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April 18, 2025

New Lancet Letter

Actions and policies that make U.S. health workforce less representative will harm health and hike costs.

WASHINGTON, DC — A new letter in The Lancet warns that decisions across sectors that help make the US health workforce less representative of, and therefore less responsive to, the communities it serves will harm population health and increase care costs. In “Population health and a representative U.S. health care workforce,”(Vincent Guilamo-Ramos, Marco Thimm-Kaiser, Adam Benzekri, and Danielle McCamey), the authors underscore the benefits of a representative health workforce (where there is concordance between patients and their providers in characteristics such as race, ethnicity, language or cultural experiences); the negative impact of recent high-profile judicial rulings, executive actions, and private sector decisions that undermine provider-patient concordance; and the need to unequivocally be guided by science in fixing every aspect of America’s broken health system.

“One badly broken piece of the U.S. health system is the fact that the health workforce isn’t representative of the populations it serves. A more representative workforce, the science shows, can improve health care access, quality, and outcomes, cut costs, and strengthen population health,” said lead author Dr. Vincent Guilamo-Ramos, Institute for Policy Solutions (IPS) Executive Director and the Leona B. Carpenter Chair in Health Equity and Social Determinants of Health at Johns Hopkins School of Nursing. “Making the health workforce less representative — deliberately or by benign neglect — will exacerbate health inequities and make a bad situation much worse.”

“We are at a crossroads, but the evidence is clear: a representative workforce saves lives. We must move forward with purpose to create a healthcare system that serves all communities,” said co-author Dr. Danielle McCamey, Founder-DNPs of Color & Faculty-Johns Hopkins School of Nursing.

The letter examines the urgent need for a representive health workforce in the context of:

• The poorly performing and expensive U.S. health system.
• Widening and costly health inequities among marginalized, racial, and ethnic minoritized communities (estimated at $400 billion), which transcend political affiliation in some parts of the nation, and create excess premature deaths.
• The real and chilling impact of: the U.S. Supreme Court’s decision to ban race-based admissions in higher education; recent executive actions to promote “colorblind equality” in the workforce; and other actions in the private sector that curtail our nation’s ability to build a representative workforce.
• The stated outcomes and policy contradictions of the “Make America Healthy Again” commission.
• Why research funding cuts will disproportionately impact underrepresented scientists conducting cutting-edge work to better understand health inequities and their elimination.    

“The science is clear: Making the health care and scientific workforce less representative will further diminish trust, limit effective communication, increase patient dissatisfaction, and perpetuate preventable costs and negative health outcomes—not just for racial and ethnic minoritized groups, but for everyone. We can help fix the health system by making it mindful of who, what, and where people are; seeing and addressing the health inequities they face; and delivering care that considers the social, political, and economic context that profoundly influences health outcomes and overall wellbeing,” Guilamo-Ramos stressed. “Bottom line: We can’t make America healthier unless we make our health workforce much more representative of the population it serves.”

ENDS

Note to editors

Link to The Lancet letter: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00659-2/fulltext

Find more information about the Institute for Policy Solutions at Johns Hopkins School of Nursing at www.ipsnow.org

More background on the issue of a more representative health care workforce

The Millbank Quarterly: Perspective: Overcoming the Impact of Students for Fair Admission v Harvard to Build a More Representative Health Care Workforce: Perspectives from Ending Unequal Treatment