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Affirmative action decision will worsen health disparities

Representation in medical environments saves lives and imbues trust. This ruling dismantles that.

Dr. Ebonie Woolcock at Bowdoin Street Health Center in Dorchester, MA on Sept. 16, 2014.Suzanne Kreiter/Globe staff

Last month, the Supreme Court struck down affirmative action, ruling that race-based admissions criteria are unconstitutional and ending what is arguably one of our most effective tools for ensuring diversity in postsecondary education in the U.S. This new ruling places the onus of overcoming racism on the individual and reveals a deep misunderstanding of how racism limits individual choice and opportunity, especially for marginalized groups in medicine.

Striking down affirmative action will have real-world consequences on the medical field and public health. It will lead to worsening health disparities, lower life expectancies and compounded health outcomes in Black, Brown and Indigenous communities. Diversity in health care is good medicine: Black, Brown and Indigenous physicians serve uninsured and Medicaid patients, practice in underserved rural and urban areas, and improve patient experience, performance and health outcomes. Among the less considered implications are the limited opportunities for non-minorities to learn from others, leaving medical students underprepared to practice in today’s diverse world.

Countless studies shed light on the disproportionately poor quality of care that leads to higher mortality rates in Black, Brown and Indigenous communities. Studies also show that concordant care aligning with social and cultural status leads to better health outcomes for marginalized groups. Concordant care can increase patient experience, appropriate screening, preventative measures, vaccination and communication. Mortality rates for Black newborns drop by half when Black physicians care for them, and a recent JAMA study showed that Black patients living in counties with more Black doctors lived longer.

Health care for the Indigenous populations has also been chronically underfunded, rife with medical experimentation and forced sterilizations, leading to a deep mistrust of the medical system and poorer health outcomes than other minority groups. A key way to mitigate these health disparities is to increase the number of Indigenous physicians, which will be much more difficult if programs do not consider the unique lived experiences and hardships that marginalized populations experience.

Unfortunately, fewer than 6% of physicians are Black, 0.3% are Indigenous and 6.9% are Hispanic. As experts who deeply understand the social determinants of health, we know that Black, Brown and Indigenous communities remain underrepresented at higher education institutions, which ultimately impacts the diversity within our health care workforce. The success of concordant care correlates with a diverse workforce that includes physicians from underrepresented groups, which will become even smaller without equitable access to higher education through policies like affirmative action.

Diversity saves lives. And the inverse is true as well: A lack of diversity shortens them.

Schools and colleges will also bear the burden of the Supreme Court’s affirmative action ban. Undue cost and uncertainty on how to achieve a diverse student body will have a higher impact on smaller institutions with limited resources. Case in point, California, which banned affirmative action at the state level in 1996, has tried a broad range of strategies and programs to boost diversity in their classrooms. After spending millions of dollars and developing practices ranging from moving away from standardized test scores to hiring a more diverse faculty, data shows this hodge-podge combination of rules and programs has not been as effective to ensure diversity.

While merit-based admission may seem fair, it fails to account for the systemic barriers that underserved and marginalized groups face. Affirmative action recognizes the reality that historical and ongoing discrimination has created significant disparities in educational opportunities. Although not a foundational solution, affirmative action creates a core opportunity to identify these inequities by naming them directly. It acknowledges that due to structural racism, students from disadvantaged backgrounds may not have had access to the same resources, quality of education or opportunities for personal and academic development as their more privileged counterparts.

This fateful ruling will undoubtedly diminish U.S. economic potential and increase the financial burden of education-related health inequities, recently estimated to be over $940 billion. Dr. Thomas LaVeist, dean of Tulane University School of Public Health and lead author of the study, asserted that “investment in achieving health equity would not only help people live longer, healthier lives, it would also pay dividends economically that would benefit community well-being long term.”

This ruling was never about combating racism or advocating for equity. If that was the case, SCOTUS would have ruled legacy admissions unconstitutional. Instead, this decision perpetuates the social injustices that have been embedded in our country’s fabric since its founding.

Even though only a small percentage of universities and medical schools use race in their admissions criteria, affirmative action was a tool available to colleges to increase the racial diversity of higher education without the fear of legal retaliation. Still, there are resources available during these treacherous times, including the Structural Racism Remedies Repository and legal guidance for advocates. These can provide avenues for advocates to center racial equity efforts with a legal foundation and avoid pitfalls.

At a time when we need to invest in policies that promote health equity for underrepresented individuals and adults with less than a four-year college degree, SCOTUS has set a new legal baseline that will undo decades of hard-earned incremental progress. It’s up to us to fight back.

Guleer Shahab, Juan Carlos Gonzalez, Jackie Leung, Joshua Budhu, Kelly Harris, Sarah Walker, Sharon Attipoe-Dorcoo, Tatiane Santos and Tyler Harvey are Public Voices Fellows of AcademyHealth and The OpEd Project.