Chapter 2: Why Diversity Matters
Educators, researchers, policymakers, and the courts have all
explored the role of diversity in education and the health
professions. While approaching the subject from different angles,
they have identified two principal reasons for increasing diversity
in our health professions schools:
- Diversity provides a better educational experience for all
- Diversity leads to improved access to care.
Similar conclusions have been reached in two highly respected
reports on minorities and health care, three Supreme Court
decisions, and a variety of scholarly publications. These
authoritative sources all agree that diversity matters, and offer
compelling reasons why educational institutions should pursue it.
In 2010, the Commission on Dental Accreditation (CODA) joined this
chorus when its revised
Predoctoral Accreditation Standards recognized diversity as an
essential component of academic excellence.
Better Educational Experience for All
While many might assert that diversity is valuable in its own
right, the key question for health professions schools is whether
and how diversity might affect their primary mission-to educate
students to become competent health care providers.
In 1978, the U.S. Supreme Court issued a landmark decision in
the case Regents of the University of California v.
Bakke. The court's ruling that, "the State has a
substantial interest that legitimately may be served by a properly
devised admissions program involving the competitive consideration
of race and ethnic origin" prompted researchers to study the
educational impact of diversity.
After surveying thousands of students and tracking their early
career choices, researchers found that:
- "Because of the racial separation that persists in this
country, most students have lived in segregated communities before
coming to college."
- "Colleges that diversify their student bodies and institute
policies that foster genuine interaction across race and ethnicity
provide the first opportunity for many students to learn from peers
with different cultures, values, and experiences."
- "Students with frequent interaction with diverse peers while in
college demonstrated greater intellectual engagement and active
thinking four and nine years after college entry."
- "They also showed a greater capacity to engage in a diverse
workplace after college."
Dr. Sylvia Hurtado, Professor and Director of the Higher
Education Research Institute at the University of California, Los
Angeles, and her former colleagues at the University of Michigan
have concluded that: "One of the key implications of this empirical
research is that diversity is an asset to learning and important
for development of the new thinking skills that are needed in the
Research by Dr. Hurtado and others is premised on the assertions
of psychologist Erik Erikson, educator Jean Piaget, and others who
believe that when students' perspectives are challenged, this spurs
their intellectual growth. Opportunities to see the world in a new
light are more likely to occur when the composition of the student
body is diverse, as suggested by a white student in his evaluation
of a course on intergroup relations at the University of
I come from a town in Michigan where everyone was white,
middle-class and generally pretty closed-down to the rest of the
world, although we didn't think so. It never touched us, so I never
questioned the fact that we were "normal" and everyone else was
"different." Listening to other students in the class, especially
the African American students from Detroit and other urban areas
just blew me away. We only live a few hours away and yet we live in
completely separate worlds. Even more shocking was the fact that
they knew about "my world" and I knew nothing about theirs. Nor did
I think that this was even a problem at first. I realize now that
many people like me can go through life and not have to see another
point of view, that somehow we are protected from it. The beginning
for me was when I realized that not everyone shares the same views
as I, and that our different experiences have a lot to do with
—From Diversity and Higher Education: Theory and Impact on
The Difference: An Empirical Analysis of
In the introduction to his book The Difference: How the
Power of Diversity Creates Better Groups, Firms, Schools, and
Societies, theorist Scott E. Page asserts that diversity
trumps ability when it comes to problem solving. He takes pains to
make clear that he does not mean that ability does not matter, only
that diversity matters, too. He acknowledges that certain
conditions must be met for differences between people to produce
benefits. For starters, he says diversity must be relevant to the
problem at hand, and the people in a diverse group must be able to
get along. Given these conditions, he believes that a group of
diverse problem solvers will outperform groups of high-ability
problem solvers, and he has created a mathematical model to
demonstrate this premise.
Page's work implies that a student body composed of diverse
individuals who possess complementary skills, abilities, and
perspectives will enhance learning for the entire class. His work
also suggests that benefits might accrue to society at large when a
more diverse cohort of students enters the workforce. Page closes
the introduction to The Difference with these words: "In
difference lies the potential to contribute."
Improved Access to Care
As an influential report pointed out in 2004, "The lack of
minority health professionals is compounding the nation's
persistent racial and ethnic health disparities. From cancer, heart
disease, and HIV/AIDS to diabetes and mental health, African
Americans, Hispanic Americans, and American Indians tend to receive
less and lower quality health care than whites, resulting in higher
mortality rates. The consequences of health disparities are grave
and will only be remedied through sustained efforts and a national
ADEA's long-held position has been that, without minority
practitioners, access to care will be limited or absent in minority
communities throughout the nation. Dental practice data from both
the American Dental Association (ADA) and ADEA support this
Getting the conversation started
Look at the slides below. These slides
illustrate the practice characteristics of U.S. dentists as
reported in a 1996 ADA survey. Note that only 8% of practicing
dentists come from underrepresented minority groups. The second
slide reveals that white, black, and Hispanic dentists are more
likely than other dentists to treat patients of their own race.
This fact supports the notion that minorities will not achieve full
access to care unless they are proportionately represented in the
health care work force.
According to the a 2002 Institute of Medicine Report,Unequal
Treatment: Confronting Racial and Ethnic Disparities in Health
Care, patients are drawn to health professionals of the same
race or ethnicity because they believe these providers will be
better able to relate to their concerns.
Ask: Should the responsibility of providing
care to URM populations reside solely with URM practitioners? How
can our institution's diversity policies engage all students in
extending access to care to the underserved?
Look at the box below. Annual surveys of practicing dentists and
dental school seniors affirm that individuals educated in diverse
settings are far more likely to work and live in racially and
ethnically diverse environments after graduation.
ADEA Annual Survey of Dental School Seniors
Table 27. Percentage of their future patients seniors expect to
be from underserved race/ethnic populations, by percentage of total
Note: Percentages may not total 100% because of
Sources of additional evidence that diversity
promotes improved access to care include:
This report warns that minorities face "unequal treatment" when
encountering the health care system. Using data from the U.S.
Department of Health and Human Services, the report states that
"racial and ethnic minority providers are more likely to serve in
minority and medically underserved communities."
The report recommends increasing "the proportions of
underrepresented U.S. racial and ethnic minorities among health
professionals" and says that "to the extent legally permissible,
affirmative action and other efforts are needed" to reach this
The report calls for increasing diversity in America's health
professions education and training programs with a goal of
increasing the numbers of health professionals from
underrepresented and underserved communities. The report outlines
three principles that it deems essential to fulfilling this
- To increase diversity in the health professions, the culture of
health professions schools must change.
- New and nontraditional paths to the health professions should
- Commitments [to diversity initiatives] must be at the highest
The report notes the urgent need to bring more URM students into
the health professions. "While African Americans, Hispanic
Americans, and American Indians, as a group, constitute nearly 25
percent of the U.S. population, these three groups account for less
than 9 percent of nurses, 6 percent of physicians, and only 5
percent of dentists." The report recommends:
4.9 Dental and medical schools should reduce their dependence
upon standardized tests in the admissions process. The Dental
Admissions Test and the Medical College Admissions Test should be
used, along with other criteria in the admissions process, as
diagnostic tools to identify areas where qualified health
professions applicants may need academic enrichment and
4.10 Diversity should be a core value in the health
5.2 To reduce the debt burden of underrepresented minority
students, public and private funding organizations for health
professions students should provide scholarships, loan forgiveness
programs, and tuition reimbursement strategies to students and
institutions in preference to loans.
6.4 Accrediting bodies for programs in medicine and the other
health professions should embrace diversity and cultural competency
as requirements for accreditation.
Supreme Court Decisions
Beginning with the historic Regents of the University of
California v. Bakke case in 1978, a series of Supreme Court
decisions have recognized the educational benefits of diversity as
a "compelling interest." While prescribing some restrictions on how
and when institutions of higher learning can apply race, gender,
and other factors in admissions, these decisions make clear that
admissions practices that are narrowly tailored to achieve the
educational benefits of diversity may be used to create a diverse
Chapter 5 for a fuller discussion of the legal issues related
to increasing diversity in educational institutions.
CODA Predoctoral Accreditation Standards
In 2010, the Commission on Dental Accreditation (CODA) approved
new Accreditation Standards for Predoctoral Dental Education
Programs. These state:
1-4. The dental school must have policies and
- achieve appropriate levels of diversity among its students,
faculty and staff;
- engage in ongoing systematic and focused efforts to attract and
retain students, faculty and staff from diverse backgrounds;
- systematically evaluate comprehensive strategies to improve the
institutional climate for diversity.
The new standards recognize diversity as an essential component
of academic excellence. They call on dental schools to educate
dentists with the interpersonal and communication skills needed to
manage a diverse patient population. They further assert that the
diversity of the student body, faculty and staff, and curriculum is
essential to creating a learning environment that improves patient
outcomes for people from all backgrounds.
The standards present diversity as having three dimensions in
the academic context. These are defined as follows:
- Structural: Structural diversity, also
referred to as compositional diversity, focuses on the numerical
distribution of students, faculty and staff from diverse
backgrounds in a program or institution.
- Curriculum: Curriculum diversity, also
referred to as classroom diversity, covers both the
diversity-related curricular content that promote shared learning
and the integration of skills, insights, and experiences of diverse
groups in all academic settings, including distance learning.
- Institutional Climate: Institutional climate,
also referred to as interactional diversity, focuses on the general
environment created in programs and institutions that support
diversity as a core value and provide opportunities for informal
learning among diverse peers. While this guide directly addresses
one aspect of diversity in higher education, the structural
diversity of the student body, the new standards make clear that
institutions will be expected to look at diversity broadly and
adopt appropriate policies and practices that impact other