Urban Health Need Statement & Rationale
PRELIMINARY DRAFT
The U.S. faces two compelling challenges in preparing the health workforce of tomorrow: the first is ramping
up the numbers of health workers to meet a national shortage, and the second is ensuring that we have the
racial and ethnic diversity and cultural competence within our health professions to provide equitable care
for all of our citizens. Urban serving universities are at the forefront of efforts to meet these needs,
particularly within the nation’s growing and culturally rich urban and metropolitan regions.
The U.S is facing a demonstrated health workforce shortage. The shortage is due, in part, to
the aging baby boomer population, with their increased health needs and the retirement of current
health professionals faster than new workers can be trained. It’s also part of a nationwide shift to
a highly skilled knowledge-based economy, where health care jobs are booming. The Bureau of
Labor Statistics (BLS) projects that 16 of the 30 fastest growing jobs in the next decade will be in
the health professions. At the same time, by 2010, health workforce retirees will outnumber
entrants by 13,800 per day.
A shortage of health professionals is forecast across the health sector. The Association of
Schools of Public Health (ASPH) estimates that 250,000 more public health workers will be
needed by 2020. To confront a projected physician shortage, the American Association of
Medical Colleges (AAMC) has recommended an increase in medical school enrollment by 15%,
and is considering recommending an increase of 30% by 2015. The Department of Labor
estimates that the United States will need 1.2 million new nurses by 2014— a projected shortfall
of between 400,000 and 800,000 nurses. Initial reports also indicate potential shortages in other
fields including dentistry, pharmacy and many of the allied health professions.
Under-representation of certain racial and ethnic groups in the health workforce is
particularly troubling. According to the most recent census data, minorities make up 25% of
the U.S. population. Yet nationwide, U.S trained minority dentists are only 5.8% of the active
dental population (American Dental Educational Association), minority nurses are approximately
8.3% of the nursing population (Bureau of Labor Statistics), and 7% of physicians are minorities
(AAMC).
The lack of a racially diverse and culturally competent health workforce contributes to the
demonstrated disparities in health care received by minorities in this country. Data supporting
this link has been clearly outlined in two reports released by the Institute of Medicine, along with
the 2004 Report of the Sullivan Commission, “Missing Persons: Minorities in the Health
Professions.”
Health workforce and diversity issues are playing out on a greater scale and acuity in U.S
cities. Nearly 80% of the population now lives in cities – a demographic reality that will become
more pronounced in the future. Cities are also at the forefront of the nation’s cultural and racial
diversification. In 2000, the top 100 U.S. cities became “majority minority.” Compounding these
demographic changes is the even more pronounced growth of the health sector within urban
economies, particularly for high skilled, higher-wage jobs surrounding large universities and
medical centers. In order to address ethnic and geographic health disparities and meet workforce
demands, cities will need to provide not only greater numbers of health workers, but also ensure
a diverse urban health workforce that mirrors its increasingly diverse population.
Unfortunately, cities face a daunting uphill battle in delivering on this promise. Currently, cities
are characterized by highly variable and inequitable care among ethnic populations and from one
urban zip code to the next. Richmond provides an illustrative example, where the city-wide infant
mortality rate among African Americans is 18.3/1000 compared to 7.4/1000 among whites. While
national reports call for greater numbers and diversification of the health workforce, the very
students who should be preparing for these positions – the increasingly diverse, urban based
young people – are not currently on track to assume even entry level jobs in the health care
arena. A recent study commissioned by America’s Promise Alliance confirmed the dramatic “high
school graduation gap” between urban and suburban public school students – exceeding 25
percentage points in twelve U.S cities. The growth and diversification of the urban health
workforce is inconceivable when only 24% of public school students in Detroit or 30% in
Indianapolis are graduating from high school, much less going on to or graduating from college.
Urban Serving Universities have a unique capacity and responsibility to increase the
numbers, diversity and cultural competence of the urban health workforce.
As public
urban research universities, USUs are centers of expertise - in education, research, and policy –
that is needed to develop the future cadre of urban health professionals and leaders. USUs are
city-located and have access to urban sites, clinics, hospitals, and communities that provide an
experiential training ground for culturally competent urban health. USUs have an existing
infrastructure of urban-university partnerships and resources that can be further leveraged and
developed to support health workforce initiatives. The research capacity within USUs drives
innovation and produces transformative knowledge - the ability to analyze existing and new
efforts and translate findings into policies that can guide leadership in cities, states, and
nationally. As major economic engines, and often the largest employer and producer of the urban
workforce, USU demonstrate a significant leadership role in cities. They are one of the few
urban-based institutions with the credibility, scope and scale to convene multiple stakeholders to
implement city-wide change.
Urban Serving Universities are already having a significant impact on the health workforce
of cities – and can do more. USUs are enormous sources of talent, producing a large share of
the current health workforce in cities. Collectively, USUs educate 30% of the nation's physicians,
and an even greater percentage of pharmacists and dentists. In a recent survey of members of
the USU Coalition, nearly 2/3 of USU students come from their respective metros and also stay in
those metros. This local link means that USUs have a significant impact on the local urban
workforce, and are primary economic drivers within their metros. The ability of USUs to
coordinate and scale up current educational efforts and develop new health workforce initiatives
will provide even greater impact on their regions and the nation as a whole.
The Coalition of Urban Serving Universities is focusing on three goals by which member
institutions can increase the numbers, diversity and cultural competence of the urban
health workforce.
GOAL ONE: Increase and further develop partnerships and programs with urban pK-12 school
systems and other city entities to strengthen the pipeline of urban students prepared for
and entering the health professions. USUs are key stakeholders in the P-20 education pipeline for
their greater metro areas, particularly because the majority of first-time, first-year students that
enroll in USU member institutions come from these same metros. USUs thus have a major stake
in the success of local urban students. As nationwide demands for a more highly skilled
workforce increase, USUs will need to go beyond outreach, recruitment and retention strategies,
and do more to increase the pool of qualified applicants ready to succeed in college and beyond.
For the urban health workforce, that means increasing both numbers and diversity of a qualified
applicant pool aware of and interested in pursuing health careers. As many USUs already have
urban pipeline partnerships and programs in place, more can be done to develop an educational
pipeline to health careers, particularly for diverse urban students. Efforts should also be made to
develop a “whole” health professions pipeline – with pathways to the full array of health
professions ranging from a phlebotomist, to a nurse’s aide, x-ray tech, physician specialist, or
health researcher.
GOAL TWO: Improve and augment innovative and “engaged” education efforts and urban
university-community partnerships to increase cultural competence, prepare greater numbers of
health professionals for urban needs, and develop future urban health leaders. As urban-based
research universities, USUs are sources of innovation and best practices in health education and
training. As doctoral granting institutions, USUs are a nexus for leadership development in health
fields, and by virtue of their urban location, have a particular relevance and capability to train
urban health professionals and leadership. Unfortunately, in their affiliated urban-based hospitals
and clinics, and in the city at large, USUs often face a cultural divide between those that they
train, and the increasingly diverse population of patients being served. This cultural divide
creates greater urgency for USUs, but it also provides a unique opportunity for training health
professionals for urban-based, culturally competent care. Based in cities, USUs can strengthen
existing urban-based educational partnerships and develop new approaches to immerse students
in the culturally rich and varied urban health environments that provide true cultural competency.
This is the “translational” component of cultural competency. USUs can also do more to ensure
that the environments within their own affiliated hospitals, clinics, or academic environments are
both diverse and inclusive. USUs can augment efforts to develop additional and innovative
training opportunities for future health leaders caring for the urban underserved in order to reduce
geographic and ethnic health disparities. Lastly, greater development of urban health curriculum
and educational programs will encourage more enthusiasm and better preparation of health
professionals desiring to work in diverse urban health settings in the future.
GOAL THREE: Attract, train, and support greater numbers of researchers and faculty working in
urban health and health disparities. [This goal is being further discussed and developed]