Medical School Association Diversity Chief Talks Health Care Reform

Dr. Marc Nivet joined the Association of American Medical Colleges in June as the chief diversity officer, tasked with developing a strategic vision for AAMC’s diversity efforts and overseeing programs designed to improve diversity in medical education and promote equity in health care. Here, Nivet talks about the benefit of health care reform to communities of color and his plans to work with historically Black medical schools.

Diverse: Why should African-Americans and other minorities pay particular attention to health care reform?

MN: Any national-level legislation that is going to impact the health and pocketbooks of all Americans deserves attention from all our communities, especially Black and Hispanic inner-city and rural communities. Health care reform has the potential to fundamentally change how we think about health and health care. We have an opportunity to think deeply about prevention and public health and bring those elements closer to the practice of medicine. 

This reform represents an opportunity to frame success in terms of how many people we can keep healthy, rather than just basing it on the cost and success of interventions necessary when illness occurs. That said, the reality is that many minorities and individuals of lower socioeconomic status have gone extended periods without health care, meaning by the time they enter the system their illnesses have progressed to a point where care is more expensive than it need be.

The fundamental benefit of health care reform is the provision of some form of insurance to 32 million more Americans previously lacking coverage. The vast majority of the newly insured will be African-Americans and Hispanics. This extension of coverage, paired with incentives for the health care system to improve on wellness and prevention, is of particular relevance to minorities.

Diverse: Why do the vast majority of Americans, according to polls, oppose health care reform?

MN: There is clearly a misunderstanding of the intentions of health care reform. Objections seem to center around the perception that this legislation represents a new entitlement program that will run up as opposed to bring down the cost of health care. Unfortunately, the expansion of coverage to individuals of lower socioeconomic status has been misperceived as an attempt to right a historical wrong or create a new social program, when at its core it is about improving the quality and affordability of health care for everyone.

Diverse: Free market advocates have couched the health care reform debate in terms of personal choices, freedom, personal responsibility and economics. How has that informed the debate?

MN: Your question pinpoints the problem! We are all guilty of allowing the health care debate to be framed in economic terms. But, I can’t think of one great social movement that has been framed solely as an issue of economics, and rightfully so. Economics should never be the driver of change for this kind of movement. Sure, the economic aspects of health reform are of critical importance for the future of the country. When we talk about competitiveness, however, we can’t forget it is impossible to thrive as a nation without a healthy population. We should be talking about the economic issues, but we should also be addressing the social issues and tackling the fundamental questions about what’s right and what’s wrong.

Diverse: Leaders from AAMC and historically Black medical schools met during National HBCU Week in Washington. What are some concrete things that came out of that meeting?

MN: For a long time, our HBCU medical schools have successfully fulfilled the social mission of medicine. Data suggest that many of their graduates go into primary care and work in underserved areas. The meeting was an opportunity to recognize the important contribution of Morehouse, Howard, Meharry and Drew to educating and preparing future physicians to meet the evolving needs of an increasingly diverse and aging population. This was an opportunity to express the AAMC’s commitment to better understand the unique challenges and strongly support the historic mission of the HBCU medical schools.

Going forward, we have to figure out how to harness the best practices that come out of these schools. To that end, we will be actively promoting innovations at HBCU medical schools to the community at large and to other medical schools. We’ll be working with these institutions to ensure participation in our myriad ongoing studies. There will also be an intentional effort to bring HBCUs into research projects, to see what we can learn from them and transfer to other schools. For instance, Howard does a great job of being community engaged. How can we make sure all of the other medical schools in the country fully implement community engagement activities?