Episode Transcription
Dr. O’Connor: You are listening to the Health Disparities Podcast. A program of Movement Is Life. Welcome to our second in this series, which is being recorded live and in person at the Movement Is Life Annual Caucus. It’s a meeting that brings together health equity advocates from across the country, and we’re proud to have been championing solutions to health inequities for over 10 years.
I’m Dr. Mary O’Connor, Chair of the Board of Directors for Movement Is Life. And I’m co-founder and Chief Medical Officer of Vori Health. Our first panel discussion is titled, “Identity Politics and Health Equity”. Disparities in healthcare are driven by both systemic and individual factors, and this esteemed panel represents traditional medical organizations, underrepresented physicians, and legal and regulatory factors. This morning, the panel discussed some of the most pressing issues related to racism and healthcare today, and opportunities which must be embraced to receive and achieve equitable care. So, it is really my pleasure to introduce the panel to our podcast listeners. First, Dr. Elena Rios serves as the president and CEO of the National Hispanic Medical Association, the NHMA, representing 50,000 Hispanic physicians in the United States. The mission of the organization is to improve the health of Hispanic people. Dr. Rios also serves as president of the NHMA’s National Hispanic Health Foundation, which directs educational and research activities. Welcome Dr. Rios.
Dr. Rios: Thank you, Dr. O’Connor. It’s a pleasure to be here.
Dr. O’Connor: Next I have the pleasure of introducing Frank McClellan, Professor of Law Emeritus at the Beasley School of Law of Temple University, where he concentrates on healthcare law. He is author of a recent book published by Rutgers University Press, entitled, “Healthcare and Human Dignity: Law Matters”. Frank is also a long-standing member of our steering committee, recently graduated to emeritus status but we’re just delighted to have Professor McClellan with us.
Prof. McClellan: Thank you so much Dr. O’Connor for inviting me.
Dr. O’Connor: Next, Dr. Bonnie Simpson Mason has recently joined the American College of Surgeons, the ACS, as the inaugural Medical Director of Diversity, Equity, and Inclusion. Dr. Mason will champion the importance and value of a diverse and inclusive environment and support the development of a vision and effective strategy to create a culture for DEI at the American College of Surgeons and ensure compliance with applicable laws. Welcome Dr. Simpson Mason.
Dr. Simpson Mason: Thank you so much, Dr. O’Connor. Pleasure to be here.
Dr. O’Connor: Finally, rounding out our panel is Dr. Ramon Jimenez. Dr. Jimenez serves on the Executive Board of Movement Is Life and is our treasurer. He has been championing diversity and equity issues for the American Academy of Orthopedic Surgeons for the past 25 years. He has been chair of the Diversity Advisory Board and recipient of both the American Academy of Orthopedic Surgeons Diversity Award and Tipton Leadership Award. This is a singular distinction amidst 30,000 academy members, which he shares only with Dr. Augustus White, a man without parallels. Welcome Dr. Jimenez.
Dr. Jimenez: Thank you very much Dr. O’Connor. And I would like to address you as Mary because and to acknowledge the fact that as chairperson of Movement Is Life Foundation, you have been stellar in leading us the way.
Dr. O’Connor: Oh, Ramon, thank you. I think we can all be first name basis here.
Dr. Simpson Mason: Absolutely.
Dr. O’Connor: So, I’m going to start by reviewing some of the questions we discussed in the panel this morning and then perhaps asking for you to expand on some of the key points that came during the discussion. We know that evidence of health disparities have accumulated over the past two decades, so there is really no question that health disparities are real. We know that racism, sexism, discrimination against those of lower socioeconomic means continues to play a substantial role in perpetuating health disparities. So, I’d like to start by asking our, our counselor on our panel, Frank McClellan, to highlight what he considers to be some of the important lessons learned from past congressional and legal actions and court decisions aimed at addressing health disparities caused by conscious discrimination, unconscious bias, and structural racism.
Prof. McClellan: So let me start by saying that when you begin to examine the legislation and court decisions since the adoption of the 13th Amendment in freedom of the slaves, that what you find is that we are clearly able to address intentional discrimination when the political will exists in the country, intentional discrimination as distinguished from the consequences of structures and practices and policies. Now, I say that because the immediate action taken after the adoption of the constitutional amendments was to free the slaves. And that was through the 13th Amendment of the Constitution and Congress adopted a series of statutes that are called Reconstruction, Civil Rights Acts, which laid dormant for almost a hundred years until the Sixties. They’re called the Civil Rights statutes because basically what they’re doing is setting black folks who were the victims of slavery, trying to set them on the same footing as white citizens by bestowing upon them citizenship and giving them equal rights and amendments, and they were passed in 1865 in the series of statutes. But the response of the country was frightening and horrifying because that’s what continued or allowed the reflection of continued battle for slavery by the South. There’s a great book called, “Slavery by Another Name,” that tracks what happened in the country after the freeing of the slaves, where they were put back into indentured contracts. These ideas that if you were a vagrant, if you didn’t have a job and you were on the street, you could be arrested. And so, they would come to you and say, aren’t you lucky you can get out of jail because Mr. Bill will post your bail money at this point and all you have to do is agree to work for him for the next five years for almost nothing on the land. So that went on and on and on. And so there wasn’t much that was done. So, something positive was finally done again during the Civil Rights era when we passed the Civil Rights statutes. And one of the major Civil Rights statutes was a statute, which we call now Title VI. And I want to just quickly clarify what that means in terms of the allocation of power, because the Constitution itself has a process for amendments which are very difficult and a lot of time consuming for the state. So, once it is written there and it is interpreted and applied, it’s supposed to continue, whereas congressional legislation can be enacted, changed, revised and amended based upon advocacy. So, what we learned was how to effectively desegregate the healthcare system and other systems during 1960s through the ‘65 Act where the Medicare statute was passed, and Congress used its power of the purse to say that if you want to have the benefit of us reimbursing you for certain medical services, you can’t discriminate on basis of race. That’s why I started by saying, we know how to do it effectively.
Interestingly, when the Obamacare statute was passed, was it six years ago now? How many years? Well, in any event, close to that. There was a challenge to that statute on the grounds that Congress didn’t have the power to do that because they tried to use the money that was available under the Affordable Care Act to induce states to comply. Some of the states objected to that and said this, you don’t have the power to make us do this by taking, by putting this carrot out there and saying that if we don’t participate in, in Medicare or Medicaid, that we’re not allowed to get the benefit of the Affordable Care Act statutes. And the US Supreme Court agreed and said, we will uphold the statute, Congress has the power to pass the statute because it has the power of the tax. And look here, it says in the statute, the power of the tax, but it doesn’t have the power to make states do what it wants to do on the basis of equal protection or rights because that’s reserved to the states. And so, they sent it back and they said, each state must now decide whether or not they want to participate in expanding and getting the benefits of Medicare and Medicaid. They did that knowing that we were continuing the battle from the Civil War, which continues now when you hear the term state’s rights, and that again is reflected in the Dobbs Decision about rights to abortion, but you’re deciding politically that you don’t want to resolve this question on a national basis, that you want each state to have the right, and each state has done that. If you look at the map of the states as they expanded or didn’t expand, you can almost put the Civil War statutes states on a map and say, we’re not expanding the other thing. Otherwise, there’s more to be said, but that’s my introduction. Sorry for being so longwinded.
Dr. O’Connor: So, I’d like thoughts from other panelists on this basically continued legacy, I’ll say, of structural discrimination, racism, sexism, etcetera, that we still see throughout our institutions and policies basically, and how that can impact professional organizations, medical education groups that are responsible for certification, for example, of physicians like the American College of Surgeons. So Bonnie, how do you see this influencing the work that you’re doing?
Dr. Simpson Mason: Well, I think, you know, because of the Medicare Act and because…
Dr. O’Connor: And I’m sorry, just for clarity, that’s Obamacare for our listeners, is that what we’re saying?
Prof. McClellan: No, there’s two separate statutes. The Medicare statute that we’re referring to is…
Dr. Simpson Mason: 1965.
Prof. McClellan: So, 1965, and then, the Obamacare statute, which came along and said that we are going to make sure that people have access to health insurance, individually, independent of government provided insurance.
Dr. Simpson Mason: Yeah, no, absolutely. So, as we know, graduate medical education is funded through Medicare. So, our trained physicians are funded federally through the requisite hospital systems, academic institutions across the country. So, you know, what happens legislatively has a huge impact and a direct connection on medical education. So, we remain concerned. You know, we are not at a state, a steady state where we can trust or can affirm that the systemic discrimination will be dismantled. In fact, we are concerned that it may be upheld with some of the decisions that may be coming down the pike from the Supreme Court, and usually those types of decisions are felt immediately across the body of organized medicine, you know, medical associations, accrediting bodies, because we’ve been working for years at this point to make sure that people understand the importance of having a diverse workforce. We have evidence that our patients for marginalized backgrounds, race, ethnicity, geographic language preference patients have worse outcomes, and that’s across the board, as you know, documented even by the institutes of medicine back in 2000. So, some of the work that’s been done legislatively that’s been carried out through some of our accrediting bodies, our certifying bodies, our medical associations, that’s been starting to address some of those issues here two decades later, and the fact that we are still at the early stages of that and knowing that we now may face some legislative decisions that may roll, what little bit of progress we’ve made back, I mean, it’s just concerning.
Dr. O’Connor: Legislative decision making that could roll our progress back is basically the Supreme Court.
Dr. Simpson Mason: Yes.
Dr. O’Connor: Hearing a case regarding affirmative action and how race, ethnicity, other factors could be considered in the admission process for higher education organizations.
Dr. Simpson Mason: Yes. Particularly UNC and Harvard.
Dr. O’Connor: So, Frank, I’m going to pull in Ramon and Elena in a minute, but can you give us some highlights about this challenge to what we see as the current application of Affirmative Action, which is there is no quota, but other factors can be brought into the admission process in order to allow a university or educational institution to create a diverse learning environment. And why have the courts upheld the value of a diverse learning environment with such a narrow focus?
Prof. McClellan: So, in the 1970s and ‘80s Affirmative Action was being adopted and applied in educational institutions as well as other kinds of institutions for employment, as a way of trying to achieve diversity. And so, the case of Bachi, which was in California, which became sort of the load star case was brought against a medical school, University of California-Davis, saying that you cannot diversify your class by being color conscious. You cannot consider race in the admissions process. You can consider test scores and you can consider grades, but you can’t reach race because that violates, according to some views, the equal protection rights of citizens in the country to not be discriminated against race. Well, Bachi didn’t have a one opinion. It had a, what we call plurality, where Justice Powell, who wrote the one decision that resulted in upholding the approach, at least considering race, got everyone on the court, or at least a majority on the court, to agree that in order to get over racism, you have to, in some circumstances consider race, to get over the effects of race. So that the case which involved looking at medical school applicants, and they had set aside a certain number of seats in the class because they’d been in existence for five years and they couldn’t get any people of color in the class. And they said, we will look at these seats and give special concern. The court said no, and most of the justices agreed. Well, some asserted, well, you can’t do that because it would be violating rights of equal (inaudible – 16:520), but most agreed that you could do it if you could show us that you as a state or institution have a compelling state interest in using this approach because you’re advancing a compelling state interest. And the compelling state interest that they agreed, and this is the most important part, that they agreed upon was diversity. They agreed that diversity as a goal could be compelling, but you had to make sure that whatever approach you took was narrowly tailored, that it was not something that violated other people’s rights or other interests of society unnecessarily. So that is the rule that was adopted, that was the rule that was applied in subsequent cases. Now, if you could prove intentional discrimination then you could bring a lawsuit, but if you couldn’t prove that it was unintentional in terms of race, I mean there was intent there, if you couldn’t prove it was intentional, but you’re looking at the effects of it, then you would be barred because you could not show that you had a compelling state interest in a system. So now we’re at a point where for 50 years, we’ve had an agreement that you can in fact achieve affirmative action to correct the effects of discrimination. One, even prior to Bachi, if you could prove intentional discrimination. Second after Bachi, if you could prove that what was going on was having an adverse effect upon diversity, and diversity was a goal, and diversity was a compelling state interest. We are now faced with a situation where the appeals that have come, they’ve come to law schools, against law school admission and undergraduate school, and the case before the court now is, I guess, undergraduate schools. University of North Carolina, and their admissions process in Harvard and this admissions process, the one important point legally, which is technical, is that Title VI is a statute that applies to institutions that receive federal funds. And therefore, a private institution that has students or other benefits federally is governed by that, whereas the Constitution applies to federal or governmental entities, and therefore, the Constitution is at stake. So, we have the 14th Amendment, protection of equal protection before the court, and we have a statute for protection of equal rights before the court. And we’re expecting, based upon the trend of this court, which has lost its moral compass, in my point of view, to say, forget about the precedent that you’ve been working on, on the next, we think that the Constitution requires us to be colorblind. We’re going to prohibit any kind of consideration of race, and therefore this will be your challenge, those of you who want to have a more diverse environment and education to find a way to do it without being color conscious.
Dr. Jimenez: For the edification of our audience, I just wanted to inform them that Bachi was a Caucasian male.
Prof. McClellan: Female.
Dr. Jimenez: Female?
Prof. McClellan: Yeah.
Dr. Jimenez: No, male.
Prof. McClellan: Right, Bachi was a male. Grueter, which is the law school, and some of the other cases we have.
Dr. Jimenez: No, I understand that.
Prof. McClellan: But thank you for doing that, Ramon. Just so, to underline and illuminate that point, what Bachi, as a white male said was, by setting aside these, I think there were 10, 11, 12 seats, and not admitting me, you have harmed me as an individual because I’m entitled to the privilege of being admitted and not precluded from consideration from one of these seats based upon my race. And I’m white and they’re black. And that’s the only reason why you’re doing it. Thank you, Ramon.
Dr. O’Connor: So, Elena, how do you see the evolution of diversity, particularly training Hispanic physicians so that we can have a more diverse healthcare workforce? How have you seen the current approach to Affirmative Action, the precedent that has been established for the last 40 years or so? How has that benefited Hispanics in this country to pursue a path in medicine? How critical has this approach been to improving diversity in the medical workforce, particularly for Hispanics and Latinos?
Dr. Rios: Well, let me just start by saying that the majority of the Hispanics in the United States, 65% or so, are Mexican American, and actually half of this country, or maybe a little less than half was Mexico up until 150 years ago. And so, the countries, the United States, you know, by, what is it, emancipation?
Prof. McClellan: Eminent domain.
Dr. Rios: Eminent domain took over Mexican territories and you know, with the Treaty of Guadalupe and all of that. So, there was quite a few Mexican families that were of all different income strata on the west side of this country. And then you have the Caribbean, the Commonwealth of Puerto Rico, and then you have all of Latin America that has been you know, faced with lots of revolutions, I’ll say in 1980s maybe. So, you have a whole group of Latin Americans moving into this country, too. And overall, we’re a very young population with low education. And, you know, I mean, there are pockets of wealth in our communities, based on land owning, landowners from the Mexican populations, especially in New Mexico and California, Texas, where there’s multi-generations of wealth. But overall, the students that and I’ll just say 50% of the students now in public education in this country are Hispanic. And these students have parents who know nothing about college or how to apply their skills, which are very, we have very good values in terms of work ethic and taking care of their families and raising their children with, you know, positive values, and I’m going to say traditional health and traditional medicine. So, there’s a lot of skills in our families, but there’s a lack of education about how to get into higher education. So, my answer is yes, definitely. The Affirmative Action policies of the 1960s tremendously opened the doors to the first generation of Hispanics in this country that were allowed to go into higher education. I went to Stanford University in 1973. I met the first 50 Hispanics and the first 50 blacks that were actually an experiment, the Class of ‘69 because the Director of Admissions was, you know, there was a demand from some of the graduate students that had transferred or had gotten into graduate school that were Latino at the time. And I have to say that the programs that were created there, cultural dorms, cultural programs, the advocacy programs like MEChA and other groups, we had pre-med groups allowed us to build a network. One of my college friends is the Secretary of HHS. Another college roommate of mine got me to work at the White House. And if it wasn’t for getting into higher education, we would never have built a network that we have to create a National Hispanic Medical Association because we’re the first group of Hispanics to go into higher education. Some of us going to medical school, public health school, and others, other health graduate schools. But to answer your question, this concept of nurturing, supporting our families, our students, our parents, because of higher education opportunities happened because of Affirmative Action and allowed a diverse group of people to become educated and to become doctors who the literature has shown end up taking care of most of the patients of the primary care doctors and dentists of Hispanics and also African-American, tend to take care of their own and go back to communities where there are high rates of Medicaid and poverty.
And so, we elevate the health of our communities. And I think that it’s very important to realize that the Affirmative Action also allowed higher education to create programs for mentoring and support of the students at different levels from, and now we have STEM programs that were created to do the same thing at the high school level. And the research programs and the, you know, the diversity research programs to allow shadowing and research experiences of high school and college students to be able to have that confidence to get in to apply to medical school. And I’ll just end with the National Hispanic Medical Association, definitely has continued the benefit of Affirmative Action programs by creating our own college health scholars program and having conferences around the country. We’ve reached 2,000 students in the last five years with the help of the Office of Minority Health to be able to find students in that are mostly first-generation students who, who have told us over and over again of the importance of mentoring because it opens up their confidence level to be able to seek help and to find tutors and to work with each other, peer counseling. And they never would have never gotten that information from their parents who, mostly are not college educated and they don’t have very few, there are very few role models in our communities of Hispanic and African American doctors or Native American doctors that reach the level, the students, because they’re busy, they’re extra busy, they’re magnets to their patients. And anyway, I’ll just say that we’re very excited about what has happened. And at the same time, we’re very much apprehensive about what to do next with this Supreme Court. It looks like the decision would be to stop all these great type of programs and we’ll have to reeducate students on a new approach to increasing diversity within health, the healthcare system workforce.
Dr. O’Connor: So, I’m going to ask a very provocative question, Ramon, and I’ll ask you to comment first. Okay, don’t we have plenty of smart students of diverse backgrounds that would get into Harvard and UNC and Yale and all these other schools on their own? I mean, if Affirmative Action was dismantled, which I mean, I’m not personally in favor of that, but I want to be provocative and ask the question. Aren’t there already students that would meet just the quote standard and be accepted anyway?
Dr. Jimenez: I would anticipate, since you do ask provocative questions, that that was going to be a type of question. And allow me to, when I thought about this and thinking about you just couched the question, I want to make it personal and tell a little bit about my personal journey. A hundred years ago Ramon Jimenez died, and he was my grandfather, and he was in the Altos the El Lesco, which is the highlands at 8,800 feet, 150 people in his ranchito, the village. Thirty-four out of150 people died. And his son and daughter were victims from the pandemic, the worldwide encephalitis, flu pandemic. That was my father’s family. And then my mom’s family for different reasons in Mexico, they immigrated a hundred years ago to California, Northern California. And so, when I was born, they had moved to San Jose. Their intention there was to push me. My mom was the stronger pusher, as Hispanic women are usually the strongest, even though they’re not the macho ones, but she pushed to say that you can compete with anybody, you’re smart enough and you will compete, and you will not get favoritism if you would. And, because that was the initial impression about Affirmative Action. And so, I did. So, my original attitude was that I could compete and, I was able to do that, went to a Jesuit high school, but I felt the effects of bias, if you would, when just a scenario is that it actually happened to me. A doctor, we will call him Frank White, asked my good friend and my classmate, Joe Irish, “Hey, do you want to come over to the hospital and shadow me in rounds and in surgery and stuff?” And I was standing right next to him. I was number one in my class of 150. Joe Irish was great guy, and he’s a physician now, but he was about 20th, 25th. And so, I was not invited. The story did come around that I ended up operating on Dr. Frank White later on when I was back in town.
Dr. O’Connor: And you were not invited because you were not the white male that the, that your classmate was?
Dr. Jimenez: Yes. And I don’t think it was implicit. It wasn’t really explicit racism bias, but just kind of like he didn’t think that I would be…
Dr. O’Connor: He didn’t even think you’d be interested.
Dr. Jimenez: Yes.
Dr. O’Connor: So, he didn’t ask.
Dr. Jimenez: No, he didn’t ask. Maybe would you like to come? Somebody else might ask, would you like to come and see my auto mechanic shop and how that works? So that’s my original thoughts. But as I’ve gone on from there, my attitude towards Affirmative Action has changed quite a bit because I’ve seen these persistent effects of hard word call it racism, call it bias, call it the social determinants, where the people live, etcetera, and I’ve come almost 360 to know that and that’s why I’ve been involved with mentorship and role model, etcetera to reach back and bring somebody else along. But now I happen to chair or govern a board of three charter high schools, 1,200 students, 99% Hispanic/Latino in the three zip codes of East San Jose, our 10th largest city, which includes Silicone Valley. And you could see that the bias of racism still exists in our state laws because our students get $13,500 per student subsidy from the state, one zip code away, they get $16,000, two zip codes away in Los Gatos, they get $24,500, and we all are held to the same standards and have to compete. So, therefore, in order to bring our students, who 86% of them graduate and go to college two-year and four-year universities, we have to bolster, we have to provide them with some evening process to level the playing field.
Dr. O’Connor: And, Ramon, just for the clarity of our listeners, so that differential, $24,000 per student going in some districts compared to the $13,000 for your schools, right, and the $24,000 is going in communities that are of greater affluence?
Dr. Jimenez: It’s all based on real estate values of homes. So therefore, it’s naturally, you know, the highway divide that we talk about a lot on one side and the other just naturally exists. And even in an area like Silicone Valley, Santa Clara, where the homes on the east side of San Jose, where I’m talking about average $700,000, but that’s only because the homes on the west side average $2 million, $3 million, and that’s all just the economics of the state.
Dr. Simpson Mason: So then to your point, Dr. Jimenez, it’s not about just being smart.
Dr. Jimenez: No, it isn’t.
Dr. Simpson Mason: We know our kids, these kids are smart, but the kids have to be given the same tools, resources, information, networks.
Dr. Jimenez: Exactly.
Dr. Simpson Mason: To be able to navigate a system that is complex enough in its structure to even get to college. It is extremely expensive to apply to multiple colleges, to take all of the steps necessary to even apply for scholarships, even sit for the standardized exams. And I’m not saying that there aren’t some course corrections in there, but we can’t make this just about being smart because if everything else was even, that wouldn’t even be a question about if there were enough smart kids.
Dr. Jimenez: Right. I have been at meetings where I have asked, orthopedic surgeons and the majority of which are from the majority of Caucasian males, I have asked them, have you experienced Affirmative Action? And the first thing they say is no. And then I point out, you’ve got legacy, you’ve got wealth, you have, “Oh yeah, well, yeah.” I said, well, that’s Affirmative Action. What are you talking about?
Dr. Simpson Mason: All points of privilege, right? Yes. All points of privilege that we may or may not recognize. And, to your point, I’m a third-generation college grad. So as a black woman in the US, a descendant of the enslaved, I have educational privilege as will my children. Right. So, they’re going to have fewer barriers with that regard, leveling that part of the playing field that has nothing to do with me. It’s what I was born into. And so, when we speak of privilege, that’s where we’re coming from. But to your point, Dr. Rios, if you’re first generation, if English is not your first language, if you’ve been educated in the system, and we saw statistics this morning where, you know, the majority of black children are educated in a public school system that is, I mean, not just poor, but poor in terms of the amount of resources, those children who are black could almost never catch up to the students who’ve had the benefit of multiple resources K through 12 versus students who have not had it. I mean, how does that, how do we make the lowest common denominator then how smart they are? Right? Which is one of the classic arguments that people want to bring to the table, and that we don’t want to acknowledge. As you all know, through Nth Dimensions, we’ve been able to have over 130 students, the majority of whom are either black or Hispanic matriculate match into orthopedic surgery programs. And over half of those students, they’re now board eligible, board-certified orthopedic surgeons. They’ve matriculated successfully because they have the course correction of the ongoing mentorship tools and resources by yourself, Dr. O’Connor, by yourself, Dr. Jimenez, to help them navigate that system, right? The structure that was not necessarily meant to include them.
Dr. Simpson Mason: And I think Dr. Simpson Mason, I think that that is the key to the future, given this outcome that we anticipate from the Supreme Court, that we protect the programs that have been created to help our communities in poor public schools or even in private schools that are in poor communities, you’re going to have less options. To get into medicine, there have been major efforts done by the federal government and our state governments to help these disadvantaged persons, students, and we need to protect those programs. Everything from science type programs, the preceptorships and the shadowing experiences that inspire students to become a doctor or a nurse to programs that actually help students understand how to pass STEM programs. All the requirements are not going to change for medical school. The requirements in terms of your, you know, year of organic chemistry, year of inorganic, year of biology, year of physics, it’s all, you know, science and math, and that is STEM. And I’ll just make that one comment that we have to protect those programs. And I know that President Obama’s major focus on consolidating all the STEM programs was a great effort to reduce duplication, have a more efficient system to get the money to the schools that needed the money to be able to increase the diversity within STEM. And what we have to do is medical educators interested in, in mentoring those students that are getting the opportunities, is to not only protect it, but to increase and expand the same effort, the effort of science, math STEM mentoring, as well as faculty development, all the way up. You talked about opening the doors to residency programs that now have a AGME accreditation requirements to have diversity. And even our research entities, NIH back in ‘94 and FDA just in 2000, require diversity within research in clinical research as well as bench research. And I think, we have our work cut out for us. And I’m looking forward to trying to figure out how to advocate to keep these programs and to educate the Congress and their staff about the importance of diversity.
Prof. McClellan: I just wanted to, I agree with what’s been said, and I just wanted to rephrase the issue that you posed in the way in which I think the court is going to demand a response to if we are going to continue with Affirmative Action programs. So, you asked the question, well, why do we need it? Why can’t we just have applications? There are plenty of smart people in every community, in every environment. Well, I would phrase it this way in terms of what the court is looking at. I think everyone concedes that diversity is a compelling state interest. The question they’re asking is, when they say narrowly tailored, can’t you achieve diversity without taking into account race? That’s the question they’re asking. They said, if you can achieve it without taking into account race, then we want to eliminate that because in our view, the Constitution is colorblind, which is another subject but is the heart of what we’re talking about. So could you say, okay, no, we can’t achieve it without taking into account there’s two different categories that we have to look at dealing with the basic human belief that governs this country. The first one is that we’re looking at potential ability to perform. That’s what these tests are for. They’re not judging really, you know, your IQ or whatever. They’re saying, are you going to be successful in this professional school, in this undergraduate school or whatever it is? And if the answer is no, because they’re discriminating against me, they say, well, we’ll eliminate that. We’ll give you a cause of action against any school, any institution, any person who intentionally discriminates you against race. So that if we eliminate that, then what’s your reason for continuing with Affirmative Action?
Well, first of all, the question is can you ever eliminate that? And the answer obviously is no. That’s sort of Derek Bell’s thesis of the Critical Race Theory, that racism is permanent and instead of running from it, we need to learn to live with it as part of our DNA and learn how to adjust and achieve equity. And he was a civil rights lawyer before and he’s sort of the father of Critical Race Theory. So that’s one area where you have to deal with. And I think what we’re dealing with, with the Supreme Court is a belief that no, the reason that we’re not getting a diverse class through the means you’re suggesting is because of inferiority and superiority. There is a white race superiority. And we believe, just going back to the Dred Scott Decision from the very beginning where they write the opinion saying that “white people, the white race is superior, and there are no rights that black folks have that need to be recognized by a civilized nation.” They won’t articulate it that way, but there is still this strong feeling among certain groups in society, in positions of influencing power, who in their hearts really believe that there is a superiority. And that superiority comes out when you give a MCAT test or LSAT test or whatever. And that these folks who are trying to achieve diversity without letting that be the governing factor, are really trying to evade proper evaluative merits.
So, we’ve got to respond to that. We have to respond to that. And I think the response is not going to be one that is convincing to all people in society, but it’s all what we’ve been talking about today. If we have all these socio and economic factors that affect health, that affect the ability to perform, that affect your ability to get a job, affect all these other things, why would we ignore them? If we’re trying to predict a person’s ability to succeed at a particular challenge, profession or whatever, why would we ignore them if diversity is a compelling interest?
Dr. Simpson Mason: That’s exactly right, Frank. I mean, so what you’re saying is narrowing the factors that we’re looking at, right, by excluding, so if we’re taking race or if we take social determinants of health, we take all those extrinsic factors off the table and we try to narrow it down to just merit, how smart someone is. A, it is not realistic and b, as scientists, we don’t do that in any other arena. Right? As scientists, we collect all the data. We try to have a large enough data pool before we draw some conclusions, right? We make sure that we are that we don’t have a cohort or an n of one. Right? You can’t base any sound conclusions off of an n of one. So really the opposite of inclusion is not exclusion, it’s incomplete. You don’t have a complete data set if you’re not considering all of the factors that one person may bring to the table in deciding if in fact, the case is, are they going to be contributors to this profession? Can they succeed long term? Can they be of benefit to their community? Well, let’s look at all of the factors that make them who they are. And certainly, race in this country is one of the factors that has been a primary driver of decisions, you know resource allocation, education provision but then to exclude that on the backend, I mean, that is the preservation of the dominant culture.
Prof. McClellan: The scientific information that has been assembled clearly establishes that standardized tests, what they reflect are income and wealth preparedness.
Dr. Simpson Mason: Correct.
Prof. McClellan: So, if we know that that’s what it is, why would we be making that the predominant factor that determines who has the ability to compete or gets the opportunity?
Dr. O’Connor: You know, it reminds me this was several years ago. The, then, president of Harvard allegedly made a comment that was reported by the Boston Globe when he was challenged by alums as to why the faculty at Harvard in science was so predominantly male. And so, the president of Harvard supposedly said, that’s because it was skewed because of the biological factor. Okay? So, of course, you can imagine he came under severe criticism for this com supposed comment about biological factor. However, there is actually data that suggests that if you want to go to the extreme tail of the curve in terms of gender, sex differences on standardized math tests, what you will find is that when you go way out there, like the 0.001, best scores are dominated by boys and not girls. Okay? So, I look at that and I say, well, okay, there could be a biological factor. Boy brains are not the same as girl brains. And maybe it is more likely that a boy brain will perform, will consistently perform better on a standardized math test than a girl brain. So, then that would lead you to the logical conclusion that all our scientists and engineers and or doctors, people that need math to be successful, that it would be normal for them to be predominantly male. All right? So, then the problem with that argument is we see examples like first generation airbags designed predominantly by a team of male engineers. Now, were the engineers incompetent, no. Did Detroit invest millions to create a safety device that would kill women, children, and small men? The answer of course is no. So how was that colossal error achieved? Right? That error was achieved because the people on the design team, predominantly men, didn’t ask the question, what if my baby’s in the passenger seat, what if my child or my, you know, small adult is in the passenger seat? And so, the first-generation airbags were tested against the quote standard passenger, which was an adult male. And so that’s how this tragedy occurred. So, if you cannot get to the right solution, you risk what I call the airbag tragedy when you don’t recognize the need for diversity of thought and diversity of experience, because it’s the diversity of experience that drives the way we think to avoid those tragedies. And so that’s a reason why looking at standardized test scores and saying, yep, we only want the best and the brightest, and they’re going to be the people that just scored highest on this standardized test, and they should be the people on this design team creating the product. That’s the risk.
Dr. Simpson Mason: And they still didn’t have all the information, right? They did not have enough heterogeneity at the table to ask all of the questions, to collect all of the data that would have prevented those deaths.
Dr. O’Connor: Correct. Because somebody would’ve thought, is this first-generation airbag, you know, safe for my child? And, I just remember, I like this story so much because I bought one of those vehicles that had a first-generation airbag, specifically because I wanted it in the passenger side to protect my children. And little did I know that I was actually purchasing a car with an airbag that could have killed them.
Dr. Simpson Mason: Yeah.
Dr. O’Connor: So, this is why diversity in our thought process and diversity on our teams is just so critical.
Dr. Jimenez: Well, I just wanted to go back to the application process itself. When I was chair of the American Academy of Orthopedic Surgeons Diversity Advisory Board, I had the opportunity to bring in three chairman of departments in orthopedics in Chicago. And when they were there, I played a scenario for them, two students with on the application process and they all just on the straight application process ranked equally, you know, academic prowess and all that, scores, etcetera. And then, I said, I wanted those students to write a statement of one sentence or two at the most. And so, one wrote, you know, I was in sports, I was this, I got injured. My family you know, I have always been in sports and this and this and this. And the second student wrote, I was in medical school, I was in college, and I was working 20 to 30 hours a week. So, my question to them was, they both achieved the same and level the of academic process, knowing that further information, which student do you think is going to be most successful? It turned out, you know, they all picked the one who had worked and still got there. And then, I said, well, let me tell you, that was me. And so, I do know that a lot of students were left, are, left out on the excuse that admissions directors can only look at and go by statistics only. And then the limitation without knowing further about the applicant.
Dr. O’Connor: Well, we’ve come to the end of our recording time for today, and I have really enjoyed everyone on the panel. And so, I want to thank you for joining us today and sharing your insights with our podcast listeners. And a quick note to our listeners, you’ll be able to access a video of the original panel discussion on our website in the coming weeks at www.movementislifecaucus.com. And if you’d like the episode today, please do let your friends and colleagues know about it. So, until next time on the Health Disparities Podcast, this is Dr. Mary O’Connor thanking you for listening and wishing that you’d be safe and be well. Great.
Producer: The Health Disparities podcast is a program of the Movement Is Life Foundation. Executive Director, Dr. Millicent Gorham, Chair of the Board, Dr. Mary O’Connor, produced and edited by Rolf Taylor. All rights reserved.
Copyright Movement Is Life 2022.
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