Rhea Boyd, MD+ Your Authors @RheaBoydMD A pediatrician and hopeful participant in democracy. Trying to do the right thing by the children of the world, one day at a time. youtu.be/xBUEsDtBfiQ Jun. 21, 2019 2 min read + Your Authors

I have something I want to say that I’ve been struggling to find the courage to say publicly.

But here goes...

The US healthcare industry doesn’t have a problem with diversity, it has a problem with segregation.

Short thread.

I wrote this for @TheLancet but want to share it here, for those who can’t access medical journals.

This is for all those who medicine has long excluded. I want you to know, I see you. DM me if you would like a pdf of the article.  https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31353-4/fulltext 

Here’s the main points

1. The majority of the US healthcare workforce, at every level, is white. From medical personnel, clinicians and nurses to executives, NIH grant recipients, professional medical association directors, and students across the academy.

2. The predominance of white professionals across the healthcare workforce is not random. It is also not evidence of a simple ”diversity” problem.

It is evidence of systematic and profound forms of racial exclusion and discrimination that normalize, favor and reward whiteness.

3. To fix it, we have to call those forms of racial exclusion and discrimination by their names.

Those name are not “under-representation” or “implicit bias.”

They are white hegemony, white normativity, white privilege and white supremacy.

4. We also have to name the ways segregation, racial exclusion and discrimination in the healthcare workforce contributes to and drives racial health inequities at a population level.

This is especially true in places where medical centers are the largest local employers.

5. To be successful, attempts to eliminate racial health inequities must engage all four processes of racial segregation explicitly and simultaneously, not implicitly or incrementally. Because each process of racial exclusion and discrimination reinforces the others.

6. Just as black teachers were not simply “under-represented” in Ruby Bridges’ elementary school, non-white professionals are not simply “under-represented” in the US healthcare industry. They are largely excluded. And the consequences are intergenerational.

7. Racial segregation continues to be ”the problem we all live with.” And instead of confronting it, we continue to iterate ways to render the problem nearly invisible - with with words like “underrepresentation” as if non-whites are just passively missing from our workforce.


Racial segregation in our healthcare workforce has become so routine, so ordinary, it escapes our collective notice and we misname it as a generalized diversity issue.

But what we need is a reckoning and reorientation, not towards diversity, but towards desegregation.

You can follow @RheaBoydMD.


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