Diversity, Equity, Inclusion, and Justice Yesterday, Today, and Tomorrow. ASN Executive Vice President's Update

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In 1960, my father immigrated to the United States to avoid religious persecution, experienced racism in Ohio, overstayed his student visa, and was considered “illegal.” My mother—whose family has deep, often racist, roots in the United States—eloped with my father, helped him become a US citizen, experienced sexism (especially in the workplace), worked for two female members of Congress, and volunteered as a counselor during the AIDS crisis.

Their individual and shared experiences shape my commitment to diversity, equity, inclusion, and justice. The American Society of Nephrology (ASN) was a pacesetter—and is now an advocate—in this arena because its members, leaders, and staff share the same commitment.

Valuing people from different races, ethnicities, cultures, and gender identities and expressions makes an organization diverse. An equitable organization treats everyone fairly, impartially, and justly. By involving, accommodating, and embracing people who have historically been excluded, an organization is inclusive. Starting (essentially) at “square one” a decade ago, ASN has increasingly promoted diversity, equity, and inclusiveness “to enhance the nephrology profession and the lives of people with kidney diseases through improved health care, research, and education” (1).

ASN has increasingly promoted diversity, equity, and inclusiveness “to enhance the nephrology profession and the lives of people with kidney diseases through improved health care, research, and education.”

Of the more than 37 million people with kidney diseases in the United States, a disproportionate number are Black or African American, Hispanic or Latinx, Indigenous or Native American, Asian American, and Native Hawaiian or other Pacific Islanders. Disproportionately, people with kidney diseases also have lower socioeconomic status. As is well documented, the kidney health of these Americans is unacceptable (2). Achieving health care justice for them requires the following:

• Identifying opportunities to promote fairness in health care and society

• Influencing social determinants of health, particularly in populations at risk for and overburdened with kidney diseases

• Acknowledging that all kidney health policy should be rooted in the principle of justice

• Making it incumbent on all kidney health professionals to seek just, equitable social conditions for their patients, their colleagues, and their communities (3)

Teams, medical specialties, and associations that embrace diversity, equity, inclusion, and justice make better decisions, are more innovative, perform at a higher level, experience less turnover, are considered more satisfying workplaces, and are financially more profitable (4). Compelling data underscore this reality. Such a culture also reveres empathy. As the poet Lucille Clifton observed, “Every pair of eyes facing you has probably experienced something you could not endure” (5).

Promoting diversity, equity, and inclusion among kidney health professionals depends on “some of the same solutions” as health care justice but often necessitates “different sets of strategies—at the levels of federal and local policies, multisector and community-academic partnerships, institutional policies and practices, individual and social group attitudinal and behavioral change—and targeted interventions to address not only organizational but also broader social and environmental influences on health,” according to ASN Secretary Deidra C. Crews, MD, ScM, FASN, and colleagues (6).

By making a public commitment, examining the society, establishing a presence, funding the next generation, continuing to learn, and addressing policy issues, ASN has created a strong foundation in diversity, equity, inclusion, and justice (Table 1). The society's leadership, staff, and I are committed to building on this bedrock in 2022 and beyond.

Table 1

ASN's activities for promoting diversity, equity, inclusion, and justice

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In addition to continuing many of the 26 activities listed in Table 1, ASN has identified five priorities centered on diversity, equity, inclusion, and justice for 2022. First, ASN must continue working with the National Kidney Foundation (NKF) to implement recommendations from the NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Diseases. ASN is responsible for addressing the legislative and regulatory issues related to the task force's recommendations, including the need to encourage and fund “research on [glomerular filtration rate] GFR estimation with new endogenous filtration markers and on interventions to eliminate racial and ethnic disparities” (7). This recommendation compels KidneyCure (established in 2012 as the ASN Foundation for Kidney Research) to enhance its grant portfolio as well.

Last month, ASN participated in a workshop, “Designing Interventions That Address Structural Racism to Reduce Kidney Health Disparities.” The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) held the workshop to review how structural racism contributes to health and health disparities for people with kidney diseases, as well as to “identify feasible areas for intervention,” including “study designs needed to evaluate potential interventions” (8). NIDDK will summarize the results of the workshop in the near future.

Second, the society launched the ASN Health Care Justice Committee in March 2021. Recently, the ASN Council discussed the committee's first set of recommendations. In the coming months, ASN will announce specific plans to pursue justice in medical education, scholarship, clinical care, innovation, and advocacy. Following the committee's advice, for example, Kidney Week 2022 will include a “Health Equity” abstract category.

In 2020, I served as president of the Council of Medical Specialty Societies (CMSS), a coalition of 47 medical specialty societies (including ASN) that represents more than 800,000 US physicians. Last year, CMSS partnered with the Accreditation Council for Graduate Medical Education to launch “Equity Matters: A Diversity, Equity, Inclusion, and Antiracism Initiative for Physicians and Medical Leadership.”

ASN's third priority is to initiate a “capstone project” with other specialty societies as part of “Equity Matters.” This project will result in concrete recommendations for increasing the pool of US medical school applicants who identify as underrepresented in medicine, improving the likelihood of their acceptance and enrollment, and reducing barriers to their successful graduation to residency training and beyond.

CMSS also plays a key role in ASN's fourth priority. Earlier this year, CMSS worked with the American Medical Women's Association, Executive Leadership in Academic Medicine, and other leading groups to establish a new alliance: the Gender Equity in Academic Medicine and Science Alliance (GEMS Alliance). The GEMS Alliance will work collectively to ensure that “all women achieve their full potential in advancing medicine and science” (9).

As its fifth priority, ASN responded last month to a request from the US Centers for Medicare & Medicaid Services “seeking public comment that will help to inform potential changes that would create system-wide improvements, which would further lead to improved organ donation, organ transplantation, quality of care in dialysis facilities, and improved access to dialysis services” (10). In its 71-page response, ASN provided specific suggestions to the federal government and emphasized: “Developing system-wide improvements that address inequitable access to kidney transplantation and home dialysis could have a strong and lasting positive impact for patients with kidney failure.”

To strengthen, target, and increase the likely success of its current and future initiatives to promote diversity, equity, inclusion, and justice, ASN is enhancing the collection of member demographic information and understanding of its members. In the future, ASN plans to:

1. Publish an anti-racism toolkit on its website.

2. Continue to refine the ASN Loan Mitigation Pilot Program. All six of the program's first participants will start nephrology fellowships on July 1, 2022.

3. Seek options for assessing workplace culture.

4. Facilitate conversations among the US Food and Drug Administration, commercial entities, the society's members, and other stakeholders on setting guidelines and developing tools to promote increased diversity of participants in clinical trials.

5. Engage with Historically Black Colleges and Universities, Hispanic-Serving Institutions, and others to reach potential health professionals, researchers, and scientists from groups underrepresented in medicine.

A pacesetter yesterday. An advocate today. An innovator tomorrow. ASN is fully committed to promoting diversity, equity, inclusion, and justice in nephrology, health care and science, and broader society.