Tensions around diversity, equity, inclusion, and accessibility (DEIA) initiatives in health services research (HSR) institutions and the broader field have grown in recent years. Institutional and government challenges to DEIA work abound, such as a changing political climate affecting use of terms like “equity” and legal challenges leading to dismantling of DEIA programs.
Over the last year, AcademyHealth hosted a pilot community of practice for DEIA leaders in HSR organizations, culminating in a discussion at the 2024 Annual Research Meeting (ARM) about the consequences of the rapidly evolving DEIA landscape. 75 percent of the ARM session audience shared via anonymous poll that their DEIA or health equity work has been affected.
Ripple Effects of the Uncertain DEIA Terrain
As research institutions, teams, researchers, and DEIA practitioners/leaders, we have felt and observed the consequences of this shifting climate, including:
- Potential impacts on career trajectories. Leaders have lost positions and programs have shuttered.
- Considerable pressure on organizational statements. Institutional leadership may struggle to decide when to make public (or internal) statements regarding global or political events that affect the day-to-day lives of their staff, what such messages entail, and the mode of delivery. As a result, organizations sometimes stay silent or delay their response–which are statements in their own right.
- Rapidly changing use of language. In some ways, DEIA work has gone “underground,” where less descriptive language serves as a compromise while the work itself continues apace. It continues to be difficult for DEIA professionals to identify potentially divisive language and the terms that will encourage continued conversations. Some DEIA councils or work groups have been rebranded as workplace culture efforts or professional development. However, some institutions have maintained their vocal commitments to DEIA and continue to push for progress.
- Data collection is more essential than ever. Although sometimes challenging, data collection is important to inform our institutions’ understanding of how to mitigate inequities. Additionally, because addressing upstream factors such as social determinants of health is necessary to advance population health, data analysis and interpretation ought to be actionable and relevant for provider or health system decision-making.
- Increasingly isolating nature of DEIA work. Due to an increasingly tense climate, those passionate about advancing equity—particularly early-career professionals entering the workforce—learn quickly who shares their commitment. Career choices soon present themselves between staying in their roles to advocate for change, accepting an employer’s lack of commitment and finding community outside of one’s job, finding a new role, or leaving the field altogether.
Reflections on Researchers’, Leaders’, and Institutions’ DEIA Commitments
When asked what actions they have taken in response to this divisive environment, 10 percent of the ARM session audience indicated they had changed their research or project plans, and half of the audience had changed the language they used to describe their work. At the same time, 40 percent of poll respondents shared that they have provided support, guidance, or mentorship to a colleague struggling with new barriers to their work, and two-thirds have advocated for their institutions to stay true to their DEIA commitments. Only five percent of the group reported having direct conversations with funding partners, which may be a missed opportunity, as many funders are also facing pressures to pull back but have reinforced their DEIA support.
The ARM session concluded with a discussion of how we facilitate respectful conversations in HSR about divisive topics. Participants shared how they are championing DEIA in their institutions and several themes emerged:
- Active Listening: An important initial step when having conversations about contentious topics.
- Role Modeling: Modeling how to have difficult conversations in the workplace and dedicating time to educate staff on how to have these conversations.
- Finding Common Ground: The need for humanity, understanding, and openness. Participants highlighted the importance of building relationships outside of controversial topics and identifying shared values as a touchstone.
- Addressing Resistance to DEIA: Fostering conversations with trusted partners, including funders, to reinforce our commitments and lend support to their decision-making under pressure. Some organizations have shied away from making statements or have not fully addressed difficult DEIA-related topics, which can be interpreted as a lack of engagement. Institutional systems and structures can clarify expectations for respect and tolerance and guide decisions about statements to make and actions to take.
- Taking Action: Leaders can commit to creating an environment in which their staff feel supported and safe. One respondent noted the “need to remain hopeful and active. Everyone can do something, even if it’s a small step.”
- Tools, Resources, and Education: DEIA champions should stay up to date and aware of DEIA-related events that can affect colleagues.
A Call to Action for DEIA Champions
The ARM discussion demonstrated what we have observed over the last year: many in the HSR community are actively advocating for their institutions to stay true to their stated DEIA commitments. We can contribute to advancing a more inclusive, equitable research field in various ways, such as:
- Identifying and unapologetically staying true to our values;
- Determining where our voice and perspective is valued;
- Pivoting when necessary to prevent burnout;
- Finding spaces to build or join community where we can learn from each other and navigate shared challenges; and
- Finding our people who can help us move DEIA initiatives forward, leveraging connections and cross-amplifying efforts for maximum impact.
We encourage HSR leaders to leverage AcademyHealth resources to assist in advancing DEIA:
- Practical toolkits and roadmaps, such as guidance on advancing racial equity through research and other tools available via the Equity and Innovation Resource Hub
- Reading for self-paced education. Over the past year, we’ve been reading:
- We Can’t Talk About That at Work! by Mary Frances-Winters
- Data-Driven DEI by Randal Pinkett
- Say The Right Thing. How to Talk About Identity, Diversity, and Justice by Kenji Yoshino and David Glasgow
- Reconstructing DEI. A Practitioner’s Workbook by Lily Zheng
- Finding community, such as the DEIA Community of Practice (sign up for more information) and AcademyHealth’s Health Equity Interest Group.