Affirmative Action at the Intersection of Women in Medicine Month and National Latinx Heritage Month

​​Historically, affirmative action policies have aimed to address the underrepresentation of marginalized groups in higher education, with great success among White women. Analyses from the Department of Labor and the American Association of University Women have demonstrated the success of these policies, in improving inclusion of women in academia and medicine. Over the past few years, medical schools have become majority women.This would not be possible without affirmative action helping to triple the number of women physicians between 1980 and 2000, but this success is racially limited to White and Asian women (as reported by the American Medical Association). Kimberlé Crenshaw uncovered through her work on Intersectional Theory and Critical Race Theory (CRT), “the primary beneficiaries of affirmative action have been Euro-American women.” As we celebrate these women reaching parity in medicine, affirmative action has ended before Latina, Black, and Native American women experience the same success.

​​In the past few weeks, we have seen the surfacing impact of the Supreme Court’s June 2023 ruling against race-conscious admissions. Top universities are reporting significant declines in 2024 enrollment of underrepresented minority (URM) groups, including Latinx, Black, and Native American, at our peer institutions, like Harvard, Columbia, and MIT, while enrollment for Asians increased. Moreover, the rise of local and state bans on Diversity, Equity, and Inclusion (DEI) and Critical Race Theory (CRT) attack URM in higher education.

The ramifications of these trends in medicine are profound. Prestigious universities serve as critical pathways to social and financial mobility among URM individuals and families, with cascading benefits for historically disinvested communities. This lack of access to higher education will exacerbate the wealth and income gap among US Latinxs.  As my researchers demonstrate across my discipline (health equity), structural racism is the fundamental cause of health disparities, working through social determinants of health including lack of access to education, income, occupation, physician representation, and segregated communities. To achieve health equity, racial equity in access to income and education are crucial social determinants of health.  Added to this, declining URM college admissions will exacerbate the lack of physician representation. Research has shown that diverse healthcare providers combat health disparities. Without acknowledging the role of structural racism in college admissions, the future of medical research may lack the diverse cultural understanding and representation necessary to address health disparities.

To combat these challenges, we can follow CRT scholars. One solution is the Holistic Admissions approach that values a wide range of factors. Traditional admissions processes that prioritize standardized test scores are biased against URM and low-resourced students. Standardized tests do not accurately predict college performance but mirror the educational, economic, and cultural advantages their families possess. Holistic Admissions evaluates a comprehensive understanding of each candidate’s merit, defining merit as a culturally relative set of experiences and perspectives enriching the campus and preparing leaders with innovative perspectives. This method had some success following California’s 1996 ban on discussing race in admissions. We can also follow the theory of community cultural wealth, that Latinx, Black, and Native American students learn from their marginalized cultural histories and upbringing, a perspective that enriches health equity research.

Social science has long evidenced the US education system’s bias towards Euroasian-centric epistemology (the theory of knowledge construction). This cultural bias marginalizes the knowledge of Black and Native American cultures. For example, public schools taught me that math and astronomy were invented in Europe, India, and Mesopotamia. However, my mother who is Quechua and Afro-Peruvian, taught me how our culture also invented astronomy and math before Spanish colonization. We used Quipus (pictured above) using complex knots and strings for math and demography. In reality, many underrepresented groups, including my own, simultaneously invented math and science. These inventions are still in widespread use, such as the Quechua quina-quina (Quinine) plant medicine for Malaria and the invention of teonanacatl (psilocybin) therapy from the Aztecs. Epistemic injustice in US education biases against Native American and Black students. However, we can integrate diverse epistemology into our faculty and curriculum, that teaches cultural relativism through critical consciousness in our classrooms and research.

One way that I integrate this in my course (“Structural and Social Determinants of Health: Achieving Health Equity”) is a lesson on the history of vaccines. US medical history and my own epidemiology education attributed the discovery of inoculation to China and India, later reaching Edward Jenner in England. Ibram X. Kendi brought this epistemological bias center stage in 2017 by presenting primary evidence that Onesimus, an enslaved man from Sub-Saharan Africa, taught cowpox inoculation to modern US science by teaching his enslaver, Cotton Mather (Harvard, Yale), science that later reached Edward Jenner. Cultural relativism is needed to fundamentally understand the sociocultural causes of health disparities, and celebration of community cultural wealth promotes inclusive science.

Throughout Women in Medicine and National Latinx Heritage Months, I challenge us to reflect on the plummeting number of Latina women. As we navigate the evolving landscape of higher education, we must recognize the cultural community wealth and science contributions within minoritized communities. Preventative efforts can include Holistic Admissions and inclusive curriculum. The future success of Women in Medicine depends on our current prevention efforts to intervene in the exclusion of Latina and URM students.