DIVERSITY AND INCLUSION: WHY THEY MATTER


Diversity and inclusion in the health professions is not a choice moving forward – it is our obligation.

Janelle M. Chiasera, PhD
Region III Director, Chair and Professor
School of Health Professions
The University of Alabama at Birmingham


 

The US census projects that by 2050 the US will look very different from the country that existed just a decade ago. The Hispanic and Asian populations will both triple, the black population will almost double and the white population will decline. By the middle of the 21 century, the US will no longer have a clear majority race. Even today, thirty percent of the US population is nonwhite and that percentage is projected to grow to 50% by 2050. The US, no doubt, will be reshaped and reenergized by racial and ethnic diversity. (See Figure 1 on page 5 for maps representing the increasing diversity from 1960 to 2010 to the projections in 2050.)

Diversity has historically been used in a legal context as being mandated by discrimination and harassment laws and has been used to refer to protected classes such as gender, race, and religion. However, diversity is a much more encompassing term. Diversity is used to describe individual and group/social differences including race, personality, socio-economic status, class, gender, and sexual orientation, country of origin, ability, as well as cultural, political, religious and other affiliations. In addition to what you can see (visible diversity), it also includes diversity of thought. In this sense, diversity can be seen as a mix of different types of people. The term inclusion, on the other hand, is a more active term. Inclusion is a term used to describe the active, intentional, and ongoing engagement with diversity in such a way that the uniqueness of beliefs, backgrounds, talents, and ways of living are welcomed and leveraged.

I realize that merely recognizing demographic trends and defining terms does not establish a case for why diversity and inclusion matter. However, I do know that as the US becomes more ethnically and racially diverse, there is a greater need for healthcare systems and healthcare providers who can reflect and respond to an increasingly diverse population. Knowing how to serve people with different values, health beliefs, and alternative perspectives about health and wellness is of critical importance in our country. Sadly, despite the demographic changes we are experiencing, the representation of diverse groups (e.g., African Americans, Hispanics, and Native Americans) within health professions is far below their representation in the general population. Recently, the Association of American Medical Colleges (AAMC), the American Medical Association (AMA) and the Institute of Medicine (IOM) all supported the explicit goal of achieving a health care workforce that reflects the diversity of the US population. The IOM report, In the Nation’s Compelling Interest: Ensuring Diversity in the Health-Care Workforce, stated that increasing racial and ethnic diversity among health professionals is important because evidence indicates that diversity is associated with improved access to care for racial and ethnic minorities, greater choice and satisfaction of those serviced, and a better educational experience for health professions students, among many other benefits. From a workforce perspective, there are at least four good reasons why diversity is critical for healthcare moving forward: 1) to establish cultural competence, 2) to increase access to high quality health care, 3) to strengthen the medical research agenda, and 4) to ensure optimal management of the healthcare system.

The first, cultural competence refers to the knowledge, skills, attitudes, and behaviors required to provide the best healthcare to people from a wide variety of backgrounds. Given the striking demographic changes mentioned previously, there is no doubt that the majority of our current and future healthcare professionals will be required to provide care to people with backgrounds different from their own. To provide care effectively in the future will require professionals who are mindful of the potential impact of language barriers, religious taboos, unconventional explanatory models of disease, and alternate remedies on the effective treatment and management of diseases. There is empirical evidence supporting that racial diversity and student involvement in activities related to diversity directly affected their learning and the way those students conducted themselves later in life; they even disrupted prevailing patterns of racial separation.

Second, access to high quality health care services remains a major problem within minority populations. Even when members of minority groups manage to receive care, they are more likely to receive lower quality care, even when insurance status and income are controlled. There is data that exists that documents that health care providers from minority backgrounds are much more likely than white providers to practice in underserved communities and to treat larger numbers of minority patients, irrespective of income. Additionally, healthcare providers who reflect the racial and ethnic backgrounds of the people they serve are much more likely to provide care that results in greater patient satisfaction.

A third reason for the importance of diversity in the health professions is to broaden and strengthen the US health research agenda. The US continues to be burdened by unsolved health problems and many of these unsolved problems affect minority populations. Being able to conceptualize these problems and find solutions to these problems will require a research workforce that is more racially and ethnically diverse. Creating that workforce starts with education programs assuring a diverse student body – and faculty – within health professions programs.

Finally, providing healthcare services to an increasingly diverse population is likely to pose significant management challenges for provider organizations and local, state, and national governments. As is the case for most organizations, seeking leadership from a richly diverse talent pool will have a substantial influence on the future of healthcare policy for all US citizens. We should strive to augment the pool of trained executives and public policymakers available to assume management roles in the system and contribute to governmental efforts as this would help ensure that strategic decisions about matters such as resource allocation and program design are tailored to the needs of a diverse society.

Diversity and inclusion in the health professions is not a choice moving forward – it is our obligation.

 

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