With widely documented health disparities, the US is facing a real crisis when it comes to the health of its racial and ethnic minorities.
Studies have shown that minority patients receive better care when physicians are from a similar racial or ethnic background. Medical schools have always defended affirmative action policies, based on this compelling need for racial diversity.
However, with eight states banning affirmative action, via ballot initiatives and other measures, a new trend is emerging across the nation which will have long-term consequences on racial and ethnic diversity in higher education.
More than that, it will have serious consequences on health care efforts as it hurts the ability to have more racially and ethnically diverse physicians that could better address the health disparities in the US.
A research project I led shows how these statewide bans have led to a drop in the already underrepresented students of color at medical schools. This research is a follow up to my earlier one showing an overall decline in the percentage of minority students coming to graduate schools, which also impacts the pipeline to medical schools.
Impact of affirmative action bans
We don’t include bans in the states of Arizona, New Hampshire and Oklahoma, as they had been enacted only recently.
The bans were implemented either through voter initiatives, or executive orders, or court cases, as was the case in Texas, known more famously as the Hopwood decision, in which Texas colleges and universities were prohibited from taking race into consideration during admissions.
We analyzed data from 19 years – 1993-2011, allowing us to cover four years before the implementation of the first ban in Texas and three years since the most recent ban in Nebraska.
While these laws apply to public institutions in the states, in our analysis we looked at the potential impact on private schools as well.
We did this considering it was possible that students would choose to enroll at private schools instead of public ones in states with bans or at medical schools in states that still allowed for the consideration of race as a factor in admissions.
We found that following these bans, underrepresented students of color at public medical schools dropped by about 3.2 percentage points.
So, if you took a four-year average across the states, as we did, the percentage of students of color who matriculated at public medical schools was about 18.5%. Our findings, showing a a 3.2 percentage-point decline, meant that this had dropped to about 15.3% during the period we looked at.
In other words, before bans on affirmative action, for every 100 students matriculated in medical schools in states with bans, there were 18 students of color, whereas after the ban, for every 100 students matriculated, about 15 were students of color.
You might think that this is not a very large difference. But in my view, it’s a very important decline that seriously hurts efforts in the field of medicine to become more racially and ethnically diverse.
I believe such a decline has negative consequences for the ability of medicine to address health disparities, improve quality of care, provide better treatment and to have healthier populations.
Decline in diversity of graduate schools
My previous research too showed a decline in the racial/ethnic diversity in graduate education and across different fields of study, including engineering, natural sciences, social sciences and humanities. These bans have also led to declines in racial/ethnic diversity at selective colleges that often form the pipeline to medical schools.
States with affirmative action bans host 35% of the nation’s research-ranked public medical schools and 29% of primary-care ranked public medical schools. Given this substantial proportion of medical schools, the action in these six states have national repercussions.
We also need to consider that despite gains over the last few decades, historically underrepresented students of color, like Africans Americans, Latinos, and Native Americans, are already underrepresented in medical schools, relative to their proportion of the US population.
While about 17% of the US population is Latino and 13% is African-American, these groups made up only 4% and 6%, respectively, of the total US medical school enrollment in 2014.
All this has consequences for physician competence and health care. There is a strong association between racial diversity of medical school students and their ability to handle cultural differences, attitudes towards access to care and plans to serve communities that are under-served.
For these reasons, a racially diverse medical workforce improves access and quality of care and in turn, health outcomes.