For the last five years, Montgomery has maintained its status as the healthiest county in Maryland, according to annual rankings by the Robert Wood Johnson Foundation.
But over the same period, health disparities between some community groups have stagnated or gotten worse, creating a divide that can often be broken down by race and geography.
The county recently released those findings in its first report to assess health disparities between residents over a long-term period. The study broke down 25 health outcomes — including infant mortality, obesity and rates of HIV — and compared them across white, black, Hispanic and Asian residents.
In many cases, the data showed significant disparities that have remained static or even widened over roughly a decade. Compared to white residents, African Americans in Montgomery County have faced higher rates of tuberculosis, syphilis, HIV, infant mortality, and emergency room visits for heart disease.
Hispanic residents have experienced higher rates of tuberculosis, syphilis, HIV, infant mortality, and emergency room visits for firearm injuries, diabetes and heart disease. Asian residents have also faced long-term disparities, including rates of tuberculosis and syphilis.
There have been some improvements, county Health Officer Dr. Travis Gayles said, and there are cases in which minority groups have better long-term outcomes than white residents.
But taken as a whole, the report is an indicator that the county’s high health rankings don’t apply to all residents.
“Those of us who work on the ground know that the county’s high numbers are an average,” he said. “And not everyone enjoys that average. I think the big take-home is that there are still disparities even in areas where we’re seeing overall improvements.”
One example is heart disease mortality. Rates among black and white residents remain sharply divided even as the overall incidence has gone down. Access to prenatal care has also remained higher among white residents than among black, Hispanic and Asian groups, even as more women appear to gain access.
Health disparities have come into sharper focus over the past few decades, Gayles said, even as the causes remain unclear. Socioeconomic status and access to health insurance aren’t always linked to better outcomes, complicating efforts to reduce the gaps.
Maternal mortality rates among black women are one area in which wealth doesn’t appear to affect outcomes. Nationwide, black mothers experience far higher rates of mortality, Gayles said, even adjusted for economic status and access to care.
“That’s where we’re beginning to look at epigenetic factors — these outside stressors that can cause changes to the body and be passed down from generation to generation,” Gayles said.
More and more research has shown that black mothers face significant racism, sexism, and barriers to care that can affect their pregnancies even when they’re economically stable and have good access to health insurance.
As the county continues to focus on disparate outcomes, health officials plan to break down the data further by geography — and even diversity within individual racial groups — to determine where interventions should be focused, Gayles said.
Access to resources can also play a significant role in health outcomes, which is why it’s important to share the data with other county departments, he added.
“Let’s say we see a particular ZIP code with higher rates of maternal mortality,” Gayles said. “And maybe we drill down and figure out that the real problem is access to transportation. That’s when we bring transportation staff in to say, ‘Let’s look at the bus routes. Let’s make sure these mothers have ways to get to their doctor’s appointments.’”
The county recently released new health objectives for 2023, which set higher goals for improving access to resources including pedestrian-friendly infrastructure and healthy food, Gayles said. Over time, the goal is to reduce disparities by concentrating interventions in the communities that need them most.
“If we only celebrate our good outcomes, it can create a sense of complacency,” he added. “We need to call out areas where those good outcomes aren’t seen by all segments of society.”