Diversity Strategies Change, Goal Remains to Improve Patient Care

Photo by Graham Ramsay Joseph Ladapo

This year marks the first time since its creation that the subcommittee dedicated to evaluating applicants from underrepresented minority groups will not be part of the admissions process. The subcommittee, whose job included prescreening Hispanic, African-American, and Native-American students for consideration by the main admissions committee, was borne out of the University’s desire to boost the admission of underrepresented minorities. Its constitutionality was called into question, however, after the Supreme Court placed limits on the University of Michigan’s undergraduate affirmative action program. As a result, the subcommittee was disbanded. Its work will be spread over four subcommittees, which are more broadly focused, since the importance of racially and ethnically diverse doctors and of cultural competency in patient care remains undiminished.

Dr. Alvin Poussaint, professor of psychiatry and faculty associate dean for student affairs, oversaw the subcommittee’s creation in the 1970s and has played a major role in diversity efforts at HMS. This month, nearly three decades after the subcommittee’s inception, Dr. Poussaint shared with me his perspective on the importance of diversity in medicine.

Changing Times
In the late 1960s, after his graduation from Cornell University Medical College, Dr. Poussaint served as the Southern field director of the Medical Committee for Human Rights in Jackson, Mississippi. In this capacity, he helped provide medical care to civil rights workers and played a pivotal role in desegregating health care facilities throughout the South. Dr. Poussaint joined the HMS faculty in 1969, which, interestingly, is the same year HMS witnessed its first double-digit admission of African-American students. Compassionate reactions to the assassination of Dr. Martin Luther King had recently spurred efforts to boost minority enrollment, which were spearheaded at HMS by Dr. Leon Eisenberg, the Maude and Lillian Presley professor emeritus of social medicine.

Since the 1960s, Dr. Poussaint has been involved in the creation and promotion of myriad minority recruitment and development programs at the medical-student, resident, and faculty levels. His efforts, along with those of other leaders at HMS and across the country, have succeeded in boosting ethnic diversity in medicine. Over the past 40 years, the portion of medical school students from underrepresented minority groups has grown from approximately 1 percent in the 1960s to about 20 percent in 2004.

Dr. Poussaint believes that the promotion of ethnic diversity and cultural competency among medical professionals “helps physicians be more holistic in their approach to particular patients.” He thinks that in the absence of cultural competency, doctors increase the risk that their patients “may not comply with the physician’s treatment.” He firmly believes that cultural competency maximizes the chances of enrolling patients as “part of the team” working to improve their health.

The Foundation for Disparities
The efforts that Dr. Poussaint has made are motivated by the belief that increasing both the ethnic diversity of medical professionals and cultural competency of all physicians will decrease health disparities in minority populations, thereby improving patient care nationwide. This argument, also espoused by the Association of American Medical Colleges (AAMC) and the American Medical Association, is supported by the Institute of Medicine in a study illustrating the differences in quality of health care received by ethnic minorities versus non-minorities. Its report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, documents the existence of serious health disparities and notes that “although myriad sources contribute to these disparities, some evidence suggests that bias, prejudice, and stereotyping on the part of health care providers may contribute to differences in care.”

Not all health professionals agree. Dr. Sally Satel, an outspoken and controversial psychiatrist who has published numerous books and articles on mental health and the political culture of medicine, remains dubious of the purported connection between ethnically charged disparities in health care and the health care experiences of minorities.

Dr. Satel contends that “racially biased doctors are not a cause of poor minority health” and instead believes differences in health care and health outcomes are rooted in the “socioeconomic factors associated with race,” not race per se. In particular, she believes that geographic differences, which largely dictate the health facilities and physicians patients have ready access to, drive the disparities.

The evidence that Dr. Satel leverages includes a 2004 study in The New England Journal of Medicine by Dr. Peter Bach and colleagues. They illustrate that black and white Medicare patients largely choose to visit different physicians, and the physicians that treat black patients are less likely to be board certified, which is an indication of quality. Dr. Satel also has cited a study conducted by Dr. Elizabeth Bradley and her colleagues, published in the Journal of the American Medical Association in 2002. They show that a “substantial portion of the racial/ethnic disparities in time to treatment [for heart attacks] was accounted for by the specific hospital to which patients were admitted” and not race or ethnicity per se.

The possibility of a link—or the absence thereof—between ethnic diversity and health care quality is difficult to demonstrate definitively. Nonetheless, most medical schools agree with the AAMC that increasing diversity and cultural competency tends to improve patient care. If their assertions are accurate, we can all rest a little easier with the knowledge that the growing presence of ethnically diverse and culturally competent medical professionals is helping to assuage one of the more egregious disparities that has plagued modern health care for decades.

—Joseph Ladapo is a Harvard medical student and a PhD student in health policy.

The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.

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