The most frustrating thing about discussing health disparities in Texas is coming to the realization that there has not been a single piece of legislature geared toward eradicating those disparities for decades. Institutional negligence is not sufficient to describe the absolute, utter lack of real effort from Texas officials. So, let us call this perpetuation of disparities what it is: institutional racism.
One must go all the way back to the 77th Legislature to find the words “health disparities” in any piece of Texas legislation. That’s when the Texas Legislature enacted House Bill 757 to establish a Health Disparities Task Force. The year? 2001.
The 79th Legislature
Four years later, the 79th Legislature was already tiring of the effort. If any strategies were ever developed under HB757, there is no evidence of either short-term or long-term progress in eliminating any health disparities.
In fact, the state was under fire for its mismanagement of Child Protective Services (CPS), yet another state agency with a horrendous record of racial and ethnic disparities. During 2005, several horrific examples of child abuse were uncovered, including the case of Daisy Perales, an 11-year-old who died as a result of severe abuse and neglect. This led Governor Rick Perry to declare CPS reform an “emergency item” in that year’s session.
In academics, the University of North Texas Health Science Center at Fort Worth (UNTHSC) established the Texas Conference for Health Disparities (TCHD). Funded by the National Institute of Minority Health and Health Disparities (NIMHD), TCHD is the only NIMHD Center in Texas as well as one of twelve in the United States.
As for the Health Disparities Task Force, it lost its capitalization in House Bill 2594. Legislators also changed the frequency of reports from every year to every two years.
The 80th Legislature
In 2007, during the 80th Legislature, the “hot potato” phase kicked in, with name changes and shifting responsibilities for this health disparities task force from DSHS to HHSC.
The 82nd Legislature
The “runaround” phase started four years later, during the 82nd Legislature. Ten years after the initial attempt to address these disparities, the health disparities task force was eliminated in favor of a new center for the elimination of disproportionality and disparities (CEDD).
Unfortunately, this new center was tasked with addressing disproportionality and disparities across multiple areas (child welfare, mental health, juvenile justice, and education). With such a wide scope of duties, the center was rendered incapable of focusing resources on any particular area.
A 2013 article by the North Dallas Gazette cited “capacity” as the biggest problem for the fledgling center. That same year, the National Institutes of Health (NIH) published “The South Texas Health Status Review: A Health Disparities Roadmap.” This report contained a comprehensive analysis of over 30 risk factors, including recommendations and suggestions for improvement.
There is no evidence that anyone in the Texas Legislature ever consulted the materials. However, we do know the session in 2015 84th Legislature came and went without a single mention of health disparities. Meanwhile, the following brief was published with recommendations about how CEDD could more effectively reach its goals. Little did we know that the office would soon be effectively shuttered.
The 85th Legislature
2017 marks the last attempt by the Texas Legislature to even nominally address health disparities. In fact, the Office of Minority Health was defunded entirely.
It is notable that at the time, Texas Republicans were reeling from a scathing report by the Task Force on Maternal Mortality and Morbidity. Which showed a near tripling of the maternal mortality rate. From 8.6 maternal deaths per 100,000 live births in 2005 to 32.8 maternal deaths per 100,000 live births in 2014. Despite the report specifically outlining the severity of this problem among Black women, the Legislature chose instead to focus on another part of the report. Namely, the rise among infants diagnosed with Neonatal Abstinence Syndrome (NAS). Which was laudable but did nothing to address the issue of maternal mortality.
Still, that statistic gave the Legislature enough red meat to begin attributing maternal mortality disparities to “safer” outcomes. So, drug usage, heart disease, high blood pressure, and poverty, hence the calls for substance abuse screenings.
2017-2024
So, what’s happened with health disparities since 2017? Well, in a nutshell, they have continued to worsen. The coronavirus pandemic in 2020 revealed an entirely new set of disparities. That Republicans continue to ignore. This isn’t surprising in a state with a Lieutenant Governor who went from proclaiming that seniors should be willing to die in 2020 for the economy to blaming unvaccinated Black Texans for a late surge in COVID-19 cases in 2021. This was after the state spent the past year railing against mitigation efforts like masks and social distancing.
How hostile were Texas Republicans to any efforts to collect data on health inequities? Texas Democrats tried to introduce a bill to reestablish a new Office of Health Equity in 2021. Republicans responded by using the bill to debate about transgender rights and the boogeyman racial issue of 2021, CRT. How either of those relate to collecting data on health disparities is unknown. Suffice it to say, Texas Republicans appear to be through pretending. Instead of half-measures on their part to address health disparities, they don’t address the issue at all.
The 89th Legislature
Between the current climate in D.C. and Republican hostility to anything they can label “DEI,” there is no reason to expect any changes any time soon.
And if that wasn’t enough, the maternal health mortality rates have increased by 56% between 2019 and 2022. Still, it is possible these numbers could be completely different. Due to the Maternal Mortality and Morbidity Review Committee not being upfront about the reviewed data.
But here’s the important thing to remember: Black women are still affected more than any other demographic. So, there’s no need (nor the will) for the 89th Texas Legislature to make it a priority.
Institutional racism at its finest. Just like in 2001. If past is prologue, expect the Texas Legislature to get around to “studying” the issue in another decade or so.