What is diversity?

Abstract

This article introduces the topic of diversity in this minisymposium by defining the terminology as well as providing descriptions of the positive impact of diversity. We aimed not only to examine the proven effects of diversity, but also to understand the barriers present so we can effectively mitigate these at the individual, institutional and systemic levels.

Definition

According to the Oxford English Dictionary, “diversity” is defined as “the practice or quality of including or involving people from a range of different social and ethnic backgrounds and of different genders, sexual orientations, etc.” [1]. Because technology has helped to make the world more accessible, and with travel and immigration (particularly when there is no pandemic), people are no longer working or living in an insular environment. Living and working with people who have differences is common. By embracing these differences, we celebrate the diversity of the human experience and enrich our profession.

Increasingly, young people live in a diverse community. Census data within the United States from 2018 indicate that most children younger than 15 years are from non-White groups [2]. Increasing attention to attributes such as gender identity, ability, ethnicity, sexual identity, creed, socioeconomic background, age, military experience, learning style, personality, education level, geographic background/country of origin, language, marital status, caretaker status, occupation and appearance is necessary because of both a history of oppression and persisting implicit bias. Within the United States, historical structures, many persisting to our modern day, have perpetuated prejudice and discrimination against those who are not able, White, straight, affluent, cis-gender Christian men. We must recognize that individuals who are members of non-dominant groups often face significant disadvantages throughout their lives inclusive of educational opportunities.

“Intersectionality” reflects the concept that combinations of social identity can have impact on oppression or privilege. It is imperative that diversity is considered in hiring or selection practices (such as for school or training programs), but also in regard to inclusion and belonging. To illustrate these concepts, diversity is like being invited to dinner; inclusivity is eating at the same table with the same offering of food and tableware; belonging is being able to eat as if you were in your own home. All three are crucial for success. “Tokenism” results when someone who is not of the majority is merely invited but not actually given the same benefits or consideration, i.e. not included.

“Equity” refers to providing resources appropriate to the environment to obtain equal outcomes. Imbalances within our social systems result in a need to provide equitable processes.

Although we know that race is a political or social construct, without a biological basis, institutional racism is a reality in the United States. The term “race” is at the forefront of descriptions and discussion of diversity and in any survey for new employees as well as in research studies, but the results can often be confusing because of the variety of definitions and perceptions as well as mistrust caused by institutionalized racism.

Institutionalized racism is at the forefront of national attention in the wake of the numerous tragic deaths that are increasingly brought to public attention. Although the murder of George Floyd in 2020 was a seminal moment for political organizing, his death has been both preceded and followed by many other Black and indigenous people of color who have died at the hands of police or vigilantes. Similarly, the poorer outcomes for people of color with regard to the coronavirus disease 2019 (COVID-19) pandemic provides a health care example of the impact of systemic bias. Bias in the community is replicated in any work environment without intervention. Diversity and equity in the workplace is a step toward bringing an end to institutionalized racism.

Increasing attention is given to the “social determinants of health,” which refers to the ways in which conditions in people’s environments contribute to their wellbeing. The literature and electronic medical records are among the realms in which we see discussion of social determinants of health [3]. Many of the features of diversity are those that are included in social determinants of health, which can contribute to inequalities in health among groups and are not caused by genetics or willful choices but by cultural factors. Once again, the example of worse outcomes for people of color with COVID-19 illustrates how social determinants of health can result in health inequalities. The impact of these social determinants of health is yet another reason for the importance of diversity within all aspects of life, but particularly within health care delivery systems. By hiring diverse people in our workplaces inclusive of leadership positions, we help broaden the perspectives of the decision makers and we present a workforce that reflects the community.

Proven benefits

Numerous studies have shown that workers demonstrate better productivity with better health care delivery when there is a diverse environment [4–8]. Further, being inclusive and welcoming is simply the right thing to do. In the United States, many forms of explicit bias are now illegal. Hewlett et al. [9] reported that more diverse groups result in higher levels of performance as well as innovation. Individuals and teams can perform better when they are able to focus on their tasks in a comfortable environment. In addition, a broader perspective and new concepts can be brought forth when all members are able to communicate their ideas. Being inclusive and embracing diversity results in a larger talent pool from which to select team members. Excluding any particular group is a loss for the field. Greater problem-solving ability is found with increased diversity [10–12]. Work output and health care delivery improve with diversity, and evidence demonstrating improved health outcomes is likely to increase steadily with more emphasis on diversity in practice and in research.

Obstacles

“Unconscious bias” or “implicit bias” is described as an attitude or reflexive behavior that alters our perceptions and affects our behavior, decision-making and interactions [13–23]. It is important to note that the influence can be positive or negative and might not coincide with our stated beliefs. Unconscious bias is unintentional. It can be seen in forms like gender bias, racial bias, disability bias, affinity bias and beauty bias. One of the notable studies illustrating bias is a randomized double-blind study in which application materials of identical students were provided to faculty with the only difference being the randomly assigned male or female gender of the applicant, and the results demonstrated a clear bias in favor of the male applicant. This bias was present in both male and female faculty [14]. This study highlights that being a member of a discriminated group does not make a person immune from bias against that group. Unconscious bias can be measured by the Implicit Association Test (IAT), which is inexpensive and accessible online [24] and can provide feedback on personal unconscious bias for self-reflection. However, although the test taker receives immediate feedback, this test does not appear to change behavior [25]. Additional work is needed to correct these biases. It becomes important to mitigate unconscious bias at both individual and organizational levels to promote diversity, equity and inclusion [26–30]. Measures can be taken to correct unconscious biases, and recognizing that they exist is the first step.

There is a shortage within our pediatric radiology workforce that creates a challenge for those trying to hire a diverse staff. Alternatively, one could view this shortage as an opportunity to recruit from groups who are traditionally underrepresented within our field.

Conclusion

The positive impact of diversity in the workforce is undeniable and offers clear benefits [31]. Some clear advantages of having a diverse workforce are a bigger talent pool, increased employee trust and engagement, new perspectives, innovation, better decision-making, improved performance and stronger business profiles and profits. Institutions that are committed to promoting diversity and inclusion have formed committees and taskforces to implement effective change at their workplace. Diversity is not just the right thing to do, it is the essential thing to do. Diversity creates a more cohesive environment so that the health care entity has all the right tools it needs to succeed.

Declarations

Conflicts of interest

None