Affirmative Action in Medicine: Improving Health Care for Everyone

Introduction

introduction This book is about affirmative action in undergraduate and postgraduate medical education, a significant part of my life’s work. Affirmative action in medicine is defined comprehensively, covering not only the equitable opportunity to be admitted to the best medical schools and postgraduate training programs, but also the equitable provision of health care. Major emphasis is placed here on the serious differentials in health status between Blacks (or Afro-Americans) and Whites or (Euro-Americans), because the social, political, and economic contrast between these two groups has been one of the defining issues of our national history. As a Black physician and medical educator, I maintain that the persistence of a system of color caste consigns our people to a subordinate social role that is a handicap separate from the poverty Black people also endure. More equitable recruitment of competent Black physicians can help meet the needs of Blacks who currently receive poor care. In 1970 the Association of American Medical Colleges (AAMC) and the medical establishment of our nation supported an affirmative action goal of admitting 12 percent minority students to our nation’s medical schools by 1975. This effort fell short, achieving only 10 percent by that date. Again in 1990, the AAMC announced the aim of enrolling three thousand underrepresented minority students by the year 2000, but that effort failed by almost one thousand students. The reasons are clear. Medical schools quite properly will admit only those who are almost certain to graduate, and the substandard educational opportunity available to Black youngsters constricts the pipeline. Blacks become physicians at about one-half the rate of other ethnic groups (Petersdorf et al. 1990; Johnson 1998). My outlook for future amelioration of this disparity is more optimistic than might be supposed, perhaps because of my personal life history. Both of my parents were born in the 1890s in a small farming village in Georgia . Following his military service in World War I, my father moved to Michigan in 1921 in response to labor recruiters seeking workers for the booming automobile industry. I was nine months old when, in 1922, my mother and I joined him in Albion, Michigan. Fortunately Albion, then a town of about ten thousand, was both a small factory town and the home of Albion College, one of the best small schools in the Midwest. Fortunately, opportunities came my way. I grew up in a strong, albeit racially segregated, Black community where the men all worked and supported their families. I had the further advantage of excellent schooling, which led to Albion College and then to the University of Michigan Medical School, from which I graduated in 1946. My career has been in academic medicine, the last position being that of director of psychiatry at Harlem Hospital Center and clinical professor of psychiatry at the Columbia University College of Physicians and Surgeons in New York City, from which I retired after eighteen years at the end of 1999. My story demonstrates what one can achieve in this country, given the right combination of ability, a strong support system, and just plain luck. In other words, I have had the good fortune of living and struggling with the troublesome problems that are detailed in this book. The state of health for Black Americans is a national problem; the overall mortality rate for Blacks is 1.6 times the rate for Whites. In 1996 Blacks had the highest death rates of any ethnic group for seven of the ten leading causes of death: heart disease, stroke, diabetes, lung cancer, colorectal cancer, breast cancer, pneumonia, and influenza (Morbidity and Mortality Weekly Review 2000; Williams 1998). In 1990 the age-adjusted death rate was higher among Blacks than Whites for thirteen of the fifteen leading causes of death. It was much higher (6.7 times) for homicide, 3.1 times higher for HIV/AIDS, 3.1 times higher for perinatal conditions, 3 times higher for kidney diseases, 2.7 times higher for septicemia, and 2.4 times higher for diabetes. Hispanic Americans and Native Americans also suffered high mortality rates, while Asian Americans had favorable indices. This is a problem of national significance that will become more and more pressing in the coming decades. While ethnic minorities represented 18 percent of the population in 1970, by 1998 they represented 27 percent, and it is expected that by 2050 their proportion will have increased to nearly 50 percent of all persons in the United States. From 1980 to 1990, African...