Although many American citizens enjoy full access to some of the best healthcare in the world, the disparity between the haves and have-nots continues to stifle the current system. A contributing factor to this gulf is the lack of diversity in the healthcare field, argues former U.S. Department of Health and Human Services Secretary Louis Sullivan. In fact, according to the recent report by the Sullivan Commission on Diversity in the Healthcare Workforce—a group of 15 health, business, higher education and legal experts—diversity among healthcare professions is one of the most pressing issues of our time.
Speaking to an audience of Columbia University Medical Center healthcare providers, Sullivan presented his report on Jan. 13 at the Julius and Armand Hammer Health Science Center in Washington Heights. The report, Missing Persons: Minorities in the Health Professions, was released in fall 2004 and addresses the question of how to boost the presence of minorities in healthcare, and why it is critical to do so.
"We are rapidly becoming a more diverse society," said Sullivan, pointing out that African Americans, Hispanics and Native Americans make up 25 percent of the U.S. population, but account for less than 9 percent of nurses, 6 percent of physicians and 5 percent of dentists. He added that projections show that by 2050 the country will no longer have any "majorities;" rather, it will consist of a "collection of minorities."
As a result of this demographic trend, reports the commission, the healthcare field must revise its policies and perspectives.
"Medicine is a scientifically based discipline, delivered in a social setting," said Sullivan. "We clearly want to have a strong science base in the health profession, but that alone is not good enough. To be effective health professionals we need scientifically trained, but culturally competent health professionals."
The report is the first major project by the Sullivan Commission, funded by a W.K. Kellogg Foundation grant to Duke University. Along with its namesake chair, Sullivan, who is the founding dean and first president of the Morehouse School of Medicine, the Commission is led by Honorary Co-Chairs Robert Dole, former U.S. Senate majority leader, and Paul Rogers, former U.S. congressman and Congressional Health Subcommittee chairman.
Sullivan and his team of 16 commissioners conducted field studies in six major cities across the country to collect data for the report. Working with representatives from medical and educational centers, the commission explored tactics for recruiting minorities to the field, types of "culturally competent" curricula, the best ways to meet the needs of underserved communities and the "dividends of diversity" in medicine.
One of the report's conclusions is that "minority providers are more likely to practice in minority and medically underserved communities," making a surge in the number of minorities in healthcare key to addressing national health disparities.
Sullivan outlined several of the commission's 37 official recommendations on the issue, including an appeal to the federal government to create an advisory council or taskforce. Sullivan also said the commission strongly supports scholarships, loan forgiveness and tuition-reimbursement programs to serve as alternatives to student loans.
"We have too many students who don't even consider the health professions because of the high costs of education, with no financing mechanism other than loans, which many low-income students find completely threatening when they come from families whose finances are already marginal," said Sullivan. "We should look at this as an investment in our society, in training those health professionals needed by society, so that our society will be better off."
Sullivan then emphasized the need to reach out to minority students as early as elementary school to stimulate their interests in medicine and healthcare. Similar tactics for older students include "bridging programs" between community colleges and baccalaureate colleges, because more African Americans and Hispanics attend two-year rather than four-year institutions.
To conclude his presentation, Sullivan answered questions from the audience including one from Allan Formicola, vice dean for community health partnerships at CUMC, who asked how realistic it is that President Bush might establish an advisory council to further explore the issue. Sullivan cited the success of the 9/11 Commission, following the publication of its report, to continue moving forward with public hearings and advocating for its recommendations.
"Our commission is still in business, and we will indeed be pushing every vision … This is a challenge, and we will meet that challenge and we will demand an answer," he said.