Miami Downtown, FL, USA - MAY 31, 2020: Woman leading a group of demonstrators on road protesting for human rights and against racism.

Intentional Commitments to Diversity, Equity, Inclusion Needed in Health Care

By Eloho E. Akpovi

“They told me my baby was going to die.” Those words have sat with me since my acting internship in OB/GYN last summer. They were spoken by a young, Black, pregnant patient presenting to the emergency room to rule out preeclampsia.

As a Black woman and a medical student, those words were chilling. They reflect a health care system that is not built to provide the best care for Black patients and trains health care professionals in a way that is tone-deaf to racism and its manifestations in patient care.

I left that clinical encounter with an uneasy feeling. This patient, despite doing everything her doctor told her to do, was being treated sub-optimally and internalizing negative subtext from her care interactions — subtext that implied she was a bad patient, a bad mom. An accumulation of compounding stressors from these interactions manifested for this pregnant patient as physiological signs and symptoms of preeclampsia (elevated blood pressure, blurred vision, etc.), a devastating contributor to severe maternal morbidity and mortality.

As a learner, I saw the direct consequences of inadequate health care and systemic racism on health outcomes. While I was able to recognize this, I didn’t feel equipped by my medical training to address it for my patient. It made me reflect on how our interactions with patients can impact their wellbeing, from the words and tone of voice we use, to our subtle behaviors and actions, which we may not even be aware of. These manifestations of our biases, whether conscious or not, perpetuate historic and systemic oppression upon our patients.

Diversifying the face of medicine has never been more critical. Racial and ethnic health disparities are pervasive throughout the U.S., and have become even more evident throughout the COVID-19 pandemic. Black and Brown patients are more than twice as likely to die from the virus compared with white patients.

Provider-patient race concordance, which takes advantage of factors such as shared cultural and lived experiences, shows some potential to mitigate outcomes. This is one of the many reasons why advocating for a diverse health care workforce — nurses, technicians, NPs, PAs, therapists, pharmacists, and physicians alike — is critical. Yet, there are fewer Black male physicians today than there were 40 years ago.

Inevitably, we must increase the number of underrepresented students entering the health care pipeline and provide them with wrap-around support throughout their journey to becoming health care professionals. This will take time to accomplish. But Black, Indigenous, and people of color (BIPOC) communities are experiencing poor health care outcomes today. There is an increasing need to properly train and retrain our existing workforce to better care for patients at higher risk of morbidity and mortality due to historic and structural inequity.

Racism, both implicit and explicit, systemic and interpersonal, is a major driver for racial/ethnic health disparities. Having identified this connection, many health care institutions across the country have created diversity, equity, and inclusion (DEI) offices, initiated curriculum reform to be more race-conscious and gender-neutral, and implemented bias training for their employees and trainees.

However, bias and discrimination trainings tend to lack core elements that prevent them from having a lasting impact. For example, some focus solely on implicit or unconscious bias and fail to acknowledge the overt and conscious biases also at play; or don’t guide us through the process of acknowledging our own biases and how we, individually, are contributing directly to the issue (“it’s them, not me”). We often leave these sessions without the resources to identify spaces to continue working through our own biases, or without tangible and actionable takeaways to incorporate into our care of marginalized patient communities. Within a given institution, these trainings are often not widely implemented as a required or iterative learning element for all employees and trainees (think CITI Program training for bias and anti-racism), and they often don’t align with the mission, vision, values, and culture of the institution.

How, then, can the health care workforce understand the importance of undoing racism to their duty of providing care? DEI work is no longer serving the communities it was created for; it only serves institutions, offering them an opportunity to feel as if they have done their part.

While we are building a diverse workforce, we must also work harder to shift the ethos of the entire health care community. Otherwise, we will continue to find ourselves plugging holes in a desperately leaking tank, instead of building a more modern, well-reinforced one. We cannot sit back and wait for the arrival of providers with marginalized identities to solve the crisis of health disparities.

We must also listen emphatically and respectfully to people from marginalized communities. It sounds simple, but recent reports of allegations from Black women physicians in administrative roles at medical institutions being pushed out of their institutions while doing DEI work demonstrate that this isn’t happening. These reports only bring light to the claim that DEI work is often performative — institutions utilize BIPOC members of their community as figureheads, and not true agents of change in this fight against institutionalized racism.

Health care institutions have a responsibility to move from performative to intentional commitment to diversity, equity, and inclusion, including guiding the existing and future health care workforce in tackling necessary change. We will not eliminate the health inequities and poor care experiences that impact our Black and Brown patients, highlighted by the COVID-19 pandemic, if we do not center health care and health professional training around introspectively and actionably unlearning racism and other forms of oppression.

Eloho E. Akpovi, MS is an MD-ScM Candidate (’21) in the Primary Care-Population Medicine (PC-PM) Program at the Alpert Medical School of Brown University.

This post is part of our digital symposium, In Their Own Words: COVID-19 and the Future of the Health Care Workforce

The Petrie-Flom Center Staff

The Petrie-Flom Center staff often posts updates, announcements, and guests posts on behalf of others.

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