Breaking Barriers in Health Equity: The Vital Need for Increased Representation in Health Care Professions

The United States has become increasingly more diverse over time, with individuals who identify as persons of color; Black, Latino, and Asian American and Pacific Islander (AAPI) making up 43.6% of the current U.S. population.¹ However, our Nation’s diversity is not reflected in the 14.8-million-member health care workforce, where more than half of the workforce is white, and employees of color, especially women, are disproportionately concentrated in the lowest-earning positions.² Individuals and communities who mistrust our health care system are less likely to divulge private health information to a provider who does not share their identity.

Structural racism, institutional mistrust and lack of accessibility to care influence health, with alarming evidence showing racial and ethnic minorities face “higher rates of illness and death across a wide range of health conditions, including diabetes, hypertension, obesity, asthma, and heart disease, when compared to their White counterparts.”³ This seemingly insurmountable issue is affecting millions of individuals, so what can be done? Increasing diversity in health care professions is one huge piece of the puzzle needed to decrease health inequities and improve the overall health of all individuals, especially people of color, living in the United States.

Where do we go from here?

The barriers people of color experience before entering the health care workforce are often experienced early in the classroom. There are notably less opportunities and resources within schools located in low-income and minoritized neighborhoods, limiting students’ exposure to quality education and related work opportunities such as math and science focused career paths.

But wait, there is some good news! Medical schools are developing strategies to increase diversity in medicine. New programs to provide middle and high school students from minority, low-income and rural communities with academic support and professional development are hoping to build a more diverse health care workforce. Many of these programs are designed to incorporate mentoring between high school students and medical school students, which can help them envision careers in medicine. One study proved that medical students of color chose to go into health care because they saw people who looked like them working in the field.⁴

Representation and diversity in nursing creates more opportunities for higher quality care. There are programs being implemented to expose high school and middle school students to the nursing field.⁵ For some students with limited exposure to nurses, these career endeavors seem unattainable. The American Association of Colleges of Nursing has made steps towards enhancing diversity, equity and inclusion within programs. They designed a network, the Diversity, Equity, and Inclusion Leadership Network (DEILN) where nursing schools can advance inclusivity in academia.⁶ This includes addressing the social drivers of health and structural racism. Enhancing diversity and inclusion has positive impacts on the delivery of care and patient outcomes. Patients are more likely to adhere to nurses’ health recommendations when trust and respect are built.⁷

Advanced practice providers such as nurse practitioners, physician assistants, licensed therapists, midwives or social workers have important roles within the care team. Allowing licensed providers to practice within their scope of expertise creates more opportunities to reach rural and low-income communities.

It is no secret that medical school is a financial strain, and unfortunately that strain begins before students even get to class. Fees for application and standardized test cost students hundreds of dollars. This looming expense of higher education turns away intelligent and talented low-income students from pursuing medical school.

Minimizing salary gaps within health professions can incentivize individuals with minority identities to go into primary care, and addressing loan repayments can aid in addressing the discrepancies of diversity in the workforce. Fortunately, there are several government initiatives to decrease loan debt for low-income and minority students.⁹ Some loan repayment programs focus on military persons and pediatric providers, which can help alleviate some financial stress.

While primary care physicians (PCPs) offer continuous care, Black Americans are still more likely to use emergency departments instead.⁹ Lack of insurance coverage and perceived quality of care influence the decision to visit emergency services instead of PCPs.¹⁰ The life expectancy rates of Black people have been shown to improve through the representation of Black PCPs.¹¹ One individual describes their experience having a physician who looks like them. They explained, “I feel like it is important. You feel so comfortable, solid, and safe, and I feel like you’d build a relationship with that person…a rapport with them.”¹² Nurturing diversity among PCPs allows more patients with diverse cultural backgrounds to be reached.

By making diversity and cultural responsiveness in the health care workforce a priority, it can help strengthen positive health outcomes. Representation in health care allows individuals to envision themselves in the health care workforce, and diversity and cultural responsiveness can improve patient-physician relationships. Exposure to changes and injustices within the health care system is the first step to fighting for real change. Are you passionate about being a part of these solutions? Join the Health Justice Now Network to collaborate with health advocates today!

Footnotes:
^1. https://www.healthcaredive.com/news/black-women-disproportionately-concentrated-low-wage-hazardous-health-jobs/618471/
^2. https://www.aamc.org/data-reports/workforce/data/figure-18-percentage-all-active-physicians- race/ethnicity-2018
^3. https://www.cdc.gov/minorityhealth/racism-disparities/index.html
^4. https://www.liebertpub.com/doi/pdf/10.1089/heq.2020.0060
^5. https://nursing.jnj.com/nursing-news-events/nurses-leading-innovation/connecting-with-communities-to-inspire-the-next-generation-of-nurses
^6. https://www.aacnnursing.org/leadership-networks
^7. https://www.aacnnursing.org/news-data/fact-sheets/enhancing-diversity-in-the-nursing-workforce
^8. https://www.aafp.org/students-residents/medical-students/begin-your-medical-education/debt-management/funding-options/forgiveness.html
^9. 10.1007/s11524-016-0054-9
^10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3556949/
^11. doi:10.1001/jamanetworkopen.2023.6687
^12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9640880/