Eve J. Higginbotham has been interested in the issues of gender, diversity, and inclusivity her entire career.
Her background is extraordinarily wide-ranging: undergraduate and graduate degrees in chemical engineering from the Massachusetts Institute of Technology; a doctorate in ophthalmology from Harvard Medical School; a Master in Law degree from the University of Pennsylvania.
Numerous boards and positions later, in 2013 she was named the first vice dean for inclusion and diversity of Penn’s Perelman School of Medicine.
Although she remains a practicing glaucoma specialist, she has been instrumental in numerous efforts to expand inclusion and diversity at Penn.
We spoke to her recently about what this means for the health care workforce of tomorrow.
How would you describe the state of inclusion, diversity, and equity in health care today?
Right now, our national health care system is severely hampered by our everyday biases and structural racism. In medicine, like everywhere else, our biases penetrate our daily lives, our relationships with each other, and our decisions. It is not difficult to imagine how these biases impact the care of patients, resulting in, most commonly, unintentional differences in care. Inequities in care across populations has been well documented.
Parallel to that, there have not been the same opportunities for those entering the health care field. Here’s an example: In the early 1900s, a report that examined medical education in the U.S. recommended closing a number of medical schools. Of the seven schools of color at that time — remember, it was segregation — five closed. The only two that remained open were Howard and Meharry.
If we had kept those five schools, we would have trained almost 40,000 more physicians of color. That was a lost opportunity. That was a policy decision with long-lasting implications. Think about the health that would have been created in communities of color, as well as the wealth of this expanded class of professionals that would have been produced for the country. Better health in the Black and brown communities is priceless. It all goes back to an acknowledgment of the structural inequities in our society.
In terms of students currently in medical schools, we already have greater than 50% women. However, representation from Black, Indigenous, People of Color (BIPOC) populations is far lower than the general populations. As an example, for Black men, it’s the same as it was 40 years ago.
But now, I think we’re at a pivotal point of more aggressive change than we’ve seen even in the last 10 years. Why? Because there is a national conversation about race, which has engaged a broader proportion of the population than ever before. I believe in the last year, I’ve said “racism” more than I have in my entire life. People are at least open to listening. Whether or not that translates to action remains to be seen. There has been progress. However, a lot more work is needed.
What should the future look like?
We need to have greater opportunities for people to be promoted to the highest level. We need to have diversity at the leadership levels so there is an appreciation for the sense of urgency to make change and the opportunity to change policies and practices at the institutional level.
If you have a critical number — it’s usually at least 30% — of individuals who are like-minded and can think beyond their immediate point of privilege, you’re going to have a different conversation. You’re going to have an acknowledgment that policies need to be developed and implemented to ensure that there is equitable representation across all levels of health care.
We should have enhanced representation of women and underrepresented individuals on boards. We should have at least 30% diverse representation on boards. We should also see greater representation across executive leadership — universities, medical centers, and health care corporations. The reason I focus on leadership is because leadership drives policies, and policies change behavior.
Certainly, we need to have greater diversity among physicians and nurses. Nursing already has greater diversity than the physician cohort, but not at the leadership levels.
Since the pandemic, there has been an increase in the number of Black and brown applicants to medical schools. I think there was a recognition of the clear value in serving others and seeing what a difference individuals made in the lives of others. I think that opened the eyes of many students who may not have been thinking about a life in medicine.
How are we going to get there?
First of all, the Affordable Care Act winning this last challenge in the Supreme Court is a major step forward for the delivery of health care. It preserved — and enhanced —health care for a growing number of individuals. If we can get more states to expand Medicaid under the Affordable Care Act, that will give us even greater traction. There are certain advantages of expanding Medicaid under the ACA that are not realized if states just use a waiver to extend Medicaid. Politics should not be in the same conversation as extending health care for more people in this country.
The other thing is we’re having the conversations we should have had 10, 20, or even 50 years ago about the inequities in the delivery of care and how our biases interface with our delivery of care.
We have to continue to support students who seek careers in primary care — physicians and nurses. We need to increase the number of primary care providers, because that’s a measure of the health of a country — the proportion of a population that has access to primary care. There are data that indicate that students of color are more likely to work in underserved areas after they graduate. Thus, increasing diversity enhances access to care for diverse communities.
What initiatives does Penn have toward reaching that goal?
Penn has always been committed to diversity, particularly under the leadership of President Amy Gutmann. She has named inclusion as one of her three pillars in the Penn Compact 2020.
Now we have the opportunity to build on that commitment. We’ve made great progress in diversifying our student population. But we need to make more aggressive, rapid improvements on the faculty side. So Penn is investing significant dollars to help seed the careers of a more diverse faculty.
We also are focusing more on culture — recognizing that if we have a respectful, inclusive, antiracist culture, we can do a better job of delivering care, as well as bringing people into our laboratories to do research. There is now clearer alignment of interest around achieving that goal.
One example: 98.8% of our 45,000 medical faculty, staff, students and trainees have been educated on unconscious bias. That is the biggest bullet point I can give you for this past year as an indication that there is some shared interest, as well as some shared language, in not only personally understanding how our biases come into play, but also collectively how we as an institution can do better.
How will this new era of inclusion, diversity, and equity transform health care?
Going forward, the workplace of the future is not going to be the same as pre-pandemic.
You’re going to see more hybrid work patterns. A silver lining is that we might really have a chance to increase diversity because of the opportunity to work remotely. In health care, the emergence of telemedicine gives more people the opportunity not only to access care, but also, as providers, to deliver care.
All of this is to achieve health equity. There is a difference between health equity and equality. Health equity assures that we are going to provide the necessary health intervention to individuals and communities, based on their needs. With equality, you’re just giving everyone the same thing.
All of these efforts are intended to transform the health of our country and our communities. And we do that by paying attention to the structural inequities that we are now recognizing. So we can now design a better road map for how we can become a healthier country.
The Future of Work is produced with support from the William Penn Foundation and the Lenfest Institute for Journalism. Editorial content is created independently of the project’s donors.