U.S. citizens who pledge allegiance to the flag finish with the phrase “and justice for all.” This month, let’s explore the concepts of justice and equity as they relate to diversity, inclusion and veterinary medicine.
Merriam-Webster dictionary defines justice as “the quality of being just, impartial or fair.” We all aspire to be fair and unbiased in our dealings with one another. But because of realities such as unconscious bias, fairness is not always a naturally occurring phenomenon. We are prone to making fairness concessions based on our biases, which can lead to unfair outcomes, such as disproportionate access to education or medical care, just to cite two examples.
Being fair often requires us to be deliberate in our application of rules and expectations. Meting out justice is not supposed to be an emotional endeavor. Being fair should simply require us to apply the standard in an impartial way that promotes equality. We are all for equality, right? Of course!
It’s Not Easy
We largely aim to create societies in which people are treated equally, irrespective of race, gender identity, socioeconomic and geographic background, ability, or any other difference. This is so clearly reflected in the coda of the Pledge of Allegiance, and it is a goal worthy of pursuit.
If only life were so simple, but it is not. Being fair and equitable requires some work.
Take, for instance, the following scenario. Two children are told they can have ice cream after they successfully complete their homework and earn a passing grade on the assignment. One completes the homework and earns a passing grade. The other child does not complete the assignment, is ineligible for ice cream and cries that this is not fair. The outcome might have felt unfair, but the application of the rules was impartial.
But what if we knew more about the two students? Would additional information and context affect the way we viewed fairness and equality?
What if you knew the assignment required computer and internet access? What if the student who successfully completed the assignment had access to both at home and the other child did not? What if you knew that the second child’s attempts to complete the assignment at the local library were thwarted by a lack of transportation and limited facility hours? What if you knew that the child asked the teacher for a comparable assignment that could be completed on paper but the request was denied?
If we knew all those things, would the denial of ice cream still be fair? I would argue emphatically, no. The child tried to achieve the goal, but numerous barriers that existed before the start of the task gave the child little chance of completing the assignment and being rewarded with ice cream.
While we cannot always know every backstory to every situation, approaching decision-making from an equity framework can help mitigate such disparities.
Guaranteed Access
Equity is a remediation of justice designed to supplement or expand the way we apply the rules. The pursuit of equity requires us to consider circumstances. In an equitable version of the ice cream example, the child without access to the tools to complete the assignment would, at a minimum, receive the assignment in an alternative, accessible format. The child could complete the assignment, which would then be graded and either the ice cream reward would be given or not based on the grade.
Equity is not about the guarantee of an equal outcome; rather, it is about the guarantee of access and the chance of an equal outcome. It is about acknowledging that there might be a need to level the playing field, and, if that is not possible, reconceptualizing fairness altogether.
The Vet School Example
There are two circumstances in which I see the dilemmas of fairness and equity play out in veterinary medicine: the process of applying to veterinary school and the efforts to serve low-income or marginalized communities.
In the most recent application cycle, research conducted by the Association of American Veterinary Medical Colleges found that nearly 30 percent of veterinary school applicants were first-generation college attendees, 30 percent were from low-income backgrounds and 20 percent were from rural backgrounds. There is a lot of overlap among these populations, and they are geographically dispersed and racially diverse as well.
The research showed that these populations are more likely to not have family financial support, to work full time during college, to attend college part time, to struggle to accumulate experiential hours, and to have limited or no access to test prep programs for the Graduate Record Examination, often resulting in a less competitive scoring profile. These candidates are statistically less likely to be admitted to veterinary school, and those offered admission are likely to receive only one offer.
Traditional methods of evaluating applicants for veterinary school admission are not designed to consider applicants beyond rigid academic and testing metrics. These applicants present competitive academic profiles, but a broader understanding of their challenges reveals attributes like resilience, creative problem solving and a strong work ethic that are all associated with academic and professional success.
Approaches to applicant evaluations that embrace a holistic review of the candidates provide a richer profile of potential students and allow admissions committees to more equitably assess for admission. This does not guarantee admission, but it does improve the applicants’ chances of an equitable assessment of their application.
Where Few Vets Practice
The American Veterinary Medical Association in recent years has reported a maldistribution of companion animal veterinarians; some communities lack access to veterinary care. There is an understanding that some communities are not economically equipped to support a high- or even mid-range veterinary clinic, which is why professionals might seek to create a business in a more-affluent area. This is completely understandable. It remains true, however, that many of these communities remain underserved by the veterinary profession through no fault of their own.
In passing, I occasionally hear rumblings that members of these kinds of communities probably should not own pets if they cannot afford or otherwise access veterinary care. We know of the wonderful benefits of pet ownership. Are these folks not worthy to benefit as well?
The reality is that people will own animals and that the circumstances of pet ownership will vary greatly. Our collective goal is to make sure that animal health is protected and society is served. Applying an equity framework to solve the problem of lack of access to veterinary medical care behooves us to consider new and creative practice models that will expand access to care and maintain or even increase practice profitability.
As we consider the future of veterinary medicine, many opportunities exist to embrace both fairness and equity in a way that expands the overall reach of the profession. Considering the circumstances of veterinary school applicants and the clients who seek medical care can only strengthen the profession.