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Equity in Health and Health Care

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Defining Terms

Health Equity: Valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.

Health Disparity: Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.

Source: HealthyPeople 2020

Our researchers actively seek to understand and address racial and ethnic disparities, social determinants of health

From its founding 75 years ago, Kaiser Permanente has held equity and inclusiveness for all its members, and the health of its communities, as guiding principles. And for nearly 60 years, the Division of Research has sought answers to support those goals.

In recent years, our investigators have sought to illuminate the social, biological, and environmental factors that contribute to racial and ethnic health disparities. And going a step farther, they identify evidence-based interventions to eliminate those differences.

This research portfolio is consistent and expanding. Investigators across our organization have taken variation by race, ethnicity, and health into account on a wide variety of topics, from medication adherence to diabetes prevalence to access to advanced surgeries.

We have long been focused on understanding the social drivers of health that have led to an increased risk for chronic health conditions, decreased access to medical care, and poorer health outcomes for our most vulnerable populations.

We know that:

Health Disparities Examples

  • A study showed starting annual colorectal cancer screening at age 45 in African Americans finds colorectal cancers at a rate similar to when screening starts after age 50” the age most guidelines currently recommend.
  • African American patients who were born in 1928 in states with the highest infant mortality rates among African American people faced a 86 percent higher risk of dementia than among white people born in states without high infant mortality rates.
  • Hypertension is devastating to communities of color, particularly among Blacks, where males have the highest hypertension death rates of any other racial, ethnic, or gender group.
  • Diabetes occurs 3 times more often among normal-BMI Native Hawaiians and Pacific Islanders than normal-BMI whites.
  • communities of historically underrepresented groups are disproportionately impacted by a lack of economic opportunity, living under sustained financial strain that creates barriers to good health.
  • inequities and disparities that have existed for people of historically underrepresented groups” women, the poor, and other marginalized groups” have been made more visible by the COVID-19 pandemic, with data showing that Latinx and African Americans are disproportionately affected by the disease as well as by its economic impacts.

The Division of Research will continue this mission to provide the data that allows high-quality health care to be accessible to everyone, no matter their social, economic, racial, or ethnic background.

Resources on Equity

Equality for All: Greg Adams, chairman and CEO, Kaiser Permanente

Equity, Inclusion, and Diversity Permanente Medicine Fact Sheet

Racism and Health Centers for Disease Control and Prevention Health Equity

Highlighted Recent Research


Messages from doctors increased COVID-19 vaccination among Black, Latino eldersKaiser Permanente clinical trial compared methods to reach at-risk populations

Lifestyle coaching helps Black adults control high blood pressureKaiser Permanente study finds culturally tailored program leads to long-term benefits in adults with hypertension

Pandemic stressors taking a toll on pregnant patients’ mental healthKaiser Permanente analysis finds more depression, anxiety among Black and Hispanic individuals

Autistic people join autism project – as research partnersKaiser Permanente investigators provide training in research methods

Medical assistants help close virtual visit digital divideKaiser Permanente study finds patients in low-socioeconomic-status neighborhoods benefited from help connecting with video medical visits

Heart disease and stroke deaths up during first year of COVID-19 pandemicKaiser Permanente study finds reversal of prior national trends and widening racial disparities

Colorectal cancer screening program erases disparities in outcomes: Regional program eliminated disparities in colorectal cancer death rates between Black and white members in Kaiser Permanente Northern California

Colorectal cancer disparities between Black and white adults were eliminated in Kaiser Permanente Northern California (KPNC) members after the health care system instituted a regionwide, structured colorectal cancer screening program, new research shows.

Racial and ethnic disparities in COVID-19 infections are not explained by social risk factors: New Kaiser Permanente study suggests working and living conditions may be key contributors to disproportionate impact of COVID-19 in communities of color

Holding a public-facing job considered “essential” and living in a multigenerational household — both of which facilitate transmission of an airborne virus — may be key contributors to the higher COVID-19 infection rates seen early in the pandemic in the U.S. in Black, Latinx, and Asian adults, a new Kaiser Permanente study suggests.

Researchers expand understanding of hernia genetics: Kaiser Permanente analysis finds several novel genome locations associated with a frequently diagnosed lower abdominal condition

A Kaiser Permanente genetic analysis found 41 new locations on the human genome related to risk of hernia in the lower abdomen, known as inguinal hernia. The study, published in Human Molecular Genetics, also identified for the first time 2 locations associated with inguinal hernia risk in people with African ancestry and another 8 that show sex-specific effects.


People with HIV are at increased risk for heart failure: Kaiser Permanente research finds risk difference more pronounced in women, Asians and Pacific Islanders, and people under 40

People with HIV are at higher risk of developing heart failure than people without HIV, a new study found.

Patients who need language interpretation less likely to initially choose a video visit: Kaiser Permanente research shows that once patients try talking to a clinician by video they will probably do it again

Patients with limited English proficiency who need a language interpreter for a telemedicine visit were less likely to choose a video visit for their first time than patients who did not need an interpreter, Kaiser Permanente research found.

Method found to remove race from controversial kidney function equations without losing accuracy: Kaiser Permanente study supports eventual use of test for cystatin C — instead of creatinine — to advance health equity

Researchers have identified an approach to remove race from equations used to estimate a person’s kidney function. These equations have been criticized for potentially perpetuating racial health disparities. The findings, reported September 23 in the New England Journal of Medicine, are expected to inform National Kidney Foundation-American Society of Nephrology Task Force guidelines on evaluating kidney function.

Stroke rate four times higher in Black young and middle-aged adults, compared to whites: Kaiser Permanente research shows the need for increased education about the dangers of high blood pressure

Black young and middle-aged adults have an incidence rate of stroke 4 times higher than that of white young and middle-aged adults, a large national multi-center prospective study by Kaiser Permanente researchers found.

American Indian, Alaska Native women less likely to start and complete hormone therapy for breast cancer: Kaiser Permanente study suggests lower rates of use my be contributing to higher breast cancer death rates

Women who identified as American Indian or Alaska Native were less likely than women of other racial and ethnic groups to start hormone therapy for breast cancer after surgery and stay on the treatment for the recommended 5 years, a new Kaiser Permanente study shows.

Analysis confirms racial disparities in COVID-19 infection: Kaiser Permanente study examines race, ethnicity and risk of infection, hospitalization, and death

An analysis of Kaiser Permanente members in Northern California early in the COVID-19 pandemic found racial and ethnic disparities in the likelihood of testing positive for the coronavirus, but no significant disparities in mortality among those who were hospitalized.

Heart failure hospitalizations and deaths vary by race and ethnicity: Kaiser Permanente study highlights need to identify reasons for these differences

Black patients with heart failure have higher rates of hospitalization for heart failure but lower rates of death than white patients with heart failure, a new Kaiser Permanente study shows.


Unique genetic factors and ancestry, along with lifestyle, influence skin cancer risk: Investigators find clues in large database of Kaiser Permanente members

People can look to the Northern European side of their genetic heritage for increased risk of nonmelanoma skin cancer, according to the first large analysis of genetic risk factors for cutaneous squamous cell carcinoma in diverse populations with European ancestry from Kaiser Permanente researchers.

Girls who do not live with both parents more likely to start puberty early: New Kaiser Permanente study supports previous research suggesting link between early life family structure and onset of puberty

Girls who did not live in a 2-parent household from birth to age 2 were significantly more likely to start puberty earlier than girls who had both parents in their homes, with the association strongest among Black girls, new Kaiser Permanente research shows.

Teens, parents, physicians support screening young people for gender identity, study suggests: Kaiser Permanente physician researchers say screening could improve care for gender diverse adolescents

Teenagers who question their gender identity may not feel comfortable bringing up the issue with their doctors. New research suggests that adding gender identity questions to a pre-visit screening could make those conversations easier.

Early colorectal cancer screening benefits African Americans: Kaiser Permanente study supports starting screening at age 45 among this higher-risk population

A study by researchers at Kaiser Permanente Northern California showed starting annual colorectal cancer screening at age 45 in African Americans can find colorectal cancers at a rate similar to that seen when screening starts after age 50 — the age most guidelines currently recommend.


Kaiser Permanente reduces racial disparities in who gets minimally invasive hysterectomies: Racial gap nearly disappears during project to train surgeons and establish best practices

Kaiser Permanente's northern California hospitals significantly increased minimally invasive surgery for hysterectomy and found the change also reduced racial disparities in the types of hysterectomies patients get.

How to reduce racial disparities in surgery: Podcast

National figures show white women are more likely to get an advanced, minimally invasive version of hysterectomy than are Black women and Hispanic women. Kaiser Permanente Northern California found much of that difference disappeared when it carried out a quality improvement project.

Chronic disease prevalence varies by Asian subgroup, Kaiser Permanente research finds: Findings suggest value in identifying Asian patients' ethnic backgrounds in medical records

Asian-Americans from different parts of Asia have very different cardiovascular risk factors and chronic conditions such as diabetes, hypertension, and heart disease, research from the Kaiser Permanente Division of Research suggests. The study, published in BMC Public Health, used electronic health record (EHR) data for 1.4 million adults aged 45 to 84 who were Kaiser Permanente Northern California members during 2016.

Minority racial and ethnic groups get diabetes at lower weights: Diabetes occurs 3 times more often among normal-BMI Native Hawaiians and Pacific Islanders than normal-BMI whites, Kaiser Permanente research finds

Being overweight or obese is commonly associated with diabetes, but a Kaiser Permanente study finds the connection differs widely by race or ethnicity. Members of racial and ethnic minority groups were much more likely to have diabetes or prediabetes at lower weights — even at normal or below-normal body mass index (BMI), according to research published in Diabetes Care.

Large study links genetic marker of aging to greater neighborhood deprivation: Kaiser Permanente and UCSF researchers find strong connection between which neighborhood a person lives in, how much education they have, and the length of their telomeres

A large Kaiser Permanente study has identified links between a genetic marker of aging, how much education a person has, and the degree of socioeconomic deprivation in their neighborhood. Genetics research suggests that longer telomeres — the "end caps" of DNA that keep strands of chromosomes from unraveling — mean more years of healthy life ahead.

More Highlighted Research ≫

 Related Studies



Comparison of Survival Rates Across Racial/Ethnic Groups Among Young Adults Diagnosed with Early-Onset Colorectal Cancer in a Large, Community-Based Population.GP0|#b0e810dd-950a-48cc-86ec-e445f117bd5a;L0|#0b0e810dd-950a-48cc-86ec-e445f117bd5a|Lee, Jeffrey;GTSet|#51778822-a7d5-4a0f-a262-0d1c0d11dae4This study will examine racial differences in overall survival among young adults 50 years of age diagnosed with early-onset colorectal cancer in a large, community- based, fully insured population with access to complete primary and specialty care to identify differences in risk factors, access to care, and treatment effectiveness and adherence.GP0|#b0e810dd-950a-48cc-86ec-e445f117bd5a;L0|#0b0e810dd-950a-48cc-86ec-e445f117bd5a|Lee, Jeffrey;GTSet|#51778822-a7d5-4a0f-a262-0d1c0d11dae42022-11-04T18:34:24Z
Trends in Diabetes Screening, Risk Factors and Incidence Before and After the SARS-CoV-2 Pandemic Between the California Medi-Cal and Commercially-Insured PopulationsGP0|#facf36d4-33cb-4c2b-94ce-04b8247909c2;L0|#0facf36d4-33cb-4c2b-94ce-04b8247909c2|Rodriguez, Luis;GTSet|#51778822-a7d5-4a0f-a262-0d1c0d11dae4Using quasi-experimental research methods, this study is assessing the extent to which disparities in type 2 diabetes prevention and outcomes were exacerbated during the coronavirus disease 2019 (COVID-19) pandemic between the Medi-Cal and commercially-insured populations. The career development plan for this diversity supplement is to receive high-quality mentorship from experts in type 2 diabetes prevention, health disparities, biostatistics and evaluation of natural experiments.GP0|#facf36d4-33cb-4c2b-94ce-04b8247909c2;L0|#0facf36d4-33cb-4c2b-94ce-04b8247909c2|Rodriguez, Luis;GTSet|#51778822-a7d5-4a0f-a262-0d1c0d11dae42022-09-26T07:00:00Z
Effect of reproductive history on longitudinal change in cardiac, vascular, and lipid parametersGP0|#6225264a-9dd8-4822-8bf4-239bfdb178e3;L0|#06225264a-9dd8-4822-8bf4-239bfdb178e3|Gunderson, Erica;GTSet|#51778822-a7d5-4a0f-a262-0d1c0d11dae4The NHLBI NGHS enrolled 871 girls (50% Black and 50% white) in 1987 at age 9 or 10 and examined them up to 17 times, to age 27. This resulted in 7 echocardiogram reports from ages 20-27, multiple saved samples, and reproductive history questionnaires. We will conduct detailed lipoprotein sizing and functionality assessments from stored and new samples, cardiovascular imaging, and repeat echocardiograms at median age 46. Our aims are to determine the specific lipoprotein particle size distribution and function changes which occur from before to short- and long-term post-pregnancy; determine whether pregnancy-related cardiac adaptations result in long-term alterations in cardiac structure and function, thereby increasing CVD risk for women in their forties; and to test whether parity increases cardiovascular risk independently of socioeconomic status in Black and white women. GP0|#6225264a-9dd8-4822-8bf4-239bfdb178e3;L0|#06225264a-9dd8-4822-8bf4-239bfdb178e3|Gunderson, Erica;GTSet|#51778822-a7d5-4a0f-a262-0d1c0d11dae42022-08-09T10:09:31Z
Multilevel Determinants of Racial/Ethnic Disparities in Lung Cancer Screening UtilizationGP0|#9a025b40-be45-45f2-a297-a5529ebf95c7;L0|#09a025b40-be45-45f2-a297-a5529ebf95c7|Sakoda, Lori;GTSet|#51778822-a7d5-4a0f-a262-0d1c0d11dae4Lung cancer screening has been underutilized nationally to date, with growing evidence suggesting that screening rates differ by race. This research aims to identify multilevel factors that influence disparities in utilization of lung cancer screening from eligibility determination to screening initiation.GP0|#9a025b40-be45-45f2-a297-a5529ebf95c7;L0|#09a025b40-be45-45f2-a297-a5529ebf95c7|Sakoda, Lori;GTSet|#51778822-a7d5-4a0f-a262-0d1c0d11dae42022-08-09T10:09:31Z
2021 Health Equity Research Supplement to Conduct Focus Groups with Black and White Women who Self-Report Cannabis Use During PregnancyGP0|#ac571ecc-16cd-4af0-b86e-264b2cb31304;L0|#0ac571ecc-16cd-4af0-b86e-264b2cb31304|Young-Wolff, Kelly;GTSet|#51778822-a7d5-4a0f-a262-0d1c0d11dae4Qualitative data are critically needed to better understand knowledge gaps, preferences, and social and cultural factors that differentially contribute to prenatal cannabis use among Black and White women. To address these important gaps in knowledge, we will conduct race-matched virtual focus groups with Black and White pregnant women who self-report cannabis use during pregnancy to learn more about what drives prenatal cannabis use, women’s understanding of harms, and barriers to quitting to inform better education and intervention materials.GP0|#ac571ecc-16cd-4af0-b86e-264b2cb31304;L0|#0ac571ecc-16cd-4af0-b86e-264b2cb31304|Young-Wolff, Kelly;GTSet|#51778822-a7d5-4a0f-a262-0d1c0d11dae42022-08-09T07:00:00Z
Do health and health care indicators differ by preferred language in Latinx and Chinese Adults? A health and health care disparities study. GP0|#8972db04-092d-4473-b1f1-caf7dfbeecd4;L0|#08972db04-092d-4473-b1f1-caf7dfbeecd4|Gordon, Nancy;GTSet|#51778822-a7d5-4a0f-a262-0d1c0d11dae4Limited English proficiency may be an important social determinant of health and health care access. This study will use electronic health record data to describe and compare health risks, chronic health conditions, quality metrics, and health care use by language preference for 2 cohorts of adults aged 25-84 who were KPNC members during calendar year 2019: Latino adults with Spanish vs. English spoken language preference and Chinese adults with Chinese dialect vs. English spoken language preference. Study results will improve understanding of whether and how limited English proficiency contributes to disparities in health and health care utilization in these 2 ethnic groups in a health care delivery system that has made extensive efforts to mitigate language barriers to care delivery.GP0|#8972db04-092d-4473-b1f1-caf7dfbeecd4;L0|#08972db04-092d-4473-b1f1-caf7dfbeecd4|Gordon, Nancy;GTSet|#51778822-a7d5-4a0f-a262-0d1c0d11dae42022-08-09T10:09:30Z

 Recent Publications



No Title312781/19/2023 2:00:36 PM racial/ethnic disparities in late-life cognitive health is a public health imperative. We used baseline data from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study to examine how age, education, gender, and clinical diagnosis, a proxy for brain health, are associated with cross-sectional measures of cognition in diverse racial/ethnic groups. Comprehensive measures of cognition were obtained using the Spanish and English Neuropsychological Assessment Scales and the National Institutes of Health Toolbox Cognitive Health Battery in a sample of 1,695 KHANDLE participants (Asians 24%, Blacks 26%, Latinos 20%, Whites 29%). A 25% random subsample was clinically evaluated and diagnosed with normal cognition, mild cognitive impairment (MCI), or dementia. Cognitive test scores were regressed on core demographic variables and diagnosis in the combined sample and in multiple group analyses stratified by racial/ethnic group. Race/ethnicity and education were variably associated with test scores with strongest associations with tests of vocabulary and semantic memory. Older age was associated with poorer performance on all measures, and gender differences varied across cognitive tests. Clinical diagnosis of MCI or dementia was associated with average decrements in test scores that ranged from -0.41 to -0.84 SD, with largest differences on tests of executive function and episodic memory. With few exceptions, associations of demographic variables and clinical diagnosis did not differ across racial/ethnic groups. The robust associations of cognitive test results with clinical diagnosis independent of core demographic variables and race/ethnicity support the validity of cognitive tests as indicators for brain health in diverse older adults.Measuring cognitive health in ethnically diverse older adults33842969J Gerontol B Psychol Sci Soc Sci. 2022 02 03;77(2):261-271.Whitmer, Rachel||Gilsanz, Paola||Miles, Sunita Q
No Title313681/19/2023 2:01:01 PM growing research on the association between discrimination and disparities in cognitive aging, an evidence gap remains on how the association varies by racial/ethnic group. This study evaluates the associations of experiences of discrimination with cognitive function and whether these associations varied by race/ethnicity and nativity. Using the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) cohort (N = 1 712) with approximately equal groups of Black, White, Latino, and Asian community-dwelling older adults aged 65 years and older, we evaluated the associations between self-reported experiences of everyday and major lifetime discrimination with overall cognitive performance and domain-specific cognition (verbal episodic memory, semantic memory, and executive functioning) across race/ethnicity and nativity. Linear regression models examined the cross-sectional association between self-reported experiences of everyday and major lifetime discrimination with z-standardized coefficients for cognition. We tested for effect modification by race and nativity. All models controlled for age, sex, and education. Among KHANDLE participants (mean age: 76 years; SD: 6.8), everyday discrimination was not associated with cognitive scores. Major lifetime discrimination was associated with better average cognitive scores among Black participants but not among other racial/ethnic groups. Major lifetime discrimination was associated with better average cognitive scores among U.S.-born but not among non-U.S.-born individuals. Our findings do not imply that discrimination improves cognition, but rather suggest that future research should include more detailed measures on discrimination and unfair treatment that could help disentangle the extent to which relationships are causal or reflect some other underlying factor.Perceived Discrimination, Nativity, and Cognitive Performance in a Multi-ethnic Study of Older Adults: Findings from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study34125189J Gerontol A Biol Sci Med Sci. 2022 02 03;77(2):e65-e73.Gilsanz, Paola||Miles, Sunita Q||Eng, Chloe||Whitmer, Rachel
No Title335121/19/2023 2:31:56 PM Diversity, Equity, and Inclusion in Scientific Publishing34740579Gastroenterology. 2022 01;162(1):59-62.e1. Epub 2021-11-03.Corley, Douglas
No Title334231/19/2023 2:31:56 PM and Ethnic Differences in Age at Diabetes Diagnosis-A Call for Action34491279JAMA Intern Med. 2021 12 01;181(12):1560-1561.Gopalan, Anjali||Grant, Richard W
No Title334461/19/2023 2:01:10 PM aim of this study was to describe the association of individual-level characteristics (sex, race/ethnicity, birth weight, maternal education) with child BMI within each US Census region and variation in child BMI by region. This study used pooled data from 25 prospective cohort studies. Region of residence (Northeast, Midwest, South, West) was based on residential zip codes. Age- and sex-specific BMI z scores were the outcome. The final sample included 14,313 children with 85,428 BMI measurements, 49% female and 51% non-Hispanic White. Males had a lower average BMI z score compared with females in the Midwest (β = -0.12, 95% CI: -0.19 to -0.05) and West (β = -0.12, 95% CI: -0.20 to -0.04). Compared with non-Hispanic White children, BMI z score was generally higher among children who were Hispanic and Black but not across all regions. Compared with the Northeast, average BMI z score was significantly higher in the Midwest (β = 0.09, 95% CI: 0.05 to 0.14) and lower in the South (β = -0.12, 95% CI: -0.16 to -0.08) and West (β = -0.14, 95% CI: -0.19 to -0.09) after adjustment for age, sex, race/ethnicity, and birth weight. Region of residence was associated with child BMI z scores, even after adjustment for sociodemographic characteristics. Understanding regional influences can inform targeted efforts to mitigate BMI-related disparities among children.Regional and sociodemographic differences in average BMI among US children in the ECHO program34467678Obesity (Silver Spring). 2021 12;29(12):2089-2099. Epub 2021-08-31.Ferrara, Assiamira
No Title334321/19/2023 2:00:58 PM or excessive intake of micronutrients in pregnancy has potential to negatively impact maternal/offspring health outcomes. The aim was to compare risks of inadequate or excessive micronutrient intake in diverse females with singleton pregnancies by strata of maternal age, race/ethnicity, education, and prepregnancy BMI. Fifteen observational cohorts in the US Environmental influences on Child Health Outcomes (ECHO) Consortium assessed participant dietary intake with 24-h dietary recalls (n = 1910) or food-frequency questionnaires (n = 7891) from 1999-2019. We compared the distributions of usual intake of 19 micronutrients from food alone (15 cohorts; n = 9801) and food plus dietary supplements (10 cohorts with supplement data; n = 7082) to estimate the proportion with usual daily intakes below their age-specific daily Estimated Average Requirement (EAR), above their Adequate Intake (AI), and above their Tolerable Upper Intake Level (UL), overall and within sociodemographic and anthropometric subgroups. Risk of inadequate intake from food alone ranged from 0% to 87%, depending on the micronutrient and assessment methodology. When dietary supplements were included, some women were below the EAR for vitamin D (20-38%), vitamin E (17-22%), and magnesium (39-41%); some women were above the AI for vitamin K (63-75%), choline (7%), and potassium (37-53%); and some were above the UL for folic acid (32-51%), iron (39-40%), and zinc (19-20%). Highest risks for inadequate intakes were observed among participants with age 14-18 y (6 nutrients), non-White race or Hispanic ethnicity (10 nutrients), less than a high school education (9 nutrients), or obesity (9 nutrients). Improved diet quality is needed for most pregnant females. Even with dietary supplement use, >20% of participants were at risk of inadequate intake of ≥1 micronutrients, especially in some population subgroups. Pregnancy may be a window of opportunity to address disparities in micronutrient intake that could contribute to intergenerational health inequalities.Disparities in Risks of Inadequate and Excessive Intake of Micronutrients during Pregnancy34494118J Nutr. 2021 11 02;151(11):3555-3569.Hedderson, Monique M||Avalos, Lyndsay A||Zhu, Yeyi