Penn Nursing Promotes Debunked ‘Racial Concordance’ Theory to Justify ‘Diversity’ Hiring

Last month, University of Pennsylvania School of Nursing (Penn Nursing) posted an announcement to its site advertising the findings of a new study set to be published in Nursing Research.

The study, “Racial Concordance of Black Nurses and Patients Across Hospitals,” was conducted by the Penn Nursing Center for Health Outcomes and Policy Research (CHOPR) and led by Penn Nursing professor and CHOPR Associate Director Eileen T. Lake.

As its name suggests, the study examines the dynamic of racial concordance – in which patients are treated by providers of the race – in the nursing context, and lays out a case for increasing “diversity,” with the implication of doing so by hiring more black nurses.

The study finds that the proportion of black nurses “was notably lower” than the proportion of black patients, characterizing this disparity as a potential danger to patient health.

“Our findings highlight a critical gap in structural competency within healthcare institutions,” said Lake in Penn Nursing’s announcement. “Despite Black patients often receiving care in hospitals with more Black nurses, the existing nursing workforce lacks sufficient diversity, especially in settings where racial concordance could be most beneficial.”

“The study emphasizes the urgent need for healthcare institutions and policymakers to prioritize diversifying the nursing workforce to better reflect patient demographics, which is crucial for addressing health inequities,” the announcement reads.

Yet the study’s premise is hopelessly flawed.

The notion that racial concordance improves health outcomes is utterly without merit.

Although the study cites several articles supporting the premise that it’s beneficial for patients to be treated by providers of the same race, the weight of the evidence suggests that racial concordance has virtually no effect on patient health outcomes.

Do No Harm’s December 2023 report on this issue examined the literature on racial concordance and highlighted the fact that four out of five systematic reviews found no evidence to support the claim that racial concordance produces positive health outcomes.

Another recent review published in the Substance Use & Addiction Journal found inadequate evidence to support the notion that racial concordance improves health outcomes for black patients in addiction treatment.

The review examined 11 articles published between 1971 and 2016 that explored the effects of racial concordance on black patients in addiction treatment.

The Penn Nursing study, meanwhile, relies on older individual studies rather than engaging meaningfully with the weight of this evidence.

Moreover, the study relies on the concept of “structural competency” to backdoor in its endorsement of this racially concordant approach, arguing that racially concordant care is part of healthcare institutions’ “structural competency.”

“Structural competency—defined as the trained ability to recognize and address the effects

of social, political, and economic structures on health—is crucial for health care institutions,” the study states.

“One effective way to demonstrate this competency is by cultivating a structurally fluent workforce that understands how external factors and social determinants contribute to health inequities,” the study continues.

Here, the study again employs a false premise: that of the validity of so-called “social determinants of health,” or social and environmental factors that can be construed as “determining” health outcomes.

Commonly-cited examples of social determinants of health, or SDOH, include income, employment, educational quality, housing quality, transportation, and so on.

However, the theory that SDOH “cause” significant variance in health outcomes lacks evidentiary support.

As Manhattan Institute Senior Fellow Chris Pope lays out, “SDOH literature is dominated by sloppily designed observational studies that do not seriously attempt to disentangle causation from correlation or to control for obvious sources of bias.”

In other words, the evidence doesn’t support that social determinants of health “determine” outcomes at all.

Moreover, implicit in the study’s premise is the claim that white nurses can’t provide the same level of care to black patients as black nurses. Not only is this claim utterly without evidence, as demonstrated above, but it is a shameful smear of hardworking healthcare professionals who have dedicated themselves to caring for all patients, no matter their race. These claims are divisive and degrade trust in the healthcare workforce.

In sum, the Penn Nursing study employs these concepts to argue for the diversification of the nursing workforce.

It’s hard to imagine how this could be achieved absent policies that distract from the mission of healthcare and favor “diversity” at the very best, and are discriminatory at worst.

It goes without saying that Penn Nursing should not promote debunked and unsupported theories. And it certainly shouldn’t do so to lobby for unethical hiring practices.