The end of affirmative action will lead to more preventable deaths

As a Black female physician, I’m basically a unicorn. We make up just 2.8 percent of doctors. Even before the Supreme Court decision banning affirmative action, this lack of diversity posed real harm for patients. This ruling will make a bad situation far worse. Outlawing affirmative action will decrease the diversity of incoming medical school classes and reduce the already low rates of physicians of color, with measurable harm to vulnerable patients. All Americans will bear the burden of a less diverse health care field and sicker citizens.

Affirmative action is not a system of quotas. It is an admissions tool that considers how race may have shaped an applicant’s experiences and the lens through which they view and experience the world. Studies show that people who are underrepresented in medicine cannot achieve enough education or money to overcome the ills of systemic racism that lead to worse education and health outcomes. This is one reason why the American Medical Association filed an amicus brief urging the court to “take no action that would disrupt the admissions processes the nation’s health-professional schools have carefully crafted.”

Even with policies that take race into account, medical schools reported that just 12 percent of matriculants in 2022 were Hispanic, compared with 19 percent of the overall population. Black people, American Indians and Alaska natives were also underrepresented. Diversity in medical school is essential for future doctors of all races: Research shows that students who train in diverse settings are more adept at caring for diverse patients. Affirmative action ensures an increase in the diversity of the medical student pipeline, creating better physicians from all backgrounds and leading to better health outcomes for all patients. 

Research shows that culturally competent care matters. Numerous studies suggest that “concordance” (when patients and doctors share race or other identifying factors) improves patient health. For instance, a 2021 study in Oakland found that racial concordance between patients and doctors increased patients’ interest in prevention, and argued that more Black doctors could “reduce the black-white male gap in cardiovascular mortality by 19 percent.”

Meanwhile, we know that racism in medicine hurts patients in obvious, documented ways. The more physicians we have from marginalized backgrounds, the more protections we have against these biases. For instance, Black patients’ pain is undertreated relative to white patients. In my own work as an emergency medicine physician, I’ve seen how biases in pain management affect patients. I’ve heard patients suffering from the painful effects of sickle cell disease, which is far more common in Black people, referred to as “sicklers” who just want a “fix.” I’ve seen how Black victims of gun violence are slower to receive pain management than white victims with less severe injuries. Meanwhile, recent evidence shows that even high-income Black women are more likely to die in childbirth than white mothers.

We already have too few people of color in health care. We can’t afford to close off more pathways, as this Supreme Court decision will do. 

If preventable maternal deaths and inequitable treatment of Black patients isn’t a strong enough argument for affirmative action and its impact on health provider diversity, then perhaps money is. A recent metastudy found that diverse healthcare teams correlated with higher quality health care and the financial performance of health organizations. This may be due to greater cultural understanding. For instance, a physician savvy enough to ask if a patient can afford healthy foods and medications could stave off a costly emergency department visit for a stroke. But with affirmative action outlawed, undermining the diverse workforce and curriculum it seeks to uphold, doctors may lack the cultural competence to ask questions pertaining to the social drivers of health — the conditions in which people live and work that affect health care outcomes.

We need more of these culturally informed conversations, and more diversity in health care, not less. When patients’ social barriers to care aren’t addressed — issues that a diverse medical team may be more likely to spot — they often end up in the hospital. Such costs are absorbed by all of us. While inequitable health outcomes disproportionately affect a fraction of the population, we all literally pay the price.

Overturning race-based affirmative action will increase preventable deaths and health inequity overall. Affirmative action is about more than just moving students of color into the nation’s ivory towers. It is about creating a diverse pipeline for fields like medicine serving a growing number of diverse and vulnerable people. 

Katrina Gipson, MD, MPH is an assistant professor of Emergency Medicine at Emory University School of Medicine. She practices at Grady Memorial Hospital and is a thought leader in health advocacy as a Public Voices Fellow of Academy Health in partnership with The Op Ed Project.