If you, like me, contributed to the more than 1.25 billion viewership hours of the Netflix series Bridgerton, you’re familiar with the coupling process for a small subset of English people in the 1800s. Glittering chandeliers and dreamy dresses meet the very real anxieties involved in attracting a match both socially advantageous and personally attractive.
But did you know it’s also a teachable moment?
A July 2022 episode of the Freakonomics podcast introduced economist Marc Goñi’s research on “assortive matching” and income inequality within that Bridgerton context. In the traditional exercise, as Bridgerton portrays and Goñi describes it, the wealthiest families flocked to London seasonally to mix and mingle and marry off their eligible daughters to fellow members of the aristocracy. The marriage market helped individual families further improve their fortunes. It also helped the queen (Victoria, in Goni’s research) strengthen her political power by gatekeeping access to the process.
But a funny thing happened in 1861, Goñi explained. Within the space of a year, Queen Victoria lost both her mother and her beloved husband. She withdrew from any real involvement in the social season during her three-year period of mourning. That withdrawal virtually shut down the traditional marriage market and, according to Goñi‘s research, temporarily upended the rigid class balance. During “the interruption,” marriageable aristocratic women tended to find partners within their home regions, and those partnerships were less socially and economically advantageous than the average partnership during previous London seasons.
All well and good, you say, but so what? Goñi suggests the liberalization of marriage patterns had knock-on political impacts, like helping expand public education in the 1870s. How? By breaking up the traditional power-building process, which Goñi says the aristocracy had used “to consolidate as an elite.”
Imagine the college search process as that London marriage market. The children of the elite apply to different acceptable schools hoping to find one that fits their own personal and career goals while meeting the expectations of their parents and communities. Of course, unlike the marriage mart, this process is technically open to anyone who can pay the application fees. In practice, though, access varies tremendously based on an individual student’s background of race, ethnicity, income, class, educational preparation, and more. There are all sorts of external indicators over which individual students have almost no control that determine the fullness of their social calendars and the perceived quality of their academic suitors.
Now imagine affirmative action as the mourning period disruption to business as usual. It doesn’t fundamentally eliminate the college mart but alters the match process enough to have a visible impact. It means the makeup of the “elite” schools is less predictable, and so are the connected power structures. It means social strata shift in noticeable ways, even if they’re slow. It can even mean the people weighing choices that impact millions of lives represent more of them.
But it’s not just about the policy impacts—important as those are. It’s also about the ways access to training changes the demographics of people providing vital services, including health care.
We’ve talked before about the Primary Care Coalition’s work with partners like the Nexus Montgomery Regional Partnership, Montgomery College, and the American Muslim Senior Society to build a more diverse healthcare workforce. These training pipelines have genuine game-changing potential for both the individuals who participate and the ability of our healthcare system to provide care that fits our diverse population. But the realities of demonstrating return on investment mean we have to start with entry-level training. We are not training doctors or physician assistants or advanced practice nurses. At least, not yet. But our community needs people in those roles who represent our full diversity, and we need them now. building-and-sustaining-a-diverse-workforce.html
An analysis of in-hospital mortality among uninsured patients in Florida found a 13% decrease in the likelihood of death among patients whose race matched their providers’. The authors suggest—based on their own analyses and on existing literature —that race matching impacts communication. Citing one study that analyzed the relationship between patient-provider race matching and the depth of lung cancer information patients received, they noted patient participation was the element that varied by race matching. In other words—and not so surprisingly—shared identities can change the conversation. Literally, and in potentially life-saving ways.
For some patients, the existence of minority doctors increases their chances of receiving care at all. A 2022 study among family physicians supported existing literature on physician race/ethnicity: “family physicians who identify as underrepresented minority groups were more likely to care for patients from vulnerable populations.”
I can’t weigh in on the full legal or educational policy ramifications of the recent Supreme Court ruling on affirmative action with any real authority—being neither a legal nor educational policy expert. I don’t even play one on TV. What I can speak to are the partners PCC works with who provide essential safety net healthcare to our neighbors every day. For many, their backgrounds make them more able to provide culturally and linguistically appropriate care. What will it cost our communities if the diversity of our provider pipeline shrinks?
As a society, we have plenty of (health) equity work ahead of us, and this decision has cost us an important tool.