WHAATtheAHEC  :  WHere Are the Areas That the AHECs Should Serve?

Background

Studies have shown that racist policies such as redlining and Jim Crow laws contribute to poor health for racial minorities in the United States. As a result, Black Americans have the lowest life expectancy of any racial group in the US and Black mothers and babies experience disproportionately high adverse maternal and infant outcomes regardless of income level. In order to fully understand how structural racism impacts health outcomes, it is important to start with how structural racism impacts the workforce that is delivering healthcare.

AHECs, or Area Health Education Centers, are organizations funded by the Health Resources and Services Administration (HRSA). They are dedicated to expanding a diverse healthcare workforce by providing training placements in real-world environments, including migrant, urban, and rural community health clinics, as well as health departments.

Historical structural racism and physician production can inform AHEC efforts by guiding the development of programs that address health inequities and diversify the medical workforce. Understanding the impact of past injustices can help shape initiatives that promote equitable healthcare access and representation within the field.

Physician production refers to the rate at which new physicians enter the workforce, a critical factor given that the growth of the primary care workforce is not keeping pace with population demands. In the United States, the production of physicians varies significantly by region, often assessed by the number of physicians emerging in relation to live births in those areas.

Data and Methods

Physician Production is measured by county and is calculated based on the number of live births in a county that eventually become practicing physicians, regardless of their location. This calculation utilizes data from birth counts by county from NCHS birth statistics and physician births from the AMA master file.

Structural racism is measured by the Index of Concentration at the Extremes (ICE), which compares the number of well-educated whites to poorly educated blacks in a given area, such as a census tract. ICE values near 1.0 indicate a predominance of well-educated whites, while values near -1.0 indicate a higher prevalence of poorly educated blacks. Additionally, black/white rate ratios for less than high school education, home renting, single-parent households, unemployment, and poverty are included as components of the RGC Social Deprivation Index.

Childhood development was assessed through community assets like bookstores, educational institutions, libraries, and museums.

Specific data sources include the National Center for Health Statistics’ Birth Data Files from 1980 to 1989; the American Medical Association’s 2023 “Physician Masterfile”; and the U.S. Census Bureau’s 1980 Census of Population and Housing, Summary File 3.

Data Visualizations

We created three tools that help visualize the impact of structural racism on physician production. These tools, called “WHere Are the Areas That the AHECs Should Serve? (WHAATtheAHEC) were created based on the input and feedback from AHECs, including a diverse mix of rural, suburban, and urban AHECs in the Midwest, Arizona, and Maryland/DC. In addition, we collaborated with the National AHEC Organization’s Executive Committee and the Diversity Committee, which includes 45 members or organizations from 26 states.

The visual tools below focus on three areas:

• “What If” — Display the difference in the number of physicians in the US if every region had equal access to comparable resources.;
• “Finding Potential AHEC Community Partners” — Enables AHECs to concentrate on regions affected by ongoing and historical structural racism to identify potential collaborators.; and
• “Exploring your AHEC Community Profile” — Enables Area Health Education Centers (AHECs) to investigate the workforce and health requirements within their existing or prospective service regions.

For additional details on WHAATtheAHEC, see our research poster “Structural Racism, Early Career Pathways, and Physician Workforce Production” presented at the North American Primary Care Research Group (NAPCRG) annual meeting in November 2024.