Affirmative action ruling threatens US public health workforce diversity, programming
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* Mark Barna

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/53/7/1.2/F1.medium.gif)

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Harvard University students join a July 1 rally protesting the Supreme Court ruling against affirmative action in admissions.

Photo by Craig Walker, courtesy The Boston Globe/Getty Images

> “To not consider an applicant’s full background…will ultimately lead to lower minority enrollment and worse overall national health.”
> 
> — Georges Benjamin
The U.S. Supreme Court’s June ruling against affirmative action in college admissions could be harmful for public health programs, the health workforce and the overall health of the nation, experts say.

On June 29, the Supreme Court ruled by a 6-3 majority that race-conscious affirmative actions in admission programs at Harvard University and the University of North Carolina were unconstitutional, rolling back decades of precedent that boosted student diversity.

But ending race-based college admissions will not just affect schools: Diversity in jobs that require higher- level degrees — including medicine and public health — will be also impacted. And the court’s reasoning may be used to dismantle some public health policies that use race and ethnicity as the basis for health programs and funding.

“The majority’s decision enshrines a ‘color blindness’ principle in the Constitution for the first time,” Lindsay Wiley, JD, MPH, professor of law and director of the health law and policy program at the University of California-Los Angeles School of Law, told *The Nation’s Health.* “That will have broader implications for race-conscious public health policies that are unrelated to higher education.”

APHA denounced the ruling, noting that diversity in the health field is needed to serve an increasingly diverse U.S. population. A study published in APHA’s *American Journal of Public Health* in July found that despite recent increases in diversity in the public health education pipeline, students of color remain underrepresented. The finding comes as the public health field struggles with continuing worker shortages, particularly in governmental settings.

“Public health professionals and physicians that bring different perspectives and experiences to their work and patients can better address sociocultural factors that influence health and access to care,” APHA Executive Director Georges Benjamin, MD, said in a news release. “To not consider an applicant’s full background — especially as underrepresentation of certain minority groups in health professions remains an enduring problem — will ultimately lead to lower minority enrollment and worse overall national health.”

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Despite recent increases in diversity in the public health education pipeline, students of color remain underrepresented. The high court ruling could further stymie inclusion work.

Photo by AJ_Watt, courtesy iStockphoto

Higher education benefits from classroom diversity, leading to improved learning, innovation, collaboration and understanding for all students, studies show. Graduates from programs with a diverse student population are more prepared socially and intellectually for a country that that will not have a white majority as of 2050.

Many studies show that patients respond more positively to health professionals and physicians when they share life experiences around race, ethnicity and gender. For example, life expectancy increases for Black people who have a Black primary care physician, a study in April’s *JAMA Network Open* found.

“A more diverse workforce drives better patient experiences — especially among marginalized groups,” Lee Jones, MD, chair of the Association of American Medical Colleges Board of Directors, said last year in a *STAT* op-ed. “People feel they receive better care and communication from doctors who share their race or gender.”

## Health schools not immune from ban

The affirmative action admissions ban is expected to have broad impact on highly selective four-year colleges, said Katharine Meyer, PhD, MPP, a fellow in governance studies for the Brown Center on Education Policy at the Brookings Institution. One model projects a 10% reduction in admissions for underrepresented groups at highly selective schools, she said, while a 2% decline is expected at four-year colleges nationally.

Medical school diversity will likely suffer more nationally. In California, Florida, Texas and three other states that banned affirmative action in admissions, medical schools saw a 17% decline in students of color, a 2015 study in the *Journal of Higher Education* found. Fewer doctors of color means fewer working in low-income minority communities where need is greatest, several studies show.

The public health field tends to attract more people of color, so it will likely not be impacted to the degree that medicine is, said Perry Halkitis, PhD, MS, MPH, board chair for the Association of Schools and Programs for Public Health and an APHA member.

Many public health schools have already abandoned the standard GRE test for graduate school admissions, as research has shown it is discriminatory. Schools instead are using a holistic method that weighs academic achievements with life experiences and motivation to work in public health. More schools and programs should adopt a holistic admissions approach, given the Supreme Court’s ruling, Halkitis said.

Increasing outreach for public health careers in underrepresented communities could also help counter the effects of the ruling, Halkitis said. Offering Assistance in application preparation will also be beneficial for low-income people of color, as many do not have the same access to counselors, tutors and college preparation tests as high-income students do.

“I think by its nature, the (public health) field attracts a diverse student base, so that’s good,” Halkitis said. “But it’s got to be even more focused right now.”

Given that the affirmative action decision could mean fewer people of color earning medical degrees, U.S. public health will need to broaden its health footprint, Halkitis said.

“Public health will play an even more important role in the health of the population moving forward,” he said.

In preparation, public health educators should team students with medical providers on population health issues, Halkitis said. During the pandemic, the partnership between public health and medicine increased COVID-19 vaccine uptake in underrepresented communities.

“One thing we’ve learned from COVID is the importance of public health sitting alongside medicine, delivering services,” Halkitis said.

Given that the Supreme Court left room for applicants to discuss the impact of race or ethnicity on their lives, storytelling in essays and interviews should receive more attention in college preparation work, particularly in a field such as public health where a diverse workforce improves health outcomes, Meyer said. But public health schools will need to make sure their evaluation is not race-based, focusing instead on the relevant skills of students.

In states that had already banned affirmative action in admissions, colleges are working to retain their goals of diversity through race-neutral means by admitting the top 5% or 10% of students from each high school, Meyer said. But the strategy has not been as successful as affirmative action.

> “People feel they receive better care and communication from doctors who share their race or gender.”
> 
> — Lee Jones
In a study in February’s *Journal of Public Economics,* researchers examined admissions records at the University of California, which used selective enrollment. They found that under affirmative action admissions, which were banned in the state in 1998, the campuses increased minority enrollment by 20%. Using the top percent policy after the state ban, campuses increased enrollment for disadvantaged students by only 4%.A holistic approach to application reviews increased enrollment by 7%.

## Public health policy could be at risk

The Supreme Court’s decision could also impact public policy that integrates race and ethnicity.

During the pandemic, for example, public health officials used a calculus of social metrics that included race to determine who would be prioritized for COVID-19 vaccines.

Race and ethnicity are often part of the metrics of public health policy at the federal and state levels. The relationship might be used to dismantle some public health policies, programs and services, according to the Network for Public Health Law.

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Ending affirmative action in college admissions could further limit diversity in both the public health and medical workforces.

Photo by Drazen Zigic, courtesy iStockphoto

A December brief from the network spotlighted dozens of programs that could be at risk. Among those are the Substance Abuse and Mental Health Administration’s Minority Fellowship Program and a nursing workforce diversity program within the U.S. Department of Health and Human Services. Equity programs at the state level are also at risk.

“The reach of the court’s opinion could immediately or later impact these efforts,” the brief said. “Direct public health efforts to ascertain, address and diminish health disparities may be seriously curtailed.”

For more information, visit [www.networkforphl.org](https://www.networkforphl.org).

*   Copyright The Nation’s Health, American Public Health Association