New in The Lancet — Actions and policies that make U.S. health workforce less representative will harm health and hike costs, warns Institute for Policy Solutions.
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New in The Lancet — Actions and policies that make U.S. health workforce less representative will harm health and hike costs, warns Institute for Policy Solutions.
In the latest edition of The Lancet, the authors of Population health and a representative U.S. health care workforce reveal a hidden impact of recent controversial actions and policies aimed at rolling back diversity and inclusion: they’re bad for everyone’s health — literally. The authors also underscore an opportunity: investing in a representative healthcare workforce is an essential strategy for fixing our broken health system. We sat down with lead author and executive director of the Institute for Policy Solutions at the Johns Hopkins School of Nursing, Dr. Vincent Guilamo-Ramos, to learn more.
Vincent, what are you and your co-authors saying in The Lancet?
Considering the recent national dialogue about DEI, we underscore how these bad actions and policies will make the health care workforce less representative and exacerbate health inequities, making our broken health system worse for everyone. We explain how a more representative health workforce improves health outcomes — including better health access, quality, and care; cuts costs, and strengthens population health. And we highlight a hidden fracture in our broken health care system — the fact that our existing health workforce is already unrepresentative of the populations it serves, and this is one of the reasons why our health system is broken.
Can you give us some examples of what you mean by bad actions and policies?
Sure. The U.S. Supreme Court’s decision to ban race-based admissions in higher education, including health professions education, is already having an impact on the representativeness of our future health workforce. For example, MIT noted a drop from 25% to 16% among Latino, Black, Native American and Pacific Islander students. In states that have implemented bans on race-conscious admissions, underrepresented racial and ethnically minoritized students in public medical schools have dropped by 5%.
Then there are the executive actions against diversity, equity and inclusion that advocate for so-called “colorblind equality.” These will likely make our health care workforce less representative. The private sector following suit makes it even harder for us to achieve a representative health workforce. Together, these policies and actions will intensify health inequities and cause further damage to our ailing health system.
Let’s also not forget the destructive power of the zero-sum mindset—which can be felt across our nation. This thinking applied to our health care and our health workforce—the idea that one person loses when another person gains—is a total myth. When properly distributed, we have the resources to provide everyone with optimal care. As the SCOTUS decision begins to take hold and our health education programs become less diverse, our future health workforce will reflect this diminished representativeness and we will all end up incurring higher costs and being less healthy.
Respectfully, the irony for folks who vehemently want a less representative health workforce is that they are undermining the very approaches that improve health outcomes for everyone, including them. This includes concordance.
What is concordance?
Concordance is one of those words that’s well-known in the health science world, not so much on “Main Street.” It means a close alignment between patients and their health care providers in characteristics such as race, ethnicity, language, or cultural and lived experiences. When this concordance exists, we get better individual and population health outcomes.
For example, in the National Academies of Sciences, Engineering, and Medicine’s Ending Unequal Treatment report, the evidence shows that the health outcomes of racially and ethnically minoritized patients in the US are generally better when there’s patient–provider concordance.
Concordance is the mechanism that makes a representative health workforce improve health outcomes for everyone. Concordance isn’t possible without a representative health workforce.
A point of clarification: are you suggesting a patient can only receive good care from a provider of the same race or life experience?
No. I’m not suggesting that every single person who is, say, Latino, should be treated by another Latino to get the best health outcomes; what I’m saying is that health outcomes will improve when we have a health workforce and interprofessional health care teams where Latinos are represented. But the behavior practice training needs for all heath care teams need to be multifaceted, sustained, and directly linked to the lived experiences of the communities being served.
We have a high cost, low performing health system. You mentioned that one of the benefits of a more representative health work force is cost savings. Can you give us an example?
Sure. A representative health workforce could save billions to invest in a better health system that delivers optimal health for everyone. Our tagline at IPS is “we eliminate health inequities,” not just because they’re unjust, unfair, and preventable, but also because health inequities drive-up costs. For example, excess health care expenditures, morbidity-related lost labor productivity, and excess premature deaths among marginalized racial and ethnic minoritized communities alone is estimated to exceed $400 billion. A more representative health workforce could help avoid those costs and free-up the resources to fund a fix for our broken health system.
What is your call to action on this issue?
We urge all leaders in all sectors who made decisions — whether deliberately or with benign neglect — that are making our workforce less representative to stop and reverse these actions and policies. These decisions are bad for everyone’s health. This is about the current and future health of our nation. As America becomes more diverse, if we don’t invest in a more representative health workforce, health outcomes will get worse for everyone, and our health system will stay broken.
More specifically, health education programs should be exempt from the restrictions imposed by the SCOTUS decision. The High Court did this for the U.S. military; why not do the same for our healthcare work force?
To make our health workforce more representative, targeted scholarships funding opportunities should be increased, not cut. Additional investments should include loan repayment programs, service‐contingent scholarship programs and pathway programs.
My final call to action is to everyone reading this: Please dig deeper on this issue. To do so, read the new Lancet editorial in full as well as a deeper dive found in the Milbank Quarterly on workforce representation. Advancing a representative health workforce isn’t just the right thing to do—it’s a powerful catalyst for eliminating health inequities, reducing cost, and building a healthier future for everyone.