Affirmative action ban harms health equity

Medical leaders across the country have spoken out against the Supreme Court’s decision to ban affirmative action, saying the ruling will undo decades of advancements aimed at fostering diversity within the nation’s physician workforce, which is widely recognized as crucial in addressing the pervasive and deeply rooted health inequities prevalent in the country. 

On June 29th, in the case of Students for Fair Admissions, Inc v. President and Fellows of Harvard College, the Supreme Court found that affirmative action policies utilized by admission at Harvard and the University of North Carolina (UNC) were in violation of the equal protection clause of the 14th Amendment to the constitution. 

“Many universities have for too long wrongly concluded that the touchstone of an individual’s identity is not challenges bested, skills built, or lessons learned, but the color of their skin. This Nation’s constitutional history does not tolerate that choice,” the decision stated. 

The decision “undermines decades of progress centered on the educational value of diversity, and will reverse gains made in the battle against health inequities,” said Jesse M. Ehrenfeld, MD, MPH, president-elect of the American Medical Association (AMA), in a press release.  

“While our country grows more diverse, historically marginalized communities have been left behind on nearly every health indicator. A physician workforce that reflects the diversity of the nation is key to eliminating racial inequities. There is convincing evidence that racially diverse care teams produce measurably positive health outcomes for patients in historically marginalized populations. The goal is not racially segregated care, but rather a health care workforce in which racial and ethnic representation is a more common aspect of care teams.”  

In their statement, The AMA cites a study with findings that suggest, “black doctors would reduce the black-white male gap in cardiovascular mortality by 19%.” Already compelling, it is just one of many studies that reverberate the same sentiment: a more diverse healthcare workforce results in better healthcare for minorities and underrepresented groups.  

 One study conducted by Health Resources and Services Administration found that for every 10% increase of Black primary care physicians in a county there was an associated increase in life expectancy among Black people by 30.6 days in that region.  

Another study found that, “When Black newborns are cared for by Black physicians, the mortality penalty they suffer, as compared with White infants, is halved.”  

“We know that racial diversity in health care literally saves lives: research and experience have shown time and time again that disparities in health outcomes decrease when patients are treated by health care professionals who have learned and worked alongside colleagues of different racial and ethnic backgrounds,” said Molly Meegan, JD, general counsel and chief legal officer of the American College of Obstetricians and Gynecologists (ACOG) in a statement.  

“The best way to ensure diversity in the medical workforce is through holistic considerations of medical school candidates that take into account race, ethnicity, and the lived experiences that each candidate could bring to their career as a physician because of their background. Comprehensive consideration of each medical student candidate as an individual can only benefit the communities for which they will ultimately provide care.”  

Though the ruling prohibits the use of race as a means to attain proportional representation, it also provided higher education admissions with an alternative, “At the same time, nothing prohibits universities from considering an applicant’s discussion of how race affected the applicant’s life, so long as that discussion is concretely tied to a quality of character or unique ability that the particular applicant can contribute to the university.” 

 Since then, colleges and universities across the country put out statements confirming their commitment to having diverse campuses, but without statistical and data-driven goals, these declarations won’t be enough to create representative matriculating classes and a subsequently diverse healthcare workforce.  

Affirmative action bans at the state level, as seen in California, Florida, Texas, Washington, Michigan, and Nebraska, led to a 17% decline in “first-time matriculation of medical school students who are underrepresented students of color.” 

“Today, this Court stands in the way and rolls back decades of precedent and momentous progress,” Justice Sonia Sotomayor said, who was joined in dissent by justices Ketanji Brown Jackson and Elena Kagan.  

“It holds that race can no longer be used in a limited way in college admissions to achieve such critical benefits. In so holding, the court cements a superficial rule of colorblindness as a constitutional principle in an endemically segregated society where race has always mattered and continues to matter. The court subverts the constitutional guarantee of equal protection by further entrenching racial inequality in education, the very foundation of our democratic government and pluralistic society.” 

Sotomayor remained optimistic that the ruling would not disrupt the path toward a more diverse and equitable environment in higher education admissions.  

“Notwithstanding this Court’s actions, however, society’s progress toward equality cannot be permanently halted. Diversity is now a fundamental American value, housed in our varied and multicultural American community that only continues to grow. The pursuit of racial diversity will go on.”