May 22 2013
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Equity in Health Care Isn’t Possible Without Equity in Health Professions

Carmen R. Green, MD, is an alumna of the RWJF Health Policy Fellows program. She is the associate vice president and associate dean for health equity and inclusion at the University of Michigan Health System, and a professor of anesthesiology, obstetrics and gynecology, and health management and policy. This is part of a series of posts looking at diversity in the health care workforce.

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More than a decade into the 21st century, Americans still face diminished health and tremendous variations in health care, depending on what they look like, where they come from, where they live, what they earn, and other factors. Significant and persistent variability in clinician decision-making also exists based upon these factors.

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The reasons for these inequities lie in part in disparities in the infrastructure for screening, diagnosing, treating and supporting patients leading to unequal treatment.

In an increasingly aging, female, and diversifying society, it is vital to have a diverse workforce to not only help put patients of varying backgrounds at ease but to provide care that is responsive to their needs and to achieve the best health care outcomes. It may be difficult for underrepresented and vulnerable people to trust the health care system if the employees largely come from the same place and have one perspective. Some of those perceptions actually become realities as biases can negatively affect patients that are marginalized and lower on the socioeconomic totem pole.

Research continues to show disparities in treatment and outcomes for a wide variety of conditions, along racial, ethnic, geographical, educational, and other socioeconomic lines. My own work has focused on differences in pain and pain care, based on race, ethnicity, gender and other factors across the lifespan. It is clear that many Americans carry an unequal burden of pain and other chronic conditions and their pain complaints unfortunately often go unheard.

I also draw from my experiences. I am a military kid. Soldiers and their dependents receive first class health care regardless of race, ethnicity or gender.  Few disparities exist in physician decision-making for those on active duty. There are few concerns about co-pays, deductibles, or premiums. During high school we were transferred and lived in the civilian sector: Flint, MI. Flint was a booming urban city where the automobile industry and those living in the city thrived. More recently, the city was hit hard by the economic downturn and has been plagued by poverty after the automobile industry left. Many Flint residents are now impoverished and their health and educational systems suffer. I contrast Flint with Ann Arbor, the home of the University of Michigan, a more affluent and opportunistic place in many respects, including access to quality health care and education.

Both scholarly and popular literature suggests a staff composed of people with different backgrounds and experiences is more capable of solving complex problems. More specifically, these diverse backgrounds are needed more than ever to create efficiencies, improve outcomes, and to relate to patients in the health care arena.  People with different illnesses and ailments have stories to tell and they need people with a wide variety of experiences and lenses to actively, not passively, listen to a wide variety of stories as we seek to see the humanity within all people. A workforce with just one subset of people may not be able to do so and is unable to relate to the entire spectrum of patients within their health system, potentially creating and exacerbating health care disparities.

"Racial and ethnic minorities are underrepresented in all of the health professions and women—especially women of color—are underrepresented in health care leadership positions."

While many professions have strategically and actively invested in diversity and are more representative of the American population than even a few decades ago, the health professions have struggled and have much further to go. More specifically, racial and ethnic minorities are underrepresented in all of the health professions and women—especially women of color—are underrepresented in health care leadership positions. Access barriers related to the quality of public education, cost of higher education, and faulty infrastructure and leaky pipelines that no longer encourage young people to pursue math and science curricula or choose health careers of all kinds, stand in the way. I believe and know we can do better. More importantly, we must do better if we are to create a diverse and inclusive health care system with equity for all.

So, the process of creating a more diverse health system begins with breaking down those barriers that many young, diverse, and non-traditional people face while trying to make it into and through college. From there, giving students a fair chance at qualifying for advanced medical programs is the next step. After that, integrating and welcoming new health professionals into our medicine, health sciences, and various hospitals and health systems are critical.

One of my first challenges in my new role is to gather and analyze data about the University of Michigan Health System (UMHS) patient population and workforce, to get a fuller picture of how well the institution is doing at creating access and optimal outcomes for those who entrust their clinical care, education, and professional lives to us. If there are inequities we plan to intervene to ensure equity.  We will also assess how well we are creating opportunities for people to train in, enter, advance, and lead in the health sciences, research, and administration at UMHS. We want to promote equity and inclusion across our clinical, education, and research missions for our learners, staff, faculty, and leadership such that we are responsive to an increasingly diversifying, aging, and female society.

Tags: Diversity, Barriers to care: cultural, gender and racial, Health care delivery system, Human Capital, Toward a More Diverse Health Care Workforce, Diversity, Voices from the Field