December 17, 2014

Demographics and Cheerios

By Billy Thomas, MD, MPH
UAMS Vice Chancellor for Diversity and Inclusion
Professor, College of Medicine

Billy Thomas, MD, MPH UAMS Vice Chancellor for  Diversity and Inclusion Professor, College of Medicine

Billy Thomas, MD, MPH
UAMS Vice Chancellor for
Diversity and Inclusion
Professor, College of Medicine

Last month General Mills aired a Cheerios commercial in which a little girl asks her mother, who is white, about the healthy heart benefits of cheerios. The mother, dressed in business attire and engaged in what seems to be work-related activity, attentively listens to her daughter’s questions and after weighing certain related facts answers her question with a “yes” – it is good for your heart. The next scene shows the father, who is black, lying on the sofa with a pile of Cheerios on his chest, presumably placed there by his daughter in an attempt to protect him from heart disease. The daughter looked like a mix of the two.

This attempt by General Mills to highlight a rapidly growing segment of the increasingly diverse U.S. population was met with the posting of some very negative comments on a YouTube video about the ad.  In addition, several comments were posted on the company’s blog. Unfortunately – or maybe fortunately – none of these comments has been published so we cannot comment on the content or severity of the statements.  But it is probably safe to say that General Mills was well aware of the possible dynamics of airing the commercial but felt (I would like to think) that the need to demonstrate their awareness and support for multiracial families along with demonstrating what they feel is a growing and important part of America’s current racial, ethnic, and social makeup far outweighed the possible negative fallout from airing what was really a benign commercial. It does offer a gaze into the future as the United States enters a new phase as the planet’s great “melting pot” through interracial marriages and immigration. To their credit General Mills has continued to run the commercial.

This brings us to the question of what does this have to do with an academic health center (AHC). In most cases educational institutions are representative of the whole of society. AHCs are just smaller versions – microcosms of society. This includes the entire workforce – ranging from non-salaried employees to staff, students, faculty, and administrators. The makeup of the institutional workforce should be reflective of the many sub-groups that make up the general population. By extension this must also be reflected in the health care workforce that UAMS trains to provide health care services to an ever-changing population.

This is most evident when we examine the admissions process for ALL health professions schools. The admissions process is primarily a meritocracy based on GPA, standardized test scores, undergraduate institution attended, and in most cases, letters of support. Who are the students that make up this applicant pool? Where do they come from? The majority of AHC applicants are products of both private and public undergraduate schools – the post-secondary educational system.  Competition to gain entrance into upper tier, selective undergraduate schools is keen, and as the term implies, these schools are selective in whom they admit. In most cases students with the competitive edge had the benefit of a solid K-12 educational program – private or public that included tutoring, AP courses, mentoring, and guidance throughout the college application process. For the most part, it boils down to an economic issue: Regardless of race in many cases it is about who can afford the best prep schools or programs.

The 2010 Census Bureau showed that interracial or interethnic couples made up 10% of the opposite- sex married couples households in the United States (1, 2). This is a significant number. In addition it has been shown that African Americans and Hispanics who marry outside their race/ethnicity are likely to have higher educational attainment than couples who do not (3). The result is an increasing number of interracial marriages between individuals that have attained fairly high levels of education, which in most cases translates into a well-educated family unit with children that potentially will compete for seats in selective colleges and universities, enjoy a mid to high socio-economic status, and be economically upwardly mobile. Many of these students go on to excel academically and make up a large segment of the applicant pool to AHCs. Many are selected and matriculate through AHCs.

In fact, many of these students are part of an emerging group of interracial students that are now being referred to as “vanguards” (3).  By definition, the term refers to black students who are multiracial in addition to being part of a pool of first- and second-generation immigrants, many of whom are from Caribbean countries (Jamaica, Haiti, Trinidad, Tobago) and Africa (Nigeria, Ghana, Ethiopia, Kenya)(3).  Many of these students are afforded the educational benefits that come with economic mobility; they are highly sought after by selective colleges. A study by the National Study of College Experience (NSCE) about highly selective colleges found that 8% of students enrolled in these colleges were multiracial with private, highly selective universities having more than 10% and public universities having 6% (3).

The numbers of multiracial students enrolled in and matriculating through both private and public universities are growing, which is a good thing for AHCs that see the value of a diverse student body and health care workforce. But many of those students, for various reasons, remain outside of the mainstream and in many cases are marginalized or just plain invisible. Interracial students are a minority and as such are exposed to and experience unique interpersonal and social challenges – isolation and difficulty in acclimating or identifying with any specific racial or ethnic group. As a subgroup interracial students have a very different perspective on social integration and require an increased level of institutional support as they progress academically.

As the population becomes more diverse and interracial marriages and families make up a greater proportion of the general population, AHCs and the health care delivery system must consider these sub-groups in all phases of planning and implementation. The health care workforce of the future will need more individuals of mixed race backgrounds – or who have the competencies – to effectively meet the needs of this growing segment of the U.S. population.

The U.S. Census Bureau projects that the percentage of the population ages 0-19 that is non-Hispanic white will decline from its 2010 level of 55.5% to 48.8% by 2025, and by 2050 will be down to 38.1% (4). Diversity will be the norm. As interracial marriages become a greater part of our social structure so will the children of these households become an increasingly prominent and productive part of the social structure. Given their current educational and economic trajectory it is very reasonable to think that many of these students will be become our business leaders, politicians (e.g., President Barack Obama) and indeed many of our health care providers and AHC leaders.

I thank General Mills for a very timely and thought-provoking commercial. In my opinion this commercial did not, nor was it intended to, spark a national conversation on race or racism. Although at some level it was a business decision, aimed at capturing a rapidly growing untapped market, I believe that a primary intent was also to show America as it is – a truly diverse nation made up of innumerable demographic groups, which are increasing in numbers and visibility. It is important to show America as it is. I would like to thank General Mills for taking the high road and doing just that.

  1. 2010 Census Shows Interracial and Interethnic Married Couples Grew by 28 Percent over Decade. U.S. Census Bureau, Public Information Office. At, Newsroom, Releases 2010 Census.
  2. A Look at Interracial and Interethnic Married Couples Households in the U.S. in 2010. U.S. Census Bureau.
  3. Espenshade, Thomas J. and Radford, Alexandria Walton. No Longer Separate, Not Yet Equal. Race and Class in Elite College Admission and Campus Life. Princeton University Press, 2009.
  4. Bridging the Higher Education Divide. Strengthening Community Colleges and Restoring the American Dream. Report of the Century Foundation Task Force. 2013.