Fact Sheet: The Need for Diversity in the Health Care Workforce

Health Professionals for Diversity (HPD) is a coalition of organizations and individuals that represents the hundreds of thousands of health care providers, researchers, educators, students, suppliers, and others dedicated to improving the health of all who live in this nation.

Our mission is to promote diversity in the health professions and, in so doing, improve the health of the nation by building a health care workforce that draws on the strengths of all segments of our diverse society.

Health-care disparities have long existed for racial and ethnic minority populations, and these shocking differences in health care continue to result in individuals from these groups suffering disproportionately, and often unnecessarily, from treatable, curable, or preventable diseases.

Numerous studies have documented that there are significant differences in health status and health care quality among racial and ethnic minority groups in the U.S. For instance:

• Whites are 78 percent more times likely than African Americans to receive certain revascularization after angiography[1]
• The average waiting time for African Americans needing kidney transplants is almost twice as long as that of white patients.[2]

These health care disparities translate into real health outcomes. Among them:

• African-American women with breast cancer are 67 percent more likely to die from the disease than are white women.[3]
• The mortality rate for African-American infants is almost 2.5 times greater than it is for whites.[4]
• Hispanic and African American youth are substantially more likely to die from diabetes than whites.[5]
• When disaggregated into subgroups, some Asian populations (i;e.) Chinese, Japanese, and Filopino) have poorer survival than non-Hispanic whites for certain cancers at certain stages.[6]

Even when controlling for access-related factors, such as patients' insurance status and income, some racial and ethnic minority groups are still more likely to receive lower-quality health care.[7][8]

Disparities in health care pose a moral and ethical dilema for our society and threaten to hamper efforts to improve the nation's health. Also, when disparities in health care result in missed diagnoses and poor management of chronic conditions, it often translates into avoidable, higher costs for health care systems.[9]

At the same time, the U.S. is rapidly becoming a more diverse nation.

Current projections predict that between 2000 and 2050, racial and ethnic minority groups will grow to account for nearly one-half of the population. Many of the groups that are going to experience the largest growth are also groups receiving lower-quality health care. According to these projections:

• White Americans, who in 2000 accounted for 69.4 percent of the population, will account for 50.1 percent of the population in 2050.[10]
• African Americans will experience a 71 percent population growth between 2000 and 2050, accounting for 14.6 percent of the population in 2050.[11]
• Hispanic Americans will experience a 187 percent population growth, accounting for 24.4 percent of the population in 2050.[12]

Currently, the nation's health-professions workforce does not nearly reflect the diversity of the nation.

Racial and ethnic minorities are woefully underrepresented in the health professions. In the 2000 U.S. Census, African Americans accounted for nearly 12.7 percent and Hispanics accounted for nearly 12.6 percent of the U.S. population. This diversity is not reflected in the health-professions workforce. As the following table shows, African Americans and Hispanics are underrepresented in both the nation's health professions and among those currently training to work in the health professions.

	Percentage of Health Professionals in the 2000 U.S. Census[13]		Percentage of Students Enrolled in Health-Professions Training in 2003-2004[14]
	African American	Hispanic	African American	Hispanic
Dentistry	3.3	3.6	5.4	5.9
Medicine	4.4	5.1	7.4*	6.4*
Nursing	8.8	3.3	11.8**	5.2**
Optometry	1.6	2.7	3.2	5.6
Pharmacy	5.1	3.2	9.3	9.5
Physician Assistants	8.4	8.1	6.8	6.5
Podiatry	4.6	1.7	14.0	7.7

*Students enrolled in an allopathic medicine program leading to a doctor of medicine (MD) degree.
**Students enrolled in a baccalaureate or masters nursing program.

If some of these trends continue, given the projected growth of the nation's minority populations during the next five decades, racial and ethnic minorities will be even more underrepresented in the health care workforce than they are today.

Increasing the diversity of the health care workforce serves as an effective strategy for addressing racial and ethnic health care disparities.

Diversity improves access to health care for underserved patients:

• African-American, Hispanic, and Native-American physicians are much more likely than are white physicians to practice in underserved communities and to treat larger numbers of minority patients, irrespective of income.[15]
• African-American and Hispanic physicians, as well as women, are more likely to provide care to the poor and those on Medicaid.[16]

Diversity leads to increased racial and ethnic minority patient choice and satisfaction:

• Racial and ethnic minority patients who have a choice are more likely to select health care professionals of their own racial or ethnic background.[17]
• Racial and ethnic minority patients are generally more satisfied with their care, and are more likely to report receiving higher-quality care, when treated by a health professional of their own racial or ethnic background.[18][19]

Increasing diversity will also lead to improving the ability of the health care workforce to effectively address the health care needs of all Americans.

Diversity in education environments improves the quality of education for health professionals, which, in turn, improves their ability to treat patients from a wide range of cultural and social backgrounds:

• By encountering and interacting with individuals from a variety of racial and ethnic backgrounds during their training, health professionals are better able to serve the nation's diverse society by having broadened perspectives of racial, ethnic, and cultural similarities and differences.[20]
• Growing evidence shows that diversity in education environments can improve learning outcomes for all students, improving such skills as active thinking, intellectual engagement, and motivation, as well as certain social and civic skills, such as the ability to empathize and have racial and cultural understanding.[21]

This nation must do more to improve diversity among health professionals.

HPD is working to ensure that policymakers and the public are aware of the importance of diversity in the health care workforce. It is also actively working with groups, such as health organizations, philanthropic foundations, and federal, state, and local governments, to find ways to more effectively promote such diversity.

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References

[1] Ayanian JZ, Udvarhelyi IS, Gatsonis CA Pashos CL, Epstein AM. Racial differences in the use of revascularization procedures after coronary angiography. JAMA. 1993; 269: 2642-2646.

[2] Young, CJ, Gaston RS. Renal transplantation in black americans. N Engl J Med. 2000 343: 1545-1552.

[3] Joslyn SA, West MM. Racial differences in breast carcinoma survival. Cancer. 2000; 88: 114-123.

[4] Collins KS, Hall A, Neuhaus C. U.S. Minority Health: A Chartbook. New York: The Commonwealth Fund; 1999.

[5] Lipton R, Good G, Mikhailov T, Freels S, Donoghue E. Ethnic differences in mortality from insulin-dependent diabetes mellitus among people less than 25 years of age. Pediatrics. 1999;103: 952-956.

[6] Lin SS, Clarke CA, Prehn AW, Glaser SL, West DW, O'Malley CD. Survival differences among Asian subpopulations in the United States after prostate, colorectal, breast, and cervical carcinomas. Cancer. 2002; 94; 4: 1175-1182.

[7] Geiger J. Racial and ethnic disparities in diagnosis and treatment: a review of the evidence and a consideration of causes. In: Unequal Treatment Confronting Racial and Ethnic Disparities in Healthcare. Washington DC: Institute of Medicine; 2003.

[8] Mayberry R M, Mili F, Ofili E. Racial and ethnic differences in access to medical care. Medical Care Research and Review. 2000; 57: 108-45.

[9] Smedley BD, Stith AY, Nelson AR, (eds). Unequal Treatment Confronting Racial and Ethnic Disparities in Healthcare. Washington DC: Institute of Medicine; 2003.

[10] U.S. Interim Projections by Age, Sex, Race, and Hispanic Origin. Washington, DC: U.S. Census Bureau; 2004.

[11] Ibid.

[12] Ibid.

[13] U.S. Census Bureau, Census 2000 Special Equal Employment Opportunity (EEO) Tabulation.

[14] 2002/2003 Survey of Advanced Dental Education. Washington DC: American Dental Education Association, 2004; AAMC Data Book: Statistical Information Related to Medical Schools and Teaching Hospitals. Washington DC: Association of American Medical Colleges, 2004; 2003-2004 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing. Washington DC: American Association of Colleges of Nursing, 2004; Number and Percentage of Full Time Students Enrolled in All Professional O.D. Programs by Ethnic Identification and Year--Summary 2003-2004. Washington, DC: Association of Schools and Colleges of Optometry, 2004; Fall 2003 Profile of Pharmacy Students. Washington DC: American Association of Colleges of Pharmacy, 2004; 20th Annual Report on Physician Assistant Educational Programs in the United States, 2003-2004. Washington DC: Association of Physician Assistant Programs, 2004; Comparison of Ethnic ID of DPMs and Enrollees to Total Population. Rockville, MD: American Association of Colleges of Podiatric Medicine, 2004.

[15] Kington R, Tisnado D, Carlisle DM. Increasing racial and ethnic diversity among physicians: an intervention to address health disparities? In Smedley BD, Stith AY, Colburn L, Evans CH, (eds.). The Right Thing to Do, The Smart Thing to Do: Enhancing Diversity in the Health Professions. Washington, DC: National Academy Press, 2001.

[16] Cantor JC, Miles EL, Baker LC, Barker DC. Physician service to the underserved: implications for affirmative action in medical education. Inquiry. 1996; 33: 167-180.

[17] Saha S, Taggart SH, Komaromy M, Bindman AB. Do patients choose physicians of their own race? Health Affairs. 2000; 19: 76-83.

[18] Cooper-Patrick L, Gallo JJ, Gonzales JJ, Vu HT, Powe NR, Nelson C, Ford DE. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999; 282: 583-589.

[19] Cooper LA, Powe NR. Disparities in patient esperiences, health care processes, and outcomes: the role of patient-provider racial, ethnic, and language concordance. Washington DC: The Commonwealth Fund, 2004.

[20] Whitla DK, Orfield G, Silen W, Teperow C, Howard C, Reede J. Educational benefits of diversity in medical school: a survey of students. Acad Med. 2003; 78: 460-6.

[21] Gurin P, Dey EL, Hurtado S, Gurin G. Diversity and higher education: theory and impact on educational outcomes. Harvard Education Review. 2002; 72: 330-366.