A 2018 population estimate from the U.S. Census Bureau confirms what has long been predicted: Less than half of the nation’s children age 15 and under are single-race, non-Hispanic and White.1 This shift toward a more diverse country is expected to continue, with estimates showing the population group of people who are two or more races expected to see the greatest increase through 2060.2
With our country growing more diverse each year, natural progression would suggest that so should our fundamental institutions, such as our government, our schools and our healthcare facilities. While all undeniably important, the latter of the three has arguably the most potential for direct negative, community-wide impact when lacking in cultural competency.
Assertions like this have led many to ask some pivotal questions: How important is cultural diversity in healthcare? Could a lack of diversity truly harm patients?
We interviewed healthcare professionals and reviewed the latest research to gather some insight on these important questions.
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The current state of cultural diversity in healthcare
If the goal is to have a diverse group of healthcare providers that reflects the varying cultures, races and ethnicities of patients they serve, many medical facilities are still falling short.
“Currently, the state of diversity in healthcare still has a long way to go to be representative of the general populations that we serve,” says Dr. Luz Claudio, professor of environmental medicine and public health.
Although the United States is growing more diverse by the day, the vast majority of physicians are White—56.2 percent, to be precise. In contrast, only 17 percent of physicians are Asian, 5.8 percent are Hispanic, five percent are Black, and 0.3 percent are American Indian or Alaska Native.3
Unfortunately, these numbers aren’t likely to see a drastic change anytime soon. Figures from the Association of American Medical Colleges (AAMC) show that 46.8 percent of medical school applicants are white. Though some areas of the medical field are showing increased diversity, researchers have found that the majority of people of color working in healthcare hold entry-level, lower-paying jobs.4
“One of the main reasons diversity is slow to increase in healthcare is because it is dependent on how diversity changes in the education of healthcare professionals,” says Dr. Jenna Liphart Rhoades, advisor at NurseTogether.com. “For example, there won’t be an increase in the diversity of nurses if there isn’t an increase in diversity during their education.”
Negative health outcomes caused by lack of diversity
This lack of representation is about far more than appearances. Lack of diversity is tied to negative health outcomes in real patients—people of color who have suffered serious health complications and even death. These are just two of the staggering statistics:
- Black, American Indian and Alaska Native women are two to three times more likely to die from pregnancy-related causes than White women. These disparities have “persisted over time,” despite the fact that most pregnancy-related deaths are preventable.5
- Racial disparities in hospitalization and death from the COVID-19 virus are well documented, with Black, Native American and Alaska Native population deaths and infections rising disproportionately.6
The causes behind these poor health outcomes are vast and complex, including topics as nuanced as lack of access to affordable health insurance and higher rates of chronic, underlying health conditions in some races.
However, there’s no denying that some of these negative outcomes are the result of implicit bias, or subconscious prejudices, about other races. This issue can cut both ways: Not only can implicit bias cause doctors to fail to treat patients with equity, but bigoted patients who distrust healthcare workers of color can also cause problems by refusing to listen to their advice.
The importance of cultural competence
In the world of medicine, the term cultural competence refers to the knowledge, skills, attitudes and behaviors required of a healthcare professional to provide optimal care and services to patients from a wide range of cultural and ethnic backgrounds.
“One step ahead is when patients and communities encounter diverse healthcare providers who have broader perspectives, have a deeper understanding of different communities and are able to be empathetic to those seeking help,” Dr. Claudio says.
For example, one study showed that Black men were more likely to be open with Black doctors about their health problems, and Black doctors were more likely to take substantial notes about their Black patients than White doctors.7
Though it won’t always be possible to match every patient with a nurse or physician of the same background, encouraging diversity and cultural competence in the field as a whole can increase empathy and active listening toward patients, not to mention encourage patients to take a more active role in their own health.
“It has been shown in different studies that patients are more likely to participate in their own healthcare and in clinical trials if they are approached by a healthcare provider who is of their own race or ethnicity,” Dr. Claudio says.
How to improve diversity in healthcare
In the end, the U.S. cannot improve diversity in healthcare without making medical training more welcoming, appealing and attainable for people of all races and ethnicities.
“I am a strong believer in internships and mentoring,” Dr. Claudio says. “I think that introducing diverse populations to healthcare work early in their careers provides a great platform for them to pursue careers in these areas.”
This isn’t a change that can happen overnight. However, part of the beauty of cultural competence is that it can be learned by anyone of any race or ethnicity. “Staff members can ask for training to be available that highlights care differences in different populations,” Dr. Liphart Rhoades says. This is one strategy for closing the racial disparity in healthcare outcomes as we wait for future generations of more diverse healthcare workers to enter the field.
Regardless of how long it takes, pursuing a more diverse healthcare field is not a goal we can give up on. “Having a diverse community of doctors and scientists helps make our work better not just for people of color but for all people needing to improve their health,” Dr. Claudio says.
While a lot of focus is understandably placed on physicians, the healthcare field and society at large can benefit from healthcare practitioners at all levels who better reflect the patients they serve. Occupations aren’t hereditary, but this generation’s nurses, medical assistants and technical health specialists may help open the door to the next generation of doctors and other healthcare leaders—and that’s an important step to take.
Are you part of the forecast for a diversified future?
The most effective healthcare professionals are those who maintain a steady commitment to continually learn and progress in their fields. Some impactful first steps toward more cultural diversity in healthcare have been taken, but the work has only just begun. It will take active participation from all involved to ensure the outcome is a diversified, more culturally competent team of caretakers and providers.
If you’re considering joining the ranks of healthcare professionals dedicated to improving diversity and cultural competence in the field, you might be wondering what your options are when it comes to pursuing a nursing education. Get started with our article “A Beginner’s Guide to Understanding the Levels of Nursing Credentials.”
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1 “Less than half of U.S. children under 15 are white, census shows,” Brookings Institution, [information accessed February 2021], https://www.brookings.edu/research/less-than-half-of-us-children-under-15-are-white-census-shows/
2 “Demographic Turning Points for the United States: Population Projections from 2020 to 2060,” U.S. Census Bureau, [information accessed February 2021], https://www.census.gov/content/dam/Census/library/publications/2020/demo/p25-1144.pdf
3 “Diversity in Medicine: Facts and Figures 2019,” Association of American Medical Colleges, [information accessed February 2021], https://www.aamc.org/data-reports/workforce/interactive-data/figure-18-percentage-all-active-physicians-race/ethnicity-2018
4 “Developing Workforce Diversity in the Health Professions: A Social Justice Perspective,” Health Professions Education, [information accessed February 2021], https://www.sciencedirect.com/science/article/pii/S245230112030016X
5 “Racial and Ethnic Disparities Continue in Pregnancy-Related Deaths,” Centers for Disease Control and Prevention (CDC), [information accessed February 2021], https://www.cdc.gov/media/releases/2019/p0905-racial-ethnic-disparities-pregnancy-deaths.html
6 “As Pandemic Deaths Add Up, Racial Disparities Persist—and in Some Cases, Worsen,” NPR, [information accessed February 2021], https://www.npr.org/sections/health-shots/2020/09/23/914427907/as-pandemic-deaths-add-up-racial-disparities-persist-and-in-some-cases-worsen
7“Does Diversity Matter for Health? Experimental Evidence from Oakland,” Stanford Institute for Economic Policy Research [information accessed February 2021] https://siepr.stanford.edu/research/publications/does-diversity-matter-health-experimental-evidence-oakland
EDITOR’S NOTE: This article was originally published in 2017. It has since been updated to reflect information relevant to 2021.
