The Steady Beat: Maintaining Nephrology's March toward Kidney Health Equity

Ray Bignall Ray Bignall, MD, FAAP, FASN, is chair of ASN's Health Care Justice Committee, associate professor of pediatrics in the Division of Nephrology and Hypertension at The Ohio State University College of Medicine, and chief diversity and health equity officer at Nationwide Children's Hospital in Columbus, OH.

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The last several years have seen efforts to advance health equity surge in popularity and attention. Across the United States, governments, corporations, and health care institutions have pledged their support to initiatives aimed at eliminating disparities in health outcomes and improving access to care, especially for historically marginalized and vulnerable populations. This focus took on a fierce urgency following the murder of George Floyd, the Movement for Black Lives, and the COVID-19 pandemic, which seemed to galvanize international attention on the matter. The kidney health community has led the way in many of these efforts—both in our progress and in acknowledgement of the work we have yet to do. Even our World Kidney Days have been dedicated to this work, with themes entitled “Kidney Health for All” since 2022 (1).

Time to celebrate? Not so fast! In fact, these nascent kidney health equity efforts have never faced more headwinds than they face today.

Increasingly, kidney health equity efforts must contend with the politics of cultural grievance. Sentiment in many communities against diversity, equity, and inclusion (DEI) has driven more than two dozen states’ legislatures to introduce bills that would target efforts to promote equity and diversity at public institutions, including state-affiliated academic hospitals (2). In Texas, the passage of recent laws to eliminate publicly funded DEI offices and to disrupt the delivery of gender-affirming care to youths has left health care practitioners deeply worried about their ability to ensure best outcomes for some of the state's sickest patients (3) and have resulted in institutions struggling to recruit diverse faculty (4). In Florida, passage of laws that overhaul DEI programs and immigration policy have many immigrants fearful to seek care at all (5). The US Supreme Court decision to strike down affirmative action in higher education (6) has likewise left many advocates for an inclusive and excellent kidney health workforce scrambling to adapt existing programming designed to maintain progress in workforce diversity that has resulted in nephrology being one of the most diverse subspecialties in the country (7). In addition to these legislative challenges, the post-pandemic and DEI-related “fatigue,” which threatens the organizational resolve to meet the challenges kidney health inequities pose for our patients, is matched only by the threat of complacency in the space, pushing the falsehood that “our work is done.”

Now more than ever, the kidney health community must commit itself to advancing equity and justice in kidney care. I propose we commit ourselves to two key areas in 2024:

  1. Diversify the impact: Initiatives that promote a diverse and inclusive workforce improve the working experience and work product of everyone in the field. Kidney health is advanced when the field is opened to minoritized and marginalized groups, “centering at the margins” the experiences of others. We should also broaden our appreciation of what diversity means. Remember: Dimensions of diversity are found in everyone. This may mean racial and ethnic diversity but also includes the experiences of other historically excluded groups, such as LGBTQ folks, women, immigrants, people with disabilities, and people from rural or indigenous communities. As colleagues and kidney health professionals, we all must work together to celebrate our differences and dismantle systems that marginalize some of us because of our differences.

  2. Demonstrate the progress: A PubMed search of the term “health equity” reveals tens of thousands of articles, with exponential growth in the last decade. However, although most of these articles provide an accounting of health equity challenges and propose potential solutions, fewer are dedicated to documenting progress toward health equity. If we do not celebrate our health equity success stories, we risk losing the motivation to make more progress! Successful kidney health equity efforts have enabled the elimination of race in estimating equations for the glomerular filtration rate (8) and have helped to close some pediatric kidney transplant disparities (9). Our field has maintained almost unrivaled workforce diversity (7), and advocacy efforts have led to novel public–private partnerships that champion innovation (10). Let us share these success stories widely in 2024 and challenge ourselves to reach even higher.

I am proud of who I am: a nephrologist, a pediatrician, a Black man in medicine, a first-generation American of immigrant parents, and an advocate for the broad and beautiful spectrum of patients and colleagues with whom I work. In 2024, I am looking forward to us continuing our important work together, championing one another, centering those who have been marginalized, and advancing the field. I hope you are too.


The author reports no conflicts of interest.