New Hampshire is one of the healthiest states in America. So why doesn’t everyone get the memo?

JAMES MCKIM

We’re frequently told we’re one of the safest states, one of the best places to live, one of the most educated states and — perhaps most impressively — one of the healthiest states in the country. Granite Staters wear these rankings like a well-worn fleece jacket: comfortably and with great pride.

And to be fair, the numbers support the bragging rights. We have long life expectancies, low rates of chronic disease and access to some of the best health care systems in the nation.

But here is a statistic that should give us pause: While New Hampshire has the lowest infant mortality rate in the United States, Black infants in New Hampshire are approximately 40% more likely to die before their first birthday than the state average.

That’s the challenge with averages. They tell us how the state is doing, but not necessarily how all Granite Staters are doing.

The average temperature in New Hampshire might be pleasant in June, but that doesn’t mean you won’t find snow on Mount Washington.

Likewise, the average health of New Hampshire residents tells only part of the story. For many Black and Brown residents, the state’s celebrated health outcomes are not showing up with the same consistency.

In other words, New Hampshire may be getting an A in health, but some of its communities are still waiting for the study guide.

The statewide report card has an equity problem

New Hampshire’s overall health rankings look fantastic from 30,000 feet. Unfortunately, people don’t live at 30,000 feet. They live in neighborhoods, communities and health care systems that don’t always provide equal opportunities for health and wellness.

Data from the New Hampshire Department of Health and Human Services show persistent disparities in health care access and outcomes among racial and ethnic groups. While communities of color continue to grow across the state, they often face greater barriers to obtaining preventive care, mental health services and culturally responsive treatment.

Think of it this way: If a restaurant boasts that 99% of customers loved their meal, the remaining 1% still matters, especially if the same groups of people keep getting served cold soup.

Or, to put it another way, New Hampshire’s health rankings are a little like saying the average person in a room is 6 feet tall. If one person is 7 feet tall and another is 5 feet tall, the average may look great, but somebody is still struggling to reach the top shelf.

Motherhood shouldn’t be a high-risk adventure sport

One area where disparities become impossible to ignore is maternal health.

Nationally, Black women are more than three times as likely to die from pregnancy-related causes as white women. Here in New Hamp-shire, maternal health outcomes are generally strong, but racial disparities still exist. According to New Hampshire’s Maternal Mortality Review Committee, Black and African American women represented 12.5% of pregnancy-related deaths reviewed by the state despite accounting for a much smaller percentage of the population.

While the total number of maternal deaths in New Hampshire remains relatively low, the disparity reflects a troubling pattern seen across the country.

Let’s pause for a moment and acknowledge how absurd this is.

We’re capable of performing robotic surgery, replacing hips and carrying tiny computers in our pockets that can instantly tell us the batting average of a Red Sox backup catcher from 1987. Yet we’re still struggling to ensure that every mother receives the same quality of care during pregnancy and childbirth.

That’s not a technology problem; that’s a systems problem.

Chronic disease doesn’t care about rankings

Health inequities don’t stop at child-birth.

Communities of color in New Hamp-shire experience higher rates of chronic disease and face greater barriers to preventive care than white residents. COVID highlighted this disparity. Public health organizations point to factors such as transportation challenges, language barriers, lack of culturally responsive providers, workforce shortages and eco-nomic inequities as contributors to these outcomes.

These are often called the “social determinants of health,” which sounds suspiciously like a term invented specifically to make people’s eyes glaze over during a PowerPoint presentation.

What it actually means is simple: Your health is influenced by much more than what happens in a doctor’s office.

Can you find affordable housing?

Do you have reliable transportation? Is healthy food available nearby? Can you take time off work to see a doctor? Can you find a provider who understands your culture and experiences? These factors influence health outcomes just as much as prescriptions and procedures.

It’s difficult to prioritize preventive health care when you’re trying to decide whether to miss work, lose income or pay the electric bill.

The cost of inequity: spoiler alert — it’s expensive for everyone

Some people hear the phrase “health equity” and assume it’s merely a social issue. It’s actually an economic issue, too.

When people don’t have access to preventive care, they often end up needing more expensive emergency care. When chronic diseases go untreated, health care costs rise. When workers become ill or die prematurely from preventable conditions, businesses lose productivity and families lose income.

Researchers estimate that racial and ethnic health inequities cost the United States more than $420 billion annually through excess medical spending, lost productivity and premature deaths. That’s billion — with a “B.”

New Hampshire may be small, but we don’t receive a discount on those costs. Every preventable hospitalization, unmanaged chronic illness, missed workday and premature death shows up somewhere: in insurance premiums, health care spending, workforce shortages and taxpayer-supported services. Health inequity isn’t just a moral issue. It’s a budget issue.

Imagine discovering that a bridge was slowly crumbling and saying, “Well, fixing it sounds expensive.” Sure. But waiting until it collapses is usually more expensive.

New Hampshire’s health equity champions

Fortunately, there are people and organizations across New Hampshire refusing to accept these disparities as inevitable. The New Hampshire Minority Health Coalition has spent more than three decades working to eliminate health disparities and improve outcomes in underserved communities. Through advocacy, education, community partnerships and data-driven initiatives, the Coalition has become one of the state’s most influential voices for health equity.

The New Hampshire Health & Equity Partnership brings together nonprofits, public agencies, health care providers and community leaders to tackle the root causes of poor health. Their work recognizes a simple truth: Health begins long before someone walks into a doctor’s office.

Housing, transportation, employment, education and economic opportunity all play a role.

The Foundation for Healthy Communities and the NH/VT Bi-State Primary Care Association have also made health equity a statewide priority, helping hospitals and health care systems identify disparities and develop strategies to better serve increasingly diverse populations.

Meanwhile, organizations such as the NAACP, Black Lives Matter New Hampshire and the NH Black Women’s Health Project have elevated issues like Black maternal health, helping ensure that conversations about health care include the voices and experiences of the communities most affected.

Local public health departments are joining the effort as well. The Nashua Division of Public Health and Community Services, for example, has explicitly identified health equity as a community priority and has worked to address the impact of systemic racism on health outcomes.

Together, these organizations are helping New Hampshire move beyond simply being one of the healthiest states and toward becoming one of the healthiest states for everyone.

A healthier New Hampshire benefits everyone

The good news is that improving health equity doesn’t require anyone to lose.

This isn’t a pie. Nobody gets a smaller slice because someone else receives quality prenatal care, preventive screenings or culturally responsive health care.

When disparities decrease, health care costs fall. Workforce participation increases. Families become more stable. Communities become stronger. Everyone benefits.

Which brings us back to those rankings New Hampshire loves so much. Being one of the healthiest states in America is a re-markable achievement. But if we’re going to keep celebrating that title, we should make sure it applies to everyone who calls New Hampshire home.

After all, the goal isn’t to be the healthiest state on average. The goal is to be healthy enough that every resident gets the memo. Or, as we might say in New Hampshire, “Live Free and Die” should never mean “Live Healthy — But Only If You’re Lucky.”