As a leading professional organization for a field working to improve health and health care for all, AcademyHealth is building on previous work and strengthening our commitment to model, lead, and influence progress toward racial equity. If you attended the 2020 Annual Research Meeting (ARM), you may have heard Dr. Lisa Simpson’s call to action or seen the many ways the impact of systemic racism were addressed by speakers in plenary and breakout sessions.
Our commitment to racial equity goes well beyond the ARM. After several years of working to diversify the health services research (HSR) workforce and build a community through networking and mentoring, we want and need to do much more to accelerate systemic change.
To that end, AcademyHealth is working with our Board of Directors and other outside advisors to shape a sustainable, action-oriented strategy to address diversity, equity and inclusion, starting with a focus on health equity and racial justice – including the ways our organization and field need to change, at all levels. These efforts start with a self-assessment process, recognizing our multiple roles as an employer, a convener, an influencer and a thought leader, and will expand to include our relationships with our members, partners, stakeholders, the field, and the larger research community, including funders.
Building on Previous Work
In September 2015, AcademyHealth’s Center on Diversity, Inclusion, and Minority Engagement (DIME) released five recommendations that have served as the AcademyHealth roadmap for our activities since that time:
- Make a public commitment to diversity
- Communicate clearly about the commitment
- Promote accountability through data collection and reporting
- Learn from and promote best practices
- Focus on the diversifying the pipeline of future health services researchers
Despite the goal of diversifying the workforce, Black, Latinx, and American Indian researchers are still under-represented in the field. Several studies, most recently the Wellcome Trust study on research culture, have identified hostile environments for women and BIPOC (Black, Indigenous, and People of Color) as a barrier in retaining diverse and marginalized members of the research enterprise.
In the fall of 2019, three student members of the AcademyHealth Disparities Interest Group, Taylor Rogers, Tongtan (Bert) Chantarat, and Carmen Mitchell proposed to conduct a study on the professional culture of diversity and inclusion within HSR. The students, Dr. Ninez Ponce, Professor at the UCLA Fielding School of Public Health and ARM 2020 Program Chair; Dr. Michelle Ko, Assistant Professor at University of California—Davis approached AcademyHealth to help distribute an online survey during this year’s ARM. The students will be following up with online focus groups to generate information to add detail and context to the survey data. The research team is working independently from AcademyHealth and will share preliminary analytic findings from the Workplace Culture Survey in early 2021.
The shared experience at the 2020 ARM highlighted that we are experiencing the stark effects of a dual pandemic – that of COVID-19, with its devastating and disproportionate impact on BIPOC – the consequence of ongoing structural and systemic racism in every domain of life. From health, housing, education, and employment to police violence, the racial wealth gap, and the impact of climate change, racial inequities are deeply embedded in U.S. institutions and culture. The window of opportunity is open, but an incremental approach will not lead to the deep structural changes that are needed. We need a new vision and a new roadmap.
Assessing Ourselves
AcademyHealth’s new strategic plan explicitly names diversity and inclusion as a core value. We are integrating this value into all of our programmatic activities, policies, and procedures.
A recent staff survey showed a strong interest in engaging in training and discussions about diversity, equity, and inclusion (DEI). So, beginning this month, we’ve scheduled a series of sessions with outside facilitators to discuss social, gender, and racial identity; implicit bias; and related issues.
We will start by looking at ourselves as individuals, to increase awareness of our own personal assumptions, values, biases, and identities as they relate to the organization’s diversity and inclusion efforts. We’re also examining and updating our hiring and retention policies. The self-assessment approach is foundational to our work as a mission-driven organization and will provide insights about the ways we interact with our members and partners, and about our role in the larger fields of HSR and public health.
Working with Our Members and Partners
AcademyHealth works with many people and organizations to accomplish our mission. To ensure that our partners represent the diverse perspectives and needs of the field, we will conduct an audit to assess the diversity represented across all these groups – from our Board of Directors to the vendors we work with. We will be adjusting our policies and nominating criteria to reduce structural barriers and engage more diverse voices on our advisory councils, interest group leadership, conference and program committees, abstract reviewers and others. As we make these changes, we will publish our updated policies and processes on our website for transparency.
Our members and partners in academia have highlighted courses on structural racism now being offered in public health, medical and nursing school curricula along with courses on health equity, intersectionality, and social determinants of health. We are working with members of our advisory councils, training program directors, and others to collect and share course descriptions and syllabi for courses on social determinants, health equity, structural racism, and related topics. We believe sharing these types of resources will help advance a racial equity agenda in HSR and help address the individual and cultural biases leading to a lack of diversity particularly among those developing the research, conducting it, and funding it.
Because mentorship can be such a powerful tool for career advancement, we’ll be working with our interest groups and others to strengthen and expand our existing mentorship and networking opportunities. These will include mentor matching, peer-to-peer mentoring opportunities, listening sessions, and other ways to scale up our current activities and build the community.
Facilitating Changes in the Field
The field is already changing. More published articles on structural racism are appearing in HSR, NEJM, Health Affairs, and other mainstream journals, including landmark pieces authored by some of our members. The newer voices in HSR and public health call for structural racism to be addressed explicitly. This includes a range of activities, from referencing the published work of BIPOC researchers and developing new methods to reduce structural bias in data collection and analytic methods, to re-evaluating promotion and tenure discussions, grant review criteria, IRB approvals, and other legacy cultural mechanisms that fail to recognize and value diversity.
The AcademyHealth councils will be working on strategies to promote an equity perspective throughout the research process, including around reducing bias in the use of data and analytics. Output from this work will inform new AcademyHealth offerings in the form of education, training and publications – all aimed at disseminating these emerging best practices to explicitly address structural racism.
To help evaluate priorities under the new strategic plan and provide continuity and feedback across all of these activities, AcademyHealth will also invite a group of experts to convene over the next eight months as the Advisory Group on Diversity, Equity and Inclusion (DEI) in HSR. The purpose of this group will be to provide strategic insights on how to develop continuity across our DEI activities, using an equity lens to help us define, facilitate, and measure meaningful change based on successful experiences and best practices.
Consistent with our culture of generating and applying evidence, and using what we learn from the new survey data on workplace culture, we anticipate that this process will lead to new reporting tools and accountability systems, increased transparency, and opportunities to engage with partners to co-develop a pathway toward a more equitable field.
Our field’s narratives are about generating and using the best evidence to impact policy and practice. There’s more than enough evidence to see the magnitude of injustices throughout our society. The challenge for a field that sees itself as impartial and unbiased is how to act to confront the reality of systemic, embedded racism as well as other forms of discrimination and challenge our assumptions about exclusion and inclusion, and the very idea of “unbiased” science.
Over the coming months, we’ll be engaging with individuals from other fields that have undergone transitions to address DEI, and in particular, structural bias and racism. In so doing, we will become part of a much larger community that is working on challenging assumptions about exclusion, inclusion, and equity. We will provide regular updates on how you can get involved in this work and look forward to engaging with you to advance this important work.