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The New DEI Battle: Derailing Equity Intergenerationally from Flexner to Florida

Updated: Feb 8

history of derailing of Equity in  american Healthcare

What Drove Historical Attacks on Anti-Racist Progress in Medicine?

In 1910, the Flexner Report implemented standards seeking to improve medical education and patient outcomes. But instead, Abraham Flexner's recommendations led to over 5,000 doctors

losing their licenses and precipitated the closing of 7 out of 8 medical schools that admitted Black physicians. With the stroke of a pen, policies steeped in systemic racism decimated diversity across scientific fields for generations.

Rather than receive government investments to sustain and improve their programs, historically Black medical schools were unjustly penalized and dismantled through policies promoting onerous equal standards devoid of equitable supports. These institutions were built up through Black communities pooling resources in the decades after slavery’s abolition. Yet white leaders in 1910 felt wholly justified in razing decades of anti-racist progress via policies cloaked under the guise of neutral, technocratic “quality improvements.”

Over 100 years later, Florida’s “Stop WOKE” Act and other emerging legislation banning diversity, equity, and inclusion (DEI) initiatives in education and training draw from the same playbook. These policies claim to create “equality” while actually protecting unequal power structures.

What Equitable Progress Do Anti-DEI Policies Seek to Undermine Today?

Constructive culture change requires truth-telling, consciousness-raising, and reconciliation — tenets of transitional justice processes. Educational and workplace trainings aim to surface injustices minimized by institutions while fostering collective responsibility for change.

The Stop WOKE Act and its supporters further the claim that such conscious examination only seeks to engender white guilt. But revealing ongoing struggles faced by marginalized groups, in fact, catalyzes institutional accountability and solidarity.

Meanwhile, empirical evidence consistently demonstrates that equitable institutions generate better outcomes — higher patient satisfaction, stronger financials, more workplace innovation. A diverse leadership team and staff help address community needs and reduce disparities.

So beyond political posturing, what equitable progress do modern policies banning DEI initiatives most threaten to derail today? What do they aim to keep unseen?

Undoubtedly, individual awareness of implicit bias has merits. But systemic oppression stems less from interpersonal prejudice than cultures centered on dominant groups. Lasting change targets transforming policies, communication norms, decision-making processes to mitigate inequities.

Yet those accustomed to privilege often view equality as oppression unless centered wholly on their experience. Segments of society remain unable to countenance difficult truths about ongoing marginalization. They reflexively attack policies expanding access and power for minorities as “reverse discrimination.”

In suspending funding for programs addressing systemic oppression, bans on DEI initiatives in various states work to reinforce the unequal status quo. They punish institutions for acknowledging harm done to marginalized groups. They stifle consciousness-raising efforts to catalyze reconciliation.

What fears underlie this desperate attempt to maintain comfort over justice? And who suffers most from this moral inaction?

Beyond Implicit Bias: Questioning the Fears That Thwart Healthcare Equity

Diversity trainings. Augmented minority recruitment. Public declarations of “commitment to equity.” Healthcare institutions nationwide have embraced such initiatives under the banner of diversity, equity, and inclusion (DEI). Yet any threat to the status quo, any whisper of more transformational change, seems to meet instant opposition and outrage.

A doctor resistant to healthcare equity

What exactly are resistors so afraid of? What do they imagine will happen if we as a society begin to acknowledge and redress centuries of oppression facing marginalized groups?

Will the “authority” of dominant groups be diminished if others finally have a seat at the table? Is the loss of assumed expertise the root fear? Or is it the specter of being held truly accountable by minority voices with real institutional power?

Proponents argue that making people aware of implicit racial, gender, and other biases can lead to more equitable behaviors and policies. But in practice, the impacts tend to be limited:

  • Multiple meta-analyses find little evidence that implicit bias training affects behavior or improves workplace equity. Any effects diminish over time.

  • Most training fails to address how implicit biases stem from historical oppression and contemporary power structures that continue to disadvantage marginalized groups. Devoid of this critical context, they locate the problem within individuals rather than systems.

  • Implicit bias training places the onus on marginalized groups to educate the dominant group, rather than the reverse. This dynamic centers whiteness and discourages solidarity.

What Are the Deeper Fears That Stifles Progress Toward Health Equity?

Rather than nurturing institutional change, implicit bias training provides a comforting illusion of progress. Companies check the DEI box without engaging in the deeper work of dismantling barriers facing women, people of color, LGBTQ+ employees, and other minority groups.

Segmented diversity trainings that fail to challenge institutionalized hierarchies cannot catalyze radical cultural change. As James Baldwin wrote, “Not everything that is faced can be changed, but nothing can be changed until it is faced.”

And so the key questions for healthcare diversity consultants like myself are:

  • What lies beneath reflexive backlash when marginalized voices finally demand to shape policy?

  • Why does even acknowledging systemic oppression meet such frenzied denial from those clinging most desperately to maintaining the myth of meritocracy?

It brings to mind how fiercely some plantation owners fought to uphold slavery as economic anxieties mounted. They clung ferociously to an unequal system that privileged them through generational wealth still benefiting descendants today. Even the notion of addressing those historic harms and associated contemporary advantages summons heated outcries of “reverse discrimination!”

Yet empirical evidence consistently demonstrates that equitable institutions generate better outcomes not just for marginalized groups but for organizations overall. So why the inaction from those most afraid to face truths about oppression?

“Freedom and justice cannot be parceled out in pieces to suit political convenience. I don't believe you discuss civil rights. You don't discuss human rights. You declare them.” - A. Philip Randolph

Undoubtedly, individuals should check their biases. But achieving equity requires much broader change to workplace culture, structures, and practices. Training staff on microaggressions means little if minorities still rarely get promoted. Employees may suppress biased language, but patients face discrimination through restrictive policies.

Increasing workforce diversity and retention facilitates culture shift. But remains insufficient without it.

Lasting change requires institutional transformation targeting:

  • Equitable HR policies and pay scales

  • Dismantling white cultural hegemony

  • Mitigating marginalization in decisions, communications, and norms

  • Ongoing training grounded in antiracism and power analyses

  • Cultural humility and unconscious bias work centered on the dominant group

  • Job conditions that provide minorities psychological safety

But such change fundamentally threatens to redistribute power and influence away from majority groups. And therein lies the deeper fear — the loss of assumed expertise, automatic authority, and cultural centrality that forms the bedrock of systemic oppression.

So to those who reflexively resist progress toward healthcare equity, I ask plainly: What future precisely are you fighting against so desperately? And why?

Facing these fears held by those clinging to power moves institutions toward reconciliation rather than stagnation. As Martin Luther King said, “Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that.”

Taking Action: Use Climate Surveys to Guide an Anti-Racist Transformation

Well-designed organizational climate surveys allow healthcare institutions to assess DEI gaps without causing further harms. Confidential surveys give voice to marginalized groups, surface inequitable treatment, and indicate policies needing reform.

Sharon Washington Consulting partners with healthcare organizations to develop tailored, inclusive climate surveys and actionable improvement strategies. Our team brings interdisciplinary expertise in structural competency, antiracism, reconciliatory processes, and healthcare equity evaluation.

Rather than implement implicit bias training devoid of context, our climate surveys explore realities like:

woman performing DEI climate survey

  • Lived experiences of discrimination by patients and employees

  • Psychological safety to express marginalized identities

  • Barriers to retention, professional development, and leadership

  • Structural policies and cultural norms requiring change

Data-driven insights direct strategic planning and culture change for health equity. Contact Sharon Washington Consulting today to discuss how customized climate surveys can catalyze progress at your healthcare institution.

The question now facing healthcare leaders is no different than those faced by generations before during times of moral crisis. Will we cling to superficial DEI gestures that protect institutional power? Or journey courageously toward a future centered on justice and collective liberation?

I, for one, intend to continue this work with brave healthcare partners committed to illuminating necessary truths.

Dr. Sharon G.E. Washington Ed.D., MPH  Founder/CEO    Sharon Washington Consulting

In solidarity,
Dr. Sharon G.E. Washington Ed.D., MPH
Sharon Washington Consulting
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