The impact of the Supreme Court’s recent affirmative action decision on diversity in health care

On June 29, 2023, the Supreme Court overturned the use of affirmative action in college admissions with two rulings between the Students for Fair Admissions (SFFA) and universities—SFFA v. Harvard and SFFA v. The University of North Carolina. With this decision, colleges and institutions are now looking for new ways to encourage diversity, equity and inclusion in education and in medicine.

In reference to the rulings, Chief Justice John Roberts, who voted in favor of the decision to overturn affirmative action, stated, “Nothing in this opinion should be construed as prohibiting universities from considering an applicant’s discussion of how race affected his or her life, be it through discrimination, inspiration or otherwise.

“A benefit to a student who overcame racial discrimination, for example, must be tied to that student’s courage and determination. Or a benefit to a student whose heritage or culture motivated him or her to assume a leadership role or attain a particular goal must be tied to that student’s unique ability to contribute to the university. In other words, the student must be treated based on his or her experiences as an individual—not on the basis of race.”

In contrast, Justice Sonya Sotomayer voted against overturning affirmative action. She declared that: “Today, this court overrules decades of precedent and imposes a superficial rule of race blindness on the Nation. The devastating impact of this decision cannot be overstated. The majority’s vision of race neutrality will entrench racial segregation in higher education because racial inequality will persist so long as it is ignored.”

On June 30, the day after the ruling, the AOA published a statement on the Supreme Court decision, stating its “disappointment in the recent decision to restrict medical schools from considering race and ethnicity as a factor for admission” given how “diversity in the physician workforce is a key aspect of eliminating health care disparities in medical treatment and is associated with improved health outcomes for patients and greater patient satisfaction.”

What is affirmative action?

In the context of higher education, affirmative action refers to a set of admissions policies aimed at increasing the number of students of underrepresented races in the United States. Historically, this has typically referred to policies aimed at increasing the number of Black and Hispanic students on campus. Examples of affirmative action include outreach efforts, scholarships/grants and representation in quotas. Within education, affirmative action may also include denying government funding to institutions that fail to follow these policies.

Why was affirmative action established in the first place, and why was it overturned?

On March 6, 1961, President John F. Kennedy issued an executive order that government contractors “take affirmative action to ensure that applicants are employed, and employees are treated during employment, without regard to their race, creed, color or national origin.” The intent of the executive order was to support equal opportunities for everyone living in the United States. Four years later, on Sept. 24, 1965, President Lyndon B. Johnson issued an executive order that prohibited employment discrimination based on race, color, religion or national origin, and two years after that, in 1967, he amended the order to include sex.

The civil rights movement and President Johnson’s War on Poverty during this decade created the right climate for the U.S. government to begin prioritizing equal access to education. In June 1965, President Johnson spoke at Howard University in Washington, DC, stating, “You do not take a man who for years has been hobbled by chains, liberate him, bring him to the starting line of a race, saying, ‘You are free to compete with all the others,’ and still justly believe you have been completely fair … This is the next and more profound stage of the battle for civil rights. We seek not just freedom but opportunity—not legal equity but human ability—not just equality as a right and a theory, but equality as a fact and as a result.”

Now, in 2023, organizations have argued that affirmative action policies discriminate against individuals who are not of underrepresented races. In the case of SFFA v. Harvard, SFFA argued that Harvard’s admissions policy discriminated against Asian-American applicants. In SFFA v. UNC, SFFA argued that the University of North Carolina’s admissions policy discriminated against both white and Asian-American applicants.

What are the benefits of diversity in medicine and the consequences of a less diverse health care workforce?

Research shows that students trained at diverse schools are more comfortable treating patients from a wide range of diverse backgrounds. Race concordance in health care has also been associated with higher levels of patient trust and satisfaction related to their care. According to the U.S. Census Bureau, 13.6% of the population is Black. However, only 5.7% of physicians are Black, reflecting a lack of representation in health care.

Similarly, 16% of the U.S. population is Hispanic, while only 7% of physicians are Hispanic. A diverse health care workforce that represents the community it serves can better address the health care disparities that community faces.

In response to the Supreme Court’s decision, AOA CEO Kathleen Creason has stated, “The osteopathic profession has a long history of advancing diversity in the physician workforce, recognizing the need to eliminate health care disparities in medical treatment. I’m proud to represent this noble profession that values inclusivity and racial and ethnic diversity among health care professionals. The AOA remains committed to ensuring that the makeup of our growing profession is representative of the patient population we serve.”

What are some proposed solutions to maintaining diversity in education and thus in medicine?

The American Civil Liberties Union has proposed a number of solutions, which include but are not limited to:

• Eliminating reliance on standardized testing, which has been shown to disadvantage students of color
• Expanding outreach and recruitment pathways from middle school and high school
• Improving access from community college to a four-year degree
• Removing barriers for justice-impacted students
• Removing financial barriers to enrollment

What can we do next?

You can make your voice heard on diversity in medicine by attending OMED from Oct. 6-8, 2023. For the last few years, OMED has offered a track focused on DEI and social determinants of health. This year, OMED is hosting a diversity, equity and inclusion session on Saturday, Oct. 7. The session will be the only one held during that time slot in order to highlight the importance of diversity, equity and inclusion in medicine.

The first 45 minutes of the session will be a lecture and simulated patient encounter to demonstrate how osteopathic students and physicians can talk to their patients about sensitive but important issues within the context of DEI. The next 45 minutes will be a discussion on how current anti-DEI practices are affecting patients throughout the country.

You can learn more about this year’s OMED or register to attend here.

Related reading:

Variety in diversity: Making medicine accessible for candidates from all walks of life

The Fiscal Responsibility Act of 2023: What is it, and how does it impact health care?