The evidence is clear: Patients of color fare better when they have a medical provider who looks like them. But even as significant racial health disparities persist, the U.S. healthcare system remains stubbornly undiversified. In 2022, for example, the Association of American Medical Colleges found that just 5.7% of doctors were Black and 6.9% were Hispanic — while nearly 14% of the population is Black and 20% is Hispanic. Last year, The Lancet concluded that without systemic change, “equitable representation of American Indians and Alaska Natives in the physician workforce will take 100 years.” It’s an imbalance that physician Jabraan Pasha has called “a public health crisis.”
Now, a conservative backlash against diversity, equity and inclusion (DEI) threatens to undermine efforts to address the longstanding lack of diversity in the ranks of medical professionals. Last year’s Supreme Court ruling against affirmative action in college admissions has provoked concerns about legal compliance at academic institutions, including medical schools. At the federal level, Republican Rep. Greg Murphy, a physician, introduced a bill that goes beyond admissions to ban any “race-based mandates at medical schools and accrediting institutions.” Around the country, anti-DEI legislation has helped make healthcare the “new battlefront for anti-DEI attacks,” according to a recent public health journal article.
But the backlash against DEI isn’t stopping the Robert Wood Johnson Foundation, the nation’s largest health funder. In fact, RWJF is doubling down on its commitment to diversity in healthcare. To date, RWJF has spent an average of $10 million a year on efforts to diversify the healthcare professions, and it just announced that it is increasing its investments by 60% over the next three years.
In its enhanced commitment, RWJF will make investments in academic institutions working to diversify the health professions, including medical schools at historically Black colleges and universities (HBCUs) and schools with large numbers of Latino and Native American students. It will also provide support for leaders “who are dismantling racism in academic admissions and health professional training,” according to the announcement.
“The push to diversify the healthcare professions has been a long-standing commitment of the Robert Johnson Foundation, and it’s been related to building a culture of health,” said pediatrician Lauren Smith, RWJF’s vice president of strategic portfolios. “More recently, the foundation has been even more explicit that health shouldn’t be a privilege for some, but a right for all… Diversity, equity, inclusion — all of those characteristics — of a healthcare workforce are essential to helping us get to our overall goals.”
A bogeyman for the right
DEI has become a bogeyman for conservatives in recent years; they argue that DEI “is reshaping the nation by leveraging education, cultural influence and claims of moral superiority,” as columnist Theodore R. Johnson put it recently in the Washington Post. “DEI is their catchall for everything that feels unfair or uncomfortable for white Americans. It’s also used as a pejorative for Black officials deemed unqualified or a quota choice.”
Amid the backlash, Black leaders such as Vice President Kamala Harris and Supreme Court Justice Katanji Brown Jackson have been demeaned as DEI hires. DEI policies were even blamed, falsely, for the collapse of Baltimore’s Francis Scott Key Bridge earlier this year.
The anti-DEI hysteria might be laughable if it weren’t already having an impact, including on the U.S. healthcare system and its future. Attacks on DEI in medical training and care “[portend] potentially devastating consequences for existing efforts to diversify the healthcare workforce in service of an increasingly diverse nation and on existing racialized health inequities in the U.S,” argued physician Oni J. Blackstock and others recently.
The consequences are already evident in states with strict anti-DEI restrictions, according to a report by the Center for Public Integrity, which found that gender nonconforming patients are also facing barriers. As Jeremy Young, the director of PEN America’s Freedom to Learn program, told the center, “Some laws specifically ban teaching students about racial disparities in healthcare, or cultural competencies that medical professionals need to learn.”
It’s not just medical schools that are affected. As the Washington Post documented recently: “A growing number of U.S. institutes created to explore the nexus between racism and health — and the researchers who preside over them — are finding themselves under attack, their missions and funding in peril barely four years after the nation had what many called its ‘racial reckoning.”
In one example, Emory University Professor Chandra L. Ford, the founding director of UCLA’s Center for the Study of Racism, Social Justice & Health, told the Post that a funder who gave money to study racism asked her not to use the word “racism” because of potential blowback. “It’s very taxing,” Ford said. “This anti-DEI movement creates a climate of fear.”
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The “curb-cut” effect
Those who oppose DEI measures not only create fear in their targets, they ignite and fan the fears of those they claim to represent. Their premise is that promoting diversity, equity and inclusion hurts those in the white majority and undermines equality by promoting different standards for different groups.
But these arguments assume that healthcare is a zero-sum game. RWJF’s Lauren Smith insists that, in fact, the reverse is true, and that improving healthcare for any one group improves the health system for everyone. To date, American healthcare systems have struggled to provide equal care to all in the absence of a diverse medical staff, while physicians of color have had a proven positive impact on the quality of care provided to patients of color. “It’s so important that our organizations, our healthcare institutions, are truly working for everyone,” Smith said.
She cited what author Angela Glover Blackwell has called “the curb-cut effect”: the idea that policies designed to benefit vulnerable groups often improve systems for everyone. “Curb cuts in sidewalks were started for individuals with mobility challenges, but they also benefit families pushing strollers or people pulling luggage,” Smith said. “The idea is that creating solutions that are meant to address equity end up having benefits for all folks.”
Smith pointed to one example in a recent blog post: “Studies show that strategies designed to address racial disparities in maternal health and mortality — such as providing doula care to expectant mothers and blood pressure cuffs to birthing people as they are discharged from the hospital — both reduce disparities for Black and brown birthing people and improve health for birthing people of all races.”
RWJF is currently in the process of determining which institutions and leaders it will support under its increased commitment. “A good part of the upcoming investment is going to go toward academic institutions that have already demonstrated or made significant contributions to diversifying health professions,” Smith said.
The leadership component of the increased commitment is under development, too. “We are going to be taking in insights and feedback from alumni and mentors and other folks who have participated in other leadership programs,” Smith said. “We want to start with the leaders who have identified that [creating a more diverse health profession] is something they want to engage in.”
Smith pointed to some of the foundation’s ongoing work to promote diversity in the health professions. Since 2023, for example, RWJF has provided support for the Indigenous Health Education and Resources Task Force, a national collaborative working to increase the number of Native Americans and Alaska Natives in the health professions. And the foundation’s Leadership for Better Health program is currently conducting a series of webinars on diversity in the health professions.
Pushing back on the culture wars
RWJF isn’t the only funder in this lane. Another philanthropic behemoth, Bloomberg Philanthropies, is also working to create a more diverse healthcare system. In 2020, for example, Bloomberg invested $100 million in the nation’s four historically Black medical schools through its Greenwood Initiative. This past August, Bloomberg announced a $600 million gift to boost the four schools’ endowments and financial sustainability. And several other funders are working to increase diversity in medical trials, cancer research and neuroscience.
It is significant that philanthropies like Bloomberg and RWJF are continuing — and even increasing — their support for diversity in the health professions, despite the anti-DEI clamor that aims to shut down such efforts. Philanthropy doesn’t always present a profile in courage, and many funders work hard to sidestep culture war battles, even when there are worthy causes to defend. As a major funder with a big footprint, RWJF can set an example that will hopefully inspire others to do the same.
“The forces that are opposed to progress in this area have weaponized and demonized [DEI] in ways that are deeply problematic and really illogical,” said RWJF’s Lauren Smith. “We know what the evidence shows, and we intend to be steadfast with the folks who are doing this work. This is a time when an organization like the Robert Wood Johnson Foundation has not just the opportunity but the obligation to step up with our words, our actions and our funding.”
