DEI Glossary of Terms

Ableism 

Dictionary: Discrimination or prejudice against individuals with disabilities. (Source: Merriam Webster)

Government: Ableism is the intentional or unintentional discrimination or oppression of individuals with disabilities. (Source: Ability. National Conference for Community and Justice.)

Source: Ableism topic for SAEM DEI Curriculum, in publication Author(s): Cori Poffenberger MD and Richie Sapp MD MS, Formal Title: Understanding and Combating Ableism in Medicine: Promoting Access and Inclusion for Individuals with Disabilities Through Systemic Change 

Accessibility

Dictionary: 1) Easily used or accessed by people with disabilities; 2) adapted for use by people with disabilities. (Source: Merriam Webster)

Government: The term “accessibility” means the design, construction, development, and maintenance of facilities, information and communication technology, programs, and services so that all people, including people with disabilities, can fully and independently use them.  Accessibility includes the provision of accommodations and modifications to ensure equal access to employment and participation in activities for people with disabilities, the reduction or elimination of physical and attitudinal barriers to equitable opportunities, a commitment to ensuring that people with disabilities can independently access every outward-facing and internal activity or electronic space, and the pursuit of best practices such as universal design. (Source: Executive Order on Diversity, Equity, Inclusion, and Accessibility in the Federal Workforce. The White House.)

"Accessible" means a person with a disability is afforded the opportunity to acquire the same information, engage in the same interactions, and enjoy the same services as a person without a disability in an equally effective and equally integrated manner, with substantially equivalent ease of use. The person with a disability must be able to obtain the information as fully, equally and independently as a person without a disability. (Source: Accessibility and its importance for individuals with disabilities. Indiana University.)

Disability Humility: Disability humility refers to learning about experiences, cultures, histories, and politics of disability, recognizing that one's knowledge and understanding of disability will always be partial, and acting and judging in light of that fact. (Reynolds J. M. (2018). Three Things Clinicians Should Know About Disability. AMA journal of ethics, 20(12), E1181–E1187. From Three Things Clinicians Should Know About Disability

Age

Dictionary: 1) The time of life at which some particular qualification, power, or capacity arises or rests; 2) one of the stages of life; 3) the length of an existence extending from the beginning to any given time; 4) lifetime; 5) an advanced stage of life. (Source: Merriam Webster)

Government: Age means how many years old you are. You reach a particular age on the day before your birthday. For example, if your sixty-second birthday is on July 1, 1979, you became age 62 on June 30, 1979. (Source: Code Of Federal Regulations)

• Legal age:  The age at which a person enters into full adult legal rights and responsibilities (as of making contracts or wills). (Source: Merriam Webster) 
  
• Age of majority: The age at which a person is granted by law the rights (as ability to sue) and responsibilities (as liability under contract) of an adult. (Source: Merriam Webster) 

Medicine: Reported as age at last birthday (that is, age in completed years), often calculated by subtracting a person’s date of birth from the reference date, with the reference date being the date of examination, interview, or other contact. (Source: National Center for Health Statistics)

Ageism

Dictionary: Prejudice or discrimination against a particular age-group and especially the elderly. (Source: Merriam Webster) 

Government: Age discrimination involves treating an applicant or employee less favorably because of his or her age. (Source: U.S. Equal Employment Opportunity Commission) 

The Age Discrimination Act of 1975 prohibits discrimination on the basis of age in programs and activities receiving federal financial assistance. The Act, which applies to all ages, permits the use of certain age distinctions and factors other than age that meet the Act's requirements. The Age Discrimination Act is enforced by the Civil Rights Center. The Age Discrimination in Employment Act of 1967 (ADEA) protects certain applicants and employees 40 years of age and older from discrimination on the basis of age in hiring, promotion, discharge, compensation, or terms, conditions or privileges of employment. The ADEA is enforced by the Equal Employment Opportunity Commission. (Source: U.S. Department of Labor) 

Medicine: Age is often used to categorize and divide people in ways that lead to harm, disadvantage and injustice and erode solidarity across generations. (Source: World Health Organization )

Ally 

Dictionary: One that is associated with another as a helper: a person or group that provides assistance and support in an ongoing effort, activity, or struggle. (Source: Merriam Webster)

Allyship

Dictionary: 1) The state or condition of being an ally; 2) supportive association with another person or group; 3) specifically: such association with the members of a marginalized or mistreated group to which one does not belong. (Source: Merriam Webster)

Government: "When a person of privilege works in solidarity and partnership with a marginalized group of people to help take down the systems that challenge that group's basic rights, equal access, and ability to thrive in our society". (Source:  What Is Allyship? National Institutes of Health, Office of Equity, Diversity, and Inclusion.)

Medicine: A lifelong process of building relationships based on trust, consistency, and accountability with marginalized individuals and/or groups of people. (Source: Forbes)

“Allies are people who recognize the unearned privilege they receive from society’s patterns of injustice and take responsibility for changing these patterns.” Anne Bishop; (Source: A Guide to Allyship, AAMC)

Additional resource: Binstadt E. Standing Up to Injustice from a Position of Privilege: Bystanders, Upstanders, and Allyship. DEI Curriculum, Society for Academic Emergency Medicine.

Bias

Dictionary: 1) An inclination of temperament or outlook especially; 2) a personal and sometimes unreasoned judgment. 3) An instance of such prejudice. (Source: Merriam Webster)

Government: Bias is a human trait resulting from our tendency and need to classify individuals into categories as we strive to quickly process information and make sense of the world. (Source: Understanding Bias: A Resource Guide)

Medicine: Bias is the evaluation of something or someone that can be positive or negative, and implicit or unconscious bias is when the person is unaware of their evaluation. It is negative implicit bias that is of particular concern within healthcare. (Source: Gopal DP, Chetty U, O'Donnell P, Gajria C, Blackadder-Weinstein J. Implicit bias in healthcare: clinical practice, research and decision making. Future Healthc J. 2021 Mar;8(1):40-48. doi: 10.7861/fhj.2020-0233. PMID: 33791459; PMCID: PMC8004354.)

“Biases are preconceived notions based on beliefs, attitudes, and/or stereotypes about people pertaining to certain social categories that can be implicit or explicit. Because biases can be based on stereotypes rather than beliefs, an individual can hold a negative bias toward a group without believing that negative bias is true... Nevertheless, biases based on stereotypes rather than beliefs may still affect behavior.  …While bias can lead to discriminatory behavior, it does not always. Notably, both individuals and institutions can be discriminatory” (Source: Mateo, Camila M. MD, MPH; Williams, David R. PhD, MPH More Than Words: A Vision to Address Bias and Reduce Discrimination in the Health Professions Learning Environment, Academic Medicine: December 2020 - Volume 95 - Issue 12S - p S169-S177 doi: 10.1097/ACM.0000000000003684)

Types of Bias:

Implicit Bias: Implicit bias, also known as implicit prejudice or implicit attitude, is a negative attitude, of which one is not consciously aware, against a specific social group (Source: American Psychological Association).

When bias occurs outside of the perceiver’s awareness, it is classified as “implicit bias” (Source: Confronting Prejudice: How to Protect Yourself and Help Others. the Online Master of Psychology program from Pepperdine University.)

Affinity bias: “is the unconscious tendency to show preference for those who are like us. This bias often shows up in the hiring process as we search for candidates that “fit” the culture of the department”. (Source: Understanding the impact of unconscious bias in a university setting: A module for faculty and staff at Brown. Discussion Guide.)

BIPOC (Black, Indigenous, (and) People of Color) 

Dictionary: POC is widely used as an umbrella term for all people of color, but now a different acronym is suddenly gaining traction on the internet—BIPOC, which stands for Black, Indigenous, People of Color. People are using the term to acknowledge that not all people of color face equal levels of injustice. They say BIPOC is significant in recognizing that Black and Indigenous people are severely impacted by systemic racial injustices.—Chevaz Clarke

In recent weeks, as protests against police brutality and racism have flooded the streets and social media, another more inclusive term has been ascribed to the population: BIPOC. The acronym stands for "black, Indigenous and people of color."—Sandra E. Garcia (Source: Merriam Webster)

Government and Medicine: Black, Indigenous, and People of Color (BIPOC) from stigmatized and marginalized communities face implicit bias in medicine. Bias toward historically marginalized patients affects patient-provider interactions and can lead to lower quality of care and poor health outcomes for patients who are BIPOC.

(Source: Casanova-Perez R, Apodaca C, Bascom E, Mohanraj D, Lane C, Vidyarthi D, Beneteau E, Sabin J, Pratt W, Weibel N, Hartzler AL. Broken down by bias: Healthcare biases experienced by BIPOC and LGBTQ+ patients. AMIA Annu Symp Proc. 2022 Feb 21;2021:275-284. PMID: 35308990; PMCID: PMC8861755.)

(Source: Kabir, R., & Zaidi, S. T. (2022). Implicit bias against BIPOC patients in clinical settings: A qualitative review.  Spectra Undergraduate Research Journal, 2(1), 28-46.)

Cultural appropriation

Dictionary: “The unacknowledged or inappropriate adoption of the practices, customs, or aesthetics of one social or ethnic group by members of another (typically dominant) community or society.” (Source: Oxford English Dictionary)

Society (Government and Medicine): The unacknowledged or inappropriate adoption of the customs, practices, ideas, etc. of one people or society by members of another and typically more dominant people or society. 

Though there is criticism for the term, “as we look more closely at the entrenched inequality in the history of cultural exchange, it becomes clear that the term “cultural appropriation” is simply giving a name to the exploitation that has always existed and continues to this day. Cultural appropriation allows people to be rewarded for the heritage and labor of oppressed and marginalized communities, disregards the origins and significance of what is being taken, and embraces the products of a culture while reinforcing or ignoring the prejudice experienced by the people who originated it.” (Source: Boston Medical Center) 

Cultural appropriation is the practice of using or taking something from another culture without giving proper recognition or respect to that culture. Cultural appropriation means using a racial, religious, or social group's customary beliefs, social forms, and material traits without authority or right. It's taking those cultural identities and pretending they are a part of your background. The opposite of cultural appropriation is cultural appreciation. Cultural appreciation is celebrating or showing respect or honor for a culture. (Source: Harmful Effects of Cultural Appropriation)

Culture

Dictionary: a. The customary beliefs, social forms, and material traits of a racial, religious, or social group also: the characteristic features of everyday existence (such as diversions or a way of life) shared by people in a place or time. b. the set of shared attitudes, values, goals, and practices that characterizes an institution or organization. c. the set of values, conventions, or social practices associated with a particular field, activity, or societal characteristic. d. the integrated pattern of human knowledge, belief, and behavior that depends upon the capacity for learning and transmitting knowledge to succeeding generations (Source: Merriam Webster)

Government: Culture can be defined by group membership, such as racial, ethnic, linguistic, or geographical groups, or as a collection of beliefs, values, customs, ways of thinking, communicating, and behaving specific to a group. (Source: Centers for Disease Control and Prevention)

Medicine: Culture is often described as the combination of a body of knowledge, a body of belief, and a body of behavior. It involves several elements that are often specific to ethnic, racial, religious, geographic, or social groups. This includes personal identification, language, thoughts, communications, actions, customs, beliefs, values, and institutions. For the provider of health information or health care, these elements influence beliefs and belief systems surrounding health, healing, wellness, illness, disease, and delivery of health services. The concept of cultural respect has a positive effect on patient care delivery by enabling providers to deliver services that are respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients. (Source: Boston Medical Center)

Disadvantaged Background

Government and Medicine: NIH definition: 

An individual is considered to be from a disadvantaged background if he or she meets two or more of the following criteria:

1. Were or currently are homeless, as defined by the McKinney-Vento Homeless Assistance Act;
2. Were or currently are in the foster care system, as defined by the Administration for Children and Families;
3. Were eligible for the Federal Free and Reduced Lunch Program for two or more years (Source: Income Eligibility Guidelines);
4. Have/had no parents or legal guardians who completed a bachelor’s degree (Source: First-Generation and Continuing-Generation College Students: A Comparison of High School and Postsecondary Experiences);
5. Were or currently are eligible for Federal Pell grants;
6. Received support from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) as a parent or child (Source: WIC Eligibility Requirements).

Discrimination

Dictionary: 1) prejudiced or prejudicial outlook, action, or treatment; 2) the act, practice, or an instance of discriminating categorically rather than individually (Source: Merriam Webster)

Government: The differential treatment of an individual or group of people based on their race, color, national origin, religion, sex (including pregnancy and gender identity), age, marital and parental status, disability, sexual orientation, or genetic information. (Source: Discrimination, Harassment, Harassing Conduct, and Retaliation Defined)

Medicine: Discrimination in the healthcare setting can be defined as negative actions or lack of consideration given to an individual or group that occurs because of a preconceived and unjustified opinion. It is worth noting that individuals do not need to be members of an unfairly treated group to experience discrimination against that group. Discrimination can occur based upon perceived membership.  Furthermore, harm does not need to occur for discrimination to exist. A group may be discriminated against if they receive something of less value than another group solely because of their race, ethnicity, gender, disability, social class, socioeconomic status, sexual orientation, gender identity, primary spoken language, or location of residence. (Source: Diversity and Discrimination in Healthcare )

Diversity

Dictionary: 1) The condition of having or being composed of differing elements; especially: the inclusion of people of different races, cultures, etc. in a group or organization (Source: Merriam Webster)

Government: The term “diversity” means the practice of including the many communities, identities, races, ethnicities, backgrounds, abilities, cultures, and beliefs of the American people, including underserved communities. (Source: Executive Order on Diversity, Equity, Inclusion, and Accessibility in the Federal Workforce)

Medicine: Diversity refers to the identities we carry. There are many kinds of diversity, based on race, gender, sexual orientation, class, age, country of origin, education, religion, geography, physical or cognitive abilities, or other characteristics. Valuing diversity means recognizing differences between people, acknowledging that these differences are a valued asset, and striving for diverse representation as a critical step towards equity. (Source: American Medical Association and Association of American Medical Colleges. Advancing Health Equity: Guide on Language, Narrative and Concepts.)

Equity

Dictionary: 1) justice according to natural law or right, specifically; 2) freedom from bias or favoritism; 3) something that is equitable (Source: Merriam Webster)

Government: The term “equity” means the consistent and systematic fair, just, and impartial treatment of all individuals, including individuals who belong to underserved communities that have been denied such treatment. (Source: Executive Order on Diversity, Equity, Inclusion, and Accessibility in the Federal Workforce)

Medicine: For the purposes of measurement and operationalization, equity in health is the absence of systematic disparities in health (or in the major social determinants of health) between groups with different levels of underlying social advantage/disadvantage—that is, wealth, power, or prestige. Inequities in health systematically put groups of people who are already socially disadvantaged (for example, by virtue of being poor, female, and/or members of a disenfranchised racial, ethnic, or religious group) at further disadvantage with respect to their health; health is essential to wellbeing and to overcoming other effects of social disadvantage. Equity is an ethical principle; it also is consonant with and closely related to human rights principles. The proposed definition of equity supports operationalization of the right to the highest attainable standard of health as indicated by the health status of the most socially advantaged group. Assessing health equity requires comparing health and its social determinants between more and less advantaged social groups. These comparisons are essential to assess whether national and international policies are leading toward or away from greater social justice in health. (Source: Braveman P, Gruskin S. Defining equity in health. J Epidemiol Community Health. 2003 Apr;57(4):254-8. doi: 10.1136/jech.57.4.254. PMID: 12646539; PMCID: PMC1732430.)

Ethnicity

Dictionary: The fact or state of belonging to a social group that has a common national or cultural tradition.

Government: There are two categories for data on ethnicity: "Hispanic or Latino," and "Not Hispanic or Latino."

Medicine: The American Sociological Association defines ethnicity as “shared culture, such as language, ancestry, practices, and beliefs.”

(Source: Flanagin A, Frey T, Christiansen SL, Bauchner H. The Reporting of Race and Ethnicity in Medical and Science Journals: Comments Invited. JAMA. 2021;325(11):1049–1052. doi:10.1001/jama.2021.2104)

Gender Identity

Dictionary: The psychological sense of the self as masculine or feminine. This is not always the same as gonadal sex. A few individuals who are genetically members of one sex feel and act as though they are members of the other sex.

Government: Gender identity means one’s inner sense of one’s own gender, which may or may not match the sex assigned at birth. Different people choose to express their gender identity differently. For some, gender may be expressed through, for example, dress, grooming, mannerisms, speech patterns, and social interactions. Gender expression usually ranges between masculine and feminine, and some transgender people express their gender consistent with how they identify internally, rather than in accordance with the sex they were assigned at birth. (Source: Addressing Sexual Orientation and Gender Identity Discrimination in Federal Civilian Employment)

Medicine: Gender identity: A person’s inner sense of being a girl/woman, boy/man, some combination of both, or something else, including having no gender at all. This may or may not correspond to one's sex assigned at birth. (Source: Addressing Sexual Orientation and Gender Identity Discrimination in Federal Civilian Employment)

Gender identity, which is a core element of a person’s individual identity. Gender expression, which is how a person signals their gender to others through their behavior and appearance (such as hair style and clothing) (Source: Measuring Sex, Gender Identity, and Sexual Orientation)

Harassment

Dictionary: 1) An act or instance of harassing; torment, vexation, or intimidation; 2) The condition or fact of being harassed (Source: Dictionary.com)

Government: Unwelcome conduct that is based on race, color, religion, sex, national origin, age, disability or genetic information. Harassment becomes unlawful where enduring the offensive conduct becomes a condition of continued employment or the conduct is sufficiently severe or pervasive to create a work environment that a reasonable person would consider intimidating, hostile, or abusive. (Source: Discrimination, Harassment, Harassing Conduct, and Retaliation Defined)

Medicine: Harassment in the field of medicine is common, but the odds of harassment are higher for trainees  (and increase with length of training), women, international medical graduates, members of the lesbian, gay, bisexual, transgender, queer or questioning, 2-spirit (LGBTQ2+) community, and physicians of color. (Source: Siad FM, Rabi DM. Harassment in the Field of Medicine: Cultural Barriers to Psychological Safety. CJC Open. 2021 Sep 23;3(12 Suppl):S174-S179. doi: 10.1016/j.cjco.2021.08.018. PMID: 34993446; PMCID: PMC8712706.)

Implicit Bias

Definition: Implicit bias, also known as implicit prejudice or implicit attitude, is a negative attitude, of which one is not consciously aware, against a specific social group (Source: American Psychological Association).

Inclusion

Dictionary: 1) The act of including; 2) the state of being included. 3) The act or practice of including students with disabilities with the general student population. 4) The act or practice of including and accommodating people who have historically been excluded (as because of their race, gender, sexuality, or ability) (Source: Merriam Webster) 

Government: The term “inclusion” means the recognition, appreciation, and use of the talents and skills of employees of all backgrounds. (Source: Executive Order on Diversity, Equity, Inclusion, and Accessibility in the Federal Workforce)

Medicine: Throughout all facets of healthcare, race/ethnicity, gender, sexual orientation, immigration status, physical disability status, socioeconomic level plays a role in representation, acceptance, and progress both within and outside of the healthcare setting. (Source: Stanford FC. The Importance of Diversity and Inclusion in the Healthcare Workforce. J Natl Med Assoc. 2020 Jun;112(3):247-249. doi: 10.1016/j.jnma.2020.03.014. Epub 2020 Apr 23. PMID: 32336480; PMCID: PMC7387183.)

Justice

Dictionary: 1) The maintenance or administration of what is just especially by the impartial adjustment of conflicting claims or the assignment of merited rewards or punishments; 2) The administration of law, especially; 3) the establishment or determination of rights according to the rules of law or equity (Source: Merriam Webster) 

Government: The mission of the Department of Justice is to uphold the rule of law, to keep our country safe, and to protect civil rights (Source: U.S. Department of Justice)

Medicine: Health justice: a jurisprudential and legislative framework for the achievement and delivery of health equity and social justice. (Source: Benfer EA. Health Justice: A Framework (and Call to Action) for the Elimination of Health Inequity and Social Injustice. Am Univ Law Rev. 2015;65(2):275-351. PMID: 28221739.)

Health justice is both a community-led movement for power building and transformational change and a community-oriented framework for health law scholarship. Health justice is distinguished by a distinctively social ethic of care that reframes the relationship between health care, public health, and the social determinants of health, and names subordination as the root cause of health inequities. (Source: Wiley LF, Yearby R, Clark BR, Mohapatra S. INTRODUCTION: What is Health Justice? J Law Med Ethics. 2022;50(4):636-640. doi: 10.1017/jme.2023.2. PMID: 36883386; PMCID: PMC10009391.’)

Race

Dictionary:  Each of the major groupings into which humankind is considered (in various theories or contexts) to be divided on the basis of physical characteristics or shared ancestry. 

Government: Social definition of race recognized in this country and not an attempt to define race biologically, anthropologically, or genetically. The standards have five categories for data on race: American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White. (Source: United States Census Bureau. About the topic of race. Published January 23, 2018.)

Medicine: Race is a social construct that is used to group people based on physical characteristics, behavioral patterns, and geographic location. Racial categories are broad, poorly defined, vary by country and change over time.

Racism

Dictionary: 1) A belief that race is a fundamental determinant of human traits and capacities and that racial differences produce an inherent superiority of a particular race also; 2) Behavior or attitudes that reflect and foster this belief; 3) Racial discrimination or prejudice. 4) The systemic oppression of a racial group to the social, economic, and political advantage of another; 5) a political or social system founded on racism and designed to execute its principles (Source: Merriam Webster)

Government: Race discrimination involves treating someone (an applicant or employee) unfavorably because he/she is of a certain race or because of personal characteristics associated with race (such as hair texture, skin color, or certain facial features). Color discrimination involves treating someone unfavorably because of skin color complexion. Race/color discrimination also can involve treating someone unfavorably because the person is married to (or associated with) a person of a certain race or color. Discrimination can occur when the victim and the person who inflicted the discrimination are the same race or color. The law forbids discrimination when it comes to any aspect of employment, including hiring, firing, pay, job assignments, promotions, layoff, training, fringe benefits, and any other term or condition of employment. (Source: U.S. Equal Employment Opportunity Commission) 

Societal: Racism is not just individual prejudice -  but a hierarchical system based on race, created and maintained by unequal distribution of power/resources.

Dr. Camara Jones highlights that there are 3 different types of racism:

1. Institutionalized racism: systematically created differential access to the goods, services, and opportunities of society by race.
2. Personally mediated racism: prejudice and discrimination, where prejudice means differential assumptions about the abilities, motives, and intentions of others according to their race, and discrimination means differential actions toward others according to their race. (In short prejudice is the negative thoughts and discrimination is the actions these thoughts engender). This is what most people think of when they hear the word “racism.” Personally mediated racism can be intentional as well as unintentional
3. Internalized racism: acceptance by members of stigmatized races of negative messages about their own abilities and intrinsic worth. It is characterized by their not believing in others who look like them, and not believing in themselves.

Medicine: Racism is a system—consisting of structures, policies, practices, and norms—that assigns value and determines opportunity based on the way people look or the color of their skin. This results in conditions that unfairly advantage some and disadvantage others throughout society. Racism—both interpersonal and structural —negatively affects the mental and physical health of millions of people, preventing them from attaining their highest level of health, and consequently, affecting the health of our nation. A growing body of research shows that centuries of racism in this country has had a profound and negative impact on communities of color. The data show that racial and ethnic minority groups, throughout the United States, experience higher rates of illness and death across a wide range of health conditions, including diabetes, hypertension, obesity, asthma, and heart disease, when compared to their White counterparts. Additionally, the life expectancy of non-Hispanic/Black Americans is four years lower than that of White Americans. (Source: Centers for Disease Control and Prevention. Racism and Health.)

Sexism

Dictionary: 1) prejudice or discrimination based on sex, especially; 2) discrimination against women; 3) behavior, conditions, or attitudes that foster stereotypes of social roles based on sex (Source: Merriam Webster)

Government: Sexism, defined as prejudice or discrimination based on one’s sex, stems from an ideology that one sex is superior to the other (Source: Centers for Disease Control and Prevention. Genderism, Sexism, and Heterosexism. Published September 1, 2023.)

Medicine:  Patronizing, gender-stereotyping comments from patients include calling female doctors “honey” or “sweetie,” viewing young female physicians as inexperienced, asking intrusive personal questions, and tacitly presuming men are physicians. (Source:  Manzoor, Fizza, and Donald A Redelmeier. “Sexism in medical care: "Nurse, can you get me another blanket?" CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne  vol. 192,5 (2020): E119-E120. doi:10.1503/cmaj.19118)

Sexual Orientation

Dictionary: a person's identity in relation to the gender or genders to which they are sexually attracted; the fact of being heterosexual, homosexual, etc.

Government: Sexual orientation means one’s emotional or physical attraction to the same and/or opposite sex. (Source: Addressing Sexual Orientation and Gender Identity Discrimination in Federal Civilian Employment)

Medicine: Sexual orientation is a multidimensional construct encompassing emotional, romantic, and sexual attraction, identity, and behavior. 

(Source: National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Committee on National Statistics; Committee on Measuring Sex, Gender Identity, and Sexual Orientation; Becker T, Chin M, Bates N, editors. Measuring Sex, Gender Identity, and Sexual Orientation. Washington (DC): National Academies Press (US); 2022 Mar 9. 1, Introduction and Background.)

Association of American Indian Physicians (AAIP)

The AAIP Mission Statement: “to pursue excellence in Native American health care by promoting education in the medical disciplines, honoring traditional healing practices and restoring the balance of mind, body and spirit”

Reference: pipelines -> pathways

(Source: University S, Stanford, California 94305. From pipelines to pathways: Researchers call for a new approach to studying academic progress. Stanford Graduate School of Education.)

Association of American Medical Colleges (AAMC)

Underrepresented in Medicine: Underrepresented in medicine means those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population. (Source: Association of American Medical Colleges)

The Association of American Medical Colleges (AAMC) defines “underrepresented in medicine” (UIM) as: “racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population.”1 Previously, the AAMC used the term “underrepresented minority,” which referred to Black, Mexican-American, Native American (American Indian, Alaska Native, and Native Hawaiian), and mainland Puerto Rican populations. (Source: Association of American Medical Colleges)

American Academy of Pediatrics (AAP)

American Board of Medical Specialties (ABMS)

1. Establishing and maintaining rigorous standards for board certification in various medical specialties, ensuring that physicians are competent and proficient in their chosen fields.
2. Supporting ongoing professional development and lifelong learning among physicians, promoting excellence and innovation in patient care.
3. Collaborating with medical organizations, institutions, and policymakers to advocate for policies that enhance the quality and safety of healthcare delivery.

Accreditation Council for Graduate Medical Education (ACGME)

The Accreditation Council for Graduate Medical Education (ACGME) recognizes how increasing diversity in the physician workforce positively impacts health care access and patient outcomes, a key part of the organization's Mission. The ACGME's goal is to contribute to the elimination of health care inequities by focusing on the physician workforce. (Source: Accreditation Council for Graduate Medical Education)

• Accreditation Council for Graduate Medical Education (ACGME) Equity Matters 
• Accreditation Council for Graduate Medical Education Clinical Learning Environment Review (ACGME CLER) - training
  

American Medical Association (AMA)

Centers for Disease Control and Prevention (CDC)

Race – The revised race standards identify five categories for data on race: American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White. These represent the minimum categories for data on race and ethnicity for Federal statistics, program administrative reporting, and civil rights compliance reporting. The minimum categories are defined as follows:

• American Indian or Alaska Native – A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.
• Asian – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
• Black or African American – A person having origins in any of the black racial groups of Africa. Terms such as “Haitian” or “Negro” can be used in addition to “Black or African American.”
• Native Hawaiian or Other Pacific Islander – A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
• White – A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Census

The U.S. Census Bureau must adhere to the 1997 Office of Management and Budget (OMB) standards on race and ethnicity which guide the Census Bureau in classifying written responses to the race question:

• White – A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
• Black or African American – A person having origins in any of the Black racial groups of Africa.
• American Indian or Alaska Native – A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment.
• Asian – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
• Native Hawaiian or Other Pacific Islander – A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

The 1997 OMB standards permit the reporting of more than one race. An individual’s response to the race question is based upon self-identification. 

An individual’s response to the race question is based upon self-identification. The Census Bureau does not tell individuals which boxes to mark or what heritage to write in. For the first time in Census 2000, individuals were presented with the option to self-identify with more than one race and this continued with the 2010 Census. People who identify with more than one race may choose to provide multiple races in response to the race question. For example, if a respondent identifies as "Asian" and "White," they may respond to the question on race by checking the appropriate boxes that describe their racial identities and/or writing in these identities on the spaces provided.

The racial categories included in the census questionnaire generally reflect a social definition of race recognized in this country and not an attempt to define race biologically, anthropologically, or genetically. In addition, it is recognized that the categories of the race item include racial and national origin or sociocultural groups. People may choose to report more than one race to indicate their racial mixture, such as “American Indian” and “White.” People who identify their origin as Hispanic, Latino, or Spanish may be of any race.

OMB requires five minimum categories: White, Black or African American, American Indian or Alaska Native, Asian, and Native Hawaiian or Other Pacific Islander.

Centers for Medicare & Medicaid Services (CMS)

Health equity means the attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, or other factors that affect access to care and health outcomes. (Source: Centers for Medicare & Medicaid Services)

Healthy People 2030

Healthy People 2030 defines health equity as “the attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.” (Source: Healthy People 2030)

Latino Medical Student Association (LMSA)

Our Mission: The Latino Medical Student Association (LMSA) exists to unite and empower current and future physicians through service, mentorship, and education to advocate for the improved health of the Hispanic & Latina/o/x community in the United States.

Our Vision: We envision a world in which improved health outcomes for all patients arise as a result of the following:

• Increased representation and support of healthcare professionals from backgrounds underrepresented among the medical workforce;
• Increased awareness of critical issues affecting the health of the Hispanic, Latina/o/x, and other marginalized communities; and
• Increased efforts to reduce disparities in the ways patients of color experience the American healthcare system.

National Academy of Medicine (NAM)

1. Providing expert advice and guidance on critical health issues to inform policy, practice, and research agendas at the national and global levels.
2. Fostering collaboration and interdisciplinary dialogue among healthcare professionals, researchers, policymakers, and other stakeholders to address complex health challenges.
3. Promoting equity and social justice in healthcare by addressing disparities in access, quality, and outcomes, with a focus on underserved populations.
4. Advancing the education and training of healthcare professionals to ensure a diverse and competent workforce capable of meeting the evolving needs of society.
5. Catalyzing innovation in healthcare delivery, technology, and biomedical research to improve health outcomes and enhance the quality of care.

National Institutes of Health (NIH)

Underrepresented group: An underrepresented population refers to a subgroup of the population whose representation is disproportionately low relative to their numbers in the general population, or in the case of clinical trials or patient registries, disease population. (Source: Underrepresented population)

Lack of representation in society has real impacts on the lives of those affected. When marginalized communities are excluded from conversations and decision-making processes that affect them directly, they are at risk for being oppressed and having policies made about rather than for them (Ezorsky, 2018). This often means low participation in decision-making process at government levels and less access to job opportunities (Borghans, Ter Weel & Weinberg, 2014).

The following racial and ethnic groups have been shown to be underrepresented in biomedical research: Blacks or African Americans, Hispanics or Latinos, American Indians or Alaska Natives, Native Hawaiians, and other Pacific Islanders.

Individuals from disadvantaged backgrounds, defined as those who meet two or more of the following criteria:

1. Were or currently are homeless, as defined by the McKinney-Vento Homeless Assistance Act 
2. Were or currently are in the foster care system, as defined by the Administration for Children and Families;
3. Were eligible for the Federal Free and Reduced Lunch Program for two or more years (Income Eligibility Guidelines);
4. Have/had no parents or legal guardians who completed a bachelor’s degree (Source: First-Generation and Continuing-Generation College Students: A Comparison of High School and Postsecondary Experiences);
5. Were or currently are eligible for Federal Pell grants
6. Received support from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) as a parent or child (Source: WIC Eligibility Requirements).
7. Grew up in one of the following areas: a) a U.S. rural area, as designated by the Health Resources and Services Administration (HRSA) Rural Health Grants Eligibility Analyzer, or b) a Centers for Medicare and Medicaid Services-designated Low-Income and Health Professional Shortage Areas (qualifying zip codes are included in the file). Only one of the two possibilities listed can be used as a criterion for the disadvantaged background definition.

Students from low socioeconomic (SES) status backgrounds have been shown to obtain bachelor’s and advanced degrees at significantly lower rates than students from middle and high SES groups (Source: National Center for Education Statistics), and are subsequently less likely to be represented in biomedical research. 

• NIH Style Guide

Student National Medical Association (SNMA)

Student National Medical Association (SNMA) is committed to supporting current and future underrepresented minority medical students, addressing the needs of underserved communities, and increasing the number of clinically excellent, culturally competent and socially conscious physicians.

The goals of Student National Medical Association (SNMA) are:

• To serve as a credible and accurate source of information relevant to minority issues in the field of medical education.
  
• To encourage and foster the development of minority faculty in order to increase the presence of minority mentors and biomedical researchers in academic health centers.
  
• To evaluate and cultivate the necessary measures to eradicate practices in the field of health profession education that compromises the goal of providing quality education to minorities and women.