The Rationale for Diversity in the Health Professions : A Review of the Evidence

Several racial and ethnic minority groups and people from socioeconomically disadvantaged backgrounds are significantly underrepresented among health professionals in the United States. Underrepresented minority (URM) groups have traditionally included African-Americans, Mexican Americans, Native Americans, and mainland Puerto Ricans. Numerous public and private programs aim to remedy this underrepresentation by promoting the preparedness and resources available to minority and socioeconomically disadvantaged health professions candidates, and the admissions and retention of these candidates in the health professions pipeline and workforce. In recent years, however, competing demands for resources, along with shifting public opinion about policies aimed to assist members of specific racial and ethnic groups, have threatened the base of support for " diversity programs. " Continued support for these programs will increasingly rely on evidence that they provide a measurable public benefit. The most compelling argument for a more diverse health professions workforce is that it will lead to improvements in public health. We therefore examined the evidence addressing the contention that health professions diversity will lead to improved population health outcomes. Specifically, we searched for, reviewed, and synthesized publicly available studies addressing four separate hypotheses: 1) The service patterns hypothesis: that health professionals from racial and ethnic minority and socioeconomically disadvantaged backgrounds are more likely than others to serve racial and ethnic minority and socioeconomically disadvantaged populations, thereby improving access to care for vulnerable populations and in turn, improving health outcomes; 2) The concordance hypothesis: that increasing the number of racial and ethnic minority health professionals—by providing greater opportunity for minority patients to see a practitioner from their own racial or ethnic group or, for patients with limited English proficiency, to see a practitioner who speaks their primary language—will improve the quality of communication, comfort level, trust, partnership, and decision making in patient-practitioner relationships, thereby increasing use of appropriate health care and adherence to effective programs, ultimately resulting in improved health outcomes; 3) The trust in health care hypothesis: that greater diversity in the health care workforce will increase trust in the health care delivery system among minority and socioeconomically disadvantaged populations, and will thereby increase their propensity to use health services that lead to improved health outcomes; and 4) The professional advocacy hypothesis: that health professionals from racial and ethnic minority and socioeconomically disadvantaged backgrounds will be more likely than others to provide leadership and advocacy for policies and programs aimed at improving health care for vulnerable populations, thereby …