As we think about healthcare during Black History Month, we should ask ourselves how we can do more to ensure that diversity, equity, inclusion, and accessibility (DEIA) remain at the forefront of our efforts. At the Office of the National Coordinator for Health Information Technology (ONC), we work every day to “be the change” that we believe in—both internally and externally. Our internal efforts include a focus on minority recruiting and standing up a DEIA committee comprising leadership and staff. Externally, we’ve issued grant funding to promote minority education in health informatics and technology. We are also implementing our work with an eye toward health equity by design.

African Americans’ Contributions to America

It is important that we reflect on the history of Black people in this country and that we realize that Black History Month is an important month not just for Black or African American people but for all of America. Many try to separate slavery from American history or just make mention of slavery as if it were a short part of American history. We must acknowledge that although the history of enslaved Africans stretches back thousands of years, there is no way to truthfully talk about American history without discussing Black history.  Between 1619 and 1865, an estimated 10 million African people were human trafficked to America, exploited for their physical labor and their intellectual property, and sex trafficked. It is estimated that enslaved people were forced to provide approximately 410 billion hours of unpaid labor into building America. Slavery was human trafficking justified because of skin color; it did not just occur in America, but across the world.  The truth is that every part of America derived financial benefit from the work of enslaved people. Not only did the South profit, but the whole nation profited from 10 million enslaved people who were seen only as free labor for 245 years (12 generations). This is one of the greatest human rights atrocities in world history.

I want to be clear that Black history in America is wholly indivisible from all American history and is not just about slavery or the 100 years of segregation and race-based discrimination enabled by the Jim Crow laws that followed slavery. Black people throughout the history of this country have been inventors, politicians, activists, teachers, business owners, clinicians, and so much more. For example, in the field of healthcare, Dr. Ernest E. Just was a pioneer in the physiology of development, especially fertilization.  In his work within marine biology, cytology, and parthenogenesis, he advocated for the study of whole cells under normal condition, rather than breaking them apart in the laboratory setting.  Dr. Daniel Hale Williams was one of the first physicians to perform open-heart surgery in the United States of America. Dr. Charles Drew was a renowned surgeon and researcher in the field of blood transfusions. His improved techniques for blood storage led to the development of large-scale blood banks. Dr. Rebecca Lee Crumpler became the first Black female Doctor of Medicine in 1864.  The legacy and accomplishments of Black people in this country are rich despite the brutality and racism inflicted upon our people.

My Personal Story

As is true of many African Americans, my family has been in this country since the 1700s. I am a descendent of slaves and people who were denied basic human rights. Through an online service, my brother found the bill of sale of my great-great-grandmother. My grandfather served in World War II but was denied his GI bill and any rights enjoyed by his White counterparts who served with him. My father served in the Vietnam War, but was denied the right to vote in the country he had just fought for and took an oath to protect.

I am the first generation in my family who did not attend under-resourced segregated schools and I am the first that had the resources to graduate from college. I am the first generation to not have to enter through so called “colored” only entrances, and I was the first Black member of ONC’s Senior Executive Service (SES) hired in 2013 (Thank you Dr. Farzad Mostashari!). In my leadership role as the Deputy National Coordinator for Operations, I ensure that ONC has the resources and tools it needs to continue our important work supporting nationwide interoperability. My achievements reflect a notable shift in equity in our country, but there is still so much work to be done to ensure that all people of color have similar opportunities.

Inequity in the Healthcare Sector

As a result of intentional discrimination and neglect, Black people are still underrepresented in many sectors, including healthcare. Per US News & World Report, the percentage of U.S. doctors who are Black has barely risen in the past 120 years, and there is still a wide pay gap between White and Black physicians. Considering racial/ethnic backgrounds, the Registered Nurse population is: 80.8% White/Caucasian; 6.2% African American; 7.5% Asian; 5.3% Hispanic; 0.4% American Indian/Alaskan Native; 0.5 Native Hawaiian/Pacific Islander; 1.7% two or more races; and 2.9% other.

The most common ethnicity among Health Informatics Specialists is White, who make up 62.3% of all Health Informatics Specialists. Comparatively, there are 13.9% of the Asian ethnicity, 10.7% of the Black or African American ethnicity, and 10.3 % Hispanic or Latino. A significant pay gap also exists between Black and White informaticians. The most common ethnicity among Public Health Workers is White (65.1%). Comparatively, there are 15.5% of the Hispanic or Latino ethnicity, 9.3% of the Black or African American ethnicity, and 5.7% of the Asian ethnicity. Similar disparities in representation and pay exist throughout the healthcare sector which further exacerbates the racial wealth gap.

The Road Ahead

We still have a long way to go to achieve real diversity, equity, inclusion, and accessibility in this country, including in healthcare, but we can each be part of the change. As I mentioned earlier, the leadership team at ONC has embraced the importance of “being the change.”

First, Dr. Micky Tripathi became our National Coordinator a little over a year ago and is spearheading our health equity by design efforts. He recognizes that equity does not just happen, it must be intentional. We are working to ensure that social determinants of health (SDOH) data can help inform the care needs for patients and that the uses of such data in interoperability, analytics, and algorithms help to mitigate health inequities.  In 2021, using American Rescue Plan (ARP) funding, we launched the Public Health Informatics and Technology (PHIT) program and awarded $73 million to 10 consortia led by or including minority serving institutions (MSIs) that will train over 4,000 students in an interdisciplinary approach to public health informatics and technology.

Within ONC, we host monthly events focused on DEIA. We also have an internal DEIA Council comprised of staff at all levels of the organization. In addition to these change efforts, I started an outreach effort to MSIs. This effort is a partnership with the Health Resources and Services Administration (HRSA), the National Institutes of Health (NIH) /National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the Centers for Disease Control and Prevention (CDC), the Centers for Medicare & Medicaid Services (CMS), and the Administration for Children and Families (ACF). The program, called Pathways to Public Service, focuses on intentionally recruiting students of color to apply for federal positions across HHS.

We are dedicated to diversity, equity, inclusion, and accessibility at ONC. We don’t just talk about it; we live it. Within ONC, we are committed to help change the face of healthcare within HHS and across the country. We are the change! What steps can you take to be the change?

I thank Shenika Industrious, Beh Lamadine, Adrienne Kimble, Dr. David Hunt, and Zhan Caplan for their research, data analysis, and technical editing of this blog post.