Diversity and Disparities: Parallel Challenges for 21st-Century Health Care

By Fred Hobby and Janice L. Dreachslin, Ph.D.


There continues to be a fair amount of confusion in the health care field about the difference between diversity and disparities.  As a result, the terms are often used interchangeably and inappropriately, leading to strategies directed at addressing one set of concerns which end up focusing on or failing to take into account the other. This makes measuring the success of initiatives difficult at best and building national platforms for action a confusing proposition.


If the field is not clear on what our priorities should be, it becomes increasingly difficult to win support for change.  While most leaders would support the goal of eliminating disparities in medical outcomes, especially among minority patients, there is, at the same time, an apparent reluctance to embrace strategic diversity management. Unfortunately, without such a commitment to diversity, organizational factors that contribute to disparities will likely remain unchanged.  An inclusive professional workforce that reflects the communities being served together with policies and practices to support their success and a shared commitment to culturally and linguistically competent care are essential underpinnings of any sincere effort to eliminate disparities.  


For these reasons, and perhaps a few more, Rich Umbdenstock, president and CEO of the American Hospital Association, commissioned a cross-association task force to develop a set of recommendations that AHA could adopt to help hospitals reduce disparities in health care.  He also asked that steps be taken to educate the field on the differences between disparities and diversity and explain their relationship to each other.  In short, he asked the task force to bring some clarity to these two concepts.


In simple terms, diversity means difference and has no negative connotations.  There is diversity among trees, flowers, cats and dogs and all living things.  There is diversity within Christian beliefs, Islamic beliefs and Jewish beliefs.  Obviously, there is diversity in thought.  And there is diversity in the health care workforce and the patient populations we serve.  This diversity is reflected in differences in age, gender, lifestyle, education, religion, marital status, economic status, race, preferred language, weight, ethnicity and much more.  Even when the workforce or the patients we care for appear to be a homogeneous group – for example, all white – there will be considerable differences among them.  


In short, diversity exists wherever differences exist.  Any difference can become a barrier to working effectively as part of a team, especially when these differences characterize a minority of the team members and are not openly acknowledged and leveraged for shared success.  It is diversity which makes each person unique.  There are no negative implications in this concept.  It is this human diversity that needs to be recognized and understood to prevent these differences from becoming barriers.


Disparities, on the other hand, are inequalities.  There is a definite negative connotation with this concept.  Inequities in treatment, access or outcomes constitute disparities.  


There is no doubt that disparities in the delivery of care appear to have a far greater and immediate impact on the medical outcomes of patients, when compared to the impact of diversity issues.  A well-documented Institute of Medicine report, Unequal Treatment, makes it very clear that minority patients are not provided the same level of access to therapeutic, diagnostic and surgical procedures as the majority population.  On the other hand, if we introduce diversity issues such as language differences, which effect the accurate communication of medical information from which patients and caregivers make choices; or religious differences, which effect the belief systems and healing processes; or even sexual orientation, which could effect the overall acceptance of a gay or lesbian patient or caregiver and the trust factor that must be present between them, wouldn’t there be increased tendencies for disparities to occur?  Perhaps the confusion that now exists between these concepts is warranted.  The relationship between diversity and disparities is so intertwined that they are virtually inseparable.  One is a consequence of the other, and vice versa.


We don’t believe there is a CEO in the country who would argue against the desire to have a single level of access and care for all patients.  There would be little resistance to such a noble cause.  Yet, this is equivalent to picking the low hanging fruit.  It is politically safe, it is humanitarian, and it is what hospitals should do to maintain the public trust.  In other words, it is the right thing to do.  In fact, the AHA already has the elimination of disparities as a priority.  However, the field has not yet expressed a shared commitment to strategic diversity management.

Diversity issues such as language, religious, cultural, gender, race and ethnic differences are not disparities in and of themselves.  They are just differences.  When they are not understood, valued and appreciated for their impact on the delivery of patient care, the healing process and communication/trust, they become contributors to disparities and unequal medical outcomes.  


Discussions about diversity are the most controversial and uncomfortable to lead.  It is difficult to develop meaningful strategies for change because change can be perceived as a threat to the status quo and may be viewed as leading to a loss of privilege or feeling of resentment, guilt, anger or denial.  Diversity continues to be the most elusive challenge in 21st Century health care delivery, and one of the greatest challenges our society as a whole faces.  Only through embracing strategic diversity management, can we transform ourselves and our organizations and create a health care environment that is truly conducive to the elimination of disparities.