As clinicians and public health workers, we’ve seen how diversity of lived experiences and identities on our teams can help us better serve communities, improve patient care and create a more equitable health system. The data agree that health workforce diversity matters: Students studying medicine and health care are more likely to practice in their representative communities, which leads to better health outcomes for their patients. Meanwhile, research shows that “a racially diverse medical workforce results in improved self-reported patient experiences” (Essien, September 2023).
This is critical information to keep in mind when considering the ongoing health disparities between Black and brown communities and their White counterparts — underscoring a glaring story of inequitable access to quality care that negatively impacts not just individuals and families but entire generations. Protecting pathways to medical education for students from these communities is vital.
New Challenges to Health Workforce Diversity
Even with affirmative action policies in place, U.S. medical professions have long struggled to improve diversity. Now, the challenge has increased. In June 2023, the Supreme Court held that race-based affirmative action in college admissions violated the Fourteenth Amendment, halting decades of diversification in higher education.
The downstream impacts of this ruling on health and public health are significant. Although some critics may label affirmative action an antiquated approach to equity, the numbers are indisputable. In 1965, 4.9% of traditional college students identified as Black. In 1990, this number more than doubled to 11.3% (National Archives).
In this new legal landscape, with affirmative action severely undermined, health care leaders have a responsibility to champion bold efforts that move our professions closer to equity. It’s not just the right thing to do — it would also improve our patient outcomes and pandemic response.
Unfortunately, many of the inequities that already existed in our health system were exacerbated during COVID-19. Between 2017 and 2021, nearly half of all public health workers left their jobs (Leider, March 2023). Physician shortages were also on the rise, particularly in areas with low socioeconomic mobility that are home to a disproportionate number of Black and brown families (Taylor, December 2019). These factors contributed to lower COVID-19 testing and limited access to vaccines and treatments — failures that were exacerbated by longstanding social and structural determinants of health and swirling misinformation (Lee, August 2022; Boehmer, October 2022).
As we move out of the crisis phase of the pandemic, research continues to show pervasive distrust among Black and brown patients, rooted in a well-documented history of medical mistreatment. These patients often do not feel seen or heard. They often do not feel their concerns are taken seriously. And they often experience worse health outcomes, compounded by barriers to quality care.
Health Workforce Diversity = Pandemic Preparedness
The future of health and public health is dependent on educational pathways for people who represent the communities they serve. These cannot be superficial by design and implementation. They must be intentional, sustainable and supported by a society that relies on their training.
As Black and brown communities continue to experience disproportionate impacts from COVID-19, the dismantling of affirmative action creates a void for leadership across health and public health to fill. Building a more diverse health care workforce must be a high-priority component of any preparedness planning and long-term patient care.
Being successful in this work will require putting equity and inclusion at the core. New educational pathways must be created and sustained. Hiring and retention of diverse candidates must be prioritized. And, as always, thriving individuals and healthy communities must be our shared goal.