Editor’s Introduction: Diversity, equity and inclusion are growing initiatives within healthcare. MD-Update asked Geraldine Young, DNP, APRN, to share her thoughts and views on the topics.
VERSAILLES Changes have occurred since the Civil Rights Movement of the 1960s to improve the treatment of Black people; however, the underpinnings of systemic and structural racism are alive and well in the United States. Through the inequitable outcomes of the COVID-19 pandemic, 2020 bestowed upon us an undeniable reality check on the national impact of systemic and structural racism in our healthcare delivery system. As of March 17, 2021, the Centers for Disease Control (CDC) reported 533,057 COVID deaths in the U.S. Of the 289,119 deaths in which the race was known, 14% of the victims were identified as Black, non-Hispanic. Although underrepresented in the U.S., Black people disproportionately led the death toll rates as they suffer from existing socioeconomic hardships in addition to the adversities brought on by the pandemic.
The COVID-19 pandemic has shone a light on the health disparities and inequalities that people of color suffer from daily. The lack of trust for the COVID-19 vaccine embodied within the Black community due to historical and current medical negligence and bias provided by a vastly white population of healthcare professionals compounds this problem. In November 2020, a survey conducted by the National Association for the Advancement of Colored People (NAACP) revealed that only 14 percent of Black respondents trusted the vaccine and only 18 percent indicated that they would definitely get vaccinated.
Healthcare disparities extend beyond the pandemic, however. For example, according to 2017 data from the CDC, Black women are three to four times more likely to die of pregnancy complications than white women. Contributing factors to these disparities are financial, bureaucratic, transportation, language barriers, and care that is not consistently culturally appropriate or respectful.
The Need for Culturally Congruent Care
To abate these tragic, disproportionate outcomes and build trust within the U.S. healthcare delivery system, the healthcare workforce must become more diverse. Our nation’s population is continuously changing and becoming more diverse. The healthcare workforce must change to match. The United States Census Bureau predicts that by 2045, over half of the U.S. population will consist of minority populations. The American Association of Colleges of Nursing (AACN) states, “With projections pointing to minority populations becoming the majority, professional nurses must demonstrate a sensitivity to and understanding of a variety of cultures to provide high-quality care across settings.”
Culturally congruent health care providers representing racial, ethnic minority populations improve trust in the health care delivery system, quality of care, and outcomes of minority populations. A 2017 report by the National Institutes of Health determined that cultural respect was an essential factor in reducing healthcare disparities and improving access to quality health care for diverse patients. According to data from the National League of Nursing and the U.S. Census Bureau, approximately 80% of registered nurses, nurse practitioners, and nurse-midwives are white. Schools of nursing must also develop strategies for increasing diversity within the nursing workforce.
A Shining Example
An example of this shift can be found at Frontier Nursing University, which, over the past decade, has placed an emphasis on diversity, equity, and inclusion (DEI), with a particular focus on increasing the enrollment and graduation rates of students of color. FNU included DEI in its strategic plan to address issues surrounding access to healthcare, health outcomes, health disparities, and health inequities, and to increase diversity in nursing. These efforts will play a significant role in ameliorating health disparities and inequities. FNU’s SOC enrollment has grown from 9% in 2010 to over 25% in 2020. FNU is continuing on the trajectory of integrating DEI and antiracism throughout the university to support racial, ethnic underrepresented students. Resilience during the COVID-19 pandemic permitted FNU to graduate 841 students, including 208 students of color, yielding an increased workforce diversity to care for diverse, rural, underserved populations. Additionally, FNU’s current retention rate for SOC is 84%, exceeding the university’s goal of 80%, and the number of faculty of color is on the rise, currently standing at 14%.
FNU is an example of the intentional focus required to begin building a more diverse, culturally competent health care system. We have known and understood for a while now that the lack of diversity among primary health care providers is a contributing factor to the glaring disparities in health care outcomes among diverse populations. The past year only acted to exacerbate the problem and heighten our awareness of the need for immediate change and action. If we have learned anything from the pandemic, it is that diversity, equity, and inclusion are the keys to the future success of our nation’s health care delivery system.