Why, exactly, is DEI so harmful to healthcare?
In practice, of course, DEI often manifests as racially discriminatory hiring, admissions, and recruiting policies; it is definitionally anti-merit and degrades the quality of health services; it treats people as members of specific identity groups rather than as individuals and organizes clinical care accordingly; and it views healthcare institutions as vehicles for social and political change, usually at the expense of clinical excellence.
But beyond these more obvious answers is a deeper issue: its premises simply aren’t true.
The premise of “equity” initiatives, for example, is that racism is embedded into the structural fabric of society and is the primary driver of unequal health outcomes between racial groups.
But the extent to which is a far cry from settled fact. As Do No Harm’s Chief Medical Officer Dr. Kurt Miceli points out, much of the literature on “structural racism” infers causality when there is, at best, only correlation. Tools that purport to measure “racism” instead often track to socioeconomic conditions, confounding attempts to determine causality.
Indeed, much of the research fails to address these confounding factors, proceeding as if the causal effect of racism, whatever that may mean, is obvious.
Is it any wonder, then, that the solutions that stem from this false premise are harmful?
Take a recent course on “health equity” provided to nursing students at Indiana University South Bend that illustrates a more benign example of how healthcare professionals can be inculcated into counterproductive programming.
“Health care inequities are a measurable, systemic, avoidable and unjust difference in health care access, utilization, quality and outcomes between groups, stemming from differences in levels of social advantage and disadvantage,” the course states.
To ameliorate these inequities, the course recommends that healthcare professionals employ skills surrounding “cultural humility,” such as constant monitoring of ones’ own biases.
“Addressing biases is an ongoing process,” the course states. “Recognizing and addressing our biases, while creating an environment where all are comfortable discussing these biases openly, is essential for fostering cultural humility.”
Of course, there is little evidence demonstrating that individual biases actually impact health outcomes. Attempts to measure these “implicit” or unconscious biases fail to predict real-world behavior or even measure “unconscious racism.”
Thus, constant vigilance of one’s own biases is built on an assumption that hasn’t been validated and functions as an ideological directive, not an evidence-based strategy for improving patient care.
Additionally, the course suggests that health equity is downstream of political and structural factors that alter the social and economic conditions of individuals’ lives.
“Understanding the social determinants of health, is an important component of developing cultural humility as is developing trusting partnerships with those we serve,” the course states. “By engaging in these practices, we can create a foundation for health equity and ensure better health outcomes for diverse communities.”
This gestures at another dubious (at best) theory that has become increasingly popular in medicine: the idea of “social determinants of health” (SDOH).
Again, the premise of SDOH is that differences in socioeconomic factors cause disparities in health outcomes between population groups.
Yet, although these factors may well be correlated with disparities in health outcomes, the causal inference is not supported by the weight of the evidence. As researchers have shown, much of the literature on SDOH fails to properly disentangle correlation from causation and infers that social factors “determine” health simply because they correlate with poor health outcomes.
This ignores alternative explanations such as individual decisions which lead to poor health outcomes, and which in turn may lead to the socioeconomic conditions that correlate with those outcomes.
In short, unsubstantiated theories that attempt to explain individuals’ health with vague gestures to societal phenomena do a disservice to medicine by treating healthcare professionals not as healers first and foremost, but as cogs in a large political project.
The focus of healthcare education should be to train future providers to administer the best possible care, above all else.
