Reflections on ‘Diversitas’ and Fisher v. Texas

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

This issue marks the one year anniversary of Diversitas. As stated in our first edition, “Our aim is to provide information and a forum for communication both within the institution and our surrounding community.” In reviewing the authors and columns that have been published in Diversitas over the past year, we feel that we have provided a forum that has been open, inclusive, stimulating, and perhaps galvanizing.

There has been a steady increase in the number of UAMS employees that read and comment on Diversitas, and in some cases, share their thoughts on the overall direction of the UAMS campus as it relates to diversity and inclusion. So it is with a great deal of optimism and excitement that we enter the upcoming year.

Since our first issue, the readership has grown to include students and faculty on both in-state and out-of-state undergraduate and graduate campuses along with an increasing number of individuals from our local community. This is a good thing because an obligation of an academic health center is to engage and energize the community in which it is located. This includes investing in the individuals that make up the community – starting with their health. One of our primary goals is the movement of services – primary care, preventive care, and health education – into surrounding neighborhoods.

Last month, as we do every September, we celebrated diversity at UAMS. This year, the traditional Diversity Week was expanded to Diversity Month, thereby spreading a week of noontime activities over four weeks. This was done in an attempt to improve attendance from what has historically been a large handful of likeminded individuals that gather and discuss the institutional benefits of diversity to a group more representative of the UAMS workforce. In spite of this effort, overall participation remained low. This could have been due to a failure on our part to rally the UAMS community around a shared value for diversity and inclusion. As a result, many missed a series of excellent presentations that covered employee engagement, diversity of personality type, unconscious bias, and an update on the accomplishments of the Center for Diversity Affairs in the past year – all very rich and timely topics. We look forward to next year.

Fisher v. the University of Texas

This month the U.S. Supreme Court is reviewing the Fisher case, which calls into question whether race may be used in college-admissions decisions, specifically, whether race may be one of multiple factors in admission decisions.1 This is not a new challenge and dates back to the 1978 Supreme Court ruling in Regents of the University of California v. Bakke, in which the court held that a college could consider race in admissions, but only pursuant to its right to select students it felt would best foster a “robust exchange of ideas.”

Twenty-five years later, the Supreme Court upheld the University of Michigan law school’s affirmative-action admissions policy in Grutter v. Bollinger. Justice Sandra Day O’Conner, in the majority opinion, said that seeking to promote diversity must give “serious, good-faith consideration” to race-neutral alternatives to affirmative-action preferences, but in those cases in which race-neutral programs were not feasible or not effective, the use of race as one of multiple factors in a holistic admissions process would be upheld.

The University of Texas case used the two Supreme Court rulings as guides in developing its current admissions policy that consists of race-neutral and holistic processes. Accordingly, any student graduating in the top 10 percent of his or her high school class gains admission to state universities. In Texas three-quarters of in-state applicants are admitted through this process.2 The remaining seats in freshman classes are filled with students chosen through a holistic process. Multiple factors including race and ethnicity are considered alongside numerous other factors, such as family circumstances, leadership qualities, special talents, and personal essays.3 These types of policies are not unique to Texas, but are in place at many undergraduate institutions and have been upheld in lower courts.  A Supreme Court ruling on the Fisher case is expected in 2013.

So what does all of this mean for health care? 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.

Why is it important that we not only maintain, but also increase, our current enrollment and graduation rate of minorities in the biomedical sciences?  By mid-century, no racial or ethnic group will comprise a majority nationally. The population will be made up of mostly people of color. So, my first response is to agree with the position of the Supreme Court ruling in the Grutter case in which they reasoned that as population demographics shift, all college graduates will need to be skilled at engaging with diverse individuals, ideas, and values.4 Nowhere is this more evident than in health care. The need for a diverse student body is a “compelling interest” for educational institutions and the nation result in improved patient access, quality of care, patient involvement in the care plan, increased adherence, and more positive patient perceptions of care – all leading to reduced health disparities and improved population health.5,6 All of these arguments provide valid reasons for pursuing and promoting diversity in higher education.

At most institutions, consideration of race in the holistic admissions process has been supplanted by socio-economic or educational disadvantage status – either based on family income or educational attainment or quality. While this approach does effectively widen opportunity for many minority and majority students, the fact remains that the long history of racial discrimination continues to impact individuals in ways that hinder their chances of success. Complete disregard of race or ethnicity as a legitimate consideration of an applicant may shut out deserving candidates. It comes down to whether we as a society and as a health care institution believe in the educational benefits of diversity – that it enriches the quality of education for everyone (students and faculty) because individuals with unique personal differences and life experiences contribute to and are part of the learning community. The outcome is a cadre of health care workers who are more open and wiser about the diversity of patients that they are trained to care for. Our job is to accept, promote and embrace diversity so that we as a society may reap the benefits in the future.

1. Chronicle of Higher Education. Retain Affirmative Action—Because It’s the Morally Right Thing to Do. Oct. 8, 2012.

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

3. Chronicle of Higher Education. Affirmative Action and ‘Victimized’ Whites. Oct. 12, 2012.

4. Gottfredson NC, Painter AT, Daye CE, Wightman LF, Allen WA, and Deo ME. Does Diversity at Undergraduate Institutions Influence Student Outcomes? Journal of Diversity in Higher Education. 2008, vol. 1, No. 2, 80-94..

5. Cooper LA, Roter DL. Patient-Provider Communication: The Effect of Race and Ethnicity on Processes and Outcomes of Healthcare. In Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Institute of Medicine: Washington, D.C., National Academies Press, 2002.

6. In the Nation’s Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Smedley B, Butler A, and Bristow L, eds. Institute of Medicine: Washington, D.C., National Academies Press, 2004.