Healthcare Inequalities in the United States: an Emerging Human Rights Crises

Posted by Catherine Deans on September 3, 2014

A recent report from the Center for Reproductive Rights (CRR) – in collaboration with Sister Song and the National Latina Institute for Reproductive Health – has labelled healthcare inequalities in the US as a “human rights crises”.  The report reveals that racial and ethnic healthcare discrimination in the US is worsening, particularly with respect to sexual and reproductive healthcare, and this is occurring despite the United States’ obligations under the International Convention on the Elimination of All Forms of Racial Discrimination to promote and protect the right to equal enjoyment of “public health, medical care, social security and social services”.

The report explored healthcare inequalities in the US on two fronts. First, the report observed that between 1990 and 2013, the maternal mortality ratio in the US has more than doubled from 12 to 28 out of every 100,000 live births, and women of colour were three to four times more likely to die in childbirth than white women. Disturbingly, the rate of maternal mortality for women of colour in some areas of Mississippi exceeded that of Sub-Saharan Africa.

Second, the report examined healthcare discrimination against non-citizen women residing in the US. The report concluded that recent state and federal healthcare policies disproportionately discriminated against non-citizen women.  For example, the recently enacted Affordable Care Act (ACA) prohibits undocumented workers from purchasing insurance under the new “universal” health insurance scheme, and non-citizens who are lawfully present in the US are subject to more Medicaid restrictions than US citizens, such as a mandatory five year wait period before they become eligible to enrol.  Without access to low-cost reproductive healthcare, immigrant women are at a heightened risk of having an unintended pregnancy and/or an undiagnosed and untreated life-threatening illness, such as cervical or breast cancer.  To exacerbate matters, recent cuts in some state’s budgets for reproductive and sexual health services has resulted in the closure of many family planning centres that provide subsidized healthcare services to impoverished immigrant women.

The UN Committee on the Elimination of Racial Discrimination (CERD) echoed many of the CRR’s concerns following its review of the US’ record on eliminating racial and gender disparities. Critically, CERD called on the US to ensure immigrant populations, including undocumented immigrants, who are excluded from the ACA, nonetheless have access to affordable and adequate healthcare services. With regards to the poor level of reproductive and sexual health among women of colour compared with their white counterparts, CERD urged the US to effectively identify and remedy the causes of this disparity.

It remains to be seen how the US will remedy the healthcare inequalities identified by CERD and CRR. However, it is plainly clear that, at present, the US government is not fulfilling its obligations to ensure all persons residing within US borders have equal access to adequate medical care, regardless of religion, ethnicity, sex, language or race.  The US should promptly implement policies that ensure the delivery of healthcare is dependent on a patient’s healthcare needs, rather than her skin colour.

Catherine Deans is a Legal Volunteer at Lawyers Collective and LLM Candidate at the University of Toronto.