Diversity and Speech Part 14: Health Equity – by Carlos Cortés, Adwoa Osei

Completing her second year as a pediatrics professor at the University of California, Riverside, Adwoa was focused on providing clinical training for her medical students.  A retired UCR history professor, Carlos had no way of imagining that he would soon be joining the staff of a medical school.  .

Then the UCR School of Medicine decided to establish a new required curricular thread on Health Equity, Social Justice, and Anti-Racism.  Shortly after that, the School asked Adwoa and Carlos to become co-directors of the thread in order to get it started.

It was decision time for the two of us.  Still at an early stage of her medical teaching career, Adwoa had numerous obligations.  Experienced in health care cultural competence training, Carlos had been giving annual workshops on that topic to UCR’s incoming medical students.  But establishing an entire curricular thread?  That was a challenge.  But also an opportunity.  We couldn’t turn it down.  

We jointly made our first decision: to listen before we acted.  So we set up a series of listening sessions with faculty, staff, and students.  What an experience, especially when it came to students!

These young people – some younger than three of Carlos’ grandchildren – blessed us with perceptive comments and challenging recommendations.  They unburdened themselves with ideas they had been considering, hopes they had been harboring, and frustrations they had been living with.  We had developed a series of questions, but the list proved unnecessary.  Once we presented the opening question – what comes into your mind when you think about health equity, then social justice, then anti-racism? – they buried us with a flood of insights about the current curriculum and how it could be improved with these three goals in mind.

The students did not always agree on details, but they came together around common purposes.  They wanted a curriculum that prepared future physicians to advocate for excellent health care for all.  A curriculum that helped them better identify and address inequity-producing flaws in the current health care system.  A curriculum that challenged the sometimes stereotypical misuse of race in health care.

In addition to listening to UCR people, we also joined Zoom discussions on diversity and health care around the country.  Some of the issues mirrored those on our own campus, but others reflected local concerns.  A young Native American student appealing to medical school faculty to avoid thinking about Indians as a singular group, but rather to address unique tribal heritages, experiences, and health care beliefs.  A Black faculty member who felt that it was her obligation to defend the right of students to criticize medical school policies, systems, and pedagogy.

As we pondered our curriculum-to-be, we recognized that health equity, social justice, and anti-racism raised related but inherently different issues.  Anti-racism focuses on one critical dimension of group-based experience.  Health equity embraces the intersection of myriad social categories.  Social justice draws our eyes to larger societal and even global cultural and structural factors.

One of the most concerning issues expressed by students, both at UCR and elsewhere, was the reticence of some professors when it came to dealing directly and consistently with diversity.  And not just professors.  Many students, too, seemed to avoid engagement in diversity-related discussions.  Why?  We need to figure that out and try to do something about it.

Maybe they lack confidence in their command of diversity language.  Maybe they harbor fears of saying something “wrong” and incurring criticism from others.  Maybe they feel that diversity, as a subject, simply isn’t all that relevant to their medical education and that it takes time away from the “real” subject matter.

But maybe some faculty and students have simply had bad experiences when discussing diversity, experiences that have made them reticent.  Unfortunately, as a trainer of diversity trainers and a long-time observer of diversity workshops, Carlos had witnessed training that actually shut down conversations through its sometimes authoritarian insistence on language conformity and intolerance of language “mistakes.”   Maybe the two of us will have to play catch up in order to create an atmosphere of openness in which well-intended efforts will be honored while learning occurs.    

What also became clear to us is that curricular change alone has its limits.  We must also address cultural change.  We need to work on altering thinking about what equitably-effective health care means, how an anti-racist physician should act, and what a social justice medical school should look like.  At the heart of this lies the issue of speech – the ability to openly, honestly, and continuously discuss diversity, to be responsive to diverse patients, and to work constructively with diverse compatriots.

We’ve got our work cut out for us.  But what wonderful work!

Also read  Come together over healthcare by Deborah Levine

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