Health Policy$ense

So, How Are We Doing in Diversifying the HSR Workforce?

We Must Prime The Pump and Widen the Pipeline for Pre-College Minorities

"How'm I doin?" Ed Koch, longtime mayor of New York City, would ask his constituency. "Am I doin’ all right?" Koch understood the importance of taking stock, assessing progress, and changing directions if need be.

The need for increasing the ethnic and racial diversity of our health services research workforce is unquestioned. A 2007 study documented a lack of diversity among health services researchers, a particularly important issue given the increasing diversity of the population. Many initiatives sprung up, including LDI’s  Summer Undergraduate Minority Research  (SUMR) program.

So, 13 years after we launched SUMR, we wanted to know, how are we doing? We obtained recent data from AcademyHealth from its 2011 membership survey. The chart below shows that there’s been some progress, and things are moving in the right direction.

African-Americans now make up 6.9% of the HSR workforce, compared to 3.4% in 2007; Hispanics had smaller gains, increasing from 2.1% to 3.7% in 2011. We also show how the distribution of health services researchers compare to the universe of students graduating with bachelor’s degrees.

chart 01

But that’s only a measure of success fairly late in the pipeline. Even if we were to equalize the bars in the chart above, some minorities would be underrepresented in HSR because they are also underrepresented in college, with lower enrollment and graduation rates.

The enrollment gap in the college-age population is shown below. In 2010, 31.9% of Hispanics and 38% of blacks were enrolled in college, compared to 43.3% of whites and 62.2% of Asians. Historical trends are promising, but the gap remains significant. It is a built-in limitation of pipeline programs that focus on minority undergraduate students.

chart 02

Pipeline programs at the graduate level have an even smaller universe because of gaps in the graduation rates of underrepresented minorities. A new report by the Education Trust indicates that the 4-year college graduation gap is substantial though narrowing. Graduation rates for Hispanic students were 11.1 percentage points below those of white students, while the gap between black and white students was 22.2 percentage points. Inasmuch as undergraduate- and graduate-level pipeline programs are slowly increasing the supply of ethnic and racial minorities in HSR, we should remember that the demand for diverse health services researchers is not college-based; it’s population based. The chart below gives us insights into how far away we are from a truly representative HSR workforce:

chart 01

One thing stands out: the extreme underrepresentation of Hispanics/Latinos among health services researchers. Hispanics/Latinos are one of the fastest growing populations in this country, and at the current rate of growth, they will constitute 30% of the U.S. population by 2050. We have much work to do to adequately include their voices, perspectives, and talents in our field.

Addressing the true underrepresentation of minorities in health services research will require pre-college programs as a long-term strategy. We must prime the pump and well as widen the pipeline.

So, how are we doing? Better, and not good enough.

[Thanks to Beth Henry Johnson and Kelly Nose of AcademyHealth’s Diversity Initiatives  for the survey data].