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John Kieffer, MD MPH's avatar

Thank you for a good analysis - always gets me thinking and working to improve. I do think your suggestion that the k-12 education system is the reason for disparities is somewhat true but greatly confounded by historical government policies that break down opportunities for certain groups and cultural factors such as loving and stable home life, reading and learning encouraged, safe places to play outdoors etc.

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Dave's avatar

Agree. While it is only a quick statement, bad (inner city) schools are not the cause. We are two full generations into affirmative action in education where we take the brightest students and give them opportunities in higher education and have built all types of programs to assist their development including maximum scholarships to overcome financial hardships. Since we are only talking about a small slice of the educated that have specific cognitive abilities (ability to pass organic chemistry) and a desire to become a physician, along with a very small amount of spots in medical schools, these programs should produce plenty of candidates of all races. If there is a dearth of candidates, it is because of other issues like actually wanting to go to school for close to a decade post HS or opportunity costs of becoming a doctor for folks who come out of poverty settings.

Now if we were talking about education in general, then we would have to look at the environments; nutritional deficiencies, violent crime, lack of fathers in the home, etc. before we look at the schools. Blaming schools is the easy way out. Poor schools is just another symptom of public policy herding poor people together into one big dysfunctional matrix.

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HardeeHo's avatar

"bad (inner city) schools are not the cause"? To a large extent the poverty stricken inner city schools are denied opportunities and those who escape them are quite exemplary. I did try to examine poverty levels in 1955 to now but can't find any ability to match circumstances, except now there seem to be many more black households with a single parent. I found https://blackdemographics.com/households/poverty/amp/ not helpful in understanding.

To my mind education is the only way out of poverty and then an environment allowing/creating children that can prosper.

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Dave's avatar

I never said poverty wasn't an issue, in fact I believe poverty IS the issue. In fact, I posted poverty rates earlier. The black poverty rate dropped from over 80% in 1940 to 55% in 1959. It's now 17% up from 16% pre-pandemic. My point always has been that by now there are plenty of Blacks living in the middle and upper middle classes attending suburban schools. The prep schools are now significantly more diverse adding more blacks into the potential medical school population. There are more than enough to fill medical schools quota's that is for sure. I'm not sure how many times I need to demonstrate/post the same set of facts. Along with the fact that few children of any race that grow up in poverty are matriculating to medical schools. This whole discussion of black poverty is a red herring when we are talking about medical schools.

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HardeeHo's avatar

I found it hard to get to poverty rates in earlier times. Your comment (https://sensiblemed.substack.com/p/does-black-representation-save-lives/comment/15033365) didn't cite the earlier numbers. Not to quibble "I believe poverty IS the issue" vs "poverty is a red herring". But we do agree that the pathway to medical school is missed by many. Perhaps learned helplessness along with low expectations might be an issue? Not everybody is excited by the prospect of a really long time in education and practicum.

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Dave's avatar

Poverty IMO is the important cultural/economic issue because it is what damages human health and welfare the most and can limit the ability of young students to learn. It's a red herring when it comes to medical school matriculation because almost all students heading into medical school came from economic situations way above poverty level no matter what their race is. And 83% of blacks don't live in poverty situations.

As to the stats, official data collecting on poverty only go back as far as 1959, anything before that is crude estimations. But, demographers are pretty good at using what was known to get good estimations, it just isn't going to be as accurate as after 1959. The current discourse on race leaves out the reality of 2023, instead pretending we are back in the 1950s or even further back.

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GBM's avatar

I served on a committee at the University of Arkansas for Medical Sciences in the 1980s which looked at the under-representation of blacks in the classes of UAMS, the only med school in the state. It became clear that there were too few qualified black students graduating from college to increase the meager % of Black med students (about 5%). We looked at the data and saw that to make a difference, a program would need to focus on students in junior high school, if not elementary school. This problem lingers today and the quality of early education leaves many children of color below average in testing and achievement. No bias of promotion from college to med school will make a difference. The ratio of Black women to Black men in med schools is quite uneven indicating that factors other than racism and intelligence are at play.

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Dave's avatar

We don't live in the same world as 1980. Black poverty, for example was 32% in 1980 and is currently 17%; 47% lower. In 1980 affirmative action was just starting, we are now 2 generations into affirmative action. Blacks living in the suburbs was 24% in 1980, now 54%, more than doubling.

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GBM's avatar

Academic achievement in black males has lagged behind. Quality of schools has NOT improved in any significant way. I wonder why. What do you think, Dave?

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Dave's avatar

I think you are wrong in your statement about quality of schools to begin with. With half of black families living in the suburbs now, they are receiving "better education." And I would also say that the important part of "black males" is the male part. Because males, in general, are "lagging behind" in academic achievment (over 60% of college undergraduates are women). HS drop out rates are higher for males than females and the gap is not trending down. While whites drop out less than blacks, the rates have been getting closer to together for 50 years and if present trajectories remain will be the same relatively soon.

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GBM's avatar

Then we have an important conundrum: why are black males still accepted at such a low rate despite interest on the part of so many DEI-endowed med schools? There is still social pathology within the young black male population. Perhaps there are many easier avenues to drive for young black men.

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Dave's avatar

Lots to unpack and I think a lot of unknowns. But, not going to med school is hardly a social pathology. But, what we do know is that you can't change the standards nor "encourage" your way to a higher ratio. Especially when you are discouraging all males at the same time.

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Dawn Hopkins's avatar

That is exactly what I was thinking too. All inequities cannot be solved by the government. A great shift in cultural expectations is needed more than government intervention.

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