Dreams deferred, health denied: How attacks on DEI impact the attainability of healthcare degrees for Black students

In the wake of recent federal and state-level actions aimed at dismantling diversity, equity, and inclusion (DEI) initiatives, the future of healthcare in the United States hangs in the balance. Education-geared DEI policies and programs, once designed to open doors for students historically excluded from higher education opportunities, are being stripped away and miscategorized as a harmful aspect of college admissions and scholarships. In actuality, for many aspiring Black healthcare professionals, these programs are the bridge between ambition and reality.

Why DEI in education matters for healthcare

The journey into healthcare is often one paved with financial and structural barriers. For many students of color (particularly Black students), access to the field is made possible through scholarships and pipeline programs that recognize the challenges posed by systemic inequality and socioeconomic barriers. These programs are critical in reducing the barriers that prevent many bright students from the opportunity to become a doctor, nurse, or other healthcare professional. These programs are not handouts. They simply open doors for students who would otherwise have one slammed in their face and address the imbalances that exist between who gets to dream of becoming a doctor and who actually has the means to get there. A recent study determined that, despite around 21% of North Carolina’s population identifying as Black, only 8% of our physicians, 3% of our optometrists, and 7% of our pharmacists are Black. 

The aforementioned comments highlighting barriers to entry speak to the matter broadly. However, what must also be mentioned is the historical underfunding of historically Black colleges and universities (HBCUs), which further widens the divide for Black students. Those attending HBCUs face enough obstacles and inequities as it is, with underfunding being a longstanding and yet to be rectified issue in many of these schools. North Carolina is home to more HBCU students than any other state, yet as recently as 2023 the U.S. Department of Education reviewed university funding allocation and determined that our state had inequitably underfunded its Black schools by a margin of billions—yes, billions—of dollars. These schools, often known to be more affordable for Black students emanating from humble beginnings, aren’t even currently being provided with the resources that they need to survive. And yet, the federal and North Carolina governments seem to think that eliminating opportunities for marginalized students will somehow lead to fairness or equity?

Without these targeted scholarships, programs, and support systems, we will undoubtedly see a decline in the number of Black students entering and completing healthcare programs. That decline won’t just affect academic institutions. It will ripple through our hospitals, clinics, and community care centers across the state. Fewer diverse professionals entering the healthcare workforce today means fewer culturally attuned providers tomorrow. It also results in a workforce that is even less equipped to understand and meet the needs of our nation’s rapidly diversifying patient population, resulting in poorer patient outcomes.

The dangers of ignoring history…and repeating it

Efforts to erase DEI are often cloaked in language about fairness or merit, yet they ignore the deeply entrenched barriers that make “equal opportunity” anything but equal. Black students have historically been underrepresented in higher education because of discriminatory policies and socioeconomic obstacles, many of which still persist today. Federal and state-level bans on DEI funding, especially those that target race-conscious scholarships and support systems, send a clear message: that the unique experiences and needs of Black students are not a priority.

The fact that legacy admissions have yet to be challenged by the same entities fighting to rid public education of DEI in North Carolina speaks volumes. Legacy admissions, which are college admissions granted to students based on the fact that they are related to alumni, remain very much a part of North Carolina university admissions. Statistically, many institutions admit several times more legacy and donor students than Black and brown ones, bringing the ethics of eliminating DEI over legacy admissions even more into question. Recently, the North Carolina General Assembly’s Senate voted to ban DEI from the college admissions process in SB 558, yet when a state senator asked that the additional provision to eliminate legacy-based college admissions be added to the bill as well, they were dismissed immediately. The implications of this hypocrisy are obvious. The students who benefit from these legacy and donor admissions do not earn their admission to a school due to their merit or hard work. They benefit due to privilege, and yet, calls for legacy admissions to be addressed by DEI ban supporters have gone unanswered.

Good healthcare doesn’t happen in a vacuum

A nation’s healthcare system can be considered a mirror of the society it serves, with its makeup either demonstrating equity or inequity. If the United States wants a system that is truly equitable and just, we must actively cultivate a workforce that reflects that ideal. That starts with access to education. It starts with being intentional about how we invest in, support, and uplift students. And it starts with understanding that policy decisions about education today will shape the health outcomes of tomorrow.

Pipeline programs such as the North Carolina Diversity and Inclusion Pathway Program (NC-DIPP), which seeks to provide HBCU students with the opportunity to complete a paid internship involving real-world experience under the mentorship of an expert in their field of choice, are under threat. This program was created due to the lack of representation of Black and brown students pursuing science, technology, engineering, and math (STEM) degrees, and it provides students with the opportunity to become better prepared for a career in healthcare research. It was born of the statistical reality that, despite many Black students expressing interest in pursuing STEM degrees, far fewer ultimately pursue it due to the many systemic barriers that exist. Pathway programs such as NC-DIPP provide students with experience, networking opportunities, and the opportunity to engage in career planning, which they would otherwise not have access to in a field in which they are already underrepresented. Then there is the RISE program established by UNC Gillings School of Global Public Health and implemented at NC A&T, which seeks to address health-related disparities affecting Black birthing persons by training students attending HBCUs to become lactation consultants. Additionally, scholarships meant to provide similar support for disadvantaged students, including those pursuing healthcare degrees in North Carolina’s HBCUs, such as Winston-Salem State University and North Carolina Central University, have somehow been weaponized by those who would seek to make equitable practices a thing of the past before equity has been achieved. 

These attacks on DEI are not just political, they are personal and deeply consequential. They threaten to silence the voices of students who, if not for DEI initiatives, will otherwise slip through the cracks of an unjust society and be robbed of the opportunity to pursue their dreams. These attacks also discourage future healthcare workers who bring with them not just knowledge, but the lived experiences needed to transform care delivery in communities that would benefit greatly from receiving services provided by practitioners and staff who are from their own community.

Call to action

We cannot afford to sit by idly as pathways for young, promising students are closed. We must raise our voices in defense of equity in education, not just for the sake of fairness, but for the health and future of our nation. As the North Carolina General Assembly picks and chooses who it believes is worthy of educational opportunity, we cannot turn a blind eye and we must sound the alarm on the injustices committed by our government. The North Carolina state seal motto, “Esse Quam Videri,” appears in giant bold letters outside of the General Assembly building and means “to be rather than to seem”. This motto pertains to the idea that actually being virtuous and authentic, rather than falsely attempting to appear so, is a fundamental tenet of North Carolina ideals. If this is truly the case, then the North Carolina General Assembly—with their support of SB 558 and several other recent pieces of legislation—has much to answer for.