by Venoncia M. Baté-Ambrus, PhD, MS, MA
As I continue my journey to engage new stakeholders throughout northern Lake County, and the surrounding areas, I have accepted multiple invitations to address health inequities in the northern suburbs. I was particularly honored to speak about the social determinants of health in events honoring the legacy of Rev. Dr. Martin Luther King Jr. These events include serving as the keynote speaker for the 13th Annual MLK Interfaith Breakfast in Crystal Lake, a reader for Voices United, A Celebration of MLK Jr. Reading Event at McCall School in Waukegan, and an impromptu panelist at Supporting People and Strengthening Communities: A Tribute to Dick Hutson in Lake Forest. In preparing for these events, I was reminded of MLK’s famous quote, “Of all the forms of inequality, injustice in healthcare is the most shocking and inhuman.”
As I dig deeper to reflect upon the root causes of injustice in healthcare, systemic, institutional, and interpersonal racism rises to the fore, causing me to consider representation as one of many important strategies to dismantle racism and injustice in healthcare. While this discussion is topical for Black History Month, it is one that needs to occur in conjunction with action to diversify the healthcare workforce twelve months of the year until health equity and parity in workforce representation is a reality rather than a lofty goal.
Ponder this: What do Mary Eliza Mahoney, James McCune Smith, Otis Boykin, Solomon Carter Fuller, E. Kitch Childs, Thyra J. Edwards, Mary Beatrice Davison Kenner, George F. Grant, Daniel Hale Williams, and Mae Jemison have in common? If you do not immediately know the answer, you are not alone. The answer is that they are all pioneers in their respective disciplines in research, medicine, psychology, social work, dentistry, and allied fields. Their accomplishments have changed the face (pun intended) of health, human services, research, advocacy, and education.
Why is this knowledge important?
Quite frankly, if you cannot see your face, language, culture, and community represented among those who educate you, those you learn about, and those who provide your health and human services, it is exceedingly difficult to imagine yourself becoming one of those professionals. Therefore, representation matters!
According to Sex, Race and Ethnic Diversity of U.S. Health Occupations (2011-2015) African Americans or Blacks are underrepresented in several healthcare professions, comprising 4.8 % of Physicians, 4.9% of Psychologists, 3.0% of Dentists, 5.9% of Pharmacists, 1.8% of Optometrists, 10.4% of Registered Nurses, 4.4% of Occupational and Physical Therapists, and 6.3% or EMTs and Paramedics. Similar findings from a 2021 JAMA Open Network article stated, “Compared with the representation of Black individuals in the current health care workforce, the representation of recent Black graduates was lower for 5 of the ten occupations included” in the study. These findings have serious implications for the current and future status of the healthcare workforce. This lack of diversity in healthcare professions profoundly and deleteriously impacts health outcomes, particularly those associated with communities of color.
However, diversity benefits not only patients but also organizations as well according to a 2023 article in Circulation: Cardiovascular Quality and Outcomes, which reports that “data show that organizations with inclusive cultures are more likely to meet or exceed financial targets, improve performance, innovate, demonstrate agility, and achieve better business outcomes than those without inclusive cultures.”
So how will we achieve more healthcare workforce equity?
Nurturing Diverse Generations of the Medical Workforce for Success with Authenticity: An Association of Black Cardiologists’ Roundtable recommends the following overall strategies for addressing inequities in healthcare:
Create a robust healthcare workforce pipeline. Focus on how future doctors are groomed and recruited, including who has access to the field and removing barriers to entry.
Address diversity among research investigators and grant funding awardees.
Improve access to equitable and quality healthcare.
Advocate for policy and institutional initiatives that eliminate educational and economic disparities.
Recognize URM (under-represented minority) professionals for their leadership and talents and address inequality in promotion, advancement, and endowed chairs.
A 2021 editorial entitled Health Workforce for Health Equity in Medical Care, the official journal of the medical care section of the American Public Health Association, provides a health workforce equity framework with the following interconnected goal-oriented domains: (1) a diverse composition of the health workforce; (2) the social mission of health professions education; (3) provider distribution according to population need; (4) high-need patients being served; (5) practice patterns that are oriented to addressing root causes of disparities; and (6) safe and fair working conditions for all members of the health workforce. This framework is helpful in understanding and addressing shortages in culturally and linguistically diverse healthcare providers.
Representation: A Matter of Local Importance:
Representation also matters because it directly impacts if, where, and how often you access healthcare. Consider these highlights from the Live Well Lake County Community Health Needs Assessment (2016-2021): African American residents from a Waukegan focus group at the Family First Center discussed the lack of cultural sensitivity in the workforce as an area of improvement stating that “Professionals, who provide services such as education, safety, health care, etc., are not familiar with the culture of their customers or passionate about the community they work in.” Mental health, older adult health, trauma, and poverty are additional concerns from the focus group. Each of these areas could be improved by developing robust healthcare workforce pipelines.
Many of the top five opportunities for improvement reported by African American residents who participated in the Live Well Lake County survey were similar to those of focus group participants, including more jobs and a healthier economy (52%) ranked 1st, more programs and support for youth outside of school 39% ranked 3rd, and improved education (34%) ranked 5th. These findings also align with the recommendations of the Healthcare Foundation of Northern Lake County 2022 Community Health Needs Assessment. Respondents for education and workforce pipelines, need for a “competent and culturally-sensitive workforce,” “financial support and workforce development,” “mental health,” “older adult health,” and “healthcare.”
In closing, as we celebrate Black History Month, let us not forget the pioneers mentioned in this column and many more who have dedicated their lives to eliminating inequities in medicine, behavioral health, research, human services, advocacy, and education. While much work has been done, there is much left to do to promote Justice, Equity, Diversity, and Inclusion and address the Social Determinants of Health.