HMI: Dr. Rose, please tell us why you selected the topic of Health Disparities, Diversity, and Inclusion for your new book?
Dr. Rose: As a young graduate student at Yale University pursuing a master of public health degree in the mid-1980s, I stumbled upon a topic that I was unfamiliar with— namely, health disparities in terms of race and ethnicity. I was taking a number of core courses, and within most there was mention of a gap between the health statuses of Black and White people in the United States. I reflected upon this issue and decided it would be a key area of interest for me, and indeed it has been to this day.
I took pride in the fact that I was studying in a field, public health, in which I could make a real difference. I would be able to help close the health status gap. Not only did I take courses that emphasized health disparities, but I also attended “Closing the Gap” conferences, read books about it, and fiercely debated with classmates and ultimately colleagues about the causes. Some argued that the primary reason for the gap was genetics, which I disagreed with, because I understood clearly that the illnesses that Black people were suffering from in the United States were not the same as those of Black people in Africa, for the most part. There were some genetic commonalities, such as disposition to sickle cell disease, but that served as a clear indicator that Black people in America were descendants of people in West Africa, primarily as a result of the slave trade.
Ultimately, after working in the field of public health for a couple of years, I decided to return to my studies to pursue a doctorate in community health education at Teachers College, Columbia University. I continued taking courses learning more about the proverbial gap and its impact on other emerging majorities, beyond Black people; further, I studied the importance of racial and ethnic diversity in the workforce, in terms of health, as it was touted as one of the many potential solutions to the problem. Many years later, in my role as an academic, I taught about health disparities and diversity, noting that the problems were the same as when I was a young student and that not only was the matter unresolved, in many ways it was worse. Hence, the key aspects of this book are the discussion of health disparities, with an emphasis on solutions, and the ongoing need for diversity in the field of health.
HMI: Will you tell us a little about the book, the structure and topics of the chapters?
Dr. Rose: The book begins with the Preface and Introduction (Chapter 1) followed by chapters which cover various topics. Chapter 2 is an exploration of the notion of health disparities - what does the term health disparity really mean? This chapter also includes a historical overview of health disparities. Chapter 3 is a candid exploration of the extent of the healthcare gap and the challenges in closing it. Initially, it was literally a black-and-white issue; that is, the health status of Black people was compared to that of White people. Chapter 4 attempts to define diversity, with the key questions being, what is diversity, and who defines it? Various definitions are explored to help us understand the concept.
Chapter 5 assesses health disparities by the numbers, briefly overviews the Patient Protection and Affordable Care Act (commonly referred to as Obamacare), and considers health care in other nations. Chapter 6 provides insight into the importance of making diversity happen and sustaining it and provides examples of “models that work.” Chapter 7 focuses on health disparities in urban communities. It compares the plight of the urban environment to that of the rural environment, as discussed in Chapter 8. Understanding the variables unique to each setting is useful in forming solutions toward closing the gap. Chapter 8 explores rural communities and unique issues associated with them that contribute to health disparities. The rural community warrants specific exploration because the dynamics of the healthcare gap change in this setting; these communities are composed primarily of White people living at a low socioeconomic level. Through the lens of these communities, further insight is provided as to why socioeconomic status is a key factor in understanding health disparities. Chapter 9 revisits topics explored in two books previously written by me entitled, Cultural Competency for Health Administration and Public Health and Cultural Competency for the Health Professional, both published by Jones and Bartlett Learning. This chapter consists of a comparative analysis of cultural competency versus diversity and offers a cogent explanation of why the two concepts are different and why both are necessary. Here, the emphasis is on the importance of cultural competency.
Women are generally the caretakers in families. They bear the children, participate in the workforce, and experience significant health disparities, largely due to race, ethnicity, and socioeconomic status. Chapter 10 explores key issues related to women and offers solutions to the health disparities they encounter. Chapter 11 considers the effects of health disparities on a unique population—children. Although children are discussed throughout the text, this chapter takes a serious look at their specific issues, as they are the future of the nation and perhaps will be the beneficiaries of any successes toward closing the gap.
Health disparities present such a grave problem that when seeking a resolution, we must look beyond typical approaches. Hence, Chapter 12 offers a spiritual approach toward resolution. It is not about religion as we typically use the word, but is more a journey into self-actualization. Chapter 13 looks into the future of healthcare, with a focus on health disparities. It offers voices, beyond this author’s, in the form of interviews; reviews recommendations from a working group, with commentary by this author; and summarizes the elements of a diversity plan. This final chapter, with regard to the pertinent issues of the entire text, considers the question, where do we go from here? Chapters 14 and 15 include case studies pertaining to racial and ethnic health disparities and diversity, respectively. These case studies offer a look at specific scenarios, which can be explored and discussed to understand the impact of the problem on individuals and systems. Commentary is provided for each case.
HMI: How did you select your contributing authors for the book?
Dr. Rose: Generally, my selection of a contributing author is based on their expertise and knowledge relevant to the topic that I ask them to write about. I always know the person and have insight into their work; some were my students, who are now professionals in the field, and others are individuals who I have worked with either on a short-term or long-term basis. I also look for commitment and heart. In terms of the latter, I do not select “arm-chair” writers/academics but people who truly understand the issues of health disparities and diversity, based on experiential knowledge.
HMI: Dr. Daniel, you are one of the collaborating authors and an HMI alum. Tell us about your chapter.
Dr. Daniel: My chapter reviews how to achieve diversity in healthcare education and how to maintain it. I have seen programs attempt to increase diversity, but as time passed and leadership changed, diversity somehow was not a priority and the institutions became less diverse overtime.
HMI: Dr. Rose and Dr. Daniel, what kind of impact are you hoping this book will make on healthcare?
Dr. Rose: My hope is that this book will serve to move individuals, communities, students and professionals in the healthcare field to delve deeper into the issue of health disparities, diversity and inclusion towards solution, indicated in this book and beyond. This book is not only informative but a call to action.
Dr. Daniel: It is my hope that healthcare education programs (whether medical, veterinary medicine, nursing, pharmacy, dentistry, etc.) would use the models that are in my chapter and the book to guide how they design and sustain diversity in their programs. We reflected on how this is done at a health science center with multiple programs and how this was achieved at the university across many different disciplines. I believe the key to achieving diversity (whether for faculty, students or staff) is strategic planning and awareness that it is not in your institution and planning to ensure that it happens. Strategic planning and assessing from a systematic approach was an intricate component of the assessment course I had at HMI. The systems thinking approach applies in many areas of long term planning and sustainability.
HMI: How do you see this book being used in healthcare education, Dr. Rose?
Dr. Rose: This book can be used as a tool or resource for professors, students and health professionals in the healthcare field and beyond. In addition to serving as a textbook, it is a book for anyone who has interest in health disparities, diversity and inclusion, and the myriad social injustices discussed, to become informed and motivated towards actions/solutions.