Twenty years ago, the Institute of Medicine, now the National Academy of Medicine, published a landmark report. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare revealed that racial and ethnic health disparities were deep and pervasive in the US, even after controlling for various socioeconomic factors (IoM 2003). Since then, little has changed nationally and in Texas. Home to the world’s largest medical center and more hospitals than any state, Texas has poorer outcomes and wider disparities than the nation on many markers of health and well-being. This reality underscores what research has long shown: health care alone is not sufficient to guarantee health.
This report identifies how the Texas health system has advanced health equity over the last two decades by moving upstream to address the nonmedical drivers of health. The Robert Wood Johnson Foundation defines health equity as “everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care” (Braveman et al. 2017, 2).
Drawing on secondary data, a systematic literature scan, and in-depth interviews with health leaders and experts in Texas, this report highlights the following topics:
- The state of racial and ethnic disparities in health and the nonmedical drivers of health in Texas over time.
- Promising programs and strategies through which health system players in Texas address midstream and upstream nonmedical drivers of health as a pathway to health equity.
- Perspectives and recommendations on what it will take to achieve health equity and realize the vision of a healthier Texas for all.
*This report was funded by Episcopal Health Foundation. The authors thank Shao-Chee Sim, C. J. Hager, Christy Serrano, and Briana Martin for their support and guidance. This report was prepared for the Urban Institute’s “Unequal Treatment at 20” initiative with generous support from the Robert Wood Johnson Foundation (RWJF), the Commonwealth Fund, the Episcopal Health Foundation, the California Endowment, and the California Health Care Foundation. We are grateful to them and to all our funders, who make it possible for Urban to advance its mission.
