Health and the Healthcare Workforce: Obama’s Second Term

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

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

January 21 – the national holiday commemorating the birth of Dr. Martin Luther King, Jr. – was marked by two truly significant moments in world history: Barack Obama was sworn in for his second term as the 44th president of the United States, and Joe Biden was sworn in as vice president by Supreme Court Justice Sonia Sotomayor – a graduate of Yale Law School and the third female and first Hispanic to serve on that high court.

These inaugural milestones sparked some questions in my mind.

What does Obama’s re-election say about America? In 2008, Obama became the first person of color, in this case African-American, to become president of the United States. The reasons for this were complex, but his broad appeal and a political platform that was inclusive of marginalized populations undeniably played a major part. For once, groups that in the past had very little to no voice in the political and social direction of the country felt that they mattered. 

I see other factors at play in Obama’s re-election. As was true four years ago, Obama was supported by a multicultural constituency that cut across race, gender, and ethnicity and included individuals with disabilities and the LGBTQ (lesbian, gay, bisexual, transgender, questioning) population. Historic policy changes of his first administration (e.g., the Affordable Care Act, support for same-sex marriage) forced debate on issues of caring and equity out in the open. In his re-election bid, a distinct set of moral and social imperatives founded on diversity and inclusion galvanized a broad demographic and in the end proved to be a hard ticket to beat. However, the focus of this commentary is not about the validity of the Obama administration, but rather the role of the multiple demographic factors involved in his re-election along with their social/political significance. It also says that America is beginning to recognize that inherent capabilities, although very complex and influenced by multiple factors, are individualized and not directly related to gender, race, culture or ethnic background.

What does this mean for health care, or more specifically, academic health centers? It means that we must recognize and embrace the fact that we serve the same diverse community that elected Barack Obama to his second term – as well as those who did not! Community must include everyone across the political and social spectrum. We must also recognize that this community is dynamic, that the demographics are rapidly and continually changing. If we believe that everyone in the community is entitled to the same quality of care, then we must be strategic in our response to change. As stated by Dr. Louis Sullivan in Missing Persons: Minorities in the Health Professions,1 health care must be provided by a well-trained, qualified, and culturally competent health professions workforce that mirrors the diversity of the population it serves. This must be central to our overall mission.  

In academic medicine, as with education, business, and government, the benefits of diversity are well documented. The range and richness of life experience and perspective that diversity brings to the workforce and workplace in the end means better products and services – in this case, improved patient care.

The appointment of Sonia Sotomayor to the Supreme Court is not only an outstanding personal achievement for her, but something for us as a nation to celebrate. The Supreme Court will soon hand down a decision involving affirmative action in the Abigail Fisher case, in which the use of race as a factor in the college admission process is being challenged by a student who failed to gain entry into the University of Texas at Austin. Texas has a combined race-neutral and holistic review admission process whereby the top 10 percent of graduating high school seniors in any Texas high school are granted automatic admission to the University of Texas system. This accounts for about 75 percent of students admitted. The remainder of entering freshmen is selected on the basis of academic performance and a host of other factors including race.2

Sotomayor, the child of Puerto Rican immigrants who settled in public housing in the Bronx, understands the merits of affirmative action. She was a product of it.  As she said in a recent “60 Minutes” interview, she is well aware of the impacts for minority individuals and society.3 In the interview she said that in her decision on Fisher v. UT Austin, she will put aside what she feels personally and consider only what is objective and within the framework of the law. This I agree with, but undeniably, each individual who has ever served on the Supreme Court brings a perspective and set of life experiences that cannot – and should not – be divorced entirely from the decision-making process. Her presence on the court is an opportunity for dialogue on critical questions facing us today. My hope is that there will be a great deal of reflection by not only Justice Sotomayor but all of the justices about the overall social impact of this case beyond what maybe outlined in black and white. Indeed this goes to a point of recognizing who we serve and who we are as a nation.  

How do we structure our educational system in a fashion that will not only embrace diversity, but also promote it to a point of inclusion, excellence and service? If race can no longer be used as one factor in the holistic admissions process, the number of minority students admitted to and matriculating through undergraduate schools will drop. Currently, only a small number of minority students pursue and receive undergraduate degrees in STEM (science, technology, engineering, or math) majors. Thus the minority applicant pool for biomedical science and health care graduate and professional programs is small. A ruling against the use of race as a factor in the undergraduate admissions process would further reduce the pool.

In the long run, a ruling in favor of Fisher will be a setback for the true American community – one where everyone, including students from disadvantaged backgrounds, is given the opportunity to learn and excel. It will also be a setback for academic health centers that are dedicated to diversity as a pathway to better population health. If we continue to fail to recognize and embrace the community that we serve, the same one that elected Barack Obama, the existing educational and health care gaps will only continue to widen, and any attempt we make at improving population health will fall short.

1. Missing Persons: Minorities in the Health Professions. A report of the Sullivan Commission on Diversity in the Health Care Workforce. 2003.

2. New York Times. Justices Weigh Race as Factor at Universities. Oct. 10, 2012.

3. Justice Sotomayor prefers “Sonia from the Bronx.” Available at Accessed Feb. 22, 2013.