When Healing Is Not Equal: The Long History of Healthcare Suffering in Underserved Communities

Susan Hendrix • June 26, 2026

How Race, Zip Code, Income, and Education Have Always Determined Who Gets Quality Care in America — and Why Progress Is Still Not Enough

When Healing Is Not Equal: Healthcare Suffering in Underserved Communities

Charlie E. & Minnie P. Hendrix Foundation for Chronic Illness Published by the CEMPH Foundation | Health Equity Awareness Series

The United States is home to some of the most advanced medical technology, world-class research institutions, and groundbreaking pharmaceutical innovation on the planet. Yet for millions of Americans — particularly people of color and those living in underserved communities — access to that care remains a distant and often unattainable reality. The question we must ask ourselves is this: How can a nation of such medical wealth leave so many of its people behind?

At the Charlie E. & Minnie P. Hendrix Foundation for Chronic Illness, we believe that healing must be equitable. It cannot depend on the color of your skin, the size of your paycheck, the level of your education, or the zip code on your driver's license. This blog post is a candid look at the history of healthcare suffering in underserved communities — where it began, where we stand today, and why the work of organizations like ours is more critical now than ever before.

A History Rooted in Inequality

Healthcare disparity in America is not a new crisis. It is a wound that has been festering since the founding of this nation — one that was built, in part, on the forced labor and systemic dehumanization of people of color.

Healthcare discrimination is deeply rooted in European colonization, industrial capitalism, and the legacy of the Atlantic slave trade. As far back as the 19th and early 20th centuries, people of color could only receive care in racially segregated hospitals. Black physicians — no matter how skilled or credentialed — were routinely barred from practicing in white-majority hospitals. As a result, Black community leaders built their own medical institutions, and by 1956, nearly 74% of all Black medical students attended just two institutions: Howard University and Meharry Medical College (National Center for Biotechnology Information, Unequal Treatment). These were not merely academic statistics — they were reflections of a society that actively excluded an entire population from the healing professions.

It was not until federal pressure during the Civil Rights era that hospitals were compelled to desegregate or face the loss of federal funding. Yet even with that ultimatum, deep inequities remained — and in many ways, they have never fully resolved.

In 1985, the U.S. Department of Health and Human Services released what became known as the Heckler Report — the first comprehensive, government-led study on the health status of people of color in America. The report quantified what communities of color had long known: that excess deaths, untreated illness, and limited access to care were not matters of personal choice but of systemic neglect. The Heckler Report led to the establishment of the Office of Minority Health within HHS, a critical step in acknowledging that healthcare inequality demanded a national response (KFF, How History Has Shaped Racial and Ethnic Health Disparities, 2025).

Nearly two decades later, in 2003, the Institute of Medicine released its landmark report, Unequal Treatment, confirming that racial and ethnic minorities continued to receive lower-quality healthcare than their white counterparts — even when controlling for insurance status, income, and severity of illness. The evidence was overwhelming. The inaction was unconscionable.

The Factors That Determine Who Gets Care

The healthcare gap does not exist because of one isolated cause. It is the product of multiple, overlapping systems of disadvantage — each one compounding the other.

Race and Skin Color

Decades of research confirm that race and skin color directly influence the quality of care patients receive. Studies have documented that Black patients are less likely to receive adequate pain management, less likely to be referred to specialists, and more likely to have their symptoms dismissed or minimized by healthcare providers. Structural racism in U.S. healthcare policy has shaped the system to advantage white patients and disadvantage racial and ethnic minority populations (Health Affairs Journal, Structural Racism in Historical and Modern US Health Care Policy). This is not coincidence — it is consequence.

Socioeconomic Status

Poverty is one of the most powerful predictors of poor health outcomes in America. Communities with higher poverty rates tend to have lower life expectancies, and economic hardship limits access to essentials like nutritious food, safe housing, and quality preventive care (The NYC Journal, Regional Disparities in American Life Expectancy, 2025). The National Health Interview Survey found that low-income Black patients have worse overall health outcomes than middle- and high-income white patients — a finding that illustrates how race and economics together create compounding layers of disadvantage (University of Chicago Medical Journalism Club, 2021).

Patients with lower socioeconomic status often receive poorer healthcare than the general population, and for those living in chronic poverty, barriers to care are not temporary inconveniences — they are permanent fixtures of daily life.

Education

Health literacy — the ability to understand medical information, navigate the healthcare system, and advocate for oneself — is profoundly affected by educational access and attainment. Communities where educational opportunities have been historically suppressed often have populations that are less equipped to identify symptoms early, communicate effectively with providers, or understand treatment plans. This is not a failing of the individual. It is the predictable outcome of decades of underfunded schools in low-income, predominantly minority communities.

Zip Code

Perhaps one of the most telling measures of health inequality in America is not a blood panel or a diagnosis — it is a zip code. Research published in 2024 confirms that environmental and socioeconomic factors within a neighborhood, including education levels, unemployment, healthcare access, racial segregation, and housing quality, directly influence health outcomes such as cardiovascular disease (PubMed, Zip Code Health Disparities: Mapping Cardiovascular Inequities at the Neighborhood Level, 2024).

Predominantly Black and Hispanic communities tend to have fewer primary care providers and lower-quality healthcare facilities than predominantly white communities (Commonwealth Fund, Advancing Racial Equity in U.S. Health Care, 2024). In rural areas, the problem is compounded further: the shortage of healthcare providers means routine checkups and preventive care are simply not accessible, leading to higher rates of untreated chronic conditions. Where you live should never determine whether you live — yet in America, it too often does.

The Chronic Illness Burden

For the communities we serve at the Charlie E. & Minnie P. Hendrix Foundation for Chronic Illness, these disparities carry a particularly devastating weight. Chronic illness does not discriminate — but the systems meant to manage it do.

Black, Hispanic, and Indigenous communities bear a disproportionate burden of chronic diseases including diabetes, hypertension, heart disease, asthma, and kidney disease. The COVID-19 pandemic brought these inequities into sharp, devastating focus: Black, Hispanic, Latinx, and Indigenous populations experienced significantly higher rates of severe illness and death, a direct reflection of the higher rates of untreated chronic conditions, limited healthcare access, and the lived stress of structural racism (NCBI, COVID-19 as a Mirror: Reflecting the Pandemic of Racism, 2025).

Implicit biases within the medical field, a lack of diversity among healthcare providers, and deep-seated historical medical mistrust among marginalized groups all hinder equitable chronic illness care. For patients living with long-term conditions, these barriers are not momentary — they accumulate over a lifetime.

Some Progress Has Been Made — But It Is Not Enough

We would be dishonest if we did not acknowledge that certain steps forward have been taken. The Affordable Care Act (ACA), signed into law in 2010, represents the most significant expansion of health insurance access in a generation. Since its implementation, the coverage gap between Black and white adults dropped from 9.9 to 5.3 percentage points, and the gap between Hispanic and white adults narrowed from 25.7 to 16.3 percentage points (Commonwealth Fund, Inequities in Coverage and Access for Black and Hispanic Adults, 2023). In 2024, a record 21.3 million people enrolled in ACA Marketplace plans, a sign that outreach efforts are reaching more communities (Commonwealth Fund, 2024).

These are real gains. They matter. They represent real people who, for the first time, had access to a doctor, a prescription, a diagnosis.

But they are not enough.

In 2024, for the first time since 2019, the overall uninsured rate actually increased — rising from 9.5% to 9.8% — as pandemic-era Medicaid protections expired. Hispanic people experienced the largest increase in uninsured rates, followed by Black and white individuals. The total number of people under age 65 without health coverage grew to 26.7 million (KFF, Health Coverage by Race and Ethnicity, 2026). Gains made over years can be erased in months when the political will to protect them wavers.

In 2024, Hispanic and Black Americans remain disproportionately represented in the 10 states that have not taken up the ACA's Medicaid expansion — states where working families fall into a coverage gap, earning too much to qualify for Medicaid but not enough to afford private insurance (Commonwealth Fund, 2024).

Systemic barriers — implicit provider bias, inconvenient office hours, limited providers who accept Medicaid, and transportation obstacles — continue to drive decreased access to care and worse health outcomes for Black Americans, even among those who carry health insurance (U.S. Department of Health and Human Services, ASPE Issue Brief, 2024).

The numbers tell a story of modest progress set against a backdrop of persistent, structural failure. Progress without equity is not progress — it is delay.

What We Must Do

At the Charlie E. & Minnie P. Hendrix Foundation for Chronic Illness, we believe that awareness is the beginning of action. We call on our community, our partners, policymakers, and healthcare institutions to commit to the following:

  • Expanding Medicaid in all remaining states, closing the coverage gap that disproportionately leaves communities of color behind.
  • Investing in primary care infrastructure in underserved neighborhoods, ensuring that communities of color have access to quality, nearby providers.
  • Addressing implicit bias in medical education and practice, so that every patient — regardless of skin color — is treated with dignity, respect, and clinical equality.
  • Prioritizing health literacy and community education, equipping individuals in underserved communities with the tools to advocate for themselves and their families.
  • Centering zip-code equity in policy, recognizing that neighborhood-level social determinants of health are matters of life and death.

The suffering is not inevitable. It is the result of choices — choices made by systems, by policies, by institutions, and by individuals. And choices can be changed.

A Foundation Built on the Belief That Everyone Deserves to Heal

The Charlie E. & Minnie P. Hendrix Foundation for Chronic Illness was established in the spirit that chronic illness does not have to mean chronic suffering — and that suffering should never be compounded by injustice. We work to fill the gaps that systems leave behind, to amplify the voices of those who have been silenced by inequality, and to ensure that the communities most impacted by health disparities have a platform, a resource, and a home.

Healthcare is a human right. Not a privilege. Not a reward. Not something determined by the neighborhood you were born into or the shade of your skin.

Until that principle is fully realized in every doctor's office, every hospital ward, and every policy chamber in this country, the work continues.

The Charlie E. & Minnie P. Hendrix Foundation for Chronic Illness is committed to health equity, community advocacy, and supporting those living with chronic illness. To learn more or get involved, visit www.cemphfoundation.com.

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