It is a peculiar sensation, this double-consciousness, this sense of always looking at one’s self through the eyes of others, of measuring one’s soul by the tape of a world that looks on in amused contempt and pity. [The American Negro] simply wishes to make it possible for a man to be both a Negro and an American without being cursed and spit upon by his fellows, without having the doors of opportunity closed roughly in his face.”
― W.E.B. DuBois, The Souls of Black Folk
In July 2023, one month after the Supreme Court’s ruling on race in college admissions, we participated in a webinar hosted by AcademyHealth and its organizational affiliate, the Weitzman Institute, to explore the historical context for this recent ruling, and how this decision will impact diversity, inclusion, and representation in the health care and health services research workforce. This piece builds on that conversation by outlining the following key recommendations to maintain diversity and foster inclusion in college admissions and the broader workforce.
Adopt a multi-faceted, intersectional approach that promotes a workforce that looks like and can relate to diverse patient populations
While the recent Supreme Court ruling has potentially grave consequences on equity and inclusion efforts, we argue that Affirmative Action is not the only approach to dismantling historical, structural, normative, and ingrained patterns of discrimination and exclusion. Instead, we recommend the adoption of a multi-faceted, intersectional approach that promotes a workforce that looks like and can relate to diverse populations. The elimination of race being considered in college admission policies should be addressed in the context of other policies including bans on gender-affirming care and threats to reproductive justice, which undermine health equity efforts and progress made to date. Thus, the need for creating a more racially/ethnically diverse health care workforce, including at the executive leadership levels, is interconnected with advocating for other policies that promote the well-being of women, LGBTQ+ populations, immigrants and refugees, persons with disabilities, among other marginalized and minoritized communities. As the great Black, queer, feminist Audre Lorde noted, “There is no hierarchy of oppression. I cannot afford the luxury of fighting one form of oppression only. I cannot afford to believe that freedom from intolerance is the right of only one particular group.” Conversely, it is important to emphasize that Affirmative Action is not the only solution, rather, part of a conglomerate of solutions that are to be supported, as outlined in the subsequent recommendations.
Highlight the importance of active civic engagement
We all have an opportunity to advocate for policies that promote a diverse public health and health care workforce that has demographics, lived experiences, and can relate to a diverse patient population. Engaging in the policy process at the local, state, and federal levels can involve submitting comments during an agency’s rulemaking process, writing letters to congressional offices or to the public via op eds or a letter to the editor, or providing written or oral testimony in support of policies that promote diversity.
Much attention has been given to legislation, especially at the state level, that limits teaching of diversity, equity, and inclusion. Engaging in policy formulation to present evidence about the detriments of these policies and the impacts on cultural competency, knowledge of equity, and harms to future workforces can be highlighted during bill hearings and through engagement with elected officials or school boards, when institutional policies seek to limit training. There is also an opportunity to engage in federal policy processes to advance diversity goals. For example, at the federal level the Faculty Institutional Recruitment for Sustainable Transformation (FIRST) is funded by the NIH Common Fund, whose programs are meant to dramatically affect biomedical research by achieving a set of high-impact goals within a defined time frame, limited to typically ten years maximum. The FIRST program aims to advance inclusive excellence and provides “funds to recruit diverse cohorts of early-stage research faculty and establish inclusive environments to help those faculty succeed.” The funds to support FIRST are determined during the appropriations process. At every stage of the budget discussions, the public can provide valuable input to ensure that programs like FIRST that support a diverse workforce can be sufficiently funded and expanded.
Policy can also be impacted by modifying who is in positions of power. Engaging in the electoral process through voter registration efforts and/or voter access and protection efforts presents another opportunity to change policy. Electing local or state legislators, governors, or judges, or school boards representatives who represent diverse backgrounds, have values that center equity, and have a track record of supporting policies that promote diversity is one additional way to engage in policy.
Advocate for more holistic admission processes, including joining admissions committees, Board of Trustees
We recognize that there is no single race-neutral approach that will ensure a diverse and representative health care workforce. However, as noted in the beginning of this piece, we acknowledge that the recent Supreme Court ruling is not the first time that the consideration of race was banned in college admissions. For example, with the passage of Proposition 209 in late 1996, the University of California was prohibited from using race, ethnicity, national origin, or sex as criteria in admissions decisions. However, UCLA, in line with UC Berkeley’s efforts, implemented a number of initiatives including increased in-person outreaches to high schools with a predominantly Black student body, additional outreach programs for low-income and first-generation students, and holistic admissions policies that take into consideration students’ achievements in the context of their environment and opportunities available to them. As of 2022, the percentage of Black students at UCLA was representative of the state’s population that identifies as Black or African American (6.5 percent). Thus, we recommend greater engagement with academic institutions, including through service on admissions committees and Board of Trustees, to implement similar policies, and doing so in a way that does not inadvertently retraumatize applicants by requiring descriptions of adversities experienced as a means of “proving” their worthiness of admission.
Address educational structural barriers by increasing funding for pathway programs and scholarships that foster increased access by marginalized groups to education, training, and professions, and doing so earlier on e.g., K-12
As founders, leaders, contributors, and as well as beneficiaries of pathway programs and scholarships, we recommend greater investment in these initiatives as part of a larger effort to overcome socioeconomic (e.g., low income/poverty, lack of financing for college and graduate school), education (e.g., less developed networks, lack of mentorship, hidden curriculum propagating bias/racism), and psychosocial (e.g., lack of cultural representation, low expectations of academic ability by others) barriers to health professions education and pursuing a career in health care. Tour for Diversity, Inc., founded by one of our co-authors and conceived by former medical student leaders, seeks to bring premedical enrichment activities to underrepresented minority undergraduate students at campuses across the U.S.
Amongst academic and political circles, there is a nationally recognized need for the diversification of the health professions workforce. The Health Policy Research Scholars program of the Robert Wood Johnson Foundation, and led by Johns Hopkins Bloomberg School of Public Health and directed by one of our co-authors, is a leadership development program for full-time doctoral students who are entering their second year of study and are from populations underrepresented in specific doctoral disciplines and/or historically marginalized populations, and who want to apply their research to advance health and equity and help build a Culture of Health. Moreover, these exemplars mobilize and mentor underrepresented minority students by providing leadership and other technical professional skills (e.g., personal statement writing) to be able to self-advocate and truly represent themselves in their applications as they seek to advance in their health care training. In addition, there is a strong body of evidence emphasizing the need to invest earlier in K-12 career pathway programs that create opportunities for underrepresented minority students to see themselves in the health care field earlier in their development, and understand the paths to get there. For example, the Mini-Nurse Academy introduces elementary school-aged students to careers in nursing with the aim of introducing children to career options early and diversifying the health care workforce.
Protect minority serving institutions and BIPOC faculty across academic institutions
There is a growing amount of evidence pointing to the importance of the country’s minority serving institutions (MSIs) as strong contributors to upward mobility of students of color, those from low-income backgrounds, and students who are the first in their family to attend college. Data from Opportunity Insights at Harvard University (formerly Equality of Opportunity Project), which tracks the 1980‒91 birth cohorts of young adults through 2014 by using student and parent tax records from the Internal Revenue Service, show that MSIs contribute to the upward mobility of their students at rates similar to—and in many cases exceeding that of— their non-MSI counterparts. Moreover, studies have highlighted the role of MSIs in awarding a disproportionate share of degrees to minority students in fields such as education and engineering as well as preparing students for doctoral studies, and providing students with stronger academic experiences and more supportive environments while in college than do non-MSIs. Thus, continued financial public and private investments in MSIs, including towards growing the body of research examining the performance and contributions of MSIs to society, are necessary and warranted.
Similarly, there is also a need to support BIPOC faculty across academic institutions beyond MSIs. “Cultural taxation” is a term coined by Dr. Amado Padilla in 1994 as a way of describing the unique burden placed on BIPOC faculty to show good citizenship towards the Academy by serving its needs for ethnic representation on committees, or to demonstrate knowledge and commitment to a cultural group, which, though it may bring accolades to the institution, is not usually rewarded by the institution on whose behalf the service was performed. Close to 30 years later, our own observations and first-hand experiences continue to resonate with Dr. Padilla’s observations. Therefore, we call on leadership of academic institutions and of professional membership associations and societies to address the invisible labor done by BIPOC faculty and at the very least, reward service efforts revolving around supporting students of color on behalf of the administration with tenure and promotion.
The recommendations we have outlined here underscore the need for transdisciplinary, multisector approaches that aim to counteract the Supreme Court affirmative action ruling, along with centuries of structural inequities and exclusionary policies. We hope you will join us as we continue to roll up our sleeves, have the courage to engage in tough, though necessary conversations, and take action toward creating a more diverse and inclusive workforce.
AcademyHealth is committed to continue promoting diversity in the health services and policy research workforce and to developing new pathway programs through partnerships with MSIs. Learn more about other DEI and health equity initiatives at AcademyHealth here.