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Equity: Critical Conversations—Introduction

Within clinical medicine, there is growing interest in both health equity and in diversity, equity, and inclusion (DEI) efforts. PM&R journal created this special issue with the goals of assembling diverse perspectives and of intentionally centering voices that are new to critical conversations that lie before us as a field. Although we originally aimed to focus on health equity for our patients, it became clear that we cannot disentangle health equity efforts for marginalized patient populations from DEI efforts for the physician workforce. When individuals and Member Communities within the American Academy of Physical Medicine and Rehabilitation were invited to speak on health equity, several themes emerged: (1) physicians who come from backgrounds that are underrepresented in medicine spoke to both the experiences of their patients and of themselves throughout their medical training; (2) historical contexts are critical to understand, such as the Flexner report, the colonization of Indigenous peoples, slavery, Japanese American internment during World War II, the HIV/AIDS crisis, the institutionalization and deinstitutionalization of people with intellectual/ developmental disabilities, the evolution of the Diagnostic and Statistical Manual of Mental Disorders, and more; and (3) workplace DEI efforts affect the environment in which physicians practice and the makeup of the physician workforce, which have implications for health equity for patients. The perspectives shared with us illustrate that the renewed interest in health equity due to the COVID-19 pandemic, in which marginalized communities have experienced worse health outcomes due to structural barriers, biases, and inequities inherent in the U.S. health care system, requires intersection with the literature on DEI efforts. The benefits of a diverse workforce have been well documented in the business literature, including findings that diverse companies have, on average, better financial results than other companies and that diversity contributes to more effective problem-solving and better decision making. Although DEI efforts are relatively new for clinical medicine, they have been ongoing in other workplaces for many years and continue to provide useful insights for the health care industry.