Harvard and the University of North Carolina at Chapel Hill are among the higher ed institutions involved in a U.S. Supreme Court battle over affirmative action that is expected to be decided this spring or summer. As a former appellate defender in the Gratz v. Bollinger affirmative action case in 1993, as well as an emergency medicine physician serving under-insured patients, I know firsthand how affirmative action can affect health equity and social justice.
White women are affirmative action’s largest beneficiaries and have been since the 1960s when conservatives attempted to change the affirmative action narrative. Even after President Lyndon Johnson passed Executive Order 11246 to improve equal employment opportunity, white women remain the top beneficiaries of affirmative action—and its greatest opposition.
Affirmative action remains a hot-button issue, despite the fact that Black and Latino students at the nation’s top universities are more underrepresented today than they were thirty-five years ago. At Harvard, for example, 43 percent of white students are legacies, athletes or related to donors or employees.
Centuries of racism in this country have resulted in unequal access to education, a social determinant of health. Yet private and public colleges and universities are still under scrutiny for using race as one of the many complex variables in the college admissions process. Education opens doors to employment in many fields, but especially highly specialized ones in medicine and health care. Diversity among physicians and health care professionals leads to improved care and financial outcomes across the board. In effect, outlawing affirmative action threatens the health of all Americans.
For too many patients, a diverse health care system may mean the difference between life and death. Without more diversity, patients may be on the receiving end of bias, such as when doctors mislabel some pain patients as “drug seekers,” or brush off a woman’s chest pain as anxiety.
Diversity is about far more than offering soul food in the college cafeteria for Black History Month. Higher education institutions and medical organizations should make meaningful investments into outreach, recruitment and mentoring programs for students and faculty who are underrepresented in medicine. Criterion for board promotions, especially in majority-white boardrooms, should also be reassessed from a lens of diversity, equity, and inclusion. This is of particular importance as states such as Florida and Iowa are cracking down on diversity, equity, and inclusion initiatives in education.
Private and public institutions’ job is to ensure that it remains a tool for expanding access to education and health care. People of all races thrive in diverse health care environments, and improved health for marginalized patients benefits everyone. This is how affirmative action lays the foundation for health equity and social justice in medicine.