Advancing Equity in Higher Ed, in a Post-Affirmative Action Era

A study identifies strategies for recruiting, retaining, and promoting diverse faculty, staff, and students—and offers recommendations for the way forward.

In the academic health sciences, equity isn’t just a buzzword—it’s one of the keys to unlocking better care for all. Imagine this: a healthcare workforce that reflects the rich tapestry of our society, where doctors, nurses, and other health professionals bring diverse perspectives and experiences to their work. Prioritizing diversity and equity in our academic health programs fosters a future workforce that delivers inclusive, culturally aware, and effective healthcare, leading to better outcomes, especially for those who have been marginalized.

But in the year since the U.S. Supreme Court’s decision banning affirmative action, building more diverse, inclusive college campuses has become much more challenging.

We’ve seen academic institutions grappling with the question of what to do with their diversity programs. Some have scaled back, while others slashed them altogether, fearing legal repercussions. Unfortunately, amidst this turmoil, faculty and staff of color who have poured their hearts into these initiatives find themselves forced to weigh the risks of staying against the toll doing so would take on their wellbeing.

However, efforts to increase diversity, equity, and inclusion on college campuses continue. While mindful of the new legal landscape, many academic institutions—including those dedicated to health sciences—still prioritize student, faculty, and staff diversity.

To us, as women of color in academia, this is a ray of hope in an otherwise turbulent sea. Just last year, Idia decided to leave her position at a prominent university rather than witness the dismantling of her health equity program. Previously, Maggie started as the lone Latina teaching professor at a prestigious medical school, highlighting an ongoing struggle for diversity in esteemed academic settings.

These experiences weigh heavily on our sense of belonging and inclusiveness within academia, even as tenured faculty. We worry about the challenges the next generation of health professionals could face if they do not feel welcomed in their academic homes.

It all begs the question: What can we do to advance equity in the academic health sciences?

A Menu of Strategies for Diversifying the Academic Health Sciences Workforce

Before the U.S. Supreme Court’s ruling, we spent more than a year looking for answers and conducted one of the most comprehensive studies on this issue. Our work revealed strategies for recruiting, retaining, and promoting racially and ethnically diverse faculty, staff, and students. Several studies we reviewed showed that some of these strategies could accomplish impressive results.

Consider embedding anti-racism initiatives, for example. This includes establishing fair hiring practices, holding evidence-based bias training, or expanding the role of race and ethnicity in the educational curriculum. After finding that only 11% of its matriculating students were from underrepresented minorities, the University of California San Francisco Medical Education Department of Pediatrics implemented anti-racism initiatives. By 2021, that percentage had increased to 50%.

Holistic admissions are another promising strategy. Our analysis suggests these policies may be a powerful way to change student recruitment efforts and diversify student bodies. This generally involves de-emphasizing the use of standardized metrics alone, such as MCAT and GRE, and putting more weight on a broader range of criteria that includes applicant experiences, characteristics, and attributes in addition to standardized metrics. In our survey, holistic admissions received the highest percentage of respondents reporting effectiveness. Other strategies that showed potential include institutional partnerships, generating scholar networks, mentorship and sponsorship, and financial support.

We discovered that interventions are more effective when combined with other actions. So, for example, an integrated strategy that includes holistic admissions, financial support, and strong scholar networks might work better than relying on just one of those tactics.

More research is needed to test these strategies to help ensure that racial and ethnic equity moves forward in the many fields of health sciences.

Actionable Recommendations for Advancing Inclusion Within Higher Ed

All of us in the health equity research field are seeing the impact of overturning 40 years of legal precedent. Thankfully, there’s still much that funders, academic institutions, and others can do to ensure that the academic health sciences are as inclusive as possible. Here are five recommendations based on the strategies our study identified:

1. Develop new funding sources that reward diversity, data transparency, and successful student, faculty, and administrative staff recruitment, retention, and promotion. Data collection efforts must be intentional. Academic institutions will require an earnest attempt to do this equity work and funders to support it long-term, not just the typical grant cycle of one to five years. Funders can, for example, create grant programs that require researchers to collect and report data on the sense of belonging and climate at their institution. This way, students, faculty, and others can learn about nuanced outcomes beyond enrollment and graduation.


2. Openly share your findings—even the ones that have negative results. Too few institutions implementing these strategies collect data on the impact of their efforts. Our review found many evaluations of strategies to diversify the students and faculty focused on the short term, with a need for longer-term studies. In addition, we identified only six randomized trials that looked at interventions or policies.
   
   Even when institutions collect data, many don’t publish them unless they have significant and positive results. But we need to learn what doesn’t work, too, or we will keep trying the same strategies repeatedly, to no avail.


3. Develop communities of practice. With research in hand, finding supportive networks willing to implement these strategies in their institutions will be essential. Students, faculty, staff, and administrators should be part of the community and involved in identifying implementation efforts. These community practice groups can help strengthen scholar networks, support and hold leaders accountable. This is also how we achieve systemic change.


4. Use systems that allow for the sharing of knowledge freely and the shifting of power to the public. We suggest developing public-facing searchable dashboards with disaggregated metrics on enrollment, retention, graduation, and racial and ethnic diversity efforts. These strategies allow institutions to share data with current and prospective students and faculty and begin making real-time changes as desired. The University of Cincinnati Academic Health Center and the University of California San Diego Health Sciences have implemented these strategies as part of their diversity initiatives.
   


5. Invest in interventions that increase the potential to achieve profound and lasting change. Change for some institutions could start with adding a health equity curriculum. Some may re-evaluate promotion and tenure policies. Along the way, institutions should incorporate support for retention and promotion, such as mentoring, academic, financial, and mental health support; and career and professional development. We suggest that institutions dedicate a portion of their budgets to these efforts to demonstrate their commitment.
   

Advancing racial and ethnic equity in today’s climate is both possible and necessary. With good data, committed leadership, and sufficient funding, institutions can achieve their goals of being welcoming, diverse higher education places that offer everyone equal opportunities.

About the Authors

Margarita Alegria, PhD is chief of the Disparities Research Unit at the Massachusetts General Hospital and The Mongan Institute, the Harry G. Lehnert, Jr. and Lucille F. Cyr Lehnert Endowed MGH Research Institute chair, and a professor in the Departments of Medicine and Psychiatry at Harvard Medical School.

Idia Binitie Thurston, PhD is a licensed clinical psychologist, professor of health sciences and applied psychology, affiliate professor of Africana Studies, and associate director of the Institute for Health Equity and Social Justice Research at Northeastern University.