and economic prosperity in the United States converged, and the nation seemed poised to commit itself to overcoming the barriers to full participation by minorities in the health professions.

The promise, however, was not fulfilled. Progress in matriculating minorities came to a virtual halt in the mid-1970s, particularly in medicine, which had been at the forefront of earlier efforts to educate minority students.

No one can point to the sole reason for the persistent underrepresentation and stalled progress that began in the late 1970s. Some of the loss of momentum has been attributed to a slower economy, rising deficits, a diminished domestic agenda, and declining interest in providing educational support in the form of scholarships to minority students—in part a response to a broadly publicized study produced in the 1980s, which predicted an oversupply of health care professionals by the year 2000.

Minority students also report an insidious set of less tangible barriers—both academic and social—that stood in the way of educational advancement and the pursuit of a health professions career: denial of access to quality education; teachers who expect too little of students; anti-intellectual peer pressure; and a cultural gap between the world of study and that of their families and neighborhoods. Even significant efforts by government agencies, leading foundations, and a number of committed institutions were not successful in building the institutional and academic infrastructure necessary to eliminate the gap between vision and reality. Past efforts have yielded only marginal gains, occasional snapshots of steps forward that have not developed into a lasting picture of significant and sustained progress.

Today the issue of revitalizing the agenda for broadening the landscape of minority participation in health careers has a new urgency and relevance that go beyond past calls for social equality and justice. Compelling demographic trends alone speak to the value and wisdom of broadening educational opportunities for minorities to pursue careers in medicine as well as other professional callings that contribute so much to a nation's strength and productivity. Minorities are increasing faster than the rest of the population. By the year 2020, 40 percent of America's youth will be members of minority groups. Policymakers have expressed concern about future productivity across most U.S. industries, including health, unless we can adopt policies that support the development of human resources within our increasingly diverse ethnic populations.

Mounting social and political pressures in support of major reform of the nation's health care system add yet another dimension of timeliness and urgency to the issue of enhanced minority representation in clinical practice and teaching. Some of the most serious deficiencies in our current health care enterprise are reflected in the growing disparity in health status between minority and majority populations. While a host of factors—socioeconomic, genetic, cultural, and institutional—determine an individual's health status and use of health care services, a starting point to improving minority access may be to increase the



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