Racial and ethnic minorities receive lower-quality health care than white people–even when insurance status, income, age, and severity of conditions are comparable.1 Black, Indigenous, and/or People of Color [BIPOC] are less likely to be given appropriate cardiac care, to receive kidney dialysis or transplants, and to receive the best treatments [than to white people].2 In a country, where the imaginative truth of freedom and liberty bears fruit, which in reality, the truth falls less than half to that. Racism and disparities are witnesses of what goes on in the United States. These issues stem from the lack of diversity in our government, healthcare, and policy. It is imperative to address the importance of having representation in these systems, specifically in healthcare and policy and how the failure of the U.S to address the lack of diversity within our healthcare has caused health disparities in patient care.
Everyone should be granted a right to fair and equal access to quality healthcare, but nearly one-third of Americans face each day without the security of knowing that medical care is available to them and their families.3 We can always appreciate modern medicine and the great innovation that occurs within our healthcare system, but it is not perfect. The lack of representation in our healthcare contributes to the health disparities in patient care. “Whites make up the majority of the U.S. workforce (64.4 percent) compared to Hispanics (16.1 percent), Blacks or African Americans (11.6 percent), Asians (5.3 percent)…”4 Patients will receive a different quality of care – whether it is intentional or not by their healthcare provider, the reason being linked to socioeconomic inequality. Difference in care amongst each patient is due to their healthcare provider’s lack of ethnic or cultural understanding and relatedness. There are numerous studies that illustrate these differentials. Persons in families who are poor (14.7 percent) are about twice as likely as persons in high-income families (7.2 percent) to be unable to get or delayed in receiving needed medical care.5 Additionally, Blacks receive worse care than Whites for 41% of quality measures; Asians, American Indians and Alaska Natives receive worse care than Whites for about 30% of quality measures.6 Hispanics receive worse than non-Hispanic Whites for 39% of quality measures.”7 There is no one quick-fix solution to these disparities, but what must occur is to increase diversity within the healthcare workforce. It is crucial to create better representation in healthcare as it will deepen inclusivity, acceptance, and sensitivity to patients. Racial patients who have a choice in their physicians are more likely to select those sharing their own race or ethnic background because they feel a stronger personal connection in terms of language and cultural sensitivity.8 In addition, providing access to equal and quality education, regardless of socioeconomic factors, is of the essence. Diversity in education environments improves the quality of education for health professionals, which in turn, improves their ability to treat patients from a wide range of cultural and social backgrounds.9 Possessing variability in healthcare helps the physician and patients to better interact, bond, and disregard their cultural differences and perspective. Increasing the multifariousness of the health care workforce serves as an effective strategy for addressing racial and ethnic health care disparities.10 Furthermore, including better representation will augment: higher levels of quality of care to diverse patients, patient satisfaction, healthcare utilization patterns, and access to care for minority patients.11 Implementing these revisions within healthcare policy is foundational to creating significant achievement in the U.S systems.
In order to relieve the flaws within the system/s, it is vital to get to the root of the problem: the leaders of those systems. The context of the leaders that make policy affects the design, delivery, and dependency of the policies that they set in place.12 The relevance of which policies should be standardized to address the needs of the individuals that are governed by is the subject at hand. It is complex to decide what issues are important at hand, therefore having variegated leaders in these systems will better advocate and address the needs of socioeconomically diverse populations. “In the House and Senate, at least 114 lawmakers are either African American, Asian or Hispanic, meaning that more than 1 in 5 lawmakers in the 116th Congress is a person of color and nearly 8 in 10 are white…about 79% of Congress is white.”13 Delivering diverse leaders to the table is the key to the solution. Allowing socioeconomic representation and competency will widen the perspective of policy makers to then implement developments that better suit the needs of communities and individuals.14 In order to properly set healthcare policies in place, healthcare members [the individual that are under and governed by these policies] should make up a portion of the board, in order to set immigration policies, individuals who are first generation and/or have immigrant parents should make up the board, in order to set agriculture policies in place, farmers and field workers should make up the board. For context, let’s take the example of SUVs. SUVs are the best choice for “family cars” because they contain more seating, better gas mileage, and overall are longer-lasting. The reason why SUVs are a great option for a family is because it addresses the transportation needs of a family. The people who create SUV add new features because they have the “experience” with families [being in a family and a family’s needs]. Now if all the creators of the SUV solely only have experience and knowledge about the needs of racecar drivers, it is probable that their SUV will not suit the needs of the community that generally drive an SUV. Moreover, providing better opportunity, access, and promotion of education to these members is vital. Many of these members are not in these leadership positions because they do not have access to higher education, are afraid to “get involved with politics”, or simply because they are not aware of these issues. In summary, it is vital to have more variable representation in healthcare policy, in order to provide the equitable treatment for all individuals.
I am a third-year pre-medicine student at the University of California, Davis. Over the years, my passion for medicine has grown deeply and I have started to become more aware of the fundamentals of the healthcare system. It is important to understand the policies that govern healthcare workers because it ultimately impacts the quality of patient care. Learning about the flaws within healthcare policy has inspired me to make a change within it. Researching and writing this article has brought up the idea of: What would I do if I was in a leadership position in the U.S Department of Health and Human Service (HHS) to solve these policy issues? For the record, I am nowhere near qualified to state what the “right” way is to tackle these issues, but much of what I would do is within the linings of this article. As a leader and policy maker in the HHS, I would address the lack of diversity, its negative effects on public health and its solution: representation. Secondly, in order to bring future representation in the department I would look for ways to provide better access to opportunity and awareness to the healthcare workers and heavily advocate why becoming active in policy is critical to these individuals. On a more personal level, in order to discuss these issues, such as care differentialities between white and BIPOC patients, is to continually educate myself and others. If you take anything from this article, it is to never stop yourself from continually learning and educating yourself. Doing this, you enrich yourself in diversity and give yourself the opportunity to contribute to society. As Maya Angelou puts it, “We all should know that diversity makes for a rich tapestry, and we must understand that all the threads of the tapestry are equal in value no matter what their color.”
- Matthew, Dayna Bowen. Just Medicine: a Cure for Racial Inequality in American Health Care. New York University Press, 2018.
- “Implicit Bias and Racial Disparities in Health Care.” American Bar Association, www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the-state-of-healthcare-in-the-united-states/racial-disparities-in-health-care/.
- “Healthcare Crisis: The Uninsured.” PBS, Public Broadcasting Service, www.pbs.org/healthcarecrisis/uninsured.html.
- U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis. Sex, Race, and Ethnic Diversity of U.S. Health Occupations (2010-2012), Rockville, Maryland; 2014. https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/diversityushealthoccupations.pdf
- Smedley BD, Stith AY, Nelson AR, (eds). Unequal Treatment Confronting Racial and Ethnic Disparities in Healthcare. Washington DC: Institute of Medicine; 2003.
- “National Healthcare Quality & Disparities Reports.” AHRQ, www.ahrq.gov/research/findings/nhqrdr/index.html.
- “National Healthcare Quality & Disparities Reports.” AHRQ, www.ahrq.gov/research/findings/nhqrdr/index.html.
- Saha, Somnath, et al. “Do Patients Choose Physicians of Their Own Race?” Johns Hopkins University, Project Hope, 1 Jan. 1970, jhu.pure.elsevier.com/en/publications/do-patients-choose-physicians-of-their-own-race-2.
- Health Professionals for Diversity Coalition – The Need for Diversity in the Health Care Workforce http://www.aapcho.org/wp/wp-content/uploads/2012/11/NeedForDiversityHealthCareWorkforce.pdf
- Kington R, Tisnado D, Carlisle DM. Increasing racial and ethnic diversity among physicians: an intervention to address health disparities? In Smedley BD, Stith AY, Colburn L, Evans CH, (eds.). The Right Thing to Do, The Smart Thing to Do: Enhancing Diversity in the Health Professions. Washington, DC: National Academy Press, 2001.
- Institute on Assets and Social Policy. “Improving Quality and Performance: Cultural Competence and Workforce Diversity Strategies”. The Heller School for Social Policy and Management. January 2016.
- Shipan, C. and Volden, C. (2008), ‘The mechanisms of policy diffusion’, American Journal of Political Science 52(4): 840-857.
- Johnwschoen. “These Two Charts Show the Lack of Diversity in the House and Senate.” CNBC, CNBC, 2 June 2020, http://www.cnbc.com/2020/06/02/these-two-graphics-show-the-lack-of-diversity-in-the-house-and-senate.html.
- Cohen, Jordan J., et al. “The Case For Diversity In The Health Care Workforce.” Health Affairs, www.healthaffairs.org/doi/10.1377/hlthaff.21.5.90.
Dylan Ocampo is a junior at the University of California, Davis and also an intern for the APAPA-SOC Chapter. He is interested in medicine and hopes to develop a career as a pediatric cardiac surgeon in the future.