Health disparities are health differences between different groups of people. These health differences may include:

• How many people get certain diseases
• How severe the diseases are
• How many people have complications because of the diseases
• How many people die from a disease
• Whether people can get health care
• How many people get screened for a disease

These groups of people may be based on:

• Race
• Ethnicity
• Immigrant status
• Disability
• Sex or gender
• Sexual orientation
• Geography
• Income
• Level of education

Health equity is the state in which everyone has a fair and just opportunity to attain their highest level of health. Achieving this requires ongoing societal efforts to:

• Address historical and contemporary injustices;
• Overcome economic, social, and other obstacles to health and health care; and
• Eliminate preventable health disparities.

To achieve health equity, we must change the systems and policies that have resulted in the generational injustices that give rise to racial and ethnic health disparities.

Preventable Health Disparities

Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by populations that have been disadvantaged by their social or economic status, geographic location, and environment. Many populations experience health disparities, including people from some racial and ethnic minority groups, people with disabilities, women, people who are LGBTQI+ (lesbian, gay, bisexual, transgender, queer, intersex, or other), people with limited English proficiency, and other groups.

Across the country, people in some racial and ethnic minority groups experience higher rates of poor health and disease for a range of health conditions, including diabetes, hypertension, obesity, asthma, heart disease, cancer, and preterm birth, when compared to their White counterparts. For example, the average life expectancy among Black or African American people in the United States is four years lower than that of White people. These disparities sometimes persist even when accounting for other demographic and socioeconomic factors, such as age or income.

Communities can prevent health disparities when community- and faith-based organizations, employers, healthcare systems and providers, public health agencies, and policymakers work together to develop policies, programs, and systems based on a health equity framework and community needs.

Social determinants of health are the conditions in the places where people live, learn, work, play, and worship that affect a wide range of health risks and outcomes. Long-standing inequities in six key areas of social determinants of health are interrelated and influence a wide range of health and quality-of-life risks and outcomes. Examining these layered health and social inequities can help us better understand how to promote health equity and improve health outcomes.

Social and Community Context (including Discrimination and Racism)

A person’s social and community context includes their interactions with the places they live, work, learn, play, and worship and their relationships with family, friends, co-workers, community members, and institutions. Interventions are critical to protecting the health and well-being of people who do not get the level of support they need to thrive from their social and community context. For example, children of incarcerated or detained parents may gain from their parents’ participation in reentry programs that assist with job placement or offer parenting support, and lesbian, gay or bi-sexual high school students who are bullied would benefit from school-based programs to reduce violence and prevent bullying.

Social and community context also includes discrimination – or the unfair treatment of people or groups based on characteristics such as race, gender, age, or sexual orientation. Discrimination exists in many systems in society including those meant to protect well-being or health such as health care, housing, education, criminal justice, and finance. Discrimination often has a negative effect on the people and groups who experience it and some people who belong to groups that historically have experienced discrimination, such as people with disabilities, people experiencing homelessness, and people who are incarcerated or detained. As a result, people who have experienced discrimination may be affected by layered health and social inequities.

A growing body of research shows that racism has occurred for centuries at many levels in society in the United States and has had a negative impact on communities of color. Racism is a system, supported and maintained through institutional structures and policies, cultural norms and values, and individual behaviors. There are various forms of racism that—for more than 400 years—have defined and created most of the inequitable structures that exist in our society and lead to health inequities today. The three types of racism include:

• Structural, Institutional, or Systemic Racism: Differential access to the goods, services, and opportunities of society by race
• Personally-mediated or Interpersonal Racism: Prejudice (differential assumptions) and discrimination (differential actions) by individuals towards others
• Internalized Racism: Acceptance by members of the stigmatized races of negative messages about their own abilities and intrinsic worth

Racism determines opportunity based on the way people look or the color of their skin. It also shapes social and economic factors that put some people from racial and ethnic minority groups at increased risk for negative mental health outcomes and health-related behaviors, as well as chronic and toxic stress or inflammation. Racism prevents millions of people from attaining their highest level of health, and consequently, affects the health of our nation.

Healthcare Access and Use

People with disabilities and people from some racial and ethnic minority groups, rural areas, and White populations with lower incomes are more likely to face multiple barriers to accessing health care. For example, structural barriers related to socioeconomic status, such as lack of insurance, transportation, childcare, or ability to take time off work, can make it hard to go to the doctor. Cultural differences between patients and providers as well as language barriers affect patient-provider interactions and health care quality. Inequities in treatment and historical events, like the Tuskegee Study of Untreated Syphilis in the African American Male and sterilization of American Indian women without their permission, might also explain why some people from racial and ethnic minority groups do not trust health care systems and the government’s health-related guidance.

Neighborhood and Physical Environment

People from racial and ethnic minority groups are disproportionately affected by difficulties finding affordable and quality housing. The practice of redlining or denying mortgages among people of color – and as a result, access to public transportation, supermarkets, and health care – has contributed to segregation of cities in the United States. Although the U.S. Federal Government has enacted legislation since the 1970’s to reduce the segregation of cities, this historical discriminatory practice has limited housing options among racial and ethnic minority groups to neighborhoods and residences that have school districts with inadequate funding, higher crime rates, and poorly resourced infrastructure. These conditions may make illnesses, diseases, and injuries more common and more severe among these groups. In addition, access to nutritious, affordable foods may be limited for these groups, and they may experience more environmental pollution within their neighborhoods.

Workplace Conditions

Not all workers have the same risk of experiencing a work-related health problem, even when they have the same job. Occupational health inequities are avoidable differences in work-related disease incidence, mental illness, or morbidity and mortality that are closely linked with social, economic, and/or environmental disadvantage, such as temporary work arrangements, socio-demographic characteristics (e.g., age, sex, gender identity, race, or class), and organizational factors (e.g., lack of worker safety measures, limited or no health insurance benefits).

Education

People who have been historically marginalized, such as people from racial and ethnic minority groups, people with disabilities, and people with lower incomes, are disproportionately affected by inequities in access to high-quality education. Policies that link public school funding to the tax base of a neighborhood limit the resources available in schools of lower income neighborhoods. This results in lower-quality education for residents of lower income neighborhoods, which can lead to lower literacy and numeracy levels, lower high school completion rates, and barriers to college entrance. In addition to educational barriers, limited access to quality job training or programs tailored to the language needs of some racial and ethnic minority groups may limit future job options and lead to lower paying or less stable jobs.

Income and Wealth Gaps

People from some racial and ethnic minority groups and other historically marginalized groups also face greater challenges in getting higher paying jobs with good benefits due to less access to high-quality education, geographic location, language differences, discrimination, and transportation barriers. People with limited job options often have lower incomes, experience barriers to wealth accumulation, and carry greater debt. The historical practice of redlining and denying mortgages to people of color has also created a lack of opportunity for home ownership, and thus wealth accumulation, due to the inability to pass down property and build wealth. Such financial challenges may make it difficult to manage expenses, pay medical bills, and access affordable quality housing, education, nutritious food, and reliable childcare.

Racism is a Serious Threat to the Public’s Health

Racism is a system—consisting of structures, policies, practices, and norms—that assigns value and determines opportunity based on the way people look or the color of their skin. This results in conditions that unfairly advantage some and disadvantage others throughout society.

Racism—both interpersonal and structural—negatively affects the mental and physical health of millions of people, preventing them from attaining their highest level of health, and consequently, affecting the health of our nation.

A growing body of research shows that centuries of racism in this country has had a profound and negative impact on communities of color. The impact is pervasive and deeply embedded in our society—affecting where one lives, learns, works, worships and plays and creating inequities in access to a range of social and economic benefits—such as housing, education, wealth, and employment. These conditions—often referred to as social determinants of health—are key drivers of health inequities within communities of color, placing those within these populations at greater risk for poor health outcomes.

The data show that racial and ethnic minority groups, throughout the United States, experience higher rates of illness and death across a wide range of health conditions, including diabetes, hypertension, obesity, asthma, and heart disease, when compared to their White counterparts. Additionally, the life expectancy of non-Hispanic/Black Americans is four years lower than that of White Americans. The COVID-19 pandemic, and its disproportionate impact among racial and ethnic minority populations is another stark example of these enduring health disparities.

Racism also deprives our nation and the scientific and medical community of the full breadth of talent, expertise, and perspectives needed to best address racial and ethnic health disparities.

To build a healthier America for all, we must confront the systems and policies that have resulted in the generational injustice that has given rise to racial and ethnic health inequities. We at CDC want to lead in this effort—both in the work we do on behalf of the nation’s health and the work we do internally as an organization.

Racism, both structural and interpersonal, are fundamental causes of health inequities, health disparities and disease. The impact of these inequities on the health of Americans is severe, far-reaching, and unacceptable.

Across the country, racial and ethnic minority populations experience higher rates of poor health and disease in a range of health conditions, including diabetes, hypertension, obesity, asthma, and heart disease, when compared to their White counterparts. The life expectancy among Black/African Americans is four years lower than that of White Americans.

The COVID-19 pandemic, and its disproportionate impact among communities of color, is another stark example of these enduring health disparities. Recent COVID-19 data show show that Black/African American, Hispanic/Latino, American Indian and Alaska Native populations in the U.S. are experiencing higher rates of hospitalization and death compared to White populations.

These health disparities underscore the urgent need to address systemic racism as a root cause of racial and ethnic health inequities and a core element of our public health efforts.

Climate change poses current and increasing threats to human health. As the climate continues to warm, the risks to human health will grow, exacerbating existing health threats and creating new public health challenges.

Many disadvantaged communities currently bear the brunt of climate-induced health risks from extreme heat, poor air quality, flooding, extreme weather events, and vector borne diseases.

There are many factors that can affect someone’s ability to prepare for, respond to, and cope with the impacts of climate change on health. These include:

• Living in areas particularly vulnerable to climate change (like communities along the coast or extreme weather)
• Coping with higher levels of existing health risks when compared to other groups
• Living in low-income communities with limited access to healthcare services
• Limited access to quality healthcare
• Limited availability of information and resources in a person’s native language
• Limited ability to relocate or rebuild after a disaster

The effects of climate change can worsen existing differences in health, adding to other longstanding differences among people that result in different health outcomes for communities in the United States. These differences include poor living conditions, racism and other forms of discrimination, and psychological stresses.

How climate change impacts human health

Climate change is already increasing the severity or frequency of health threats occurring in some areas. In other areas, climate change affect on land, water, and air quality can cause new health problems where they hadn't previously occurred.

• Heat: More frequent and severe heat waves lead to more heat-related illnesses and deaths.
• Seasonal Changes: Seasonal changes can shift the geographic area where disease-carrying insects, such as mosquitoes, ticks, and fleas transmit West Nile Virus, dengue fever, Lyme disease, and malaria to humans.
• Air Quality: Increasing exposure to pollen due to increased plant growing seasons, to molds due to severe storms, and to air pollution due to increased temperature and wildfires, can all worsen lung diseases, such as asthma.
• Temperature Changes: Increasing temperatures can cause poor air quality that affects the heart and worsens cardiovascular disease.
• Flooding: Flooding events can contaminate water with harmful bacteria, viruses, and chemicals that cause foodborne and waterborne illnesses.
• Severe Weather: In addition to injuries, illnesses, and deaths, more frequent and severe extreme weather events can harm mental health due to damage to property, loss of loved ones, displacement, and chronic stress.
• Health Care System Impacts
  Extreme climate events can place added stress on hospital and public health systems and limit people's ability to obtain adequate health care during crises

Our health is a combination of physical and mental well-being, which is affected by our behavior, biology, environment, societal policies, and importantly, our lived experiences. The lived experiences of people in the U.S. vary based on their race and ethnicity, socioeconomic status (SES), geographic location, sexual orientation, gender identity, and other sociodemographic characteristics.

Lived experiences also need to be understood in the context of the individual and structural social determinants of health.

How and where we live, learn, work and play, and our access to high quality health care, healthy foods, and a quality education, can enhance our health outcomes.

Similarly, negative experiences and exposures, such as pollution, violence, structural racism and discrimination, can negatively affect our health.

Our health status reflects the interwoven effects of such factors.

Clinical trials evaluate the efficacy, safety, and effectiveness of clinical treatments and devices, including drugs, surgeries, diets, behavioral approaches, and lifestyle interventions seeking to improve individual and community health. To account for the diverse lived experiences and exposures of various populations, clinical trials must be appropriately inclusive of racial and ethnic minority groups, as well as other populations experiencing health disparities, including sexual and gender minority or socioeconomically disadvantaged populations.

Why Are Clinical Trials Important?

Clinical trials can:

• Determine if a new treatment or intervention is safe, works better, and/or has fewer side effects than an existing treatment.
• Examine ways to detect a disease early, when it is potentially more treatable, or ways to prevent a health problem altogether.
• Evaluate ways to improve the quality of life of people who have an illness or chronic medical condition.
• Include testing of behavioral, social, environmental, and structural interventions.

Participating in clinical trials is voluntary. People volunteer to participate in clinical trials for a variety of reasons. One of the most common reasons is altruism—the opportunity to contribute to science and the common good and/or help those with similar health issues. People also volunteer when it allows them to try a new treatment or intervention for life-threatening or disabling disease where no standard treatments are available or were already tried without success.

New treatments for common conditions may also be offered (e.g., weight loss or tobacco cessation interventions) that haven’t yet been approved by the U.S. Food and Drug Administration (FDA) but might help a condition in situations where current treatments or interventions don’t exist, haven’t worked, or provide symptomatic relief, but offer no cure.

The Importance of Diversity & Inclusion in Clinical Trials

People may experience the same disease differently. It’s essential that clinical trials include people with a variety of lived experiences and living conditions, as well as characteristics like race and ethnicity, age, sex, and sexual orientation, so that all communities benefit from scientific advances.

Factors that can influence the risk and likelihood of developing a disease, long-term health outcomes, and responses to treatments, include (but are not limited to):

• Age
• Biological sex
• Pregnancy status
• Life experiences (negatives such as psychosocial stress and lack of basic resources, or positives such as educational and employment opportunities)
• Unhealthy behaviors (e.g., substance use, sedentary lifestyle, overeating, risky sexual activity)
• Health-promoting behaviors (e.g., adequate sleep, obtaining recommended preventive services, physical activity, healthy eating)
• Environmental conditions (e.g., pollution, access to health care or healthy foods, neighborhood segregation)
• Genetic variation and geographic ancestry
• Underlying medical problems or presence of comorbidities (additional diseases or conditions)

Historically, clinical trials did not always recruit participants who represented the individuals most affected by a particular disease, condition, or behavior. Often, these clinical trials relied almost exclusively on White male study participants. This shortcoming has created gaps in our understanding of diseases and conditions, preventive factors, and treatment effectiveness across populations. These gaps in knowledge can impede the quality of health care decision making, ability to counsel people on ways to reduce their risk, optimal treatment responses, and even the development of more effective medications or interventions.

Clinicians and researchers should carefully consider the inclusion or exclusion criteria for their clinical trials. For example, a clinical trial excluding participants with high blood pressure or other comorbidities may end up excluding many people over 65 years old, who are more likely to have these conditions. The trial may then underrepresent certain groups in the study and make the results less applicable to groups who may benefit the most from the findings.

TBI has contributed to the deaths of more than one million Americans over the last two decades. For survivors, a TBI can lead to short- or long-term problems that may affect all aspects of a person’s life, including the ability to work or build relationships with others, and it can change how a person thinks, acts, feels, and learns.

Health disparities are differences in health outcomes and their causes among groups of people. Groups can be defined by factors such as race, ethnicity, sex, education, income, disability, geographic location (e.g., rural or urban), sexual orientation, and gender identity. When examining disparities in TBI, CDC analyzes differences in incidence rates, prevalence rates, and outcomes by group.

Which groups are most affected by TBI?

While anyone is at risk for getting a TBI, some groups have a greater likelihood of dying from a TBI or living with long-term problems that resulted from the injury.

Certain groups have a higher chance of sustaining a TBI.

Older adults

People aged 75 years and older had the highest numbers and rates of TBI-related hospitalizations and deaths. This age group accounts for about 32% of TBI-related hospitalizations and 28% of TBI-related deaths.

Racial and ethnic minorities

American Indian/Alaska Native children and adults have higher rates of TBI-related hospitalizations and deaths than other racial or ethnic groups. Factors that contribute to this disparity include higher rates of motor vehicle crashes, substance use, and suicide as well as difficulties in accessing appropriate healthcare.

In addition to differences in rates of TBI, racial and ethnic minority groups, particularly non-Hispanic Black and Hispanic patients, are less likely to receive follow-up care and rehabilitation following a TBI compared to non-Hispanic white patients. Racial and ethnic minorities are also more likely to have poor psychosocial, functional, and employment-related outcomes after sustaining a TBI than non-Hispanic white individuals.

Military service members and Veterans

More than 450,000 U.S. service members were diagnosed with a TBI between 2000 and 2021. Military conflicts involve risks for TBI among service members, still TBIs among this group most commonly occur when the person is not deployed, such as from a motor vehicle crash. Studies suggest that service members and Veterans who have sustained a TBI may:

• have ongoing symptoms,
• experience co-occurring health conditions, such as post-traumatic stress disorder (PTSD) and depression,
• have difficulty accessing healthcare (particularly mental health services), and
• report thinking about or planning a suicide attempt.

People in correctional or detention facilities

Research in the United States and from other countries suggests almost half (46%) of people in correctional or detention facilities such as prisons and jails have a history of TBI, but the exact number is not known. Research shows an association between people in correctional or detention facilities with a history of TBI and:

• mental health problems, such as severe depression and anxiety,
• substance use disorders,
• difficulty controlling anger, and
• suicidal thoughts and/or attempts.

People in correctional or detention facilities with TBI-related problems may not be screened for a TBI or may face challenges with getting TBI-related care. These challenges may continue after a person is released from the facility.

People who experience homelessness

Compared to the general population, people who experience homelessness are:

• 2 to 4 times more likely to have a history of any type of TBI and
• up to 10 times more likely to have a history of a moderate or severe TBI.

People who experience homelessness and have a history of TBI have worse overall physical and mental health and are more likely to report experiencing violence and/or trauma during childhood, substance use, and thinking about or attempting suicide.

Survivors of intimate partner violence

Survivors of intimate partner violence who have a TBI due to an assault are more likely to:

• be diagnosed with PTSD, insomnia, and depression, and
• report worse overall health.

People with lower incomes and those without health insurance have less access to TBI care.

Survivors of a moderate or severe TBI may face a difficult road to recovery that requires services such as physical therapy and mental health treatment for months or years in order to return to pre-injury function. TBI survivors with lower incomes or who are uninsured face significant barriers in accessing appropriate TBI care. Compared with patients who have private health insurance, those who are uninsured are:

• Less likely to receive a TBI procedure (e.g., craniectomy/craniotomy, ventriculostomy, intracranial pressure monitor placement, arterial line placement, or central line placement).
• Less likely to receive inpatient services, such as rehabilitation.
• More likely to die in the hospital.

People in rural areas are more likely to die from a TBI.

People living in rural areas have a greater risk of dying from a TBI compared to people living in urban areas. Some reasons for this disparity include:

• More time needed to travel to emergency medical care.
• Less access to a Level I trauma center (the highest level of medical care).
• Difficulty getting services, such as specialized TBI care.

Children living in rural areas are more likely to get a TBI and to die as a result of this injury compared to children living in urban areas. Children in rural areas may also be more likely to:

• Experience delays in getting TBI-related care.
• Be unnecessarily transferred to another hospital for TBI-related care.

Overview

Drug overdose data show troubling trends and widening disparities between different population groups. In just one year, overdose death rates (number of drug overdose deaths per 100,000 people) increased 44% for Black people and 39% for American Indian and Alaska Native (AI/AN) people. Most people who died by overdose had no evidence of substance use treatment before their deaths. In fact, a lower proportion of people from racial and ethnic minority groups received treatment, compared with White people. Some conditions in the places where people live, work, and play can widen these disparities. For instance, areas with greater income inequality—a larger income gap between the rich and the poor—have higher rates of overdose deaths. Comprehensive, community-based prevention and response efforts should incorporate proven, culturally responsive actions that address disparities in drug overdose deaths and the inequities that contribute to them.

• Increasing access to proven treatment for all people who have substance use disorder(s) is a critical part of their care and recovery.
• Harm reduction services can further reduce overdoses and save lives. Harm reduction services can include naloxone, fentanyl test strips, and referral to substance use disorder treatment. Syringe services programs can serve as a valuable way to reach people who inject drugs and provide them with overdose prevention education and opportunities to link to substance use disorder treatment.

Drug overdose death disparities are widening at the same time as a record-breaking 92,000 lives were lost to drug overdoses during 2020. More must be done to prevent overdoses and deaths.

Challenges

Racial and ethnic minority groups have less access to proven treatments for substance use disorders. This difference is not simply because of a lack of availability of services. Communities with higher capacity to provide care had the highest death rates, and this pattern was even worse for Black and AI/AN people. Income inequalities, often negatively impacting people from racial and ethnic minority groups at a greater level, can lead to lack of stable housing, reliable transportation, and health insurance.  This makes it even more difficult for people to access treatment and other support services.

In addition, overdoses are becoming more common and deadly. Mixing drugs or using more than one drug (polysubstance use) and the increasing spread of illicitly manufactured fentanyls (IMFs) in the drug supply are major concerns. It is critical for prevention efforts to address polysubstance use while also working to reduce historical health inequities, promote primary prevention, and expand proven treatment, recovery support services, and harm reduction strategies. Public health departments can bring together criminal justice, health care, social services, employers, and government partners to focus on comprehensive efforts that have the greatest potential to prevent overdose.

What Can Be Done

To Advance Health Equity

Drug overdoses are preventable. The growing overdose crisis, particularly among people from racial and ethnic minority groups, requires tailored prevention and treatment efforts. These efforts should be designed to restore optimal health for all. Public health professionals, healthcare providers, policy makers, and communities can consider:

• Improving access to treatment and recovery support services by offering telehealth and similar options that help people start and continue treatment and care over time. This is especially important for people from racial and ethnic minority groups, who encounter more barriers to accessing these vital services. Expanding insurance coverage can help.
• Offering structural support such as housing assistance, transportation assistance, and childcare to help reduce barriers to accessing and staying in treatment and recovery.
• Combining culturally appropriate traditional practices, spirituality, and religion, when appropriate, with proven substance use disorder treatment.
• Creating culturally tailored campaigns that help raise awareness and reduce stigma around treatment and recovery.
• Offering support groups and opportunities for community connection to help reduce stigma and mistrust.
• Reducing criminalization of substance use disorders.
• Linking people to treatment from a variety of settings (such as primary care, syringe services programs, and healthcare settings during incarceration) and through trusted messengers, which helps people to continue treatment over time.
• Improving access to programs that address past and prevent future trauma and other risk factors for substance use.

To Prevent Overdose Death

Prevent Overdose

• Reduce adverse childhood experiences (which can increase risk for substance use and use disorder) and root causes of health disparities.
• Raise awareness about the dangers of illicitly manufactured fentanyls and using more than one drug.
• Reduce stigma around seeking substance use disorder treatment, harm reduction, and recovery support services.

Treat Substance Use Disorder

• Link people to care and help people start and stay in treatment from different settings.
• Improve access and reduce barriers to proven treatment for substance use disorders (i.e., medication for opioid use disorder).
• Include culturally tailored traditional practices, spirituality, and religion, when appropriate, with proven substance use disorder treatment.

Support Harm Reduction

• Expand community naloxone distribution and education, as well as prescribing and dispensing from pharmacies.
• Expand access to harm reduction services to include distribution of naloxone, fentanyl test strips, syringe service programs that include overdose prevention efforts, and connections to same-day substance use disorder treatment.
• Expand education about substance use and risks for overdose and overdose deaths to include employers, Medicaid and other health insurance payers, and policy makers.

Everyone can:

• Talk to a doctor if you or someone close to you needs help for substance use.
• Learn about naloxone, a lifesaving drug that can reverse the effects of an opioid overdose when administered in time. Ask your doctor or pharmacist for a naloxone prescription or get naloxone from local organizations if you or a loved one uses illicit drugs, has a substance use disorder, takes high-dose prescription opioids, or has other risk factors for opioid overdose.
• Read and share resources about overdose prevention and raise awareness about the communities who are disproportionately impacted by overdose.
• Learn more about reducing stigma, which can be a major barrier to getting help.

What is Health Equity?

Health equity means that everyone has the opportunity to be as healthy as possible. Lack of health equity among people and communities can result in

• Reduced length and quality of life
• Increased rates of disease, disability, and death
• Increased disease severity

Challenges in Achieving Health Equity for People with Genetic Disorders

Public health efforts to achieve health equity need to include people with genetic disorders. Thousands of inherited genetic disorders affect millions of people in the United States. Genetic disorders include both single-gene disorders, such as cystic fibrosis and sickle cell disease, and conditions that make people more likely to develop common chronic diseases, such as hereditary breast and ovarian cancer syndrome, Lynch syndrome, and familial hypercholesterolemia.

Many people with genetic disorders are more likely to

• Have health problems
• Require specialized care
• Be hospitalized
• Have higher health care costs
• Need to take time off work or school
• Die at a younger age

In addition, many people with genetic disorders face barriers to health equity that are related to social determinants of health, which refer to conditions in the places where people live, learn, work, and play that affect health and quality of life. Social determinants of health can affect whether people with genetic disorders

• Get needed health care: Health care access and quality
• Succeed in school: Education access and quality
• Have support from friends, family, and community: Social and community context
• Find and keep jobs: Economic stability
• Live in places without health or safety risks: Neighborhood and built environment

CDC’s Office of Genomics and Precision Public Health (OGPPH) works to promote health, prevent disease, and reduce health inequities for people with genetic disorders of all ages, so they can have the opportunity to be as healthy as possible.

How OGPPH Supports Health Equity for People with Genetic Disorders

• Work to increase identification of people with genetic disorders to prevent disease or find it early
  Many people with genetic disorders remain undiagnosed, which limits them from taking steps to prevent disease or find it early, when it is more treatable. Finding people with genetic disorders is an important step in improving their health. To address health inequities, approaches to identify those with genetic disorders must be applied broadly and equitably across different communities and populations.

• • Identify when genomic tests and family health history can help guide medical care to prevent disease
    The CDC Office of Genomics and Precision Public Health (OGPPH) maintains a database of genomic testing, family health history, and precision health guidelines categorized by the highest level of evidence they contain. Guidelines categorized as tier 1, meaning they are ready for use in clinical settings, are available for cystic fibrosis, sickle cell disease, hereditary breast and ovarian cancer, Lynch syndrome, hereditary hemochromatosis, hypertrophic cardiomyopathy, and other conditions. OGPPH works to increase awareness of these applications to broaden their use.
  • Promote collection and sharing of family health history information using My Family Health Portrait
    Many people with genetic disorders can be identified through family health history, yet family history remains underused in clinical care. To address this, OGPPH promotes the use of family health history information across populations for different common chronic conditions. OGPPH maintains My Family Health Portrait, a free, online tool that can be used to collect family health history and assess risk for certain conditions.
  • Increase awareness of inherited genetic disorders through web pages and blogs
    The OGPPH website includes information written for the general public on family health history, genetic counseling and testing, and many different genetic disorders, as well as Genomics and Precision Health Blog posts addressing health equity issues.

• Increase understanding of inequities in use of genetic services and health outcomes for people with genetic disorders
  Identifying and measuring inequities in use of genetic services and health outcomes for people with genetic disorders is an important first step in addressing these inequities.

• • Published study looking at use of BRCA testing in women residing in metropolitan and non-metropolitan areas
    Using claims data from Marketscan, OGPPH found that women living in non-metropolitan areas had lower rates of BRCA testing and use of some preventive services, compared with women living in metropolitan areas.
  • Identify relevant publications in Health Equity PHGKB database
    Health Equity PHGKB is an online, continuously updated, searchable database of genomics and precision health information and publications relevant to health equity.

In addition to OGPPH, other groups at CDC work on health equity for people with genetic disorders. For example, the Division of Cancer Prevention and Control (DCPC) launched the Bring Your Brave campaign to broaden awareness of breast cancer in young women, many of whom have hereditary breast and ovarian cancer syndrome. DCPC’s Cancer Genomics Program  included activities that address health inequities in funded states.

Overview

Firearm deaths continue to be a significant and growing public health problem in the United States. In 2020, 79% of all homicides and 53% of all suicides involved firearms. From 2019 to 2020, the firearm homicide rate increased about 35%, and the firearm suicide rate stayed high. The firearm homicide rate in 2020 was the highest recorded in over 25 years.

Long-standing systemic inequities and structural racism limit economic and education opportunities. They contribute to unfair and avoidable health disparities among some racial and ethnic groups. Against the backdrop of the COVID-19 pandemic, the substantial increase in the firearm homicide rate, along with notable increases in firearm suicide rates for some groups, has widened racial, ethnic, and other disparities. For example, young people, males, and Black people have the highest firearm homicide rates and experienced the largest increases in 2020. The reasons for the increasing rates and widening disparities are likely complex. Multiple stressors associated with the COVID-19 pandemic may have contributed to the increases, including:

• Changes and disruptions to services and education
• Mental stress
• Social isolation
• Economic stressors, including job loss, housing instability, and difficulty covering daily expenses

Stopping firearm violence now and in the future requires a comprehensive prevention approach focused on reducing inequities. Strategies should address the underlying physical, social, economic, and structural conditions known to increase firearm homicide and suicide risks. Some prevention strategies will be more immediate, and others will have more long-term effects.

Challenges

• Ripple effects: Firearm homicide and suicide can have a ripple effect in communities—reaching beyond the people immediately impacted by the deaths and affecting friends, families, and coworkers.
• High risk for death: Firearms can lead to deadly injuries and are often used in homicides and suicides.
• Growing racial and ethnic gaps: The COVID-19 pandemic may have worsened existing social and economic stressors that increase the risk for firearm homicide and suicide, particularly among racial/ethnic minority communities.
• Poverty effects: Counties with higher poverty rates had higher firearm homicide rates. People living in these areas experienced higher increases than those living in counties with the lowest poverty rates. Higher county poverty levels were also associated with higher firearm suicide rates.
• Multiple stressors: Multiple factors, including social, economic, and physical conditions in communities, contribute to firearm homicide and suicide risk, as well as racial and ethnic inequities.
• Preventive actions urgently needed: The increases in firearm deaths and widening disparities have heightened the need for comprehensive preventive actions. Programs, policies, and practices can have immediate and lasting benefits.

What Can Be Done

To Advance Health Equity

Preventing firearm deaths requires a comprehensive approach and various partners from across sectors working directly with communities to decrease inequities and increase resiliency and well-being. Programs, policies, and practices can reduce inequities by focusing on the places and people experiencing the greatest burden of violence as well as the underlying conditions contributing to risk. Some actions can have a more immediate impact on preventing violence, and some can be long-term solutions. A few examples include:

• Street outreach and hospital-based prevention programs can ensure that people with the greatest needs are connected to services and work to reduce tensions and risk for violence.
• Enhancing and maintaining green spaces, like cleaning vacant lots and planting grass and trees in high-risk areas, can change the physical and social conditions that contribute to violence and inequities. Revitalized vacant lots in communities are associated with reduced firearm assaults, particularly in areas with the highest poverty.
• Strengthening economic and household stability through housing assistance, childcare subsidies, tax credits, and livable wages can help lift families out of poverty, reduce stress, and enhance positive outcomes for individuals and families.

A comprehensive approach includes engagement of policy makers; local, state, and tribal governments; health, education, justice, and social service agencies; businesses; and community organizations. Their involvement in selecting data-driven violence prevention programs and policies can ensure that local needs are met.

To Stop Violence Now and in the Future

Firearm deaths are preventable—not inevitable—and everyone has a role to play in prevention. Resources like CDC’s violence prevention technical packages and surveillance systems can help leaders choose proven programs to make their communities healthier and safer.

Healthcare and Service Providers

• Hospital-based programs that intervene with victims of violence can prevent future violence, and interventions with those at risk for suicide can prevent future reattempts.
• Counseling and education paired with giving out a safety device, like a lockbox, are associated with safer firearm storage practices in the home.
• Community organizations, hospitals, and clinics can expand access to social, emotional, physical, and mental health services and supports to prevent substance use and suicide attempts and to address trauma associated with violence and prevent the continuation of violence.

Community Partners

• Community and street outreach programs like CureViolence engage populations at higher risk for firearm violence and connect them with community services while reducing tensions that may lead to violence.
• Individuals, communities, and businesses can promote safe firearm storage practices to reduce unauthorized use of a firearm.
• Many approaches, like mentoring, supporting norms against intimate partner and other violence, teaching coping and problem-solving skills, and programs to prevent substance use, have far-reaching benefits, including increasing well-being and reducing key risks for all types of violence.

Local and State Governments

• Communities and governments can use data to select effective and sustainable programs and policies to address the underlying conditions that contribute to violence inequities and enhance safe firearm practices.
• Policies to address household and economic stability can have a long-term impact by reducing family poverty and other risk factors for violence.

Health disparities: Preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by populations that have been socially, economically, geographically, and environmentally disadvantaged.

Health inequities: Particular types of health disparities that stem from unfair and unjust systems, policies, and practices and limit access to the opportunities and resources needed to live the healthiest life possible.

Overview

Flu can be serious and lead to hospitalization or death. Flu vaccination is the best way to protect against flu. Between 140,000 and 710,000 people were hospitalized with flu each year during 2010–2020. People from some racial and ethnic minority groups are more likely to be hospitalized with flu. Compared to White adults, flu hospitalization rates* are:

• Nearly 80% higher among Black adults
• 30% higher among American Indian/Alaska Native (AI/AN) adults
• 20% higher among Hispanic adults

Vaccination may not always prevent infection, but it can make symptoms less severe and reduce the risk of being hospitalized. Since 2010, flu vaccination coverage has been consistently lower among Black, Hispanic, and AI/AN adults. During the 2021–2022 season, flu vaccination coverage was 54% among White adults, 42% among Black adults, 38% among Hispanic adults, and 41% among AI/AN adults. There are many reasons for these inequities, including lack of access to health care and insurance, missed opportunities to vaccinate, and misinformation and distrust. Racism and prejudice are known to worsen inequalities. In addition to disparities in vaccine uptake, there are likely other factors contributing to worse outcomes for some groups.

Increasing equitable vaccine uptake requires addressing the range of reasons why people do not get vaccinated. Over the past two years, CDC has begun two programs to address vaccination barriers and raise awareness about the importance of flu vaccination, specifically among people from racial and ethnic minority groups: the Partnering for Vaccine Equity (P4VE) program and a targeted flu vaccination campaign.

Challenges

Access: People from some racial and ethnic minority groups face barriers to health care in general and, specifically, lack easy access to vaccination. Last flu season, adults with insurance, a healthcare provider, and a medical checkup in the past year were more likely to get a flu vaccine compared with those without. Hispanic adults were less likely to have insurance. Hispanic and AI/AN adults, as well as adults of other races, were less likely to have a healthcare provider and a checkup in the past year. These data suggest lack of healthcare access is contributing to flu vaccination disparities. Further, lack of access to culturally competent providers remains a barrier to vaccination for many people from racial and ethnic minority groups.

Missed opportunities to vaccinate: Among adults who reported a recent medical checkup, vaccination coverage was lower among Black, Hispanic, AI/AN, and other/multiple race adults than among White adults. This suggests that healthcare providers are missing opportunities to vaccinate people from some groups during routine medical appointments.

Mistrust and misinformation: Misperceptions about how severe flu can be and misinformation about vaccine safety have hurt flu vaccination uptake for years. Systemic racism and historical events have added to a lack of confidence in flu vaccination.

People from Some Racial and Ethnic Minority Groups Are at Higher Risk of Flu Hospitalization

Black, Hispanic, and AI/AN adults were hospitalized with flu at higher rates than White adults during most seasons from 2015 to 2022.

Inequities in Flu Vaccination Coverage Continue

Hispanic, AI/AN, and Black adults received a flu vaccine at lower rates compared to White adults during the 2021–2022 flu season.

Multiple Actions Work Best to Improve Access and Vaccine Confidence

Using proven measures may help increase flu vaccination among people from racial and ethnic minority communities.

Multiple Actions Work Best to Improve Access and Vaccine Confidence

Using proven measures may help increase flu vaccination among people from racial and ethnic minority communities.

• Promote community-based vaccination
• Use culturally responsive messages
• Partner with trusted messengers
• Emphasize flu vaccination

Credits: Philippine Nurses Association of American Foundation (top left), The Ad Council (top right)

To Advance Health Equity

COVID-19 vaccination efforts have shown that partnerships with community organizations and trusted messengers can help to increase vaccination rates. The Partnering for Vaccine Equity (P4VE) program aims to reduce disparities in adult vaccination. These partnerships seek to build trust, increase access to vaccination, and combat misinformation. Several promising practices have emerged. Working with community organizations to hold town halls, pop-up clinics, and other outreach activities helps increase trust and access. Partnering with healthcare providers and local media channels can raise awareness of the importance of flu vaccination and address misinformation through accurate information about vaccines.

National vaccination campaigns also can help build confidence in vaccines. Campaigns increase awareness by sharing information about the vaccine(s) and addressing barriers to getting a vaccination. The Ad Council, American Medical Association, and CDC have supported campaigns tailored to reach Black and Hispanic audiences. These campaigns feature culturally responsive content shared through communication channels that are commonly used and trusted. After two years, concerns about flu vaccine risks or side effects decreased from 43% to 33% among Black adults and from 41% to 32% among Hispanic adults. These successes show that tailored messages, when delivered through frequently used and trusted channels, can increase awareness and decrease fears.

To Fight Flu

Healthcare providers

• Strongly recommend flu vaccination to all patients 6 months and older.
• Check vaccination status at all medical visits.
• Work with healthcare systems to provide vaccines where people live and work.
• Provide culturally appropriate vaccine recommendations, answering all questions from the patient.
• Provide a referral if vaccine is not in stock.
• Vaccinate all clinic staff and educate them on how to discuss vaccination.

State and local governments

• Educate community and faith-based organizations on building trust and vaccine confidence within their communities.
• Identify barriers to vaccination and work with community organizations to remove those barriers and increase access and convenience.
• Host vaccination clinics where people work and play.
• Develop influencer-led, culturally responsive community outreach and campaigns with accurate vaccine messages.
• Partner with media groups that reach people from racial and ethnic minority communities.
• Work with local businesses to make it easy for employees to get vaccinated—for example, host multiple on-site vaccination clinics, open vaccination clinics to employees’ family members, and offer paid time off or financial incentives for employees who get vaccinated.

Everyone

• Get vaccinated today. The best way to protect yourself and your family against severe flu is to get an annual flu vaccine.
• Encourage others to get a flu vaccine and share facts about flu vaccines with your community.

Having access to nutritious food is a basic human need.

• Food security means having access to enough food for an active, healthy life.
• Nutrition security means consistent access, availability, and affordability of foods and beverages that promote well-being, prevent disease, and, if needed, treat disease.

On the other hand, food and nutrition insecurity is an individual-, household-, and neighborhood-level economic and social condition describing limited or uncertain access to adequate and affordable nutritious foods and is a major public health concern.

Food insecurity and the lack of access to affordable nutritious food are associated with increased risk for multiple chronic health conditions such as diabetes, obesity, heart disease, mental health disorders and other chronic diseases. In 2020, almost 15% of U.S. households were considered food insecure at some point in time, meaning not all household members were able to access enough food to support active, healthy lifestyles. In nearly half of these households, children were also food insecure (see chart above), which has implications for human development and school experience. Food insecurity disproportionately affects persons from racial and ethnic minority and socioeconomically disadvantaged populations:

• 20% of Black/African American households were food insecure at some point in 2021, as were 16% of Hispanic/Latino households when compared to 7% of White households.
• Food insecurity for U.S. Hispanic/Latino adults differs by origin. Current national data is not available but from food insecurity was highest among those identifying from Puerto Rico (25.3%), followed by Mexico (20.8%) Central and South America (20.7%) and Cuba (12.1%).
• In the past 20 years, American Indian/Alaskan Native (AI/AN) households have also been at least twice as likely to have experienced food insecurity when compared with White households, often exceeding rates of 25% across different regions and AI/AN communities.
• Native Hawaiian and Pacific Islander (NHPI) adults also experience a high food insecurity prevalence (20.5%) and had significantly higher odds of experiencing low and very low food security compared with White households.
• While national data on specific Asian American national origin populations is not readily available, among Asian Americans living in California from 2001-2012, food insecurity was highest among Vietnamese households (16.4%), followed by Filipino (8.3%), Chinese (7.6%), Korean (6.7%), South Asian (3.14%), and Japanese households (2.3%), highlighting considerable variation across Asian American communities.
• Food insecurity is inextricably linked to poverty, with 35.3 % of households with incomes below the federal poverty line being food insecure.
• National trends in food insecurity does not capture the full impact of the COVID-19 pandemic, food insecurity is likely to increase, and racial and ethnic disparities in food insecurity experiences could worsen.

Most Pregnancy-Related Deaths are Preventable

Each year in the United States, about 700 people die during pregnancy or in the year after. Another 50,000 people each year have unexpected outcomes of labor and delivery with serious short- or long-term health consequences. Every pregnancy-related death is tragic, especially because two in three of them are preventable. Recognizing urgent maternal warning signs and providing timely treatment and quality care can prevent many pregnancy-related deaths.

Racial Disparities Exist

Black women are three times more likely to die from a pregnancy-related cause than White women. Multiple factors contribute to these disparities, such as variation in quality healthcare, underlying chronic conditions, structural racism, and implicit bias. Social determinants of health prevent many people from racial and ethnic minority groups from having fair opportunities for economic, physical, and emotional health.

Working Together to Reduce Black Maternal Mortality

During Black Maternal Health Week, learn how you can support pregnant people in your life to reduce factors that contribute to pregnancy-related complications and death.

Pregnant people and their families can:

Talk to a healthcare provider if anything doesn’t feel right or is concerning.

• Know and seek immediate care if experiencing any of the urgent maternal warning signs, including severe headache, extreme swelling of hands or face, trouble breathing, heavy vaginal bleeding or discharge, overwhelming tiredness, and more. These symptoms could indicate a potentially life-threatening complication.
• Document and share pregnancy history during each medical care visit for up to one year after delivery.
• Maintain ongoing healthcare and social support systems before, during, and after pregnancy.

Healthcare providers can:

Ask questions to better understand their patient and things that may be affecting their lives.

• Help patients, and those accompanying them, understand the urgent maternal warning signs and when to seek medical attention right away.
• Help patients manage chronic conditions or conditions that may arise during pregnancy like hypertension, diabetes, or depression.
• Recognize unconscious bias in themselves and in their office.
• Address any concerns patients may have.
• Provide all patients with respectful care.

Hospitals and healthcare systems can:

• Identify and address unconscious bias in healthcare.
• Standardize coordination of care and response to emergencies.
• Improve delivery of quality prenatal and postpartum care.
• Train non-obstetric care providers to ask about pregnancy history in the preceding year.

States and communities can:

• Assess and coordinate delivery hospitals for risk-appropriate care.
• Support review of the causes behind every maternal death.
• Identify and address social factors influencing maternal health such as unstable housing, transportation access, food insecurity, substance use, violence, and racial and economic inequality.

CDC Activities to Prevent Maternal Mortality

To prevent pregnancy-related deaths, CDC:

• Supports states through the Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) Program. This work facilitates an understanding of the drivers of maternal mortality and complications of pregnancy to better prevent maternal deaths and reduce racial disparities.
• Supports state perinatal quality collaboratives (PQCs) to improve the quality of care for mothers and their babies. This work supports the capabilities of PQCs to improve the quality of perinatal care in their states, including efforts to reduce racial/ethnic and geographic disparities.
• Helps states standardize their assessments of levels of maternal and newborn care for their delivery hospitals by offering the CDC Levels of Care Assessment Tool and providing technical assistance to those who want to use it.
• Promotes the Hear Her campaign to raise awareness of potentially life-threatening warning signs during and after pregnancy and improve communication between patients and their healthcare providers.

COVID-19 and Pregnancy

People who are pregnant or were recently pregnant are more likely to get severely ill from COVID-19 compared to people who are not pregnant. Getting a COVID-19 vaccine can help protect pregnant people from getting very sick from COVID-19. COVID-19 vaccination is recommended for people who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future. Non-Hispanic Black women have lower COVID-19 vaccination coverage during pregnancy compared to pregnant women from other racial and ethnic groups. This inequity is related to past and other existing inequities in health and its social determinants.

• All people deserve a fair and just opportunity to breathe smokefree air and be as healthy as possible. However, because not all populations are equally protected by a comprehensive smokefree law intended to address exposure to secondhand smoke (SHS), it is not always possible for people to reach their full health potential.
• The proportion of people who do not smoke and are exposed to secondhand smoke has declined in the USbut disparities in secondhand smoke exposure remain.
• Disparities in secondhand smoke exposure exist and persist because of uneven protections and unfair and unjust practices.
• More than a third of the US population lives in a state or community without protection from a comprehensive smokefree law that prohibits smoking in all workplaces and public places. In addition, many people who live in multi-unit housing (like apartment buildings) live in buildings without smokefree policies and are exposed to secondhand smoke because smoke travels between units of the same building.

What are the trends in secondhand smoke exposure in the US?

The percentage of persons in the US who do not smoke and are exposed to secondhand smoke has decreased over the last 60 years. For example, between 1999-2000 and 2011-2012, secondhand smoke exposure in the US among persons who do not smoke was reduced by half. Likely reasons for the decline in secondhand smoke exposure are:

• Implementation of comprehensive smokefree laws that prohibit smoking in workplaces, restaurants, and bars
• Decreased cigarette smoking prevalence
• Increased awareness of the risks of secondhand smoke exposure
• Adoption of voluntary smokefree home rules

What drives disparities in secondhand smoke exposure?

Uneven adoption of smokefree policies, unfair and unjust marketing and advertising practices by the tobacco industry, and social determinants of health (the conditions in which people are born, grow, live, work, and age) contribute to disparities in secondhand smoke exposure.

Not everyone is protected by comprehensive smokefree policies that prohibit smoking in all areas.

• Smokefree policies are important because they protect people who do not smoke from secondhand smoke exposure, motivate those who use commercial tobacco to quit, and prevent people from starting to use commercial tobacco. Right now, not everyone in the nation is equally protected by these policies.
• As of June 2021, of the ten US states with the highest proportion of Black residents, only three of those states have comprehensive smokefree laws that prohibit smoking in all workplaces and public places. Of the seven states that do not have comprehensive laws, two also prevent local communities from adopting comprehensive smokefree laws.
• As of July 2022, almost 38% of the US population is not protected by comprehensive smokefree laws at the state or community level.
• People of lower incomes and with less education may be less likely to be covered by comprehensive smokefree laws.
• Homes and vehicles remain major sources of secondhand smoke exposure for babies, children, and teens.
• People who live in multi-unit housing are more likely to be exposed to secondhand smoke because many buildings do not have smokefree building policies.
  • Approximately 1 in 3 multi-unit housing residents are covered by smokefree building policies.
  • Many multi-unit housing buildings are rental properties. Secondhand smoke exposure during 2017-2018 was higher among people who rented (36.6%) their housing than those who owned their housing (19.2%).
• Comprehensive smokefree laws and policies that also prohibit the use of e-cigarettes can protect people who do not use e-cigarettes from exposure to e-cigarette emissions. The e-cigarette aerosol that people who use e-cigarettes breathe from the device and exhale can contain harmful and potentially harmful substances. More information about e-cigarettes can be found on the Electronic Cigarettes page.

The tobacco industry has spread misinformation about the dangers of secondhand smoke.

• A federal court found that tobacco companies deceived the American public about the health effects of secondhand smoke.

Who is exposed to secondhand smoke?

Despite the decline in secondhand smoke exposure, not all populations are equitably protected by smokefree policies and some population groups remain more likely to be exposed. These groups include children ages 3-11 years; non-Hispanic, Black people; people with lower incomes; people with less education; people who live in rental and multi-unit housing; people who live with someone who smokes inside the home; and people who work in traditionally “blue collar” occupations.

Children and adolescents

• Almost two of every five children ages 3 to 11 years, including over half of non-Hispanic, Black children, were exposed to secondhand smoke during 2017- 2018.
• An estimated 6.7 million (25.3%) of middle and high school students self-reported secondhand smoke exposure in the home in 2019.

Non-Hispanic, Black people

• Non-Hispanic Black people (47.2%) had a higher prevalence of secondhand smoke exposure than non-Hispanic Asian people (21.2%), Mexican American people (16.4%), and non-Hispanic White people (22.1%).

People with lower incomes

• People living below the poverty level (45.0%) have a higher prevalence of secondhand smoke exposure than those with incomes at or above the poverty level (21.4%).

People with less education

• People aged 25 or older with a high-school education (24.3%) or those with less than high-school education (26.4%) have a higher prevalence of secondhand smoke exposure than people with a college diploma or higher (11.1%).

People living in rental and multi-unit housing

• An estimated 80 million people—or 25% of the population—in the US live in multi-unit housing—like apartment buildings with many homes next to one another in the same place such as apartments or condos.
• People who live in rental housing (36.6%) have a higher prevalence of secondhand smoke exposure than people who own their housing (18.6%).
• Even when no one in the home smokes, secondhand smoke can drift from other units including via hallways, stairwells, and ventilation systems.
• In homes where no one smokes, people who live in multi-unit housing such as apartments or condominiums have higher serum cotinine levels than people who live in single-family homes.

People who live with someone who smokes inside the home

• People who live with someone who smokes inside the home (87.8%) have a higher prevalence of secondhand smoke exposure than people who do not live with someone who smokes in the home (21.4%).

People working in traditionally “blue collar” occupations

• Secondhand smoke exposures in the workplace are more likely among workers who reside in states without comprehensive smokefree laws, and among workers employed in traditionally “blue collar” industries (e.g., construction, industrial machinery, or equipment repair).

More information about Tobacco-Related Disparities

Secondhand smoke exposure can be measured either through conducting surveys or through lab tests. For example, most studies of blood tests look at how many people have serum cotinine levels  between 0.05-10 ng/mL. Serum cotinine levels in this range reflect recent exposure to nicotine in tobacco smoke at levels consistent with secondhand smoke exposure. People who smoke almost always have serum cotinine levels higher than 10 ng/mL.

Some groups are at greater risk for suicide.

Suicide is a serious public health problem that can have lasting harmful effects on individuals, families, and communities. People of any age, race, ethnicity, or sex can experience suicide risk, but certain groups have substantially higher rates of suicide than the general U.S. population (13.9 per 100,000).

Veterans, people who live in rural areas, sexual and gender minorities, middle-aged adults, and tribal populations may disproportionately experience factors linked to suicide. These factors include substance use, job or financial problems, relationship problems, physical or mental health problems, and/or easy access to lethal means. Additionally, people who have experienced violence, including adverse childhood experiences (such as physical abuse), bullying, or sexual violence, have a higher suicide risk. Some of these groups may also be impacted by other health disparities. Health disparities are differences in health outcomes and their causes among groups of people.

Groups can be defined by factors such as age, sex, race, ethnicity, geographic location (such as state, county, or rural or urban), sexual orientation, and gender identity. CDC is concerned with groups disproportionately impacted by suicide and tracks and monitors suicide rates in these groups.

Suicide rates differ by age

Middle-aged Adults

Middle-aged adults (aged 35–64 years) account for 47.2% of all suicides in the United States, and suicide is the 9th leading cause of death for this age group.

• Among middle-aged men, suicide rates were highest for non-Hispanic American Indian or Alaskan Native (AI/AN) men (36.0 suicides per 100,000), followed closely by non-Hispanic white men (35.3 per 100,000).
• Among middle-aged women, suicide rates were highest among white women (10.5 per 100,000) and non-Hispanic AI/AN women (9.8 per 100,000).

Older Adults

Adults aged 75 and older account for fewer than 10% of all suicides but have the highest suicide rate (19.1 per 100,000). Men aged 75 and older have the highest rate (40.5 per 100,000) compared to other age groups. Older non-Hispanic white men had the highest suicide rate compared to other racial/ethnic men in this age group (47.8 per 100,000).

Youth and Young Adults

Youth and young adults ages 10–24 years account for 14% of all suicides. The suicide rate for this age group (10.5 per 100,000) was lower than other age groups. However, suicide is the third leading cause of death for young people, accounting for 6,643 deaths. For youth ages 10-14, suicide is the second leading cause of death.

Some groups of young people (ages 10-24 years) most at-risk for suicide include non-Hispanic AI/AN, with a suicide rate of 33.0 per 100,000. Sexual minority youth are also at increased risk (see below).

Youth and young adults aged 10-24 have lower suicide rates, but they have higher 2019 rates of emergency department (ED) visits for self-harm (342.5 per 100,000) compared to people ages 25 years and older (121.9 per 100,000).

• There was an estimated 217,447 ED visits for self-harm among this younger age group. Girls and young women aged 10-24 are at particularly high risk, with their ED visit rate (487.9 per 100,000) being twice the rate of ED visits among boys and young men (203.3 per 100,000).
• Further, the rate of ED visits among girls in 2019 was double compared to 2001 (244.3 per 100,000).

In 2019, 9% of high school students reported attempting suicide during the previous 12 months. Suicide attempts were reported most frequently among girls compared to boys (11% vs. 6.6%) and among non-Hispanic American Indian/Alaska Native students (25.5%).

Suicide risk is higher among people who identify as lesbian, gay, or bisexual

Data are limited on the rate of suicide among people who identify as sexual minorities. However, research has shown that people who identify as sexual minorities have higher rates of suicide attempts compared to heterosexual people.

Almost a quarter (23.4%) of high school students identifying as lesbian, gay, or bisexual reported attempting suicide in the prior 12 months. This rate is nearly four times higher than the rate reported among heterosexual students (6.4%).

The rate of self-reported suicide attempts in the prior 12 months among sexual minorities decreases with age, from 5.5% among people ages 18-25 to 2.2% among people ages 26-49.

Suicide rates are higher among veterans

Veterans have an adjusted suicide rate that is 52.3% greater than the non-veteran US adult population. People who have previously served in the military account for about 13.7% of suicides among adults in the United States.

In 2019, 1.6% of former active-duty service members aged 18-25 years reported making a suicide attempt during the previous 12 months. This was an increase from 0.9% in 2009.

Suicide rates vary by race and ethnicity

Age-adjusted suicide rates are highest among non-Hispanic AI/AN people (23.9 per 100,000) and non-Hispanic white people (16.9 per 100,000) compared to other racial and ethnic groups.

• Suicide is the 9th leading cause of death among AI/AN people.
  • Non-Hispanic AI/AN people have a much higher rate of suicide (23.9 per 100,000) compared to Hispanic AI/AN people (2.0 per 100,000).
  • The suicide rate among non-Hispanic AI/AN males ages 15–34 is 68.4 per 100,000.
• Suicide is the 12th leading cause of death for both Hispanic and non-Hispanic people of all races. Between 2019 and 2020, age-adjusted suicide rates decreased 4.5% among non-Hispanic white persons. At the same time, they increased 4.0% among non-Hispanic black people and 6.2% among non-Hispanic AI/AN people.

Suicide ideation is higher among people with disabilities

Limited data are available on suicide among people with disabilities. However, a recent survey highlighted that in 2021, adults with disabilities were three times more likely to report suicidal ideation in the past month compared to persons without disabilities (30.6% versus 8.3% in the general U.S. population). Prior research has also reported on increased mental distress among this group which is a risk factor for suicide.

Suicide rates differ by industry and occupation

CDC researchers have studied suicide rates by industry and occupation. Industry is the type of activity at a person’s place of work and occupation is the kind of work a person does to earn a living. A 2020 CDC study found that the suicide rate among workers in certain industries was significantly greater than the general U.S. population. The industry groups that had the highest suicide rates are:

1. Mining, Quarrying, and Oil and Gas Extraction (males: 54.2 per 100,000)
2. Construction (males: 45.3 per 100,000)
3. Other Services (such as automotive repair; males: 39.1 per 100,000)
4. Agriculture, Forestry, Fishing, and Hunting (males: 36.1 per 100,000)
5. Transportation and Warehousing (males: 29.8 per 100,000; females: 10.1 per 100,000)

The suicide rate was also greater than the general population for the following major
occupation groups:

1. Construction and Extraction (males: 49.4 per 100,000; females: 25.5 per 100,000)
2. Installation, Maintenance, and Repair (males: 36.9 per 100,000)
3. Arts, Design, Entertainment, Sports, and Media (males: 32.0 per 100,000)
4. Transportation and Material Moving (males: 30.4 per 100,000; females: 12.5 per 100,000)
5. Protective Service (females: 14.0 per 100,000)
6. Healthcare Support (females: 10.6 per 100,000)

Suicide rates differ based on where you live

Suicide rates can vary substantially across geographic regions, and rural areas experience much higher rates of suicide than urban areas. Suicide rates increase as population density decreases and an area becomes more rural:

• Large central metropolitan: 10.9 per 100,000
• Large fringe metro: 12.5 per 100,000
• Medium metro: 15.3 per 100,000
• Small metro: 17.2 per 100,000
• Micropolitan (non-metro): 18.3 per 100,000
• Noncore (non-metro): 20.5 per 100,000

Suicide rates in rural areas are highest among non-Hispanic AI/AN males (59.6 per 100,000) and non-Hispanic white males (37.9 per 100,000).

You—as a community member or member of an organization—can join the effort to ensure that all people have equitable access to resources to maintain and manage their physical and mental health, including easy access to important information, goods and services, and affordable medical and mental health care. Community- and faith-based organizations, employers, healthcare systems and providers, public health agencies, policy makers, and others play a key part in promoting fair access to health, improving opportunity, and ensuring all communities can thrive.

Communities can promote health equity by adopting policies, programs, and practices that:

• Support equitable access to quality and affordable health and other social services (e.g., education, housing, transportation, child care) and accessibility within these services.
• Recognize, respect, and support the diversity of the community they serve.
• Partner with trusted messengers and community health workers/promotores de salud to share clear and accurate information tailored to a community’s languages, literacy levels, and cultures.
• Include community engagement efforts that can help strengthen partnerships between community members and public health entities, build trust, and promote social connection.

• Engage trusted leaders known by the community and who share the same race and ethnicity, sexual orientation, and cultural or religious beliefs as the community to share information, collect input, or conduct outreach.
• Use clear, easy-to-read, accurate, transparent, and consistent information from a reputable source that is locally and culturally relevant in terms of language, messaging, tone, images, and format. Information should be suitable for diverse audiences, including people with disabilities, limited English proficiency, low literacy, or people who face other challenges accessing health information.

Below are examples of additional actions that organizations and agencies can take to support health equity.

Community and faith-based organizations can:

• Help connect people with healthcare providers, goods (e.g., healthy foods, temporary housing), and services to meet their physical, spiritual, and mental health needs.
• Work with others to address misinformation, myths, and lack of access to appropriate resources. This might include working with trusted local media, local public health departments, or community members to share information or community insights that help connect individuals to resources and free or low-cost services.

Employers can:

• Train employees at all levels of the organization to identify and interrupt all forms of discrimination; provide them with training in implicit bias.
• Establish and maintain equitable leave policies that are fair and flexible to meet the needs of all employees.

Healthcare delivery systems can:

• Deliver all health-related services in a culturally appropriate way and according to the needs of patients. This may include providing the necessary patient supports (e.g., translator, patient navigators).
• Ensure providers show awareness of and respect for culture when providing care.
• Collect and report race and ethnicity data on all patients and educate staff and patients on why this information is an important part of making sure populations are receiving equitable access to care.

Public health agencies can:

• Build partnerships with different sectors (e.g., community- and faith-based organizations, racial and ethnic minority-serving organizations, tribal communities, school and transportation systems, scientific researchers, professional organizations) and community members to share information and collaborate to advance health equity in communities.
• Address misunderstandings about why people are being asked for personal information, including race and ethnicity, and why this information is important to allocate resources and information sharing to people who need them most.

State, tribal, local, and territorial governments can:

• Explore options to provide free or low-cost broadband Internet access so people can use telehealth and get information on health care and social services.
• Reassess policies that create barriers for healthcare providers to collect and report data on race and ethnicity and social determinants of health.
• Partner with public health agencies to evaluate current and proposed policies in transportation, housing, community development, and more for their impacts on health, using a Health in All Policies framework. Prioritize health for communities experiencing health disparities in all policy change.
• Explore options to protect renters from evictions.
• Work to expand childcare service options.
• Increase public transportation services (e.g., free access to city bike programs).