Race and Gender Inequalities in Medicine and Biomedical Research

Introduction

In 2015, African Americans and women remain underrepresented as senior medical faculty and among biomedical federal grant recipients (Carr et al., 2015; Ginther et al., 2011). There has been an attempt in recent literature to address these disparities that centers on how African American women’s perception of social identity and belongingness affect their expectations and experiences in medicine and biomedical research (Purdie-Vaughans et al., 2008; Steele et al., 2002; Murphy et al., 2007; Cheryan et al., 2009; Good et al., 2012; Burgess et al., 2012). This literature provides a useful point of departure to understand individual experiences and also to identify institutional practices that shape the experiences of African American women’s experiences in academic medicine and biomedical research. However, while the literature acknowledges the historical devaluation of women and African Americans in a broader U.S. context, it stops short of explicitly connecting the history of academic medicine to current patterns of gender and ethnic representation in the field. Toward that end, using a diversity science framework, the authors seek to link the history of academic medicine to the persistent underrepresentation of African American women and African Americans more globally. Further, the authors offer suggestions to address the continued barriers for women and minorities.

Diversity science framework¹ is a sociocultural analytic tool useful in understanding how an individual’s behaviors are a reflection of the inscription of social, cultural and historical ideologies (e.g., ideas, beliefs or cultural assumptions), institutional practices (e.g., laws, language, or organizational policies) and daily experiences (Plaut, 2010). The diversity science framework suggests that the underrepresentation of African Americans in medicine has its roots in a report by Abraham Flexner in 1910, which would lay the foundation for the transformation of 20^th century medical education. The Flexner report led to wide-sweeping reforms and shifted the paradigm of medical education toward a more professional model with well-trained professors, quality laboratories, and access to hospitals (Duffy, 2011; Hiatt & Stockton, 2003; Sullivan & Mittman, 2010; Savitt, 2006; Steinecke & Terrell, 2010; Barkin et al., 2010). However, the costly requirements were out of reach of most African American medical schools. As a result of his recommended reforms in medical education, most of the schools that provided medical education to women as well as African Americans were closed (Flexner, 1910; Duffy, 2011). The reduced opportunities for African Americans and women have contributed to the current inequities in the representation of African Americans in U.S. medical education and, ultimately, biomedical research (Hiatt and Stockton, 2003; Sullivan & Mittman, 2010; Savitt, 2006; Steinecke & Terrell, 2010; Barkin et al., 2010). Consistent with the theory of cumulative disadvantage (DiPrete TA, 2006), we posit that differences in treatment over a prolonged period have cumulated into substantial inequalities in race and gender representation in both medicine and biomedical research (Sheltzer & Smith, 2014).