New Census Report Signals Need for Change in Health Care Workforce
By Daniel L. Howard, PhD, executive director of the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College. The Center’s mission is to provide leadership in health policy education, research and reform, while improving the health and health care of underserved communities.
On May 17th, the U. S. Census reported a dramatic and historic shift in the nation’s demographics. For the first time, babies born from multicultural groups—African Americans, Hispanics, Asians, and others—comprise the majority of new births in the United States. This trend indicates that the nation will soon transform from a white-majority-dominated population of approximately 85 percent, just a generation ago, to a minority-majority-dominated country.
The population shift also has great implications for the nation’s overall health. The groups that will soon make up the majority of our citizens suffer from significant health care disparities by almost every indicator—access, quality of care and health status.
The New America
In the 1950’s, the U. S. Census reported that whites were roughly 90 percent of the population, while Blacks were 10 percent. In the 1970’s, whites were approximately 84 percent of the population, Blacks 11 percent, and Hispanics 5 percent. By 1990, whites were less than 79 percent and Blacks and Hispanics were 12 percent and 9 percent, respectively.
As of 2011, African Americans, Hispanics, Asians and other minority groups account for 50.4 percent of births, 49.7 percent of all children under five years old and slightly more than half of the 4 million children under one year old. A key reason is that a greater share of the minority population is of child-bearing age. Striking median age differences exist between races; Hispanics (27.6) and whites (42.3) are on either end of this spectrum, while African Americans (30.9) and Asians (33.2) are in between.
Yet, we live in a country where, “African Americans live sicker and die younger than any other group of Americans,” according to noted medical sociologist Thomas LaVeist, PhD, director of the Hopkins Center for Health Disparities Solutions at the Johns Hopkins Bloomberg School of Public Health. And many other diverse groups struggle to obtain needed care and manage a range of chronic health problems—a situation that greatly contributes to national health care costs and underscores the need for health care policies and institutions capable of addressing health disparities.
The Population/Workforce Gap
For decades, a worsening trend has been identified in the morbidity and mortality data on minority groups, while improved health and increased life-expectancy has been reported among the white population. This racial health disparity gap exists because of many historical and social inequalities, such low levels of health care literacy and education, poverty, poor health behaviors and other factors.
In an effort to close the health disparity gap, the National Institutes of Health (NIH) recently investigated the problem and found that one of the key issues is the lack of congruence between the racial composition of the population and the health care workforce trained to treat, study and advocate for all Americans. In a 2011 NIH report, Donna Ginther, PhD, professor of economics at the University of Kansas and lead author wrote, “In order to improve the health outcomes of all Americans, it's important for the biomedical workforce to reflect the diversity of the population. As the population becomes increasingly diverse, we will continue to get further from that goal unless the community intervenes.”
For the last 40 years, for example, African American physicians have been stagnant at only 3.9 percent of the total physician workforce. The same lack of diversity exists among individuals participating in national health policy debates, research and analysis. Racial and ethnic minorities are under-represented in the core disciplines relative to the field of health policy—economics, sociology and political science. African Americans and Hispanics comprise only 8 percent of PhDs in these disciplines. Consequently, whites make up 76 percent of the full-time faculty at educational institutions, compared to 9 percent of African Americans and Hispanics.
Long before the Census Bureau reported the nation’s new demographics, the Robert Wood Johnson Foundation (RWJF) foresaw the need to improve the diversity of the workforce committed to national health policy debates, research and analysis. To this end, the Foundation established a center at Meharry Medical College, the nation’s oldest historically black medical school, to become a national resource for the training of minority scholars in the field of health policy. The center’s mission is to increase African American and Hispanic leaders in the social, behavioral, and health sciences, particularly economics, sociology and political science, who will one day influence health policy at the national level. Health policy analysts are focused on improving both the health of an individual as well as improving how their health care is delivered, how it is paid for and how it is utilized.
Achieving health equity for all populations calls for the dual application of a medical approach and a public health/health policy approach. The medical approach involves treating vulnerable communities, one patient at a time. The public health/health policy approach directs health interventions, strategies and solutions toward vulnerable communities as a whole.
Inevitable societal change, such as the advent of a minority-majority United States population, calls for innovative interventions. As a nation, we must address the imminent growth of health care disparities that can be expected from having historically-disadvantaged populations move from the background to the forefront of demographic significance.