Jump-Starting The Conversation About Workforce Diversity

Editor’s Note: This is one of several posts Health Affairs Blog is publishing stemming from sessions at the June 2015 AcademyHealth Annual Research Meeting (ARM) in Minneapolis. Watch Health AffairsBlog for additional posts on topics raised at the ARM, including a related post by Don Goldmann, Amy Reid, and Alex Anderson.

Most policy conversations about workforce diversity refer to the ability of clinical providers and health systems to provide high-quality care to a range of racially, ethnically, economically, and culturally distinct individuals and communities. Expanding the workforce to include people from a wider variety of backgrounds, particularly under-represented minority (URM) groups, has been a key strategy to reduce health disparities associated with racial bias, discrimination, stereotyping, and other implicit biases.

The research community also has acknowledged disparities in access to resources among URM researchers. Recruiting, mentoring, and retention programs for individual researchers have been in place among professional organizations, such as the Association of American Medical Colleges (AAMC), for several years. However, a recent study using the AAMC faculty roster database found that the percentage of URM faculty in medical schools increased by only 1.2 percent over the ten years between 2000 and 2010. Only the programs that had been in existence for more than five years and that had multiple components in addition to individual mentoring were able to achieve a larger increase in URM representation.

The National Science Foundation (NSF) has recognized that some disparities in access to resources are related to institutional and systemic biases. The NSF began a program in 2008 to reduce unconscious bias among grant reviewers and senior faculty as one strategy to provide more opportunities for women and people of color to enter the STEM (Science, Technology, Engineering, Mathematics) fields. Beginning in 2014, the National Institutes of Health (NIH) undertook comprehensive reforms after an internal review uncovered a systematic bias against funding URM researchers. These reforms have included diversity tracking, training, and program development for the NIH-funded workforce, and appointment of a Chief Diversity Officer for NIH.

Looking Inward

In our view, diversity of opinion and perspective leads to a richer and more nuanced understanding of what works to improve health, health care, and population health.

We also know that we have much farther to go to achieve this goal. About ten years ago, AcademyHealth started convening expert panels on diversity of the health services and policy (HSR) workforce as a way to produce better evidence to inform policy.

Since 2010, with support from the Aetna Foundation, AcademyHealth has provided fellowships for approximately 75 under-represented minority (URM) researchers, forming a community of practice for them to collaborate and share resources and ideas, among themselves and with mentors from a variety of backgrounds. Our mentoring programs have not been formally evaluated yet. However, our informal evaluations have found career benefits for URM researchers through enhanced access to research funding and academic positions because of connections with more established researchers and the visibility generated by participation in the program.

In 2014, we worked with the Institute for Alternative Futures to take our mentoring program to another level by convening a group of health services and policy researchers, professional association leaders, diversity officers, and experts in strategic communications and change management to discuss four scenarios about the future of the field. The scenarios incorporated drivers of systems change at three levels:

1. The broad US economic, social, and policy environments;
2. The health and health care ecosystem, focusing on trends in health coverage, access to care, and new data sources, such as electronic health records (EHRs); and
3. Factors specific to health policy and systems research, including availability of research funding, public awareness, and support for research, and the career pipeline for URM researchers.

After discussion, the experts recommended that AcademyHealth take these steps:

1. Make a public commitment to workforce diversity, through reports and online forums;
2. Communicate clearly about our commitment through goal statements, programmatic language, graphic images, and special events;
3. Report publicly about progress in improving diversity through keeping current workforce statistics;
4. Train and prepare the current HSR workforce in best practices in diversity; and
5. Create a more racially and ethnically diverse pipeline for research careers, beginning with high school students and undergraduates.

Expanding The Discussion

We presented these recommendations in a public session at the AcademyHealth Annual Research Meeting in Minneapolis on June 15, 2015. The session featured Drs. Darrell Gaskin, a health economist, associate professor at the Johns Hopkins Bloomberg School of Public Health, and incoming Chair of the AcademyHealth Board of Directors; Don Goldmann, Chief Medical and Scientific Officer at the Institute for Healthcare Improvement, Board member; Ernest Moy, Medical Officer at the Center for Quality Improvement at the Agency for Healthcare Research and Quality (AHRQ); and Rachel Hardeman, Assistant Professor in the Mayo Clinic Research Program on Equity and Inclusion in Health Care.

During the open discussion, the 100 or so participants generally accepted the recommendations as a reasonable place to start, and they encouraged AcademyHealth to be bold in implementing them. We heard several requests to facilitate more conversations like this one, creating a “safe space” for discussions about the lived experience and effects of racial discrimination and institutional racism on career paths for people of color. There was an acknowledgement of the desire to discuss the effects of micro-aggressions (e.g., being ignored in meetings or not being invited to join grant proposal teams) on personal health and stress levels for people of color. While mentoring can help to mitigate some of these stressors and encourage URM researchers to remain in the field, much more needs to be done.

Several participants also noted the emerging view in the public health community that three levels of racism—individualized, institutional, and systemic—interact with gender, socioeconomic status, geography, and other factors to affect workforce diversity and racial and ethnic health disparities. We find that these three levels correspond to the three levels we used to build and drive our futures scenarios. Mentoring is primarily an individualized approach to promoting diversity, and evidence from the AAMC study and others show that it is more effective when it is accompanied by organizational supports, such as multi-component programs involving community-building, public events, and policies for retention and promotion such as those recommended by the Council on Education for Public Health Accreditation Criteria.

AcademyHealth has just released a report with these recommendations. We hope to use the report as a tool to accelerate the conversation about what we can do to ensure that the best talent from all backgrounds are at home in our field.

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