goyal, associate chief of emergency medicine at Children's National Hospital, who is unaffiliated with the study. “It’s not unique to one specific area of medicine. It’s really everywhere and it’s all around us.”

Researchers also found there were drawbacks for white children from this inequitable care. They often received painkillers, antibiotics, IV fluids and diagnostic imaging that were found to be medically unnecessary.

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“People are getting suboptimal care no matter what,” said lead author Dr. Nia Heard-Garris, pediatrician and researcher at the Ann & Robert H. Lurie Children’s Hospital and Northwestern University. “That was really fascinating to me and kind of drove home the point that we need to really think about pediatric care through an equitable lens… in a way that will help to promote good health for all of us.”

Although the report controlled for factors outside the healthcare system, such as insurance and socioeconomic status, the study authors outlined in a second report how policies in housing, employment and the criminal justice system have perpetuated structural racism, leading to pediatric health disparities.

Goyal, from Children's National Hospital, said it's also important to take a critical look at what healthcare providers can do to check their personal biases and what policies healthcare systems can put in place to mitigate against those biases.

"People that go into medicine generally want to help people," Heard-Garris said. The report is not only a "sad story," but can also be used "as a tool of empowerment, especially for health care providers, parents and advocacy organizations to demand better."

Send tips to Adrianna Rodriguez at adrodriguez@usatoday.com.

This article originally appeared on USA TODAY: Kids' health care is not equal. And it starts the moment they're born.