The Benefits of “Bottom Up” Approaches in Affirmative Action

Affirmative action policies often encounter resistance even among those groups who they are designed to help. One of the reasons for this is that they are typically implemented in a “top down” fashion: Those in leadership positions within or outside of an organisation identify the need for affirmative action, decide on the policies and “force” them on the organisation.

A study by Louise McCall and colleagues addresses this issue by investigating whether a “bottom up” approach is more effective. They used focus groups to raise awareness of the under-representation of women in senior positions in academic medicine and to develop equal opportunity strategies. This approach did indeed result in a number of benefits. Not only did members of the focus groups come up with their own ideas of addressing gender inequality, but members of the faculty were also more accepting and supportive of the developed affirmative action strategies.

Lack of acceptance of affirmative action has been shown to be one of the main barriers to its effectiveness. Using focus groups or other “bottom up” approaches might be a great way of circumventing this problem and tackling inequality issues more effectively.

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Class-Based Affirmative Action in Medicine

Although women remain under-represented in surgery, there has been a huge change in the number of women in medicine in general and they now make up about half of new medical students. Unfortunately, things look quite different with regards to socioeconomic status (SES).

Speaking from an American perspective Stephen Magnus and Stephen Mick discuss the literature on whether medical school should adopt an affirmative action approach with regards to social class and come to the conclusion that this may indeed be beneficial for a number of reasons. First and foremost, it would contribute to presenting equal opportunities to all members of societies. Lower SES students have to face a variety of additional obstacles compared to their higher SES counterparts and affirmative action would counteract some of these obstacles.

In addition to that, the authors also make compelling arguments that affirmative action policies would benefit lower SES patients as well. First, evidence suggests that doctors from lower SES backgrounds are better at communicating with lower SES patients and second, doctors from lower SES backgrounds are more likely to offer medical services to lower SES patients in the first place.

On the other hand, critics of affirmative action often argue that these policies stigmatise minority groups, who are already battling with negative stereotypes. What do you think?