Majoring of the “Minority” – Increasing Minority Representation in Healthcare in California

Have you ever heard the saying, “Don’t major in the minor”? Although this expression is good advice for someone to have a “big picture” perspective rather than focusing on smaller, albeit insignificant, minor details, there is an exception. There exist health inequities and inequalities in California’s Hispanic population stemming from the non-representation or inadequate representation of the group in the healthcare workforce. These disparities are attributed to multiple factors, including non-representation or the underrepresentation of the Hispanic population at different levels of healthcare. The Encyclopedia of Critical Psychology defines a minority population as a subgroup of a larger population with unique racial, ethnic, religious, social, and/or other attributes that differ from those of a majority group within the population.¹ Sadly, a large body of evidence shows prejudice, discrimination, and stereotyping of minority populations in the US,¹ resulting in health outcomes that impact not only those minority populations, but also the entire population at large.

In the US, the Office of Management and Budget (OMB) identifies five minority populations, including the Hispanic/Latino American population.² The ideal representation of any subgroup within a larger population, at all healthcare planning and delivery levels, should be by individuals who identify with, have tangible experiences, and fully understand the culture and experiences of the subgroup. In California, the Hispanic population is grossly underrepresented at all levels of healthcare. Additionally, the Hispanic/Latino population is often erroneously viewed as one group when, in fact, they are highly heterogeneous with different experiences, cultures, beliefs, and practices that result in highly varied health outcomes.³ Unfortunately, this heterogeneity within the group is often ignored, misunderstood, or trivialized,³ resulting in a monolithic healthcare planning and delivery to the group. The consequences of non-representation or inadequate representation of minority groups in healthcare are numerous and negative. These consequences include communication/language problems, limited healthcare planning and delivery perspectives, bias, increased health disparities and poor patient outcomes.⁴

These negative health consequences are incredibly significant in California due in part to the high diversity of the population. According to the US Census Bureau, the state of California has a slightly higher chance (69.7%) that two randomly chosen individuals are from different races and ethnic groups compared to the nation at large (61.1%).^5,6 This phenomenon is referred to as the diversity index (DI). California’s DI is second only to Hawaii (76.0%). This high DI is attributable, in part, to the large proportion of the Hispanic population in California. Ironically, although the Hispanic population is the largest in California, they have the lowest representation in the healthcare industry. For example, whereas 39% of California’s population is Hispanic, only 6% of active patient care physicians in California identify as being of Hispanic heritage. This underrepresentation of the Hispanic population mirrors the national trend evident by only 5% of pharmacists in the country identifying as of Hispanic descent compared to the 18% of the US population being Hispanic.⁷

There is a strong relationship between race/ethnicity, social determinants of health, and adverse health outcomes.⁸ Hispanic Californians are reported to be more likely to experience poverty, be uninsured, live without a usual source of healthcare and experience hardship in accessing specialist care.⁹ These factors directly or indirectly contribute to non-enviable health outcomes/statistics amongst Hispanics in California such as: increased prevalence of overweight/obesity,¹⁰ high rates of emergency services use for preventable conditions due to a lack of primary care services,¹¹ significant cancer morbidity and mortality rates and a high prevalence of cardiovascular illnesses and deaths.⁹

A low or non-representation of the Hispanic population in the California healthcare workforce ranging from policy makers to providers results in a worsening of health outcomes for the members of this community.¹² To improve the current situation with Hispanic health, more policies prioritizing the health needs of the Hispanic population must be formulated and signed into laws. Another step to be considered is increasing the overall diversity in education.^12,13 More funding needs to be made available for minority population recruitment into healthcare programs. Additionally, the advantages and evidence-based research outcomes on the importance and benefits of diversity in healthcare should be publicized to increase public buy-in for increasing diversity in healthcare.¹⁴

There are multiple advantages of diversity in healthcare.¹⁴ These include better patient communication, less medical errors, empathy, more provider cultural competence and better patient experience and outcomes.¹⁴ Unfortunately, despite having the highest percent of minority population in California, Hispanics are one of the least represented minority groups in the healthcare workforce. As such, the need for the prioritization of Hispanic representation at all healthcare levels remains an urgent priority.

Author Bio

 

Olayemi Adeoye, MBBS, PhD, MPH

Dr. Adeoye is an Associate Professor of Physiology and Pharmaceutical Sciences at the School of Pharmacy. His research interests include maternal obesity and steroid fetal programming; hypoxia and drug metabolism during pregnancy; and cardiovascular effects of health disparities. He actively engages in collaborative research with the Center for Perinatal Biology in the School of Medicine, where he holds a secondary faculty appointment.

References

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2. National Institute on Minority Health and Health Disparities (NIMHHD), 2024. Retrieved on May, 27, 2024 from https://www.nimhd.nih.gov/resources/understanding-health-disparities/mi…).
3. Roth, K. B., et al. (2019). "Heterogeneity of Latina/os' acculturative experiences in the National Latino and Asian American Study: a latent profile analysis." Ann Epidemiol 38: 48-56 e42.
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6. Rabe, Megan, 2024. Some of the Most Diverse Census Tracts in 2020 Were in Anchorage, Alaska, and Queens County, New York. Retrieved from https://www.census.gov/library/stories/2024/01/racial-ethnic-diversity-… on May 24, 2024.
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9. California Health Almanac, 2021. Retrieved on May 28, 2024 from https://www.chcf.org/wpcontent/uploads/2021/10/DisparitiesAlmanacRaceEt…
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