Commission on Diversity in Health Workforce

Sullivan Commission tours the country to study and promote diversity in the health care workforce

by Tony P. Martinez and Alison P. Martinez

"Role models are important!" says Louis W. Sullivan, M.D. founding dean of Morehouse School of Medicine and former U.S. Secretary of Health and Human Services. "Too many minority young people have never interacted with any minority health professionals. [This type of interaction] tells the youngster-even if silently or indirectly-that they can be successful, too.

Sullivan urges all minority health care practitioners to become role models for minority youth in their communities by providing information, guidance, and support.

"Minority health professionals can answer questions with greater credibility for these youngsters. We need minority physicians, dentists, nurses and [other health care providers] to play such a role. We need local involvement; this is one of those local activities that can mean so much. It makes it real, rather than abstract, for a youngster to have [a role model] right in the room or right in the community as opposed to on television."

Shortage of Minority Health Professionals

Role models for future minority health care practitioners is extremely important in a time when African Americans, Hispanics and American Indians combined make up more than 25% of the U.S. population but represent less than nine percent of nurses, six percent of physicians, five percent of dentists, and similar low percentages of other health professions.

In certain regions, the disproportion is worse. For example, in Georgia, the Hispanic population has surged to four percent, but only 0.8% of the state's nurses are Hispanic.

The American Council on Education reports that fewer than 8,000 minority men and women earned master's degrees in health professions in 2001 (the most current year data was collected). That's only 18% of all the health professions master's degrees awarded that year.

And the shortage may be getting worse-fewer minority students are enrolling in health care education programs. For example, in 2002, of more than 8,000 medical students in the state of New York, there were only 265 minority first-year students. This was 5.4% fewer than in 2001; it was also a ten-year low. "Deans and university officials are saying that they have none or only one new black or Hipanic student in their classrooms for the first time in decades," Sullivan reports.

"We know that the lack of minority health professionals is adversely affecting critical racial and ethnic health disparities," Sullivan adds. African Americans, Hispanics, and American Indians and Alaskan Natives on average receive less prenatal care, lower vaccination rates, less cancer screening, and worse control of diabetes and hypertension. In general, non-majority Americans receive less effective health care and are more likely to report poor or fair, rather than good or excellent, health. For many, life expectancy is cut short.

Sullivan Commission Takes to The Road

Louis Sullivan is not accepting deteriorating health outcomes with resignation. Supported by Kellogg Foundation funding, he has organized the Sullivan Commission on Diversity in the Healthcare Workforce in order to create solutions. "This is a problem that can be solved," he affirms.

Since the fall of 2003, the Commission has held field hearings in Atlanta, Denver, New York, Chicago, Los Angeles and Houston, and a town hall meeting in Boston. At each hearing and meeting, the Commission has collected data and testimony from health experts, community advocates, business leaders and local governmental officials.

In New York, U.S. Representative Charles B. Rangel stated, "Increasing diversity in medicine, dentistry and nursing is one of the key strategies to reduce the alarming health disparities facing our nation. In the last decade, we have seen hardly any increase in the number of minority health professionals despite the growing ethnic diversity of our population. The work of this Commission will provide Congress a needed roadmap on how to solve this health care problem facing our nation's citizens, including the poor and millions of minorities."

In Chicago, U.S. Representative Jesse L. Jackson, Jr. stated, "Racial minorities--especially blacks, Hispanics and American Indians--are over-represented when it comes to disease and illness, but underrepresented in the healing professions. Both dimensions-health and healing-must change for the better soon. Increasing diversity in the healing professions is one way to bring about that change. The Sullivan Commission is pointing the way to close these gaps in the health care professions."

Rupert Evans, president of the American Hospital Association's Institute for Diversity in Health Management, testified, according to Associated Press reports, that minorities seek out medical care more frequently with providers of the same race. He said that in order to solve the racial disparity issue, the country needs providers that are culturally similar to and sensitive to patients. "It's all tied together," Evans concluded. "You can't have one without the other."

Take Action Now

"Now is the time to confront the crisis in the nation's health care system and utilize the tool of diversity in crafting solutions," Sullivan declares. "Barriers that are blocking the aspirations of minority students to become health professionals must be removed."

The Commission emphasizes that all children deserve quality education from kindergarten on up. "We must strengthen educational preparation so that young people don't have to leap over a chasm to gain entry to health care careers," Sullivan says.

The Commission calls for better coordination at each level of school-from kindergarten through junior high, high school, college and graduate programs-so each level doesn't stand alone "like a silo in a field," as Sullivan puts it.The transition from two-year to four-year institutions of higher education is especially critical. At the hearings in Denver and again in Houston, the Commission heard that many minority youth enter higher education through community colleges. The Commission believes colleges and universities should smooth the way for these transfer students, with coordinated curricula, guaranteed transfer of credits, and even guaranteed admission to four-year programs for successful two-year students.

Another major recommendation is improved financial aid for students in health care programs, with more scholarships and low-interest loans, rather than unsubsidized loans. The prospect of heavy student debt distorts career choices, Sullivan explains. "It's hard to explain to a young person from a low-income family that with the professional credential they would be earning enough to pay off the loan. That kind of debt can be a barrier. And financial barriers affect majority as well as minority youngsters.

"We have to find easier ways for youngsters to finance their health professions education than we have now," Sullivan warns. "Our current system is very threatening for a youngster coming from a low-income background."

For college graduates seeking careers as physician assistants, pharmacists, and other professions requiring graduate education, the Commission recommends short, "brush-up" programs to improve their preparation for professional school. "Students who have the intellectual capacity but find a weakness or deficiency in some area" would thereby be better prepared for admission to, and success in, graduate programs.

The Commission's hearings also highlighted the often-overlooked fact that many minority people are already working in other jobs when they decide to pursue their dream of a health care career. "This represents a new career shift for them," Sullivan explains, and the Commission calls for "strategies to help identify and assist those people in the transition to a second career."

Cultural Competence for a Diverse America

"Years ago, when we talked about minority populations we were talking primarily about the African-American population," Sullivan relates. "But today the Hispanic population has increased significantly; it is now larger than the African-American population. We also have Vietnamese, Hmong, Cambodian, Eastern European and so many other groups. The concept of diversity now implies a lot more specific cultural backgrounds that those in the health professions have to be aware of and adapt to.

"We need to meet these people more than half way, Sullivan says. "Even if you have a highly competent, technically and scientifically trained group of health professionals with the best facilities, it doesn't help [patients] if there is no communication. If there is a communication barrier, then all that excellence is frustrated.

"The ideal that we envision in the Commission," Sullivan adds, "is a health professions community sufficiently multicultural in orientation and understanding so that they know how to communicate with someone from a different background. They can communicate in such a way that patients are comfortable and develop trust. Then you'll have patient compliance, whether it's taking medicine, coming in for a follow-up visit, or any of a whole host of things." Ultimately, patient compliance leads to better health outcomes.

Similarly, institutions of health care education can create environments that are more "user-friendly," Sullivan suggests, so that "minority students have an experience that is affirming, rather than hostile or indifferent."

All health care workers should take on these changes, Sullivan believes. "The health issues of minorities are not going to be addressed solely by minorities," he says, "nor should they be, from an idealistic point of view. We need everyone involved, because, frankly, this is a problem and a challenge for all of us.

"As we find solutions, not only will there be improvements within the minority community in terms of improved access to health care careers, improved health care and improved health status, but also there will be advances in community development, social stability, and economic development. All of these things are intertwined."

Sullivan gives credit to neighborhood institutions like the Boys' Club and Girls' Club that help young people develop self-esteem and become successful. "Youngsters have to view themselves as capable of achieving something," he points out. "The more confidence they have, the more willing and able they are to take risks" such as pursuing demanding professional careers in health care.

His own Morehouse School of Medicine invites grade school children to a "Saturday Academy" on campus, collaborates with the Explorer Scouts, and even awards a scholarship to Boys' and Girls' Club members.

"Advocating for the necessary changes, including greater availability of financial resources, will be essential," Sullivan concludes. He invites everyone in the health care field to make their views known.

"Individuals who are decision makers in federal government, state governments, the business community and the philanthropic community will have to be convinced that this is a worthwhile investment. The case has to be made that our society will get important and significant returns on this investment.

"Ultimately, there has to be a broad societal understanding of this problem and a belief that by investing the time, effort, and resources, this is a problem that can be solved."

L-R: The Hon. Louis Stokes, former Congressman and founder of the Congressional Black Caucus Health Braintrust; Dr. Regina Benjamin, CEO, Bayou La Batre Rural Health Clinic in Alabama; Dr. John Rich, medical director, City of Boston Public Health Commission; Dr. Patricia Gabow, CEO and medical director, Denver Health; The Hon. Louis W. Sullivan, chair, Sullivan Commission; Dr. Ben Muneta, president, Association of American Indian Physicians; Dr. Geraldine Bednash, executive director, American Association of Colleges of Nursing; Dr. Joan Reede, dean, Office for Diversity and Community Partnership, Harvard University; and Mr. Tom Perez, director of Clinical Programs, University of Maryland Law School

Dr. Geraldine Bednash, executive director, American Association of Colleges of Nursing, to her left is Dr. John Rich, medical director, City of Boston Public Health Commission

Dr. Elena Rios, president of the National Hispanic Medical Association, to her right is Dr. Joan Reede, dean, Office for Diversity and Community Partnership, Harvard University

Tony and Alison Martinez are writers based in Santa Fe, New Mexico. Tony was an educator, Alison a research librarian.