Representation matters to health. Improving pathways into health care and public health is an important way to increase workforce diversity. This is a crucial step in reducing health disparities and advancing health equity in the U.S.
Black, Latinx, and American Indian and Alaska Native communities face higher rates of chronic and life-threatening health conditions. Yet a diverse health care and public health workforce can increase the quality of life for people of color, and contribute to longer life expectancy. In fact, in counties with more Black primary care doctors, Black people appear to live longer. A diverse public health workforce knows firsthand the challenges to health equity. Those who intimately understand how harmful racial discrimination is will be more prepared to address the health effects of inequity.
A Diverse Health Care Workforce Improves Health Outcomes
As the chair-elect of the board of directors for the Association of American Medical Colleges, Lee Jones aptly said, “People feel they receive better care and communication from doctors who share their race or gender.” Healthcare providers who share a marginalized identity with their clients or patients have a built-in, foundational level of trust. People are more likely to openly discuss their health concerns and seek preventative care. Trust, along with stronger relationships and better communication, result in better health outcomes.
Diversity in Public Health Leads to More Inclusive Solutions
The public health workforce must reflect the communities it serves. How can we best understand the needs of an increasingly multicultural population? One of the primary ways to eliminate health disparities is to increase the diversity of the workforce in all areas of public health.
Health policy and law professionals, for example, can address health disparities and promote health equity through law and policy. Researchers, epidemiologists, and biostatisticians from diverse backgrounds are more likely to ask more inclusive research questions. They also more apt to study communities that have historically been ignored in public health research. Health educators, program managers, and community planners from marginalized communities can better tailor the design of community-specific public health programs and services, and deliver them in culturally responsive ways. Through their lived experience, a diverse workforce is more attuned to address cultural and linguistic barriers.
Community health workers (CHWs) are essential to public health practice and effectiveness. Because CHWs are trusted members of, or have a deep understanding of, the communities they serve, they are uniquely positioned to be successful agents of change in health outcomes. But CHWs are often grossly underpaid, lack benefits, and experience burnout in high-stress jobs.
The case for a more diverse public health workforce has never been so clear. The need is so dire that the President’s Council of Advisors on Science and Technology released a report in 2023 addressing this issue and calling for additional funding to support public health.
Impact on Admissions from the Affirmative Action Ruling
The Supreme Court’s harmful ruling on race-conscious admissions will have significant impacts on the health care and public health workforce. Fewer practitioners of color mean less equitable and culturally responsive health care. The ruling also likely means fewer epidemiologists, biostatisticians, disease investigators, environmental health scientists, and health behavior professionals and researchers of color to impact how research is conducted and how data is shared.
Further, there will likely be impacts on equitable policy design and implementation. This is because diverse teams are more likely to create more equitable, inclusive, and accessible policies. There is ample research showing that racially diverse practitioners significantly improve health outcomes for historically marginalized populations. In the U.S. there is already a dearth of healthcare providers and executives of color. This ruling will have a negative impact on the number of practitioners entering the field. It will also exacerbate the healthcare disparities that already disproportionately affect communities of color.
What’s Needed to Diversify the Workforce
In light of this detrimental ruling, the need to strengthen the health care and public health workforce has never been so great.
For the last 15 years, the public health workforce has been declining, losing 40,000 workers over the past 10 years. And nearly one-third of the workforce reported considering leaving their organization in the next year. Some reasons for the desire to leave are the trauma of the pandemic, work overload and burnout, and low pay. Lack of advancement opportunities, stress, and organizational climate are also factors. When we look at demographic makeup from a 2021 study of governmental public health workers, most self-identify as white (54%), as women (79%), and as age 40 or older (63%). Additionally, 66% of all public health executives are white.
Among U.S. medical schools, the student population is slowly becoming more diverse. From 2022-23, the number of Black or African American students enrolled in medical schools increased by 9% over two years, making up 10% of total enrollees. Students who are Hispanic, Latino, or of Spanish origin made up 12% of total enrollees, up by 4%. However, American Indian or Alaska Native students declined by 9%, comprising only 1% of matriculants. Women make up 54% of total enrollment. While these gains are positive, there is much work to be done to achieve a workforce that is truly representative of the U.S. population. When it comes to current physician demographics, women comprise only 37% of the overall physician workforce. Yet about two-thirds (67%) of physicians overall are white, and they hold a majority of positions in leadership.
Creating Intentional Career Pathways
It’s crucial to develop career pathways for young people to enter health care and public health. This is especially true for historically marginalized communities that disproportionately experience health inequities.
Even though the diversity of the public health workforce shows an upward trend, students of color remain underrepresented in public health. While the trends in the public health student body and workforce that identify as LGBTQ+ or having a disability are sparse, these groups also remain underrepresented. These striking disparities in higher educational attainment deserve pause and require innovative strategies to level the playing field for marginalized communities.
We must design intentional, meaningful career pathways to prepare the future health care and public health workforce in a way that centers diversity. And one that reflects and respects the identities and lived experiences of the populations they serve. Student diversity of schools of public health and medicine has been correlated with institutional characteristics, such as faculty diversity, area of study, and program degree level. The National Institutes of Health has an initiative to engage and retain students from diverse backgrounds in biomedical research, and has a focus on Historically Black Colleges and Universities and Minority Serving Institutions.
In addition to diversifying the workforce, diversity in what is taught in public health and medical schools also matters. Curricula should be rooted in a social justice perspective, and intentionally centered on the intersection of health care, public health and systemic injustices.
What’s Needed to Recruit and Retain Diverse Workers
- Mentoring programs, especially for younger workers and workers of color
- Providing meaningful and robust job benefits that support the health of workers and their families
- Providing a flexible work environment that allows workers to care for their families
- Embedding strategies for advancement opportunities and salary adjustment
- Redefine minimum requirements for entry-level jobs
- Hire from alternative pathways, like those listed below
- Offer loan forgiveness and subsidy programs
Example Programs That Support a Diverse Workforce
- Public Health AmeriCorps – A partnership between AmeriCorps and the CDC that provides a pathway to recruit, train, and develop the next generation of public health leaders.
- Doctors Back to School Program – The American Academy of Family Physicians has adapted the AMA’s Doctors Back to School program to help encourage young people from underrepresented minority groups to consider family medicine as a career option.
- The Ladder for America – Through mentorship and leadership opportunities, this program helps young people from minority and low-income families explore and learn about careers in the healthcare industry.
- African-American Behavioral Health Center for Excellence – A national center that aims to increase workforce development opportunities and transform behavioral health services for African-Americans.
- Tennessee Medical Meharry College HBCU Wellness Project – Trains Student Health Ambassadors at Historically Black Colleges and Universities as health promotion and disease prevention advocates, investigating key community health issues through extensive study.
- Dynamic Futures Program – Behavioral health career pathway program for teens of color at UMass Chan Medical School. This program exposes teenagers of color to jobs in psychology, psychiatry, and social work, hoping to fill a shortage of diverse providers.
- Administration for Community Living – Funding to expand the public health workforce to respond to the needs of people with disabilities and older adults.
The health care and public health workforce is a vital component to improving health in America. Systemic problems require systemic solutions. In order to achieve our collective vision of health equity, we must advocate for a more diverse workforce. We must focus on improving pathways into health care and public health to achieve more equitable health for all.