HEALTHDISPARITIESANDSOCIALISOLATIONINMAJORITY BLACKCITIES
EXECUTIVESUMMARY
Thisreportexamineshowdisparitiesinhealthcareaccess,provideravailability, andtransportationaffecthealthoutcomesandmentalwell-beinginDetroit,MI; Philadelphia,PA;andHouston,TX.Blackurbancommunitiesencountersubstantial barrierstoaffordable,accessible,andtimelycare.Thesechallengesarerootedin historicdisinvestment,structuralinequities,andunder-resourcedmentalhealth systems.RecentchangesunderH.R.1,theOneBigBeautifulBillAct includingnew Medicaidworkrequirementsandstrictereligibilitycheckssettogointoeffecton January1,2027—willmakeclosingthesegapsmorechallenging.Tomitigate theseimpacts,statescanimplementstreamlinedreportingsystems,provide assistancewithdocumentation,andexpandhardshipexemptionstoprotect vulnerablepopulationsfromlosingcoverage.
KeyFindings
Out-of-pocketspendingislowbutmasksdeepergaps:Residentsinallthree citiesspendalowerpercentageofincomeonhealthcarethanthenational average,butthisdoesnotmeancareisequitablyaccessible.Thesedisparities signaltheneedfortargetedpoliciesthatexpandcoverageaccessfor uninsuredpopulations,particularlyyoungadults,whoexperiencethehighest uninsuredratesandaremostlikelytorelyonemployer-basedinsurance.
Depressionandsocialisolationarewidespread:Allthreecitiesreport depressionratesexceedingthe18.5%nationalaverage.Thisreflects concerninglyhighdepressionratesandemphasizestheurgentneedto providesafe,accessiblethirdplacesthatcanhelpalleviatesocialisolation.
Severeshortagesinmentalhealthprofessionals:NearlyallofHouston(96%) andDetroit(98%)arefederallydesignatedMentalHealthProfessional ShortageAreas(MHPSAs).Thishighlightstheurgentneedtostrengthenthe mentalhealthcareinfrastructureandexpandaccesstoqualifiedproviders.
Transportationshapesaccesstocare:Accesstomentalhealthservices variessharplybycity.InBlackurbancommunities,longdistancestocare pairedwithlimitedtransportationoptionscansignificantlyhindertimely accessanddeependisconnectionfromessentialmentalhealthsupport.
Solutionsmustaddresssystems,notjustservices:Federalandstatepolicies mustprioritizeexpandingmarketplaceinsurancecoverageandMedicaid access.However,theintroductionofan80-hourmonthlyworkrequirement threatenstowidenexistingdisparities,particularlyincommunitiesalready facinglimitedaccess.