The Need for Political Diversity in Professional Health Education

The class activity started well. The students were genuinely engaged. We had just finished our annual cultural simulation in our school’s “Care of Diverse Populations” course. Students were divided into two groups, each of which was assigned a distinct culture to adopt. The groups then took turns visiting the other culture and trying to successfully interact. Often, students struggle during these visits and have many misconceptions about the other culture—highlighting this is the intent. This struggle leads to revelatory moments about perception, bias and communication. Afterwards, we debriefed and asked students to describe the other culture. As usual, they listed negative qualities, such as rude, prejudiced and unwelcoming. Then, surprisingly, one student shouted “Republican,” at which the class laughed and nodded. Even more surprisingly, no one spoke up in disagreement. I was disheartened. The students had missed the entire point.

Something similar occurred during a recent debate exercise. Students were split into groups to debate a current healthcare issue. One of the debate topics was Hillary Clinton’s health care reform versus Donald Trump’s. Topics were placed in an envelope and group leaders were asked to reach in and pick one. Students were adamant about not wanting to pick Donald Trump’s side. Their hands were literally shaking as they reached into the envelope: no one wanted to face their group’s wrath if they chose Trump. When Trump was eventually picked by an unlucky leader, his entire group moaned in frustration, while the other students uttered literal sighs of relief. Once again, no one seemed concerned about what had transpired. This response was considered the social norm.

Occurrences such as these, involving both students and faculty, are increasingly common. In health professions curricula, students are taught to be culturally competent. Yet, despite challenging students to provide optimal care for those who differ from them, we are often dismissive and condescending towards people with different political beliefs. As a faculty member, I would be remiss if I allowed any student to provide poor care to anyone ever. After all, these students are the future practitioners, policy-makers and faculty of my profession. After many discussions with colleagues who’ve had similar experiences, I’ve become concerned about the future of health care—and especially the academic environments in which students are trained. What are the ramifications of a lack of viewpoint diversity within the student, faculty and administrative body? What kinds of health professionals are entering the workforce? How could this impact patients?

What Is Viewpoint Diversity?

Heterodox Academy defines viewpoint diversity as “the state of a community or group in which members approach questions or problems from multiple perspectives” and it “enables colleges and universities to realize their twin goals of producing the best research and providing the best education.” Currently, lack of viewpoint diversity (e.g. political diversity) is an epidemic within academia, especially in the humanities and social sciences. Political affiliation impacts many important preferences, including where people choose to live, who they choose to marry, who they prefer their relatives to marry, and who they choose as friends. Essentially, people surround themselves with the like-minded in echo chambers. This increases distrust and animosity towards those who differ politically. The healthcare professions are not protected from this cultural shift. Can students, faculty and institutions which take strong political stances provide optimal care for patients and communities that differ from them politically— when research indicates growing divisiveness and animosity?

The Value of Different Viewpoints

A lack of viewpoint diversity may impact patients in several ways. First and foremost, a practitioner’s political stance may influence their treatment decisions. One study found that Democrat and Republican physicians differ in how they would treat patients facing politicized health issues. I’ve witnessed politically conservative pharmacists refuse to provide Plan B and campaign against safe injection programs and medical marijuana. Furthermore, healthcare shortages in specific areas could be caused by providers choosing not to live or work in those places because of their political affiliations. Voting patterns overwhelmingly indicate that people with similar political beliefs choose to live near each other. This shift towards political homogeneity within communities may explain the lack of health professionals in certain settings. Lastly, research shows that some patients prefer practitioners of the same race and/or native language. Is this effect also seen with political concordance? Are some patients not receiving optimal care because they differ politically from their provider? Are some patients and communities not receiving the best care because certain political beliefs are not represented among providers and policies in that community?

Every political ideology has flaws, inconsistencies and failures. The moment we stop critiquing each other is the moment we open ourselves up to these blind spots. Having diverse political beliefs will not only keep our own bias in check, but lead to rigorous debate, higher quality work and better policies.

I do not wish to promote particular political views or demean other aspects of diversity here, but to bring to light issues associated with homogeneous thought, especially in academic institutions, which train impressionable minds. If a student is only taught one perspective on a politically divisive health care issue (e.g. birth control, marijuana, substance abuse/opioids, universal health care, religious grounds for refusal, entitlement programs, capitalism, Big Pharma), is that student really gaining a full appreciation of what their patients believe and value? We also want students to be aware of current and evolving issues within health care. If students hear only one side of an argument and surround themselves with others who think like them (which evidence shows they do), they will lack the ability to grasp the complexity of an issue and the arguments involved. What kinds of policies and initiatives are likely to result from these incomplete understandings?

The Current Environment

How are students and practitioners impacted by this societal shift towards political intolerance and decreased willingness to engage with different viewpoints? We don’t know. There has been a lack of research into viewpoint diversity and its relationship to quality of care. Now is the time to assess this topic. There’s no reason to believe that polarization will lessen or remain stagnant as people become more segregated by their political beliefs. In fact, undergraduate students are becoming increasingly polarized and differences in people’s values and beliefs—as demonstrated by implicit, explicit and behavioral indicators—are largely determined by politics, even more than by race. Furthermore, note the demographic profile of faculty and administration in the health professions—white, educated, older, urban. This is statistically the most politically intolerant group.

In other academic professions, the roots of political homogeneity run deep and, although new dialogue is emerging (often due to controversy), there is much more work to be done regarding viewpoint diversity. The recently released American Psychological Association’s Guidelines for Psychological Practice with Boys and Men attracted a vast amount of criticism—the controversy underscores our stark differences along political and ideological lines. This divisiveness might enter the health professions as well. It is unclear how it might manifest itself.

The Challenge

With few exceptions, higher education has repeatedly shown that it is not interested in promoting political diversity. Although the government is beginning to exert its influence, ensuring viewpoint diversity in the health professions is the responsibility of the health professions themselves. There is no reason why we should let this issue become as intractable as it has become in some other fields. Change will not occur accidentally, but requires purposeful intent, thought and planning. New tools promoting viewpoint diversity are available for use by individuals and institutions. Additionally, utilizing existing personnel dedicated to diversity and inclusion is critical. At a personal, institution and profession-wide level, we should ask the following questions:

  1. Value: Do we want viewpoint diversity? Why or why not?
  2. Assessment: Do we have viewpoint diversity?
  3. Action: What will we do to maintain or improve viewpoint diversity?

The health professions are not immune from societal shifts. I fear that increasing political polarization and echo chambers will further entrench animosity, leading to decreased ability and willingness to care for certain people and less consideration given to helpful policies of a different political slant. Ultimately, a homogeneous political climate and decreased political tolerance will hurt students and patients. Our role as healthcare providers is to heal this growing divide, not contribute to it.

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  1. Of course you’ve never heard a good argument from a Trump supporter, why would any sensible person want to spend time explaining anything to someone who has decided in advance that they’re a petulant idiot incapable of reason?

  2. People are entitled to good medical care regardless of their political beliefs. A Democratic surgeon saved Ronald Reagan’s life when Reagan was shot. I don’t think we really need to have Republican health care providers to give service to Republican patients, any more than we need criminals to represent criminal defendants in court.

  3. Viewpoint diversity is not important. What is important is a respect for other viewpoints and the humility to realise that what we believe might, be wrong.
    Mor ethan anything it is the maturity to relaise that if someone disagrees with something you believe passionately is an essential moral issue that doe snto make them a bad person. It just makes them someone with a different opinion.

    The problem with valuing viewpoint diversity is that it can easily tilt into viewpoint relativism, that all views are equally valid. They arent. Homeopathy for example is dangerous nonsense and no doctor should value this viewpoint. When it comes to politics, and paticularily the merit of different policies, the reality is no one should be confident that they can predict the future effects and outcomes. We should all be very humble when it comes to politics.

  4. It comes down to this. Sometimes there really is a wrong side. Sometimes there is no place or space for debate, tolerance, or understanding of the “other”. Because sometimes, there really are view points and beliefs that reflect how shitty human beings can be; Trump and his supporters are the modern-day icons of this.
    You want to be able to think and speak out like Trump, then go find a place to live with all the like-minded people and be happy without us. We don’t want you around dragging and slowing down progress.

    1. There is a certain assumption among too many that goes like: ‘If my viewpoint is not represented to my satisfaction, there is not viewpoint diversity.’

    2. I have no respect for Trump. He is childish, petulant, vindictive and chronically dishonest. He seems to be intent on undermining respect for the law and legal instituitions and promoting a polarised acrimonious form of politics which I think is dangerous. However regarding all his supported as so obviously wrong headed that they should be ignored and suggesting that we form segrgate society along the line of pro and anti Trump supportes is a recipe for more politicla polarisation and taken to the logical extreme for social fragmentation and civil war.

      The questions you should ask is why are people Trump supporters?
      Why are people not attracted to the alternatives?
      My believe is that people vote for what they least dislike and for all his manifest problems the illiberality, racism and sexism in modern left wing politics is even more frightening and unpleasant for many people than the narcisstic, venal, childishness and petulance of Trump.

      1. I have never had a Trump supporter answer any of your questions with any semblance of reason if answered at all. Give me an example where a Trump supporter came to you with rational thought or offered more than a sound bite or illogical argument. And they truly believe themselves like OJ Simpson believes his innocence. So it’s a non-starter.

        And this is beyond their petulance. This is about their culture whose “thinking” is so low, so bottom of the barrel that they put all of us at risk. We live as though “it can’t happen to us”, but it can and it very well may be. Jews, “gypsies”, and Poles in Germany/Europe never thought they would be exterminated, but 12 million were murdered because of one man’s spread of lies, and fear, and “petulance” that was given space and consideration. Generation after generation of African people never thought their one shot in life would be used in bondage by white slave owners but look at what the south’s “way of thinking” did to an entire population of human beings, and continues to do because of its legacy. Do you think the Dark Ages was an accident? PEOPLE created the dark ages because of their beliefs, and it took millions in terms of human potential and hundreds of years to pull out of it.

        We are living in a time where history is re-writing the same story and we sit here concerned about whether we’re not being “nice” enough, whether we should cede space to prevent more polarizing thought. We need to stop chasing Trumps rabbits, stop fighting AGAINST something, and start fights FOR something. And we need more polarizing thought to do so, because Trump supporters will only change their mind when it’s too late. And I am not afraid to be non-PC, because sometimes there really is a dark side, a wrong side to humanity and frankly, Trump and his supporters reflect it.


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