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Perceived discrimination in medical settings remains prevalent within the U.S. health care system. However, the details of these experiences and their associations with perceived quality of care are not well understood. Our study assessed multiple measures of perceived racial/ethnic discrimination in medical settings and investigated the locations and purported perpetrators of the discriminatory experiences within a population-based sample of 1,543 Black, White, Mexican, Puerto Rican, and Other adults. We used logistic regression to estimate associations between perceived discrimination in the medical setting and three quality of care indicators. Overall, 40% of the sample reported one or more types of perceived discrimination in a medical setting, with significant differences by race/ethnicity. Discrimination was perceived across health settings and from a variety of providers and staff. In adjusted logistic regression models, individuals reporting discrimination had more than twice the odds of reporting fair or poor quality of care (OR = 2.4 [95% CI: 1.4-4.3]). In addition, perceived discrimination in medical settings was significantly associated with report of not having enough time with the physician and not being as involved in decision-making as desired. These findings expand our understanding of perceived discriminatory experiences in health care and the consequences of it for patients, providers, and health care systems. This information is essential for identifying future provider interventions and improving the training of health care professionals.

Background Racial inequities in life expectancy, driven by structural racism, have been documented at the state and county levels; however, less information is available at the city level where local policy change generally happens. Furthermore, an assessment of life expectancy during the decade preceding COVID-19 provides a point of comparison for life expectancy estimates and trends post COVID-19 as cities recover. Methods Using National Vital Statistics System mortality data and American Community Survey population estimates, we calculated the average annual city-level life expectancies for the non-Hispanic Black (Black), non-Hispanic White (White), and total populations. We then calculated the absolute difference between the Black and White life expectancies for each of the 30 cities and the U.S. We analyzed trends over four time periods (2008-2010, 2011-2013, 2014-2016, and 2017-2019). Results In 2017-2019, life expectancies ranged from 72.75 years in Detroit to 83.15 years in San Francisco (compared to 78.29 years for the U.S.). Black life expectancy ranged from 69.94 years in Houston to 79.04 years in New York, while White life expectancy ranged from 75.18 years in Jacksonville to 86.42 years in Washington, DC. Between 2008-2010 and 2017-2019, 17 of the biggest cities experienced a statistically significant improvement in life expectancy, while 9 cities experienced a significant decrease. Black life expectancy increased significantly in 14 cities and the U.S. but decreased significantly in 4 cities. White life expectancy increased significantly in 17 cities and the U.S. but decreased in 8 cities. In 2017-2019, the U.S. and all but one of the big cities had a significantly longer life expectancy for the White population compared to the Black population. There was more than a 13-year difference between Black and White life expectancies in Washington, DC (compared to 4.18 years at the national level). From 2008-2010 to 2017-2019, the racial gap decreased significantly for the U.S. and eight cities, while it increased in seven cities. Conclusion Urban stakeholders and equity advocates need data on mortality inequities that are aligned with city jurisdictions to help guide the allocation of resources and implementation of interventions.

Background Racial inequities in life expectancy vary significantly across US cities, with city-level gaps ranging from zero to more than 10 years. Given that these inequities are rooted in racism and maintained through social structures and policies, population-level solutions are needed. Local health departments (LHD) are well-situated to lead these types of changes. Methods We conducted an environmental scan and document review of formal health plans of the LHDs with jurisdictions covering the 30 most populous US cities. We assessed the inclusion of equity priorities and specific and measurable equity goals. Secondary outcomes related to organizational structures, data, formal declarations, and other practices were also assessed. Data were collected between January and August 2022. Results The extent of focus on racial equity in the identified strategic health plans varied. Less than half of the cities with a formal public health plan (13 of 29) listed racial health equity as an area of focus. Only seven cities (all of which had a health plan focusing on racial health equity) had specific goals related to racial health equity. Twenty-five LHDs provided local data on racial health inequities. All but seven cities had declared racism a public health crisis. About half of the LHDs had positions or divisions focused on racial equity, or specified equity as an area of focus for Covid-19 efforts. Conclusions These findings reveal that few large cities translate growing support for anti-racism into their formal planning. While most LHDs acknowledge (and provide data pointing to) gaps in racial health equity in their jurisdictions, more attention is needed to incorporate specific and measurable racial health equity goals into strategic plans, and provide adequate structure and resources to attain those goals.

•There are significant racial disparities in prostate cancer mortality in the US and in many of its largest cities.•More than half of the largest cities in the US showed a widening gap in prostate cancer mortality rates between Blacks and Whites between 1990–1994 and 2005–2009.•Disparities differed across cities, even within the same state, with some cities having a Black mortality rate that was three times higher than the White rate and some cities having no significant difference between races.•As Black segregation levels increased at the city level, the racial disparity in mortality rates worsened.•City-level data can inform, guide, and motivate local health officials and clinicians. This paper presents race-specific prostate cancer mortality rates and the corresponding disparities for the largest cities in the US over two decades. The 50 largest cities in the US were the units of analysis. Data from two 5-year periods were analyzed: 1990–1994 and 2005–2009. Numerator data were abstracted from national death files where the cause was malignant neoplasm of prostate (prostate cancer) (ICD9=185 and ICD10=C61). Population-based denominators were obtained from US Census data. To measure the racial disparity, we calculated non-Hispanic Black: non-Hispanic White rate ratios (RRs), rate differences (RDs), and corresponding confidence intervals for each 5-year period. We also calculated correlation and unadjusted regression coefficients for 11 city-level variables, such as segregation and median income, and the RDs. At the final time point (2005–2009), the US and all 41 cities included in the analyses had a RR greater than 1 (indicating that the Black rate was higher than the White rate) (range=1.13 in Minneapolis to 3.24 in Los Angeles), 37 of them statistically significantly so. The US and 26 of the 41 cities saw an increase in the Black:White RR between the time points. The level of disparity within a city was associated with the degree of Black segregation. This analysis revealed large disparities in Black:White prostate cancer mortality in the US and many of its largest cities over the past two decades. The data show considerable variation in the degree of disparity across cities, even among cities within the same state. This type of specific city-level data can be used to motivate public health professionals, government officials, cancer control agencies, and community-based organizations in cities with large or increasing disparities to demand more resources, focus research efforts, and implement effective policy and programmatic changes in order to combat this highly prevalent condition.

Safety-net health care systems disproportionately serve the most marginalized and historically excluded groups in the U.S. Research from these systems not only focuses on those most affected by health inequities but is often strengthened by environments that are rich in direct experience, genuine community engagement, and awareness of social injustices. Despite this, research from safety-net systems is limited. Safety-net institutions face substantial structural barriers, primarily financial, that undermine their capacity to develop necessary infrastructure and compete for grants. We present a case study of a research center based in a safety-net system in Chicago to explore these challenges and potential solutions. Recommendations include the implementation of equity-focused funding approaches, research collaborations that take advantage of the expertise and community connections of safety-net providers, and strengthening the complex funding structure for safety-net hospitals. Health equity research must be driven by those most affected, and safety-net systems are well-positioned to help accomplish this.

Background: Race/ethnic discrimination is associated with poorer mental and physical health, worse health behaviors, and increased mortality, in addition to overall race/ethnic disparities in health. More specifically, it has been suggested as a possible determinant of the significant race/ethnic differences in the quantity and quality of medical care received by individuals in the United States. Objectives: The current study examines the association between 3 measures of racial/ethnic discrimination (Experiences of Discrimination, Everyday Discrimination Scale and discrimination in health care) and 6 types of preventive services (mammogram, clinical breast examination, Pap smear, colonoscopy/sigmoidoscopy, blood pressure screening, and diabetes screening). Research Design: Frequencies and correlations are run within a population-based sample of 1699 respondents from Chicago that includes whites, African Americans, Mexicans, and Puerto Ricans. Adjusted logistic regression models are run separately by race/ethnicity. Results: Findings show that levels of perceived discrimination vary between all race/ethnic groups, with blacks consistently reporting the highest levels and whites the lowest. Discrimination is only inconsistently related to obtaining screenings for cancer, hypertension, and diabetes. The few significant relationships found differed both by measure of discrimination and the respondents' race and ethnicity. Conclusions: Given the growing diversity in the United States and the prevalence of discrimination, more research regarding its impact on health care utilization is needed. Only when all the factors influencing patient behaviors are better understood will policies and interventions designed to improve them be successful. These are important steps that will help attain our national goals of eliminating race/ethnic disparities in health.

Community health workers (CHWs) are frontline public health workers who bridge the gap between historically marginalized communities, healthcare, and social services. Increasingly, states are developing the CHW workforce by implementing training and certification policies. Health departments (HDs) are primarily responsible for community health through policy implementation and provision of public health services. The two objectives of this study are to explore: (1) state progress in establishing CHW training and certification policies, and (2) integration of CHWs in HD workforces. In this scoping review, we searched PubMed, CINAHL, and Google Scholar for articles published between 2012 and 2022. We looked for articles that discussed state-level certification and training for CHWs and those covering CHWs working with and for city, county, state, and federal HDs. We excluded studies set outside of the US or published in a language other than English. Twenty-nine studies were included for review, documenting CHWs working at all levels of HDs. Within the included studies, HDs often partner with organizations that employ CHWs. With HD-sponsored programs, CHWs increased preventative care, decreased healthcare costs, and decreased disease risk in their communities. Almost all states have begun developing CHW training and certification policies and are at various points in the implementation. HD-sponsored CHW programs improved the health of marginalized communities, whether CHWs were employed directly by HDs or by a partner organization. The success of HD-sponsored CHW programs and state efforts around CHW training and certification should encourage increased investment in CHW workforce development within public health.

Discrimination has been found to be detrimental to health, but less is known about the influence of discrimination in health care. To address this, the current study (1) compared levels of racial/ethnic discrimination in health care among four race/ethnic groups; (2) determined associations between this type of discrimination and health care outcomes; and (3) assessed potential mediators and moderators as suggested by previous studies. Multivariate logistic regression models were used within a population-based sample of 1,699 White, African American, Mexican, and Puerto Rican respondents. Overall, 23 % of the sample reported discrimination in health care, with levels varying substantially by race/ethnicity. In adjusted models, this type of discrimination was associated with an increased likelihood of having unmet health care needs (OR = 2.48, CI = 1.57–3.90) and lower odds of perceiving excellent quality of care (OR = 0.43, CI = 0.28–0.66), but not with the use of a physician when not sick or use of alternative medicine. The mediating role of mental health factors was inconsistently observed and the relationships were not moderated by race/ethnicity. These findings expand the literature and provide preliminary evidence that can eventually inform the development of interventions and the training of health care providers.

Evidence supports an association between religion and spirituality and health outcomes. The aim of this study is to examine religious beliefs related to health and their relationship to self-rated health in a large and diverse population-based sample in Chicago. Three religious beliefs were assessed—the importance of prayer for health, God’s will as the most important factor in getting well, and sanctity of the body. All three beliefs were highly prevalent, especially among racial/ethnic minorities. Unadjusted models showed a significant association between two of the beliefs and self-rated health, which did not persist in the adjusted models. This study provides insight into different belief patterns among racial/ethnic groups and has practical implications for both clinicians and public health practitioners.

To address elevated mortality rates and historically entrenched racial inequities in mortality rates, the United States needs targeted efforts at all levels of government. However, few or no all-cause mortality data are available at the local level to motivate and guide city-level actions for health equity within the country's biggest cities. To provide city-level data on all-cause mortality rates and racial inequities within cities and to determine whether these measures changed during the past decade. This cross-sectional study used mortality data from the National Vital Statistics System and American Community Survey population estimates to calculate city-level mortality rates for the non-Hispanic Black (Black) population, non-Hispanic White (White) population, and total population from January 2016 to December 2018. Changes from January 2009 to December 2018 were examined with joinpoint regression. Data were analyzed for the United States and the 30 most populous US cities. Data analysis was conducted from February to November 2020. City of residence. Total population and race-specific age-standardized mortality rates using 3-year averages, mortality rate ratios between Black and White populations, excess Black deaths, and annual average percentage change in mortality rates and rate ratios. The study included 26 295 827 death records. In 2016 to 2018, all-cause mortality rates ranged from 537 per 100 000 population in San Francisco to 1342 per 100 000 in Las Vegas compared with the overall US rate of 759 per 100 000. The all-cause mortality rate among Black populations was 24% higher than among White populations nationally (rate ratio, 1.236; 95% CI, 1.233 to 1.238), resulting in 74 402 excess Black deaths annually. At the city level, this ranged from 6 excess Black deaths in El Paso to 3804 excess Black deaths every year in Chicago. The US rate remained constant during the study period (average annual percentage change, -0.10%; 95% CI, -0.34% to 0.14%; P = .42). The racial inequities in rates for the US decreased between 2008 and 2019 (annual average percentage change, -0.51%; 95% CI, -0.92% to -0.09%; P =0.02). Only 14 of 30 cities (46.7%) experienced improvements in overall mortality rates during the past decade. Racial inequities increased in more cities (6 [20.0%]) than in which it decreased (2 [6.7%]). In this study, mortality rates and inequities between Black and White populations varied substantially among the largest US cities. City leaders and other health advocates can use these types of local data on the burden of death and health inequities in their jurisdictions to increase awareness and advocacy related to racial health inequities, to guide the allocation of local resources, to monitor trends over time, and to highlight effective population health strategies.