Recommendations from the 2020 Macy Foundation Conference
Harmful bias and discrimination are pervasive in health care, fueling inadequate treatment of patients:
- Black patients are significantly less likely to be prescribed proper pain medication in part related to false beliefs that Black people experience less pain.
- Black, American Indian and Alaska Native patients are more likely to die from complications of pregnancy or childbirth.
- Nearly 1 in 5 transgender and gender non-conforming people have been refused care outright.
It’s not just patients who suffer. Health care professionals and students also experience prejudice and discrimination that cause harm and limit their career opportunities:
- Studies show that students of color, women and those who are LGBTQ are more likely than other medical school classmates to experience mistreatment during their training.
- While more women than ever before are enrolled in US medical schools, they remain underrepresented in leadership positions at medical schools and health care delivery organizations.
Creating a workforce that reflects the broad diversity of current patient populations is one of the most powerful ways to reduce bias and discrimination within the health professions. Yet efforts focused simply on recruiting more people from diverse population groups have not worked. Today, just 5% of the physician workforce is Black, and 5.8% is Hispanic. Only 6.2% of the registered nurse workforce is African American, and just 5.3% is Hispanic.
The imperative to address harmful bias and discrimination in health care is urgent. As the world battles COVID-19, public health experts fear bias in treatment has contributed to the disproportionately high rate at which the novel coronavirus is killing African Americans and other patients of color.
To accelerate efforts to address harmful bias and eliminate discrimination within health professions learning environments, the Josiah Macy Jr. Foundation—the only national foundation solely dedicated to improving health professions education—convened more than 40 health professions education leaders, faculty and students to map a path forward.
The recommendations provide a roadmap to help our health professions schools and clinical practice sites take action on equity, diversity and inclusion to ensure a better future for our patients and for the next generation of health care providers.
The group outlined a series of action steps that must be taken to ensure our nation’s health professions learning environments—from classrooms to clinical sites to virtual spaces—are equitable, diverse and inclusive of everyone in them, no matter who they are. These action steps are organized within four overarching recommendations:
- Build an institutional culture of fairness and respect by making diversity, equity and inclusion top priorities.
- Develop, assess and improve systems to mitigate harmful biases and eliminate discrimination.
- Integrate equity into health professions curricula, explicitly aiming to mitigate the harmful effects of bias, exclusion, discrimination and all forms of oppression.
- Increase the numbers of health professions students, trainees, faculty and institutional administrators and leaders from historically marginalized and excluded populations.
True diversity is inclusive of any and all possible voices and perspectives. With these recommendations, the Macy Foundation hopes to find ways to create a sense of belonging for everyone within our health professions learning environments.
We can and we must eliminate discrimination and reduce harmful bias among health professionals. Advancing an agenda of equity, diversity and inclusion within the health professions is central to improving overall health and well-being for all Americans.