July 11, 2023
The Supreme Court’s Rulings on Race Neutrality Threaten Progress in Medicine and Health
In landmark rulings, the US Supreme Court significantly restricted race-conscious admissions policies in higher education, a chilling echo of its evisceration of settled law on abortion. In principle, race neutrality is desirable—but it is one thing to set aside race in a society with genuine equal opportunity, and another to do so where stark differences persist in opportunities and outcomes, fueled by a 400-year history of systemic racism. While the Court focused on education, its rulings could have broad and pernicious implications for health. They could upend programs designed to achieve equity and actively harm population health.
In companion cases,1,2 the Supreme Court struck down affirmative action programs at the University of North Carolina (UNC), which until the 1950s did not admit Black students, and Harvard College. The justices held that UNC, a state institution, violated the Fourteenth Amendment's guarantee of equal protection of the law. Harvard, a private institution, ran afoul of the Civil Rights Act of 1964 because it accepts federal funding. Chief Justice John Roberts concluded that the admissions programs lack focus and measurable objectives, use race in a negative manner, involve racial stereotyping, and lack meaningful end points. In a sweeping declaration, he wrote: “Eliminating racial discrimination means eliminating all of it.”1,2 In a footnote, however, Roberts left open the possibility to use race in the military.
Incongruously, the Court relied on Brown v Board of Education’s “fundamental principle that racial discrimination in public education is unconstitutional.” The Court used a post–Civil War amendment designed to rectify historical discrimination, but wielded it to neuter programs created with the specific aim of remedying a history of structural racism. In a fierce dissent, Justice Sonia Sotomayor said the majority opinion “contravenes the vision of equality embodied in the Fourteenth Amendment,” cementing “a superficial rule of colorblindness as a constitutional principle in an endemically segregated society where race has always mattered and continues to matter.”2
The Court continues to allow universities to consider applicants’ discussions of how race has affected their lives, for example, tied to their quality of character or unique abilities. Even so, the Court’s ruling will directly limit affirmative action in medical education, and indirectly impede public health programs designed to achieve equity.