example, comprise over 12 percent of the U.S population, but only 2 percent of the registered nurse population, 3.4 percent of psychologists, and 3.5 percent of physicians. Similarly, one in eight individuals in the United States is African American, yet less than one in twenty dentists or physicians is African American.

These stark figures, in part, have prompted many major health professions organizations and health professions educational institutions (HPEIs) to develop initiatives to increase the proportion of underrepresented minorities (URM)2 in health professions fields. These efforts, however, have met with limited success. To a great extent, efforts to diversify health professions fields have been hampered by gross inequalities in educational opportunity for students of minority racial and ethnic groups. Primary and secondary education for URM students is, on average, far below the quality of education for non-URM students. Proportionately fewer URM students enter higher education than their white or Asian American peers, and an even smaller percentage of these go on to graduate (post-baccalaureate) study. The “supply” of URM students who are well-prepared for higher education and advanced study in health professions fields has therefore suffered.

Equally important, however, are efforts to reduce policy-level barriers to URM participation in health professions training, and to increase the institutional “demand” for URM students. For example, several events—including public referenda (i.e., Proposition 209 in California and Initiative 200 in Washington state), judicial decisions (e.g., the Fifth District Court of Appeals finding in Hopwood v. Texas), and lawsuits challenging affirmative action policies in 1995, 1996, and 1997—forced many higher education institutions to abandon the use of race and ethnicity as factors in admissions decisions (in some cases temporarily, in light of the June 2003 Supreme Court decision in Grutter v. Bollinger, in which white plaintiffs sued—unsuccessfully—in an effort to halt the University of Michigan’s admissions policies that consider applicants’ race and ethnicity as one of


providers are less capable than minorities of providing high-quality care to these populations. Rather—as will be discussed later in this chapter and throughout the report—greater racial and ethnic diversity in health professions may offer broad benefits to help improve healthcare access for minorities and improve the cultural competency of all health-care providers and the health systems in which they work.


URMs are defined as those racial and ethnic populations that are underrepresented in the heath professions relative to their numbers in the general population. This definition allows individual institutions to define which populations are underrepresented in its area of interest. See the subsection on “Which Racial and Ethnic Groups Are Examined?” later in this chapter for a fuller explanation of this definition.

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