HJNO Nov/Dec 2025

WHAT’S WRONG WITH HEALTHCARE 12 NOV / DEC 2025 I  HEALTHCARE JOURNAL OF NEW ORLEANS   and surgeries, procedures, and imaging over listening, thinking, educating, advising, and problem-solving. Diversity, Equity, and Inclusion: A Necessary Expansion Radical inclusion resonates with the debate over diversity, equity, and inclusion (DEI). In to- day’s polarized climate, DEI is often politicized into a toxic phrase meant to imply unfairness and promotion based on lack of merit rather than effectiveness. But the evidence does not support that view: Diverse and inclusive teams don’t just feel more equitable — they perform better. Research shows that organizations with greater diversity recover more resiliently from crises, 17 and that creative output is significantly higher in gender-diverse groups when inclu- sion is present. 18 Healthcare disparities illustrate the costs of inequity and exclusion: Black women in the U.S. are three to four times more likely to die in childbirth than white women. Native Ameri- cans experience rates of diabetes and kidney disease at higher rates than those of whites, shaped in part by poverty, food insecurity, and other social determinants of health. 19 And dur- ing the COVID-19 pandemic, Black, Latino, and Native American communities experienced disproportionately high infection and death rates. If not DEI, then what is the alternative? For us to remain divided, clinging to inequitable and exclusive structures? Reframed, the alternative to DEI becomes DIE (division, inequity, and ex- clusion) — a society willing to accept dispari- ties that literally cost lives. In this sense, radical inclusion is not simply a leadership philosophy but a moral imperative. It calls us to expand the circle, to amplify silenced voices, and to recog- nize that equitable outcomes strengthen us all. The case for diversity, equity, and inclusion is not only moral but practical. Harvard Busi- ness School professor Frances Frei, in her book Unleashed: The Unapologetic Leader’s Guide to Empowering Everyone Around You , argues that the best leaders unlock performance by building trust and creating inclusive environ- ments where diverse perspectives can thrive. 21 She emphasizes that teams marked by diversity and genuine inclusion consistently outperform homogenous teams, even when the latter are comprised of equally talented individuals. The reason is that diversity expands the range of perspectives and solutions, while inclusion en- sures those perspectives are heard and acted upon. Scott Page’s groundbreaking book, The Difference , offers the mathematical and empiri- cal foundation for this argument, demonstrat- ing that cognitively diverse groups solve com- plex problems more effectively than groups of high ability but like-minded individuals. 22 Together, Frei’s leadership lens and Page’s ana- lytic framework reinforce the same conclusion: Diversity is not a concession to fairness but a driver of excellence. Away fromMe vs. We and Toward “We Are All in This Together” Healthcare is inherently collective. Illness does not respect state lines or party affiliation. Risk pooling only works when the healthy and the sick share the same insurance pool. Pan- demics remind us that individual choices ripple outward into our community with real, often devastating, consequences. Yet American cul- ture preferentially exalts the me — autonomy, freedom, consumer choice. These do mat- ter, of course. But in healthcare, they must be tempered by we — the recognition that none of us can navigate sickness or aging alone. If a conservatively minded four-star general and a liberal Berkeley academic can model inclu- sion across ideological divides, surely provid- ers, payers, patients, and policymakers can do the same. The question is not who wins in me versus we or us versus them. The question is whether we can imagine healthcare as a com- mon need and a shared story — one in which everyone belongs and that moves us away from me versus we and toward we are all in this to- gether. n REFERENCES 1 Franklin D. Roosevelt, “State of the Union Message to Congress,” January 11, 1944, FDR Library & Museum, https://www.fdrlibrary.org/ address-text. 2 David Blumenthal and James Morone, The Heart of Power: Health and Politics in the Oval Office (University of California Press, 2010). 3 Jonathan Oberlander, The Political Life of Medicare (University of Chicago Press, 2003). 4 Richard Nixon, “Special Message to the Congress Proposing a National Health Strategy,” February 18, 1971, The American Presidency Project, University of California, Santa Barbara, https://www.presidency.ucsb.edu/documents/ special-message-the-congress-proposing- national-health-strategy. 5 Helen Levy, “Health Reform: Learning from Massachusetts.” Inquiry 49, no. 4 (2012): 300–302, https://doi.org/10.5034/inquiryjrnl_49.04.06. 6 Jonathan Oberlander, “The Future of Obamacare,” New England Journal of Medicine 367, no. 23 (2012): 2165–7. 7 Elizabeth Arias, Xu Jiaquan, Tejada-Vera Betzaida, et al., “U.S. State Life Tables, 2021,” National Vital Statistics Reports 73, no. 7 (August 21, 2024), https://www.cdc.gov/nchs/data/nvsr/ nvsr73/nvsr73-07.pdf. 8 Sarah Miller, et al., “Medicaid and Mortality: New Evidence from Linked Survey and Administrative Data,” Quarterly Journal of Economics 136, no. 3 (2021): 1783–1829. 9 Eugene E. Petersen, et al., “Racial/Ethnic Disparities in Pregnancy-Related Deaths — United States, 2007–2016,” Morbidity and Mortality Weekly 68, no. 35 (2019): 762–5. 10 Hawaii Prepaid Health Care Act (PHCA), Hawaii Revised Statutes, Chapter 393, 1974. 11 “Uninsured in Hawaii,” America’s Health Rankings, 2023. 12 D. L. Driscoll, et al., “Process and Outcomes of Patient-Centered Medical Care with Alaska Native People at Southcentral Foundation,” Annals of Family Medicine 11, Suppl 1 (2013): S41– S49. 13 Patricia Mazzei, “Florida Surgeon General Advises Against Covid-19 Vaccines for Healthy Children,” New York Times, March 7, 2022. 14 Martin E. Dempsey and Ori Brafman, Radical Inclusion: What the Post-9/11 World Should Have Taught Us About Leadership (Missionday, 2018). 15 Exec. Order No. 9981, 13 F.R. 4313, 1948. 16 S. A. Nancarrow, et al., “Ten Principles of Good Interdisciplinary Team Work,” Human Resources for Health 11, no. 19 (2013). 17 This study shows that organizations with more diversity are better able to adapt, maintain performance, and bounce back from disruptions. S. Duchek, “The Role of Diversity in Organizational Resilience,” Business Research (2020). 18 The authors find that gender diversity only leads to improved creativity when combined with inclusion — diverse teams with inclusion perform better in creative tasks than those without. B. Vedres and O. Vasarhelyi, “Inclusion Unlocks the Creative Potential of Gender Diversity in Teams,” arXiv (preprint), 2022, https://doi.org/10.48550/ arXiv.2204.08505. 19 Nilka Ríos Burrows, et al., “Sustained Lower Incidence of Diabetes-Related End-Stage Kidney Disease Among American Indians and Alaska Natives, Blacks, and Hispanics in the U.S., 2000– 2016,” Diabetes Care 43, no. 9 (2020): 2090–7. 20 Katherine Mackey, et al., “Racial and Ethnic Disparities in COVID-19–Related Infections, Hospitalizations, and Deaths: A Systematic Review,” Annals of Internal Medicine 174, no. 3 (2021): 362–73. 21 Frances Frei and Anne Morriss, Unleashed: The Unapologetic Leader’s Guide to Empowering Everyone Around You (Harvard Business Review Press, 2020). 22 Scott E. Page, The Difference: How the Power of Diversity Creates Better Groups, Firms, Schools, and Societies (Princeton University Press, 2007).