On June 29th, 2023, the Supreme Court overturned 45 years of established precedent by invalidating admissions plans at Harvard and the University of North Carolina when they declared that race cannot be a factor in the admission process. The decision was met by immediate disappointment and frustration among those fighting for equality. It served as yet another example of how the power and momentum of systemic social norms can be an unstoppable force.
According to Wikipedia, "inertia is the idea that an object will continue its current motion until some force causes its speed or direction to change." The parallels between physics and human behavior are sometimes quite uncanny. For centuries, people of color have faced marginalization and oppression. Without a powerful counterforce, these norms continue to shape our world.
Efforts like affirmative action in college admissions were intended to disrupt the centuries-old inertia of suppressing people of color. But now, with the court's decision, colleges and universities must adjust their approaches to achieve diversity without considering race. Unfortunately, we can look to examples from states like California, Michigan, and Washington, where similar rulings resulted in a significant decline in minority enrollment at top public universities.
In Michigan, the enrollment of Black and Hispanic undergraduates has not fully recovered since the 2006 decision to end the use of race in admissions in that state. Despite an increase in Hispanic enrollments, the number of Black students in Michigan universities has continued to decrease, dropping from 8% of undergraduates in 2006 to a mere 4% at present.
Following the recent Supreme Court decision, officials from Amherst College relayed that they anticipated that adopting a completely race-neutral approach would lead to a 50% reduction in the Black, Hispanic, and Indigenous student populations at their university. This predicted lack of diversity in higher education enrollment will undoubtedly impact efforts to diversify the workforce, especially in higher paying white-collar jobs.
One industry that will likely suffer is health care, particularly in the number of African American physicians. Despite progress in diversifying medical school student bodies, African Americans remain vastly underrepresented among physicians. According to the AAMC, African Americans make up 5.7% of the physician workforce while comprising 12.8% of the population. Diversity among medical school students has continued to climb but that growth has not been equivocal. The number of African American medical school students has lagged far behind other diverse groups.
As stated by the National Medical Association, "the more Black physicians in the U.S. healthcare system leads to greater patient satisfaction and better adherence to medical recommendations, which translates to better outcomes for Black patients, reducing the overall healthcare disparities that plague Black communities."
The need for diversity in medicine is undeniable as the literature as consistently demonstrated the positive impact on health outcomes. Yet, 21 public medical schools across eight states were forced to change their admissions practices when affirmative action was banned. The risk here is the corresponding and predictable drop in underrepresented minority enrollment that is to come.
A study published by the Annals of Internal Medicine tracked the percentage of underrepresented minorities (URM) prior to the bans and five years later. A year prior to those bans, URM enrollment averaged 15%. Five years later, all schools saw that number drop by at least a third.
In 2021, the US Centers for Disease Control and Prevention declared racism a “serious public health threat.” The scarcity of Black physicians in the United States is a cause for concern, as it exacerbates the disproportionate impact of infectious diseases, chronic illnesses, and other medical conditions on communities of color. Experts have warned that these shortages pose a significant public health threat. This Supreme Court decision further perpetuates health disparities that disproportionately affect communities of color.
When the inertia of our implicit biases is allowed to go unchecked in health care, it leads to substandard health care delivery that is influenced solely by race. For example, several studies have reported that African Americans were less likely to undergo cardiac catheterization compared to Whites even after controlling for age, education, and clinical variables. For Black patients having unfortunately suffered from a myocardial infarction (MI), this disparity in treatment is attributed to a three-year reduction in life expectancy post-MI compared to whites. These findings are another poignant reminder of the need for diversity in medicine.
Recognizing the inertia of systemic racism is unfortunately omitted from most conversations on race in our country. Perhaps this illustration may help. If you were to extend your arms and imagine that from fingertip to fingertip represented our country from 1619 to present day, the time invested in sincere efforts to revers centuries of systemic racism would be represented by one of your hands. Who we are now as a society bears no resemblance to who we were centuries ago. But ask yourself, how long does it take to undo something like that?
If we all decided tomorrow that we would no longer shake hands, how long would it take for hand shaking to end in our country. Days? Months? Years, or maybe decades? The most likely answer would be measured in generations. When a social norm is engrained, it is very difficult to dislodge. It takes a concerted effort to reverse the inertia gained by generations of familiar ways of thinking, responding, and acting. What's missing from most conversations about race in our country is the intentionality needed to reverse the inertia of centuries of norms. In fact, quite the opposite is occurring where there is a concerted effort to downplay the horrific circumstances of periods like slavery, Jim Crow, and systemic marginalization based on one's race. What's missing is context and empathy. In their place, people of color have witnessed time and time again the refusal to play a role in slowing the inertia of centuries of racism. It is that effort and only that effort that can provide the healing that our nation so desperately needs.
The Supreme Court’s decision on college admissions will likely reverse gains in diversifying student representation across the nation. This will likely result in fewer underrepresented minorities entering the health professions. The only way of mitigating these risks is by taking a physicist’s approach to social momentum.
We must confront the implicit biases that perpetuate these inequities. The need for diversity in higher education and health care has never been more critical. It's time to disrupt the inertia that upholds systemic oppression and work towards a more equitable future. The only way to impact the inertia of systemic practices intended to marginalize people of color is by addressing that momentum head on. This means having tough conversations. We will need to turn animosity into allyship. We will need people who are willing to try trading comfort for compassion.
We don’t need laws. We need love. We don't need walls. We need bridges.
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