Note from the author: I am intentionally writing “diversity, equity, inclusion, and belonging" as its full name in order to prevent the reduction of this important work into a morbid acronym.
Diversity, equity, inclusion, and belonging have become defining pillars in professional and academic spaces, and the optometric profession is no exception. This article, penned after much contemplation, is an invitation to reflect on our profession’s progress, the challenges that remain, and how optometrists should prepare themselves to advance efforts.
Though written in the shadow of a transformative election cycle, the principles of diversity, equity, inclusion, and belonging transcend any political moment and underscore our collective responsibility to foster a more equitable and inclusive field.
Personal reflections on health equity
The murder of George Floyd in 2020 marked a watershed moment for America, propelling conversations about race, equity, and justice to the forefront. I dove headfirst into diversity, equity, inclusion, and belonging work at a time when health and social justice issues reached a generational climactic fervor in this country and worldwide. These discussions, while invigorating, revealed the pervasive inequities embedded in every sector, including optometry.
As an optometrist and educator committed to health equity, I have often pondered, “What does it mean to champion diversity, equity, inclusion, and belonging in a profession grappling with its historical and current exclusions and systemic barriers? How do we ensure our efforts endure beyond performative gestures?”
These questions are not easily answered, yet they are central to the work we must do.
Defining diversity, equity, inclusion, and belonging
Diversity, equity, inclusion, and belonging is a framework for transformative change:1,2
- Diversity encompasses the range of identities and experiences that individuals bring to the table.
- Equity ensures fair treatment and access, recognizing that different people require different resources to succeed.
- Inclusion fosters environments where everyone feels valued and supported.
- Belonging goes a step further, creating spaces where individuals are integral to the group’s success and culture.
These concepts, once confined to compliance and affirmative action, have evolved into a comprehensive approach to dismantling systemic barriers.
With the aim of addressing the root causes of inequity rather than merely treating its symptoms, today’s diversity, equity, inclusion, and belonging efforts emphasize:
- Justice: The dismantling of systemic barriers to ensure all individuals have equal access to resources and opportunities
- Accessibility: Ensuring all environments, services, and resources are usable and beneficial to people with diverse abilities
- Anti-racism: Recognizing the systemic nature of racism and working to dismantle its centuries-long effects through intentional action, policy changes, and sustained effort.
A legacy of advocacy in optometry
The National Optometric Association (NOA) stands as a testament to the resilience and vision of Black optometrists who, in 1969, created a space to address the unique challenges they faced. Founded by Dr. C. Clayton Powell and Dr. John L. Howlette, the NOA has long been a beacon for minority optometrists, focusing on student recruitment, community service, and advocacy.
Today, the NOA continues its mission to advance the visual health of underserved communities while fostering diversity within the profession.3 Building on this foundation, newer organizations have emerged with innovative approaches to diversity, equity, inclusion, and belonging.
Black Eyecare Perspective’s 13% Promise, for example, calls on the profession to mirror the US population’s demographic composition, which includes 13% Black individuals.4 Their efforts aim to create pathways for Black students, connect communities with Black optometrists, and build bridges within the industry.
Similarly, Latinos en Optometry (LEO) addresses the underrepresentation of Latinx professionals in optometry, while advocating for culturally competent care for this community.
PRIDE (People Respecting Inclusion Diversity, and Equity) ODs, founded in 2023, fosters inclusivity for LGBTQ+ individuals in optometry through education and community building, exemplified by their annual Queer Symposium. The Asian American Optometric Society (AAOS), established in 1972, remains a vital platform for promoting cultural exchange and professional development.5
These organizations demonstrate the power of collective action and the importance of intersectional approaches to diversity, equity, inclusion, and belonging. They remind us that representation matters, not only for practitioners but also for the communities we serve.
Progress and challenges in diversity, equity, inclusion, and belonging
In the wake of 2020, awareness of diversity, equity, inclusion, and belonging principles has grown, yet challenges persist. Optometry’s student body remains a poor reflection of our society’s demography, with White and Asian students being well represented and only 4% of students identifying as Black and 9% as Latine, despite these groups comprising 13% and 20% of the US population, respectively.6
Inclusion has improved as our educational institutions and professional organizations adopt more intentional practices. For example, some schools no longer require the OAT score for admission, more merit- and need-based scholarships have been provided to help reduce the debt burden for graduating students, and pathway programs introduce more students to the profession and help ease the transition to optometry school.
We are also seeing more diverse representation on committees, boards, and as key opinion leaders across the profession. However, equity for the patient population remains elusive. Disparities in access to eyecare, particularly for Medicaid patients and those uninsured, highlight systemic inequities that demand urgent attention. Reimbursement rates and biases against Medicaid users exemplify the barriers that perpetuate inequity in our profession.
I have been encouraged by the raised level of awareness about topics such as social determinants of health, race, and bias. Awareness, while necessary, is not sufficient. Moving beyond “colorblindness” to continued meaningful engagement requires humility and a willingness to confront uncomfortable truths about race, privilege, and systemic discrimination.
5 steps to advancing diversity, equity, inclusion, and belonging
To advance diversity, equity, inclusion, and belonging in optometry, we must remain persistent and intentional. Here are five steps you can take.
1. Prioritize health equity.
Ensure equitable access to eyecare for underserved communities. Advocate for policies that address social determinants of health and push for fair reimbursement rates for Medicaid services.
2. Expand opportunities.
Increase access to optometric education for underrepresented and disadvantaged groups. Strengthen pathways for diverse talent through mentorship, scholarships, and outreach.
3. Foster leadership.
Encourage more voices to rise in advocacy and leadership roles. Diversity, equity, inclusion, and belonging is not solely the responsibility of marginalized groups; it benefits everyone and requires collective effort.
4. Promote accountability.
Measure progress through data while recognizing the limitations of numbers alone. Success must also be gauged by the depth of cultural shifts within organizations.
5. Sustain momentum.
Resist complacency and push back against rollback efforts. The recent Supreme Court ruling on affirmative action and newer anti-DEI legislation underscores the fragility of progress and the need for vigilance.
Your call to action
Anyone who has benefited from diversity, equity, inclusion, and belonging initiatives (including its predecessor affirmative action) has a role to play in their continuation, and that is most people in this country.
Whether you identify as a member of a marginalized group or as an ally, your voice and actions matter. Together, we can build a profession that not only reflects the diversity of our society but also exemplifies the principles of equity, inclusion, and belonging.
Optometry is at a crossroads. The choices we make now will shape the future of our profession and the care we provide. Let us choose to lead with purpose, courage, and an unwavering commitment to justice.
A note from Eyes On Eyecare: We believe that optometry students, as the future of our profession, hold the key to ensuring these principles are embodied, expanded, and enacted.
We hope students are inspired to foster these principles to ensure the field develops deeper cultural competency, increased representation within the profession, and more equitable care for all patients.
