Social Drivers of Health: The Role of Representation in the Healthcare Workforce

This is the second post of a three-part series on Modern Healthcare’s Social Determinants of Health Symposium, which was held virtually on October 25, 2023. You can read the first one here. 

Today, more and more healthcare systems are placing social drivers of health at the center of their initiatives and are working hard with community partners to address healthcare disparities for at-risk and vulnerable populations. Through initiatives that ensure these vulnerable populations have access to affordable housing, nutritious foods, transportation to and from medical appointments, and internet access for telehealth, cancer programs and practices are rolling up their sleeves to find new ways to help underserved communities.

However, by examining history and the threads that bind diversity, representation, and social drivers of health together—such as systemic racism in healthcare and systemic disenfranchisement of scores of underserved populations—it becomes apparent that to truly address social drivers of health, healthcare systems need to dig deeper, to the roots of inequity.

Modern Healthcare’s Social Determinants of Health Symposium featured several standout initiatives and programs that are addressing disparities in healthcare. This was culminated in the event’s final pair of Speaker Spotlights, as each packed a powerful punch and raised the bar on the work that needs to be done to address health inequities.

Why Representation Matters

The first was Michellene Davis, president and CEO of National Medical Fellowships, who made the case that to effect real change, programs need to move beyond conversations about the current state of healthcare disparities and move towards examining social drivers of health through a lens of a root cause analysis.

National Medical Fellowships (NMF), founded in 1946, works to achieve equity of opportunity in medicine and equity of access to quality healthcare for all groups through scholarships and support for underserved minority students in medicine and other healthcare professions. As Davis explains, NMF has been “advancing health equity at the intersection of the health wealth gap for the last 77 years. Way before health equity was the ‘thing to do’—NMF was out on the battlefield doing exactly that.”

Healthcare has a long history of segregation, and at one time, hospitals, medicine, and specialty training were completely segregated. However, through the work of powerful organizations like NMF, people of color from diverse backgrounds are entering the healthcare workforce and turning the page on its bleak past.

“NMF alumni are making certain that healthcare is more equitable for all of us, and NMF in turn continues to advance those with the same lived experience of those who come from communities made most vulnerable.” As NMF alumni often come from communities with a household income of $35,000 to $45,000, Davis believes the organization is facilitating access for individuals living at the federal poverty level. “We are ensuring that these individuals have the access they need not just to financial assistance, but to community, to someone who is in their corner,” she said. “Even after they graduate from medical school, we endeavor to ensure that they receive the proper training to become clinical researchers. As a result, we are bringing diversity to clinical research just as we have always brought it to medicine.”

Diversifying the Healthcare Workforce

James E.K. Hildreth, MD, president and CEO of MeHarry Medical College in Nashville, Tennessee—the oldest and largest historically Black academic health science institution in the nation dedicated to training medical professionals to aid underserved communities—knows the history of segregation in healthcare well. He shared his own first-hand experiences during his Speaker Spotlight.

“I know what drives them. I am one of them. I was born in rural Arkansas in the 1950s and watched my father die of cancer because no one would or could care for him,” Dr. Hildreth shared. “During his battle with cancer, I was struck by the way that doctors and the medical system treated him because he looked like me and my MeHarry students…I saw the fatal impact of systemic racism in healthcare…But I took my grief and vowed to become a doctor that cared and advocated for Black and Brown patients.”

Fully committed to working in rural and urban communities, many students at MeHarry have watched family members die from untreated medical conditions or suffer from a lack of wellness checkups. These firsthand experiences help shape their drive and dedication to challenging the status quo.

Medicine remains a predominantly White profession as Black people remain disproportionately underrepresented in the field. In 1940, Black males accounted for 2.7% of physicians. According to a study in the Journal of General Internal Medicine, as of 2018, only 2.6% physicians were Black males—demonstrating the stark and daunting fact that the number of black male physicians has not changed in over 80 years. As of 2021, only 5.7% of American physicians are Black, despite the group comprising more than 12% of the United States population.

The Need for Change

According to Dr. Hildreth, the time for change is well overdue. “In the midst of a healthcare workforce shortage, we are headed in the wrong direction,” he said. “According to the Association of American Medical Colleges, if underserved populations were to experience the same healthcare use patterns as populations with fewer barriers to access, the US would need an additional 102,000 to 180,000 physicians. Already we need more Black doctors, but the pipeline for making this possible continues to weaken.” Dr. Hildreth went on to argue that the value of a diverse workforce cannot be underestimated. “Trust, cultural competency, and a strong background in social determinants of health are as crucial during these times as medical training,” he concluded.

Today (January 15) is Martin Luther King Junior Day, making Dr. Hildreth’s call-to-action fitting. However, the work can only truly begin when the barriers to medical training are broken down. In building a new, stronger healthcare workforce focused on delivering next generation care, cancer programs and practices must ensure physician training is centered on implementing care plans for patients that address the complex social factors that directly impact their health and well-being.