What do Martha Stewart house paint and the allied health workforce have in common? Give up? Both come in any shade of white you can imagine. Of course, the controversial diva of decorating also offers 4,000 or so other choices, whereas the color palette for allied health professionals is currently much more limited. In fact, statistics indicate that minorities comprise only about 10% of allied health care professionals in this increasingly diverse country.
At the turn of the 20th century, the U.S. population was 13% minority (African American, Hispanic, Native American and Asian/Pacific Islander). Today, these individuals comprise one-quarter of our nation's population. According to the U.S. Census Bureau, by 2050 it is likely that more than one-third of our residents will identify themselves as minority. With this kind of increase, one would expect to see a similar rise echoed in the health care workforce across the U.S. This, disappointingly, is not the case.
The lack of diversity certainly is not due to a lack of available positions. The Allied and Auxiliary Health Care Workforce Project from the Center for the Health Professions at University of California, San Francisco, reports that allied health workers make up an estimated 60% of the U.S. health care workforce, totaling more than 11 million workers. The Bureau of Labor Statistics lists pharmacy technicians, laboratory technologists, physician assistants, physical therapists and occupational therapists as some of this decade's fastest-growing occupations. In fact, out of the list of the top 30 fastest growing jobs in the U.S. from 2000-2010, more than half are expected to be allied health jobs. Unfortunately, the supply of allied health care workers isn't expected to keep up with this rise in demand. The American Hospital Association (AHA) estimates vacancy rates of 21% for pharmacists, 18% for radiological technologists and 12% for laboratory technologists.
The Importance of Diversity
Having a poor representation of minorities in the allied health care profession poses many problems. It has become painfully obvious that in this culturally rich country, minorities do not receive the same level of health care as their white counterparts. Research from the Institute of Medicine, the Kaiser Family Foundation and the Commonwealth Fund suggests that there are differences in treatment and health care outcomes based on race and ethnicity. These disparities are caused by many factors, such as differences in socioeconomic status (education level and income), differences in the health behaviors of those seeking care and adhering to treatments, the lack of multicultural tools and sensitivity in part of the health care provider, language barriers, payment and coverage, outright discrimination and stereotyping by health care practitioners, and the lack of diversity in the health care workforce.
The recognition that we have a problem in this area has prompted the federal government to issue the bold goal of eliminating racial and ethnic health disparities in this country. As addressed in the U.S. Department of Health and Human Services' Healthy People 2010 initiative, the mission is to achieve health care parity by the end of the decade. Specific emphasis will be placed on ensuring cultural competency among health care providers.
With a more diverse population of health care providers, many issues of health care disparity might be resolved. By increasing the representation of minorities in the health care workforce, more underserved populations could receive health care. A culturally diverse health care workforce can more effectively care for a diverse population, as many people prefer to discuss their health care concerns with someone from a similar background.
"Most of the major public health issues today disproportionately affect minorities," says Terry Brown, RD/LD, vice president of the North Texas Chapter of the National Organization for Blacks in Dietetics and Nutrition. "Who could better understand their plight than someone from their racial/ethnic group? We want to speak to people who understand us culturally and face some of the same challenges we do."
By creating a more culturally diverse health care team, better patient communication and treatment will occur along with the bonus that non-minority health care workers will become more aware and sensitive to ethnically diverse patients. In "up close and personal" professions, like physical therapy and occupational therapy, cultural sensitivity becomes even more important in patient care. "When mastering activities of daily living like meal preparation, bathing, etc., you need to have an appreciation of the values and beliefs of a population," says Janie Scott, the director of the Practice Department and Ethics for the American Occupational Therapy Association.
How Do We Get There From Here?
Most everyone agrees that we need a more culturally diverse population walking the halls of America's hospitals and clinics, but how do we get them there? This is the question that has puzzled allied health organizations for years. Many professional organizations faced up to the issue of workplace diversity about 20 years ago, formally waging war against the underrepresentation of minorities in their professions.
Johnette Meadows, PT, MS, who served as director of the Department of Minority and International Affairs in the American Physical Therapy Association (APTA) for 14 years, reports that the APTA recognized the need to address this issue about 15 years ago. Since then, the APTA has worked to embed cultural diversity into its goals, objectives and vision. "We are involved with promoting cultural diversity in workshops at schools, in our Web page, and during recruitment and speaker's bureaus," says Meadows.
"We market people of color. We want to show that our membership is diverse. We want advocates and speakers of all races to represent our organization," Meadows continues. "The APTA is proud of their accomplishments, which not only promote cultural competency to its professionals, but also attempts to recruit a diverse enrollment at the local level."
Despite the APTA's ongoing efforts to increase diversity, they currently report that 90.8% of their members are white, 4.2% Asian, 1.9% Hispanic, 1.5% African American, 0.5% American Indian/Alaskan Native and 1.1% other. Physical therapy has traditionally been considered a female field, with 65% of its members female.
The American Dietetic Association (ADA) has also long recognized that their membership is far too homogenous, with only 13.6% male, 2.5% African American, 1.7% Hispanic, 4.8% Asian/Pacific Islander, and .2% American Indian/Alaskan Native/Hawaiian Native. According to Terry Brown, RD/LD, "The lack of visibility of dietetics to young minority people and the academic disadvantaged is one of the principle reasons for underrepresentation of minorities." She also credits poor rates of cultural diversity among dietitians to contributing factors such as few minority role models, low pay in the profession, lack of access to a dietetics program, discrimination, poor recruitment, lack of knowledge to the field of dietetics, and lack of financial resources for a program.
In an attempt to improve diversity, the ADA has promoted a diversity committee, mentoring contract, action award, promotion grant, resource list, and ADA networking groups, such as the National Blacks in Dietetics and Nutrition, the Chinese American Dietetic Association and the Hispanic Dietetic Association.
Jeannette Jordan, a Charleston, S.C.-based registered dietitian and spokesperson for the ADA, serves as a nutrition consultant for the Reach 2010 Project, which is funded by the Centers for Disease Control and Prevention to decrease disparities in African Americans with diabetes. Jordan believes that lack of knowledge regarding the opportunities that exist in the field, apprehension about acceptance into the profession, the difficulty of being accepted into an internship affect minority participation in the profession of dietetics.
In the mid-1980s, the American Occupational Therapy Association (AOTA) began establishing multicultural initiatives that focused on student recruitment from a cross section of the population. "When our profession started in World War I, it was primarily white middle class women who wanted to help soldiers. This captured the hearts of women at the time. Services were provided in private hospitals, in a confined community," says Janie Scott, of the AOTA. With noncompetitive salaries, the profession became a convenient one for suburbanite mothers who wanted to move in and out of their profession.
The AOTA looked at ethnicity in their membership in 2002. Out of 33,003 members, 20% did not list ethnic origin. Of those who did list their ethnicity, 1.9% were African American, .2% American Indian, 3.3% Asian, .3% Asian American, 1.5% Hispanic/Latino/ Latina, .2% Multiracial, .8% other and 71.9% white. With a growing diverse patient base, the AOTA wants to enlist a more diverse membership and boost support groups such as the Black Occupational Therapy Caucus and the Native American Occupational Therapy Group.
Educating the Future
The problem of poor diversity in health care professions has its roots in the higher education system. For many reasons, minorities are not enrolling in allied health programs, as is evidenced in the 10th Report by the Center for Health Workforce Studies, which shows a decline in the number of minorities applying to all health professions education programs.
Despite ardent measures to attract a diverse population, at the Texas Tech University Health Sciences Center in Lubbock the enrollment is estimated at 8% minority. Yet at Texas Southern University College of Pharmacy and Health Sciences in Houston, enrollment is typically only about 10% white. Since 1949, Texas Southern University College of Pharmacy and Health Sciences has educated approximately 35% of the nation's black pharmacists. Schools that have been designated as special purpose institutions serving minorities, such as Texas Southern University of Pharmacy and Health Sciences, don't appear to have troubles attracting diverse students in search of allied health careers to campus.
The University of Kansas Medical Center and the University of Missouri-Kansas City recognized that they needed to increase the participation of minority students in health professions and put together a groundbreaking package to do something about it. The Health Professions Pipeway Initiative, a multi-institutional, multidisciplinary strategy, hopes to lead the way to greater diversity in health professions.
Funded by a grant from the U.S. Department of Health and Human Services, Division of Disadvantaged Assistance and the University of Kansas Medical Center, this program targets high school seniors and college undergraduates. Offered throughout the year at satellite centers on university campuses, the program hosts many opportunities, such as counseling, field trips, academic enrichment, tutorials, health career clubs and seminars. At no cost to the student, an eight-week Health Science Enrichment Institute Summer Program is provided for disadvantaged or minority students and offers them preparation for admission to a health professions school. The enrichment program focuses on reading, communication, mathematics, biology, chemistry and test-taking skills, which may not be developed in disadvantaged students.
Many other organizations are addressing the health care diversity crisis. The Institute of Medicine has identified strategies to increase the racial and ethnic diversity of the nations' health care workforce, which includes modifying admissions practice and criteria, placing greater emphasis on cross-cultural skills and competencies in heath professions training and accreditation procedures, and increasing the number of minority faculty. In South Carolina, the South Carolina Hospital Association and South Carolina Technical College System announced a $476,000 grant through the federal Workforce Investment Act to assist students seeking a career in health care.
One of the programs shining the brightest light on the path of cultural diversity in health care is the Health Careers Opportunity Program (HCOP), which has established goals of increasing the number and quality of individuals from disadvantaged backgrounds into health profession schools. By achieving these goals, we might better meet the expanding health care needs of an underserved population while developing a more competitive applicant pool to build diversity into health professions. In 1999, the Bureau of Health Professions awarded 112 HCOP grants for a total of $28.2 million to 59 undergraduate institutions and community colleges, 50 health professional schools and health science centers, and three public and nonprofit organizations. Of these 112 grants, 29 grants were awarded to Historically Black Colleges and Universities.
The HCOP has made a significant impact on careers. Over the past 20 years, the HCOP has nurtured the entrance and graduation of thousands of minority and disadvantaged students into health professions school. Between 1980-1999, an average of 8,500 students participated in HCOP each year. In addition, thousands of students received counseling or other services.
Now the HCOP focuses on increasing education and social and cultural competence early on in the educational pipeline. Major emphasis is placed on developing partnerships with community-based organizations that promote education and cultural diversity. They reach out to students in lower grade levels to attract more into heath professions.
Often health professional programs admit students in their junior year of college, which may be too late to attract the interest of minority students who are simply underrepresented in college to begin with. Organizations like the AHA have developed a Commission on Workforce for Hospitals and Health Systems, which encourages hospital leaders to build a thriving workforce by reaching out to students in grades K-12 with the help of local colleges and universities.
The Robert Wood Johnson Foundation and the W.K. Kellogg Foundation, in conjunction with the Health Professions Partnership Initiative, awarded six grants to increase minority participation in health professions. A requirement of this grant is that efforts focus on middle and high school curricula.
A Question of Class
Chances are, however, that plenty of minority kids will still go to disadvantaged schools that aren't targeted for recruitment or aid, causing them to miss the opportunity to discover careers in health professions. Even the kids that consider an education in a health field may lack the math and science skills, not to mention the financial resources, needed to enter an allied health program.
Michael Castillo, now president of the Latino Midwest Medical Student Association, attended the University of California, Berkeley, where he graduated with an undergraduate degree in biochemistry and molecular biology. Castillo reported that at Berkeley the initial enrollment of 180 minority students in his class wound up with only three graduating with a degree.
When talking about the issues of cultural diversity in the health care education setting, Michael Castillo says, "This isn't an issue of color. It has to do with socioeconomic class. The minority students who attend college are from affluent backgrounds; the black child from Beverly Hills doesn't share the same experience as the white person in Harlem."
Even for college-bound minorities, the allied health professions may not appear glamorous or financially rewarding enough to be worth the cost in sweat and dollars. "There is a hefty cost associated with entering an allied health field. It's much cheaper to become a computer programmer," says Janie Scott of the AOTA.
But the wave of the future may be in the hands of those working the health care beat. Health professionals on the home front can make a difference in diversifying the health care force. As they create opportunities to educate children about their profession, mentor minority children in the community and attend career days at local schools, they can make a difference by boosting the number of minorities entering their profession.
Providing high-quality, sensitive care to all cultures probably speaks the best recommendation to the impressionable patient and their families. It sends the message that these careers offer opportunities for all ethnicities. And the more culturally diverse the health care team becomes, the more role models are sent out into the community. By creating a diverse profession that provides health care services to an equally diverse population across our country, the caregiver opens his or her eyes to the unique values and backgrounds of every patient.
Springer Publishing Company