Americans, unlike people in other industrialized nations, are uncomfortable with the concept of social class. We like to believe we live in a land of equal opportunity.

However, race and ethnicity have always served as proxies for social class when measuring U.S. population disparities. Blacks and most Hispanics lag behind whites and most Asians in social determinants of well-being, including education, income and health.

Gender adds another level of disparity on many fronts, including health. Granted, U.S. men lead less healthy lives and pay the price by dying on average five years earlier than women. Men are more likely to smoke, drink excessively, be overweight have heart disease and practice poor dietary habits.

There are clear differences in how men and women use the healthcare system. Women make up 60 percent of hospital admissions because they have more chronic conditions and specific reproductive health issues.

That is why they are charged as much as 50 percent more when they attempt to buy individual health insurance policies, even though Texas women earn 64 cents for every dollar earned by white Texas men.

Women are less likely to be employed full-time (52 versus 73 percent of men), making them ineligible for employer-based benefits. They are more likely to delay or avoid care (52 versus 39 percent of men). About one-third report having to give up basic necessities, use up savings or go into debt to pay medical bills.

A recent Kaiser Family Foundation report examined women’s health by state and by race and ethnicity. It was not surprising that minority women fare more poorly on most measures in every state. But it was also revealing to compare women by state of residence, controlling for race and ethnicity.

Highlighting the disadvantages of minority women is especially important in Texas because racial and ethnic groups will increasingly dominate the state’s health profile. According to Texas state demographer Karl Eschbach, Hispanics will make up as much as 59 percent of the state’s population by 2040.

Nationally, white women overall had the best health outcomes, but they smoked more often than their minority counterparts, had higher cancer death rates and suffered more serious psychological distress. Black women had the highest health screening rates but were disproportionately more likely to be obese and have chronic health problems. Hispanic women are less likely to be insured and more likely to be poor and less educated. Low racial and ethnic disparities in a given state generally meant that white women were not faring comparatively well, not that minority women were thriving.

The study shined a spotlight on the state’s socioeconomic burdens and their effects. The state’s low rankings feed off one another other, reflecting the results of poverty, especially among Hispanics.

Texas women have the highest uninsured rate. Almost 28 percent lack health insurance compared with less than 18 percent nationally. The uninsured rate for Hispanic women exceeds 45 percent.

Texas women have the highest percentage of failure to graduate from high school. About 40 percent of Hispanics did not graduate, including 60 percent of the foreign-born, according to the Pew Hispanic Center. About one-third of Texas Hispanics were not born in the United States. According to Kim Waller, associate professor of epidemiology at the University of Texas School of Public Health, Mexican-born women often have less than an eighth-grade education.

Of all socioeconomic factors, education attainment has the most direct link to health. High school graduates earn twice as much as those without a diploma. Nearly 75 percent of those without a high school education have basic or below-basic health literacy, which means they cannot understand a prescription label.

Texas women ranked last on health services and utilization. This was a corollary to the lack of insurance. They had the worst two-year dental checkup rates, were second in the nation on having no personal doctor and led the nation on forgoing doctor visits because of cost. The state’s white women scored better than minorities on these measures but significantly lagged behind their counterparts in other states.

Texas women were among the poorest in the nation. More than 1 in 5 was at or below the federal poverty level of $19,350 for a family of four in 2005, ranking fifth-lowest in the nation.

Texas white and minority women were more obese and had more diabetes and cardiovascular disease — all of which are interrelated conditions — and the results reflected the typical profile of Southern states. The state’s Asian population ranked lowest in self-rated health compared to Asians in other states. Waller said Vietnamese, the second-largest immigrant group in Texas, and other Southeast Asians have comparatively poor health outcomes.

Kathryn Cardarelli, assistant professor of epidemiology at the University of North Texas Health Science Center and director of the university’s Center for Community Health, said the report is more evidence that Texas’ government "continues not to put a priority on health."

Until it does — or in the unlikely event that the federal government implements transformational health reform — the demographic trends will not bode well for Texas women.