The U.S. has made little progress in advancing health care equity over the past two decades, and racial and ethnic inequities remain a fundamental flaw of the nation’s health care system, says a new report from the National Academies of Sciences, Engineering, and Medicine.

Despite spending the most on health care among high-income countries, the U.S. has some of the worst population health outcomes, the report states. The U.S. health care system is highly influenced by societal factors, and delivers different outcomes for different populations by its very design. The system’s inadequacies disproportionately affect minoritized populations, with stark racial health care inequities in life expectancy, maternal and infant mortality, and many chronic diseases.

The report documents evidence of numerous and pervasive inequities in U.S. health care. For example, one analysis found that diabetes in the U.S. is most prevalent in American Indian and Alaska Native adults at 13.6%, followed by Black populations at 12.1%, Hispanic populations at 11.7%, Asian populations at 9.1% and White populations at 6.9%. However, non-White patients are less likely to receive newer, higher cost drugs and diabetic technology. Black patients with diabetes experience hospitalization rates more than 2.5 times higher than those for White patients.

More broadly, the report says, racially and ethnically minoritized individuals are significantly less likely to have a usual source of primary care, and during emergency department visits, they experience longer wait times and are assigned less acute triage severity scores. Long-term care facilities serving predominantly racially and ethnically minoritized residents offer fewer clinical services, have lower staffing levels, and have more care deficiency citations.

The report recommends multiple actions that Congress, the U.S. Department of Health and Human Services, National Institutes of Health, Centers for Medicare & Medicaid Services, and other agencies should take to remedy inequities in health care.

“Eliminating health care inequities is an achievable and feasible goal, and improving the health of individuals in the nation’s most disadvantaged communities improves the quality of care for everyone,” said Georges C. Benjamin, co-chair of the committee that wrote the report, and executive director of the American Public Health Association. “This is not a zero-sum game — we are all in this together.”

Read the full article about racial health care inequities at National Academies.