Correspondence: T. Q. Tan, MD, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, and Division of Infectious Diseases, Ann and Robert H. Lurie Children’s Hospital of Chicago, 225 E Chicago Ave, Box 20, Chicago, IL 60611 (ttan@northwestern.edu; titan@luriechildrens.org).
Search for other works by this author on:The Journal of Infectious Diseases, Volume 220, Issue Supplement_2, 15 September 2019, Pages S30–S32, https://doi.org/10.1093/infdis/jiz198
20 August 2019Tina Q Tan, Principles of Inclusion, Diversity, Access, and Equity, The Journal of Infectious Diseases, Volume 220, Issue Supplement_2, 15 September 2019, Pages S30–S32, https://doi.org/10.1093/infdis/jiz198
Navbar Search Filter Mobile Enter search term Search Navbar Search Filter Enter search term SearchSteven Covey, the author of The 7 Habits of Highly Effective People, wrote that “[s]trength lies in difference, not in similarities” [a 1]. Over the last several decades, there has been a major effort made to initiate changes in policy, practice, and programs that address persistent gender disparity and other issues related to the sociocultural context of the practice of medicine [ 1]. Consider that, in 1960, only 1044 women applied to US medical schools and that, of these, 600 were accepted. Women composed 7.3% of applicants and 7.0% of accepted students. Since 1972, when Title IX of the Education Amendments became law, prohibiting discrimination on the basis of sex for educational programs that received federal funding, including postsecondary programs [ 2], medical schools have been close to gender parity at the student level, but women physicians continue to remain underrepresented in certain specialties and subspecialties, in healthcare leadership positions, and in the higher ranks of academia, despite the fact that over one third of the physician workforce (36%) is composed of women [ 1, 3–6].
Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) healthcare providers and healthcare providers with disabilities continue to face multiple specific challenges and general work-related stressors and biases. These biases include being passed over for promotion, tenure, and leadership opportunities; being denied referrals from heterosexual colleagues; social ostracism; and subjection to derogatory comments and behaviors in the workplace from both coworkers and patients [ 7–12]. To address some of the biases and disparities encountered by disabled healthcare providers and LGBTQ+ healthcare providers and patients, many healthcare institutions and medical schools have started to implement formal diversity training and LGBTQ+ health education into their curriculum; however, information on the impact of this training remains largely unknown [ 10, 13–16].
In recent years, diversity has been embraced as a core value and fundamental priority across the different fields of medicine, science, and technology. In 2016, in a presidential memorandum, President Barack Obama stated that “[r]esearch has shown that diverse groups are more effective at problem solving than homogenous groups, and policies that promote diversity and inclusion will enhance our ability to draw from the broadest possible pool of talent, solve our toughest challenges, maximize employee engagement and innovation, and lead by example by setting a high standard for providing access to opportunity to all segments of our society.” This resulted in the creation of the Diversity, Equity, and Inclusion in Science and Technology: Action Grid, a collection of key actions and sample strategies on how to promote diversity and inclusion in the science and technology workforces, through the White House Office of Science and Technology Policy [ 17–19]. Even though diversity in the healthcare, science, and technology workforce has been recognized as critical for the advancement of patient care and scientific research agendas, there continues to be a significant lag in the areas of inclusion, equity, and access, especially for women, underrepresented minorities, LGBTQ+ persons, and persons with disabilities.
There are many definitions and principles of inclusion, diversity, accessibility, and equity (IDA&E); however, the establishment of IDA&E within an organization is not a one-size-fits-all approach, and the definitions and principles that are adopted need to reflect what works for that organization. The Infectious Diseases Society of America (IDSA) comprises almost 12 000 active members, the majority of whom also represent membership in the sister societies of the HIV Medicine Association, the Pediatric Infectious Diseases Society (PIDS), and the Society for Healthcare Epidemiology of America. To be a leader in the field of infectious diseases, the IDSA (including its sister societies), needs to be committed to the full integration and practice of the principles of IDA&E at all levels of the organization. Below are definitions and principles of IDA&E and some reasons that they are important to the mission of IDSA.
Inclusion refers to the intentional, ongoing effort to ensure that diverse people with different identities are able to fully participate in all aspects of the work of an organization, including leadership positions and decision-making processes. It refers to the way that diverse individuals are valued as respected members and are welcomed in an organization and/or community. Verna Myers stated that “[d]iversity is being asked to the party. Inclusion is being asked to dance” [ 20].
Respecting and celebrating the diverse and rich pool of talent that the members of IDSA bring to the organization and promoting the participation of these individuals at all levels of IDSA will strengthen the organization. This will occur by using the talents and skill sets of its members, fostering collaboration with other societies, and creating a welcoming environment to attract the best and the brightest to the field of infectious diseases. IDSA needs to work on addressing gaps in its membership data and focus on obtaining information in areas for which data is lacking (eg, LGBTQ+ members, members with disabilities, and underrepresented minorities). This will provide information about areas where work is needed as well as more accurate information regarding membership demographic characteristics. The goal is to have all members being “asked to dance.”
Diversity is defined as the presence of differences within a given setting. This may include gender, race, ethnicity, religion, nationality, sexual orientation, place of practice, and practice type. It is the way people are different and yet the same at the individual and group levels. Organizational diversity requires examining the makeup of a group to ensure that multiple perspectives are represented.
Recognizing the power that a diverse membership brings to an organization and implementing this diversification at all levels of IDSA will allow for increased creativity and innovation, promotion of leadership opportunities, and enhancement of opportunities for growth. IDSA needs to focus on further diversifying its membership by partnering with other healthcare societies whose practitioners are specialized in infectious diseases (eg, advanced practice nurses, pharmacists, clinical microbiologists, and foreign medical societies). This will allow IDSA to lead the way forward as a medical society that embraces and uses the talents of its membership to ensure that the most culturally competent and highest-level care is provided to the diverse patient communities that its members are privileged to serve, as well as to maintain the highest ideals and standards in the performance of all areas of research.
Access/accessibility refers to giving equitable access to everyone regardless of human ability and experience. It refers to how organizations encompass and celebrate the characteristics and talents that each individual brings to the organization. It is about representation for all.
By consciously providing access to all opportunities among its membership, IDSA will be able to harness the incredible pool of talent that its members bring to the organization. This will eliminate real and perceived barriers and cultivate, develop, and advance the talent pipeline.
Equity refers to an approach that ensures that everyone has access to the same opportunities. It recognizes that advantages and barriers exist and that, as a result, everyone does not start from the same place. It is a process that begins by acknowledging that unequal starting place and works to correct and address the imbalance. Equity ensures that all people have the opportunity to grow, contribute, and develop, regardless of their identity. Basically, it is the fair and just treatment of all members of a community. It requires commitment and deliberate attention to strategic priorities, resources, respect, and civility, with ongoing action and assessment of progress toward achieving specified goals.
Intentionally recognizing and celebrating the diverse strengths of our membership and the incredible advantages that this holds, IDSA must be committed to cultivating and promoting equal opportunity for all its members to contribute to its growth and development.
IDSA is a proven leader and staunch advocate for the highest standards in the practice of infectious diseases. For IDSA to continue to grow as an organization and advance the field of infectious diseases, the principles of IDA&E need to be consciously and intentionally implemented at all of its levels. The field of infectious diseases, the research agendas, and the communities of patients to which we provide care are broad and diverse in multiple different facets. Hence, the members of IDSA and the missions and goals of the organization should reflect this diversity.
Supplement sponsorship. This supplement is sponsored by the Infectious Diseases Society of America.
Potential conflicts of interest. Author certifies no potential conflicts of interest.
All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.