inclusion through exclusion

Note: The harmful ramifications of discrimination permeate every area of life, whether based on race, ethnicity, ability, gender, sexual orientation, neurodiversity and beyond. We see it in the workplace, in schools, in public spaces; it affects us financially and can hinder access to healthcare.

Within the framework of health, I discuss why the exclusion of certain groups to ultimately achieve inclusion is so important, which in turn illustrates why positive action is needed in every aspect of life.

4 years ago, corporate America saw a 123% increase in the number of diversity, equity and inclusion-related job postings during the summer of 2020 alone, impelled by the murder of George Floyd, the amplifying efforts of Black Lives Matter and pandemic inequities. This surge led many to believe that the investment and prioritization of DEI efforts would only strengthen in time, with McKinsey projecting that companies worldwide would be spending $15.4 billion on this by 2026.?

However, not even 4 years later are we witnessing a backslide, with corporations such as Meta, Tesla, DoorDash, Google, Zoom and Lyft slashing DEI-focused teams and workers. Is the scale-back due to the resounding success of these programs? Of course not. The relentless attacks on historically marginalized groups are still rife, with the right to basic human rights often being ignored and in some cases, written into legislation. For example, in 2022, the Supreme Court overruled Roe v. Wade, revoking the right to abortion in many states and this year, there have already been 486 laws passed that oppose gender-affirming care or are anti-LGBTQ+.

The rise and fall of DEI-focused programs indicates that the initial spotlight was nothing more than a trend, which is particularly worrying as trends do not last. Despite this, employee resource groups, which are usually voluntary and employee-led, remain steadfast. Safe spaces like these are so important as they facilitate a sense of validation, belonging, and ultimately empowerment.

ERGs are generally for historically marginalized populations and for these populations alone; they exist to provide specific professional development and support to communities that are underrepresented within their organization. 'Equity' over 'equality' necessitates that resources, allowances and opportunities that are granted reflect circumstance so that true equal outcomes can be achieved. It’s understandable why ERGs don’t exist for populations that haven’t been harmed significantly by inequity. From this, I’m reminded of a quote by Ibram X. Kendi: "The only remedy to racist discrimination is antiracist discrimination. The only remedy to past discrimination is present discrimination. The only remedy to present discrimination is future discrimination." But what does this mean in practice?

'equity' over 'equality' necessitates that resources, allowances and opportunities that are granted reflect circumstance so that true equal outcomes can be achieved

Looking back through the healthcare lens as above, it means that spaces need to be created that exclude other majority populations in favor of the traditionally underserved for the sake of affecting real change. Women and underrepresented groups were only allowed to be included in clinical trials from 1993 despite some health conditions impacting certain populations more and disproportionately: rheumatoid arthritis, cardiovascular disease, Alzheimer’s disease and lung cancer in women; asthma, pneumonia, diabetes and maternal mortality in the Black community; and chronic obstructive pulmonary disease, hepatitis B and liver disease in the Asian community. In order to rectify this, we need to find specific solutions that work to address these specific issues.

spaces need to be created that exclude other majority populations in favor of the traditionally underserved

This is why companies like FOLX Health , Plume Clinic , Evvy , Elektra Health , Health In Her HUE and Noula are so important, to name a few. They increase accessibility to care, ultimately improving health outcomes and reassuring patients that their healthcare professional knows what they’re doing and is providing the right care. Otherwise, solutions will be designed on assumptions and stigmatized labels. Ultimately, you cannot improve the health of the population whilst leaving populations behind.

Creating spaces for traditionally marginalized communities and excluding majority groups is necessary to achieve inclusion and to compensate for the systemic discrimination that has gotten us to this point.