As everyone knows, debates continue over affirmative action programs in higher education. But a leading health care policy physician believes the implications of affirmative action programs for health care delivery are many. Atheendar S. Venkataramani, MD, Ph.D.associate professor of medical ethics and health policy at the Perelman School of Medicine at the University of Pennsylvania and attending physician at Penn Presbyterian Hospital and the Hospital of the University of Pennsylvania, believes those questions should be examined, on behalf of communities of color.
In an opinion piece on “Perspective” published online on September 28 in The New England Journal of Medicine entitled “Affirmative action, population health and the importance of opportunities and hope” Dr. Venkataramani raised a number of points about some of the implications of the presence or absence of affirmative action programs in higher education and their potential impacts on health care delivery.
Venkataramani noted that “[A]Affirmative action programs have important consequences for healthcare personnel. There is growing evidence that state-level bans on the use of affirmative action in public university admissions in recent decades led to a decline in enrollment of students from historically marginalized populations in public medical schools. Lack of diversity in the medical workforce has implications for population health and health equity, as illustrated by evidence that having access to physicians from concordant racial and ethnic groups can improve trust and commitment to care preventive and, consequently, reduce premature mortality among patient populations that have long faced structural barriers to good health,” he emphasized.
He also wrote that a “lesser discussed mechanism by which affirmative action programs may affect health is through the messages they send to population groups that face structural barriers. These programs (and their completion) can signal to young people their prospects for upward mobility, their membership in society, and the degree of systemic discrimination they may face. These “affective” consequences (i.e., the effects of policies on hope and beliefs about opportunities for upward mobility) can significantly shape health-related behaviors and outcomes. State bans on affirmative action were associated with large and persistent increases in adverse health-related behaviors (smoking and alcohol use) among black, Hispanic, American Indian, and Alaska Native adolescents, including those whose college prospects would not have been seen directly affected by police officers.» Importantly, he wrote, “the association between affirmative action bans and smoking extended into adulthood; Health-related behaviors among white students were not affected by these policy changes. The importance of hope and opportunity as a channel linking affirmative action programs to health and well-being is also supported by emerging evidence about the positive effects these programs can have on future-oriented behaviors, such as school attendance and academic effort.”
Venkataramani noted that, “after several states banned race-based affirmative action in college admissions, debates over affirmative action culminated in the Supreme Court’s June 2023 decision in Students for Fair Admissions v. President and Fellows of Harvard College and a concurrent case involving the University. of North Carolina.” And he wrote: “The decision in Students for Fair Admissions v. President and Fellows of Harvard College, along with evidence on the relationship between affirmative action and health, invites clinicians and policymakers to think differently about approaches to improving population health. In particular, affirmative action illustrates the critical role that opportunities for social and economic advancement play in boosting health and well-being. Opportunities shape hopes, aspirations, and access to healthy goods and services, all of which influence health. Several other policies also influence population health through similar mechanisms, including policies that increase access to stable, well-paid jobs; policies that address discrimination and barriers to advancement faced by members of certain racial and ethnic groups, people living with disabilities, migrants, and lesbian, gay, bisexual, transgender, and queer people; policies that shape the risk of incarceration; and policies that strengthen access to safety net services in times of need.” In fact, he emphasized, “Using the concept of opportunity to draw analogies between these various policy domains and populations could help inform debates about how best to intervene to improve population health and build consensus among various interest groups.” .
In the end, Venkataramani wrote: “In the United States, two major challenges that have been evolving over the past four decades are the worsening health of the population, as evidenced by declines in life expectancy in recent years, and the declining economic opportunities, as evidenced by growing economic inequality. Affirmative action is a powerful example that illustrates how these long-standing challenges are closely related: opportunities shape health and well-being. Understanding and intervening in this fundamental relationship will be critical to addressing population health challenges in the future.”
