What Does the End of Affirmative Action Mean for Health Equity? 

Following the Supreme Court’s 2003 decision upholding race-conscious affirmative action policies, former Justice Sandra Day O’Connor stated that “in 25 years, affirmative action will not be necessary.” However, two decades after her original statement, affirmative action policies continue to be necessary. Research shows that racially and ethnically minoritized groups are underrepresented in higher education compared to their white counterparts. Despite this, such policies have since been ruled unconstitutional.  

The June 29th Supreme Court decision to end affirmative action comes after years of cases in which the court has generally ruled in favor of policies that continue race-based affirmative action in college admissions. Such policies are designed to combat hundreds of years of discriminatory hiring and educational practices that failed to give opportunities to populations experiencing disadvantage due to race or ethnicity. Beginning in 1978, the court famously concluded that colleges, universities, and employers have a compelling interest in creating a diverse student body. Therefore, race was just one of many aspects colleges have considered when admitting students for the past several decades. 

In contrast, banning affirmative action policies has been shown to harm diversity and representation within college classrooms. For states that have already done so for their public colleges in the past, research has presented vast declines in enrollment and graduation rates for minoritized students before and after the bans were enacted. These results reflect in undergraduate and graduate programs like medical school, as well as the quality of colleges attended by students. According to the Urban Institute, after the passage of Proposition 209–the law that banned affirmative action in California– there was a 12% decrease in the enrollment of Black, Latinx, and other underrepresented populations, with the decrease becoming even more stark––a 60% reduction––when considering University of California, Berkeley and University of California, Los Angeles alone. This drop in educational achievement was also associated with at least a 5% drop in income for students from marginalized groups. These economic barriers circle back into the vicious cycle of negative social determinants that make it difficult to achieve better health. As our Founder and Director Lisa Cooper told Scientific American, economic barriers contribute to a lack of access to healthy foods, unsafe living conditions, and limited options of space to exercise. 

Decades of research have shown an association between educational attainment and health outcomes. It is well documented that educational attainment is an essential factor in social mobility– and is a precursor to stable employment, financial security, and healthcare access. While education was once described as “the great equalizer,” others have also considered it a “reproducer of inequality”. Individuals from higher socioeconomic backgrounds are better positioned to educational opportunities. Zajacova (2018) argues that policies must ensure that marginalized groups have equal or greater access to similar opportunities to avoid further intensifying such disparities.  Even before the recent Supreme Court ruling, there were stark differences in educational attainment across racial lines. In 2018, the Center for American Progress reported that in the U.S., white students were nearly twice as likely to hold a bachelor’s degree in engineering, physical science, and other STEM degrees than Black students. The recent Supreme Court ruling to end affirmative action is likely to exacerbate the current trends, predicting that we will only see an increase in these disparities in educational attainment. 

Along with this comes the confirmation of the continued legality of “legacy admissions,” giving students who are the children of university alumni an advantage in their admission to the given school. While this only permits colleges to consider legacy rather than requires it, should the admissions process continue in the same manner (with the omission of affirmative action and continuation of legacy admissions practices), this bi-directional suppression of access to education for students from disadvantaged backgrounds will create a future ripple effect into our society and employment opportunities—particularly in the health professions. In response to the decision, President of the American Medical Association Jesse Ehrenfeld, states: “This ruling is bad for health care, bad for medicine, and undermines the health of our nation. A physician workforce that reflects the diversity of the nation is key to eliminating racial inequities."  

The representation of marginalized groups in health care is critical to our understanding of health inequities, as well as key to patient-physician relationships and improvement in  quality of care, and health outcomes. In research roles, it is crucial to include researchers and collaborators that represent the groups studied and to prioritize finding solutions and interventions that promote health equity. Should these admissions trends continue, the 5.7% of physicians that identify as Black will decline, the 9.6% of epidemiologists that are Hispanic or Latinx will wane, and the 8.5% of nurses that identify as Asian American or Pacific Islander will lessen in a time that direly requires an increase in diversity of health professionals to meet the needs of our increasingly diverse nation.  

To ensure diversity in public college and university classes that are more representative of the population at large, postsecondary institutions around the country will need to rethink other aspects of admissions that overlook communities marginalized due to race, ethnicity, income, or geography to create a more holistic process. Amidst all of the recent changes in legislation, postsecondary researchers, educators and scholars give us hope through their proposed solutions to create a more equitable future of access to education. Some of these solutions include investing more resources into recruitment and outreach in more diverse areas and high schools, tuition-free programs and initiatives that automatically admit the top 10% of a high school class to a local college, and the de-emphasis of standardized test scores—or even making applications test-optional.  

As Supreme Court Justice Ketanji Brown Jackson said in her dissent on the ruling, “Our country has never been colorblind.” Racially and ethnically tied disparities are present in every aspect of health and wellness in the United States. Education is one piece of the puzzle, but a critical one in which we must continue to uplift diverse voices and experiences. Like our approach to advancing health equity, the change to college admissions practices requires a shift in perspective. One where we take the opportunity to listen to the stories of Americans of diverse racial, ethnic, and social class backgrounds, and learn about the barriers they face in order to adequately address them—all in the name of empowering people to live a better, healthier life.