Diversity, Equity, and Inclusion in Veterinary Medicine E-Book
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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
An insightful discussion of DEI and its application to a wide variety of real-world veterinary settings
Diversity, Equity, and Inclusion in Veterinary Medicine takes a broad approach to the concept of DEI, delivering a practical discussion of effective strategies for applying diversity, equity, and inclusion (DEI) practices within the veterinary setting. Written by a diverse set of voices, the book provides a comprehensive understanding of DEI as it relates to veterinary medicine. Arranged from A to Z, the 26 chapters discuss important concepts in DEI, with actionable advice for how to incorporate DEI into the practice of veterinary medicine.
The chapters define the concepts, explain why each concept is important to veterinary medicine, and give practical examples of how to apply the concepts in the real world. Each chapter stands on its own and can be approached individually but taken together these chapters expand the boundaries of DEI into topics that are both familiar and novel.
Readers will also find:
- A thorough introduction to the concept of access to care and one health medicine through the lens of DEI
- Comprehensive explorations of equity, intersectionality, justice, representation, and other central DEI concepts that impact the veterinary profession’s ability to benefit society
- Practical discussions of how unconscious bias and cultural competency impact both client and team interactions impacting patient care
- In-depth examinations of specific community engagement, including First Nation, queer, and neurodiverse communities
Diversity, Equity, and Inclusion in Veterinary Medicine is an invaluable resource for practicing veterinarians, veterinary technicians, veterinary practice managers, other veterinary professionals, veterinary students, veterinary technician students, and anyone involved with animal health.
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Veröffentlichungsjahr: 2025
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Table of Contents
Cover
Table of Contents
Title Page
Copyright Page
Dedication Page
List of Contributors
Preface
CHAPTER A: Access to Veterinary Care: A Gateway to Family Health and Social Equity
INTRODUCTION
ACCESS TO VETERINARY CARE: A FAMILY AND COMMUNITY AFFAIR
SOCIAL RESPONSIBILITY OF HEALTHCARE PROFESSIONS
ACTION STEPS: BUILDING A ONE HEALTH INTERPROFESSIONAL SYSTEM
SUMMARY
REFERENCES
CHAPTER B: Belonging: “Finding Home: Navigating the Landscape of Belonging”
WHAT IS BELONGING?
THE POWER OF BELONGING
HIRING PRACTICES
CREATING SAFE AND INCLUSIVE WORKPLACES
EXAMPLE: REIMAGINING THE VISUAL REPRESENTATION OF OUR PAST, PRESENT, AND FUTURE
REFERENCES
ADDITIONAL RESOURCES
CHAPTER C: Cultural Competence and Cultural Humility in Veterinary Medicine
INTRODUCTION
CULTURAL COMPETENCE
CULTURAL HUMILITY
SHIFT TO EMBRACING CULTURAL HUMILITY
APPLICATION OF CULTURAL HUMILITY IN CLINICAL VETERINARY PRACTICE
APPLICATION OF CULTURAL HUMILITY IN THE WORKPLACE
CONCLUSIONS
REFERENCES
CHAPTER D: Diversity
INTRODUCTION
DIVERSITY DEFINED
SO WHAT? WHY DOES DIVERSITY MATTER IN VETERINARY MEDICINE AND SOCIETY AT LARGE?
NOW WHAT? HOW DO WE ENGAGE WITH AN INCREASINGLY DIVERSE CLIENTELE AND CLINICAL WORKFORCE IN THE INTEREST OF IMPROVED ANIMAL CARE?
SUMMARY
REFERENCES
CHAPTER E: Emotional Intelligence
WHAT IS EMOTIONAL INTELLIGENCE?
SIGNS OF EMOTIONAL INTELLIGENCE
IMPACT OF EMOTIONAL INTELLIGENCE
THE FOUR Es
MANAGING INTERACTIONS
ENHANCING YOUR EI CAPABILITY
WORKING IN A DIVERSE AND INCLUSIVE SOCIETY
IMPACT OF THE COVID‐19 PANDEMIC
MAKING THE CONNECTION BETWEEN EI AND DIVERSITY
THE RESPONSIBILITY IN VETERINARY MEDICINE
EMOTIONAL INTELLIGENCE AND LEADERSHIP
PROTECTING YOUR EMOTIONAL STATE WHILE ENGAGING IN PATIENT CARE
SUMMARY
REFERENCES
CHAPTER F: First Nations
FIRST NATIONS
TERMINOLOGY
HOW TO REFER TO NATIVE AMERICAN PEOPLE
IDENTITY AND RECOGNITION
NATIVES IN EDUCATION
NATIVES IN MEDICINE
INDIGENOUS KNOWLEDGE IN VETERINARY EDUCATION
ACCESS TO CARE
EMBEDDED EDUCATIONAL INITIATIVES
NATIVE AMERICAN VETERINARY ASSOCIATION (NAVA) AND OTHER ALLYSHIP EXAMPLES
INCLUSIVITY OF NATIVE AMERICAN PEOPLE IN VETERINARY MEDICINE
MAKING YOUR PHYSICAL SPACE INVITING
UNDERSTANDING DIVERSE CULTURAL NORMS
CULTURAL SENSITIVITY IN CONSULTATION AND COLLABORATION
REPRESENTATION AND VISIBILITY
CONCLUSION
REFERENCES
CHAPTER G: Gender
INTRODUCTION
CONTENT WARNING
GENDER WHAT IT IS AND WHAT IT ISN'T
SITUATION: THE VETERINARY FIELD MUST ACTIVELY SUPPORT REPRODUCTIVE HEALTHCARE
SCENARIO: INSTITUTIONAL HIERARCHY CREATES OPPORTUNITIES FOR ABUSE
SCENARIO: MODELING CONSENT, INVITATION AND COMMUNICATION–BASED CULTURE WITH NONGENDERED ASSUMPTIONS CAN BE POWERFUL BEYOND THE IMMEDIATE SITUATION
DEDICATION
ACKNOWLEDGMENTS
REFERENCES
CHAPTER H: Historically Black Colleges and Universities
INTRODUCTION
IMPACT OF THE HBCU
SCHOOLS AND COLLEGES OF VETERINARY MEDICINE: THE ORIGIN STORY OF LAND‐GRANT INSTITUTIONS (LGIS)
AFRICAN AMERICANS IN VETERINARY MEDICINE
LEVERAGING PARTNERSHIPS TO DEVELOP A MORE DIVERSE AND INCLUSIVE VETERINARY PROFESSION
REFERENCES
CHAPTER I: Intersectionality
FIRST, A WALK IN MY SHOES
WHAT DEFINES INTERSECTIONALITY?
WHY IS INTERSECTIONALITY IMPORTANT IN VETERINARY MEDICINE?
APPLYING INTERSECTIONALITY IN VETERINARY ESTABLISHMENTS AND INSTITUTIONS
REFERENCES
CHAPTER J: Justice
INTRODUCTION
JUSTICE AND THE WAGE GAP
REFERENCES
CHAPTER K: Kindness
WHY KINDNESS?
KINDNESS DEFINED
KINDNESS IMPACT
CULTIVATING KINDNESS – THE HOW
THE TIME IS NOW
SUMMARY AND NEXT STEPS
REFERENCES
CHAPTER L: Listen
INTRODUCTION
WHAT THEY DIDN'T TEACH IN VETERINARY SCHOOL
TURNS OUT, IT IS NOT JUST ME
CONTROLLING WHAT I CAN CONTROL
MY PREP WORK BEFORE THE CLASSROOM LISTENING ASSIGNMENT
THE CLASSROOM LISTENING ASSIGNMENT BEGINS
WHAT FRANKLIN TAUGHT ME
LESSONS LEARNED
FINAL THOUGHTS
REFERENCES
CHAPTER M: Multiculturalism
WHAT'S CULTURE GOT TO DO WITH VETERINARY MEDICINE?
LANGUAGE AND OTHER CULTURAL EXPRESSIONS
A BRIEF REVIEW OF CULTURAL LITERATURE FROM HUMAN MEDICINE
PRACTICAL CULTURAL VETERINARY REALITIES
A ROYAL BON VOYAGE
PUTTING IT ALL TOGETHER IN PRACTICE
REFERENCES
CHAPTER N: Neurodiversity
INTRODUCTION
NEURO‐WHAT‐ISITY?
NEURODIVERSITY IN THE WORKPLACE
“BEST” PRACTICES
THE FUTURE
CONCLUSION
REFERENCES
CHAPTER O: Veterinary Medicine and One Health
WHAT IS ONE HEALTH?
VETERINARIANS AND VETERINARY PROFESSION AS ONE HEALTH PRACTITIONERS
PERSONAL EXAMPLES OF VETERINARY MEDICINE IN ONE HEALTH
BRINGING ONE HEALTH AND DEAI TO YOUR PRACTICE
CONCLUSION
REFERENCES
CHAPTER P: Psychological Safety
INTRODUCTION
WHAT IS PSYCHOLOGICAL SAFETY?
MEDICAL SETTINGS
POWER DYNAMICS
TEAM CONFLICT
MENTAL HEALTH, WELL‐BEING, AND BURNOUT
CASE EXAMPLE
CONCLUSION
REFERENCES
CHAPTER Q: Queer
INTRODUCTION (WHAT?)
LGBTQ+ HISTORY IN VETERINARY MEDICINE
DEMOGRAPHICS/FACTS/STATS
WHAT DOES IT MEAN TO BE QUEER IN VETERINARY MEDICINE? (NOW WHAT?)
SCENARIOS
CONCLUSION
ACKNOWLEDGMENTS
REFERENCES
CHAPTER R: Representation
REPRESENTATION
FIVE PRACTICES THAT CREATE A MORE INCLUSIVE WORKPLACE
REFERENCES
CHAPTER S: Systemic
INTRODUCTION
SYSTEMIC APPLICATIONS IN VETERINARY MEDICINE
SYSTEMIC ISSUES IN VETERINARY PRIVATE PRACTICE
SUMMARY
REFERENCES
CHAPTER T: Tokenism
INTRODUCTION
WHY DIVERSIFY A HOMOGENEOUS ORGANIZATION?
TOKENISM EXPLOITS EMPLOYEES
TOKENISM IN PATIENT ENGAGEMENT
THE TOLL OF TOKENIZATION IN MEDICAL RESIDENCIES
TOKENISM BREEDS IMPOSTER SYNDROME
TOKENISM CEMENTS STEREOTYPICAL VIEWS
HOW THE TOKENIZED ARE SET UP TO FAIL
ADVERSE EFFECTS OF TOKENISM PERSONAL AND ORGANIZATION
HOW TO AVOID TOKENISM
WAYS TO BEGIN MITIGATING TOKENISM
CONCLUSION
REFERENCES
CHAPTER U: Unconscious Bias
INTRODUCTION
WHAT IS UNCONSCIOUS BIAS?
SO WHAT? WHY IS UNCONSCIOUS BIAS IMPORTANT TO VETERINARY MEDICINE?
NOW WHAT? IDENTIFYING AND UNDERSTANDING UNCONSCIOUS BIAS IN OUR WORLD
NOW WHAT? ADDRESSING BIAS IN VETERINARY SCHOOL ADMISSIONS PROCESSES
NOW WHAT? ADDRESSING UNCONSCIOUS BIAS IN THE WORKPLACE
NOW WHAT? MITIGATING YOUR OWN UNCONSCIOUS BIAS
UNDERSTANDING THE IMPACT OF UNCONSCIOUS BIAS ON OUR LIVES
REFERENCES
CHAPTER V: Values
INTRODUCTION TO VALUES
VALUES IN ACTION
VALUES CORRELATED TO DEI
BUILDING TRUST IN ORDER TO CENTER VALUES
INCLUDING AS AN ACTION THAT BUILDS TRUST
CATALYZING CHANGE TO (RE)CENTER VALUES
APPRECIATION AS THE MECHANISM FOR SUSTAINING AND SCALING
REFERENCES
CHAPTER W: Welcoming
THE RECEPTIONIST/CUSTOMER SERVICE REPRESENTATIVE (CSR) TEAM
THE TECHNICAL TEAM
THE ASSOCIATE VETERINARIAN TEAM
PRACTICAL TIPS TO CREATE A MORE WELCOMING EXPERIENCE
REFERENCE
CHAPTER X: Xenacious
INTRODUCTION
DEFINING XENACIOUS
WHY IS VETERINARY MEDICINE IN NEED OF CHANGE?
HOW DO YOU KNOW WHEN TO MAKE A CHANGE?
BEING XENACIOUS IN VET MED
CONCLUSION
REFERENCES
CHAPTER Y: You
INTRODUCTION
THE STATE OF VET MED
LEADERSHIP IS A CHOICE, NOT A TITLE
UNDERSTANDING THE DYNAMICS OF CONFLICT
MANAGING CONFLICT
WHAT CAN YOU DO NOW?
CONCLUSION
REFERENCES
CHAPTER Z: Zero‐Sum Game
INTRODUCTION –
“SOMEBODY'S GOTTA WIN; SOMEBODY'S GOTTA LOSE”
IMPLICATIONS OF ZERO‐SUM GAME BIAS
THE STATE OF VETERINARY MEDICINE
MITIGATING ZERO‐SUM BIAS
CONCLUSION
REFERENCES
Afterword
Index
End User License Agreement
List of Tables
Chapter O
Table O.1 Current transdisciplinary approaches based on the understanding o...
Chapter U
Table U.1 Characteristics subject to unconscious bias.
Table U.2 Manifestations of unconscious bias.
Chapter Z
Table Z.1 AVMA Market Research Statistics Food Animal and Companion Animal ...
List of Illustrations
Chapter A
FIGURE A.1
Chapter B
FIGURE B.1
Chapter C
FIGURE C.1
Chapter D
FIGURE D.1
Chapter E
FIGURE E.1
FIGURE E.2
FIGURE E.3
FIGURE E.4
FIGURE E.5
FIGURE E.6
FIGURE E.7
FIGURE E.8
Chapter F
FIGURE F.1
Chapter G
FIGURE G.1
Chapter H
FIGURE H.1
Chapter J
FIGURE J.1
Chapter K
FIGURE K.1
Chapter L
FIGURE L.1
Chapter M
FIGURE M.1
Chapter N
FIGURE N.1
Chapter O
FIGURE O.1
Chapter P
FIGURE P.1
Chapter Q
FIGURE Q.1
Chapter R
FIGURE R.1
Chapter S
FIGURE S.1
Chapter T
FIGURE T.1
Chapter U
FIGURE U.1
FIGURE U.2
FIGURE U.3
Chapter V
FIGURE V.1
Chapter W
FIGURE W.1
Chapter X
FIGURE X.1
Chapter Y
FIGURE Y.1
FIGURE Y.2
Chapter Z
FIGURE Z.1
Guide
Cover Page
Title Page
Copyright Page
Dedication Page
Table of Contents
List of Contributors
Preface
Begin Reading
Afterword
Index
WILEY END USER LICENSE AGREEMENT
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Diversity, Equity, and Inclusion in Veterinary Medicine
Edited by
Kemba Marshall, MPH, DVM, DABVP (Avian Medicine), SHRM‐CP
KLMDVM Consulting LLC34522 N. Scottsdale Rd.Scottsdale, AZ, USA
Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies.
Published by John Wiley & Sons, Inc., Hoboken, New Jersey.Published simultaneously in Canada.
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Cover Design: WileyCover Image: Courtesy of Kemba Marshall
This book is warmly dedicated to my family. To my grandparents, whose shoulders I stand on; my mother, Lee, who taught me to love language; my father, Reese, who taught me to love logic; my sister, Dara, who taught me to love laughter; my brother, Reese Evans, who taught me to love silence; and my niece, Brynne, who taught me to love the process of finding out. This book would not be possible without my classmates, teachers, professors, and instructors who have poured into me. Raines High School in Jacksonville, Florida, Howard University in Washington, DC, the University of Florida College of Veterinary Medicine, the University of Tennessee College of Veterinary Medicine, and the University of Iowa College of Public Health have afforded me lessons that significantly influence this work.
To those who have authored or reviewed these chapters, thank you for your time, effort, and shared passion for veterinary medicine. What we have in common is a combination of professional and lived experiences that caused us to want to contribute to the veterinary medical profession. We have a shared passion to see the profession sustained through increased diversity, equity, inclusion, and belonging. Our intention is that this text will be used during team huddles, in breakrooms, on mobile devices, in libraries, on farms, and wherever people and animals are together. Our intention is to contribute thought leadership that uses our knowledge and skills to benefit society.
List of Contributors
Michael Bailey, DVM, DACVR, AAAS/AVMA (he/him)American Veterinary Medicine Association (AVMA), President 2025–2026IDEXX Laboratories, IDEXX Drive,Westbrook, ME 04092, USA
Rob Best, CVPM, CFN (he/him)Best Leadership, 34522 N. Scottsdale Rd. Ste.120–216, Scottsdale, AZ 85266, USA
Michael J. Blackwell, DVM, MPH (he/him)Assistant surgeon general, USPHS (Ret.),director, Program for Pet Health Equity, Centerfor Behavioral Health Research, University ofTennessee, Knoxville, TN 37996, USA
Olga Bolden‐Tiller (she/her)Dean, College of Agriculture, TuskegeeUniversity, Tuskegee, AL 36088, USA
Iran Brown (he/him)Thurgood Marshall School of Law, TexasSouthern University, 3100 Cleburne Street,Houston, TX 77004, USA
Allen Cannedy, DVM (he/him)Director for Diversity and Multicultural Affairs(Retired), North Carolina State University,College of Veterinary (NCSU‐CVM) Medicine,Raleigh, NC 27607, USA
Ashlee Canty (she/her)Director for Diversity and Multicultural Affairs,North Carolina State University, College ofVeterinary (NCSU‐CVM) Medicine, Raleigh,NC 27607, USA
Mia Cary, DVM (she/her)Cary Consulting, 34522 N. Scottsdale Rd. Ste.120‐216, Scottsdale, AZ 85266, USA
Theresa L. Cosper‐Roberts, RVT, CVPM, CVBL ACE (DE) (she/her)Louisiana State University School of VeterinaryMedicine, Baton Rouge, LA 70803, USA
Harold Davis, RVT, VTS (he/him)International Veterinary Emergency andCritical Care Society, San Antonio,TX 78257, USA
Sandra Dawkins (she/her)Director, Admissions and RecruitmentThe Ohio State University, College of VeterinaryMedicine, Columbus, OH 43210, USA
Sharon L. Deem, DVM, PhD, DACZM (she/her)Director, St. Louis Zoo Institute forConservative Medicine, St. Louis,MO 63110, USA
Odette Doest, DVM (she/her)Dierenartsen Praktijk Doest, 41 St. Michielsweg,Willemstad, Curacao, USA
Monica Dixon Perry, CVPM (she/her)Director of Veterinary Consulting ServicesBurzenski & Company PC, East Haven,CT 06512, USA
Evelyn Galban, DVM, MS, DACVIM (Neurology) (she/her)Associate Professor of Clinical Neurology,Chief of Neurology and Neurosurgery, AssociateMedical Director & Director of House Officers,University of Pennsylvania School of VeterinaryMedicine, Philadelphia, PA 19104, USA
Briana D. Jones (she/her)Mississippi State University, College ofVeterinary Medicine 39762 USA Class of 2026
Sue Knoblaugh, ACVP (she/her)Faculty Director, Diversity Equity Inclusion andBelonging, The Ohio State University,College of Veterinary Medicine, Columbus,OH 43210, USA
Erika Lin‐Hendel, VMD, PhD (they/them)Not One More Vet,1120 Bird Ave, Ste F,San Jose, CA 95125, USA
Kemba L. Marshall, MPH, DVM, SHRM‐CP (she/her)KLMDVM Consulting LLC, 34522 N. ScottsdaleRd., Ste. 120–216,Scottsdale, AZ 85331, USA
Rustin Moore, DVM, PhD, ACVS (he/him)Dean, The Ohio State University, College ofVeterinary Medicine, Columbus, OH 43210, USA
Joelle A. Murchison (she/her)Exec Mommy Group, East Hartford, CT 06118,USA
Adesola Odunayo, DVM, MS, DACVECC (she/her)Michael Schaer Endowed Professor ofEmergency and Critical Care, Universityof Florida College of Veterinary Medicine.Gainesville, FL
Zenithson Ng, MS, DVM, ABVP (Canine and feline) (he/him)University of Tennessee College of VeterinaryMedicine, Knoxville, TN 37996, USA
Ruby Perry, MS, DVM, ACVR (she/her)Dean, Tuskegee University College ofVeterinary Medicine, Tuskegee, AL 36088, USA
Tierra Price, MPH, DVM (she/her)Unleashed Veterinary Care, Lanesville,IN 47136, USA
James Pritchett (he/him)Vice President for Engagement and ExtensionColorado State University, Ft. Collins,CO 80523, USA
Cristina Risco, PhD (she/her)Department of Psychology, Universityof Maryland College Park, Baltimore,MD 21250, USA
Carlos A. Risco, DVM, ACT (he/him)Dean College of Veterinary Medicine,Oklahoma State University Stillwater OK74075, USA
Elizabeth Strand, MSSW, PhD (she/her)Director, Veterinary Social Work, University ofTennessee College of Veterinary Medicine, 2407River Drive, Knoxville, TN 37996, USA
Ewan Wolff, DVM, ACVIM (they/them)Blue Pearl Specialty + Emergency Pet Hospital,2030 NE 42nd Ave., Portland, OR 97213, USA
Chesney Ward (she/her)University of Tennessee College of VeterinaryMedicine, 2407 River Drive, Knoxville, TN37996, USA
Melody Martínez, CVT (she/her)Acorde Consulting P.O. Box 1742, Silverdale,WA 98383, USA
Dane Whitaker, DVM, MPVM (he/him)PrideVMC, 584 Castro Street, #492, SanFrancisco, CA 94114, USA
Indya Woods, DVM (she/her)Cy‐Fair Animal Hospital, 12725 Louetta Road,Cypress, TX 77429, USA
Preface
At the age of 8, I announced to my parents that I was going to become a veterinarian. Together, my parents and siblings could never have imagined the path that veterinary medicine would set our family on. We have owned countless German Shepherds and African cichlids. We have driven cross country with snakes in pillowcases and feeder mice in habitats. We have taken African safaris, air‐boated along alligator farms, and visited zoos domestically and internationally, all in pursuit of experiencing veterinary medicine.
As a child, I had the great fortune of seeing a lot of different professions. I saw pediatricians, obstetricians, gynecologists, dentists, postal carriers, pharmacists, home builders, HVAC specialists, restaurateurs, attorneys, and teachers. However, when I saw Dr. Larry Wallace vaccinating my family's German Shepherds, I saw my future. I could have never imagined my future would hold the pages you are now reading.
In order to tell you how this book came about, let us go back and see how veterinary medicine started in the United States and where we are as a profession right now.
Lyon, France, is the official birthplace of veterinary medicine, opening the first veterinary school in 1761. In the United States in 1776, George Washington issued an order that each newly formed regiment in the Revolutionary War include a farrier knowledgeable in horse care to look after the cavalry horses. Farriers were not credentialed veterinary caregivers but provided necessary animal care for these working horses. This was the foundation of the eventual creation of the US Army Veterinary Corps.
During the Civil War, the Union Army recognized the need for a formal veterinary service. The Confederate Army conversely relied on each soldier to care for their own horse during the Civil War. President Abraham Lincoln established the US Department of Agriculture on May 15, 1862, under the Department of Agriculture Act (Michigan State University CVM 2019).
Lincoln also signed into law the Morrill Act, which established the first group of Land Grant Institutions, in 1862 (NIFA). The Morrill Act set in motion a set of policies designed to harness the power of education to positively impact agriculture and rural America. Lincoln remarked that “…no other human occupation opens so wide a field for the profitable and agreeable combination of labor with cultivated thought, as agriculture.” The first Morrill Land Grant College Act granted 30,000 acres of land for each senator and representative. The first Morrill Act led to the construction of agricultural and mechanical schools (known also as land grant institutions, or LGIs). Significant portions of the goal of the Morrill Act were stymied when Confederate land grant institutions refused to integrate. Thus, the second Morrill Act was signed 28 years later in 1890, which granted money instead of land to Historically Black Colleges and Universities (HBCUs) as LGIs to begin to receive federal funds to support teaching, research, and extension intended to serve underserved communities of African Americans and other minorities who were prevented from attending many of the 1862 LGIs (Lawrence 2022; McMillan 2012). Without the granting of land, the 1890 institutions faced significant hurdles in building teaching institutions on par with the 1862 institutions.
Later, veterinarians made a significant professional contribution to the 1906 Federal Meat Inspection Act, which was signed into law by President Theodore Roosevelt. This law requires pre‐ and postmortem inspection of livestock and authorizes the US Department of Agriculture to monitor and inspect slaughter and processing operations. Sanitary standards for slaughterhouses and meat‐processing plants were also established in 1906. In 1916, as the United States was preparing to enter World War I, President Woodrow Wilson and Congress passed the National Defense Act of 1916, including the creation of the Veterinary Corps of the US Army.
As the number of horses in use for transportation and farming began to decline, two British government reports in 1938 and 1944 suggested that veterinarians should specialize in the treatment of farm animals. In 1958, veterinarians would again contribute to significant legislation, the Humane Methods of Slaughter Act. This Act ensures that animals are sedated and completely insensible to pain just prior to slaughter. Inspectors of the USDA Food Safety and Inspection Service at slaughtering plants ensure that these guidelines are met. There are approximately 1200 veterinarians employed in public practice at the USDA. Veterinarians are heavily involved in ensuring that meat, egg, and poultry producers comply with sanitation standards.
Small animal practice as a business may be attributable to one woman, Marla Dickin and her companion animal charity, the People's Dispensary for Sick Animals of the Poor (PDSA), created in the United Kingdom (UK) in 1917. Four sentences encapsulated the PDSA value proposition: “Bring your sick animals: Do not let them suffer! All animals treated. All treatments free.” The people who worked at PDSA clinics had no veterinary training. The people who took their animals to PDSA would not have been able to afford a professionally trained veterinarian. Nevertheless, the veterinary community frowned upon the PDSA. G.H. Livesey, a prominent veterinarian of the time, referred to people involved in animal welfare as “cranks” and said, “All of us who have had experience in dog practice know that there are ladies (generally childless) who have to turn their attention to something, and nearly always they turn to dogs.” By 1927, PDSA treated 410,000 animals annually. These patient numbers indicated the possibility for dog and cat medicine to be enough to support a business.
In 1926, when Sarah Martha Grove Hardy left PDSA £50,000, the Royal College of Veterinary Surgeons tried to claim some of the funds. This claim was rejected, and with that infusion of cash the PDSA flourished. As time went on, veterinarians did go on to provide professional services for PDSA. As a matter of fact, PDSA is still in existence today, serving 2.3 million animals annually in the United Kingdom (Todd 2017). In the United States, Daniel Salmon was the first veterinarian to earn a doctorate in 1876 and went on to lead the Department of Agriculture's Bureau of Animal Industry. One of Dr. Salmon's first accomplishments was to eradicate bovine pleuropneumonia (National Agricultural Library n.d.).
In the US, 1903 saw the first female veterinarian enter the profession, graduating from McKillip Veterinary College in Chicago. In 1910, Elinor McGrath graduated from the Chicago Veterinary College and Florence Kimball graduated from Cornell University College of Veterinary Medicine. Both of these women would go on to become small animal veterinarians (Wuest 2019).
Through the types of practice, public vs. private, and the animal types we focus on (exotic, avian, small, mixed, large, food animal or zoo), no two days for no two veterinarians look exactly alike. We excel in the diversities of our practice type, location, and lived experience of veterinary caregivers. Ethnic, cultural, and racial diversity, on the other hand, have long been a challenge for our profession.
In late 2019 and early 2020, as we were in the midst of the global COVID‐19 pandemic and social unrest, I was forced into increased interest in diversity, equity, and inclusion (DEI) within veterinary medicine. As images of George Floyd, Breonna Taylor, and Ahmaud Arbery were seen internationally, many of my White veterinary colleagues began calling me to talk. I was so personally traumatized by the events that I initially refused to take any of those calls. I thought I had nothing to say. It turns out I was wrong about that; I had a lot to say. I realized that I had influence in the veterinary space and a responsibility to leverage that influence. I penned a letter to the American Veterinary Medical Association (AVMA) questioning an online pledge to reaffirm the AVMA's commitment to DEI. As a member in good standing with decades of membership dues paid, I was unaware that the AVMA had such a written statement of DEI support. I also saw no commitment in action on the AVMA's part to advancing DEI. That letter, along with the AVMA's response to my letter, led to me joining the AAVMC/AVMA Joint Commission for a Diverse, Equitable and Inclusive Veterinary Profession in 2020. The Commission's Strategic Recommendations were released on October 28, 2021 (AVMA 2022).
I began to develop the concept for this book during my time on the Commission. Many books and articles have been written about DEI in veterinary medicine (e.g. Kornegay 2011). Dr. Lisa Greenhill has had significant contributions in this area and continues to provide evidenced‐based thought leadership in her role as Chief Diversity Officer at the American Association of Veterinary Medical Colleges (AAVMC) (Greenhill et al. 2013). At the Purdue University College of Veterinary Medicine, Dean Willie Reed (San Miguel et al. 2014) championed DEI in veterinary medicine for years and worked closely with Dr. Latonia Craig, who is now Chief Diversity Officer at the AVMA. The Ohio State University College of Veterinary Medicine is also making significant contributions to DEI in veterinary medicine (Burkhard et al. 2022; College of Veterinary Medicine 2019).
The concept of this book is an A–Z guide of terms that relate to diversity, equity, and inclusion. Each chapter can stand on its own, but when taken together these chapters are designed to advance the understanding of DEI terms and appreciation of DEI in the veterinary medical profession.
Each chapter will start with “what.” We define the term or phrase, and then detail the “so what” – why this term or phrase is important to vet med. Each chapter is designed to include “now what” practical examples of how to apply learnings from the chapter in veterinary workplaces. The workplaces will be diverse and include academia, companion animal practice, zoo medicine, and food animal medicine. Additionally, authors from inside and outside of veterinary medicine have contributed to this book. The contributions of academicians, DEI experts, veterinarians, veterinary students, social workers, lawyers, agricultural economists, veterinary technicians, and veterinary practice managers are reflected in this book.
I have chosen individuals who have a mix of credentialed and lived experiences to write these chapters. Chapters conclude with a focus on the “now what,” applying these terms and concepts to veterinary workplaces. These chapters are also designed to be read and incorporated during individual and group learnings. Each author has given of their time and talent in contributing to these chapters to add to the vibrancy and richness of the profession of veterinary medicine.
As we conclude this book preface in anticipation of reading the chapters within, I will leave you with our professional North Star, the Veterinarian's Oath. The Veterinarian's Oath is remarkably similar to the Veterinary Technician's Oath. The earliest version of the Veterinarian's Oath was adopted by the AVMA House of Delegates in 1954, revised in 1969, and revised a second time in 1999 (Nolen 2010.) The Veterinarian's Oath reads as follows:
Being admitted to the profession of veterinary medicine, I solemnly swear to use my scientific knowledge and skills for the benefit of society through the protection of animal health and welfare, the prevention and relief of animal suffering, the conservation of animal resources, the promotion of public health, and the advancement of medical knowledge. I will practice my profession conscientiously, with dignity and in keeping with the principles of veterinary medical ethics. I accept as a lifelong obligation the continual improvement of my professional knowledge and competence.
Reading the Veterinarian's Oath even now as I type the preface of a work that I have been curating for the better part of a year with my co‐authors, I am personally anchored by the significance of the Oath. This Oath is usually taken on the day of graduation from vet school, so when oath‐takers read the first eight words, it is in both a celebratory and a sobering setting. According to the Encyclopedia of Business and Professional Ethics, professional oaths go back at least as far as Hippocrates (c. 400 BCE). The binding force and moral weight of a professional oath is generally larger than those made of mere promises. Professional oaths, when carefully designed, may foster professionalism, facilitate moral deliberation, and enhance compliance with professional standards. The Veterinarian's Oath and Veterinary Technician's Oath are bedrocks of the profession and do accomplish the purpose of facilitating moral deliberation.
When we solemnly swear, we make an Oath to use our scientific knowledge and skills for the Oath's first beneficiary, society. Yes, veterinarians and veterinary technicians take an oath to first benefit society, the other human beings we exist with on planet Earth. We are to benefit society by protecting animal health and welfare, preventing and relieving animal suffering and conserving animal resources. We again affirm utilization of our knowledge and skills for the promotion of public health and the advancement of medical knowledge. We swear to practice our profession conscientiously, being very much aware of and in agreement with our Oath. We agree to lead professional lives where we practice with dignity and in keeping with the principles of veterinary medical ethics. We swear on the first day of being a veterinarian to a lifelong obligation of continual improvement of our professional knowledge and competence.
Therefore, in furtherance of our professional knowledge and competence, this book is offered to the veterinary profession with hopes of bolstering our professional knowledge and competence as it relates to diversity, equity, and inclusion. This book is designed to offer new insight on familiar terms. This book also explores terms that, though often not traditionally associated with DEI, are intrinsically tied to an advanced understanding of DEI.
My hope for those who read all or portions of this book is that you will use this information to begin dialogues and further discussions in your places of learning, work and community. This text is offered to the profession as a means to encourage us all toward continual improvement of veterinary knowledge and competence. I will live my life being the one thing I dreamt of as a small child. I hope future generations are also able to experience both the art and the science of veterinary medicine in fulfilling lifetime commitments to this esteemed profession.
REFERENCES
AVMA (2022). Strategic recommendations. Commission for a Diverse, Equitable and Inclusive Veterinary Profession. (approved October 28).
https://www.avma.org/sites/default/files/2022‐07/mcm‐dei‐strategic‐recommendations‐v1‐0710‐2022.pdf
Greenhill, L.M., Davis, K.C., Lowrie, P.M. et al. (2013).
Navigating Diversity and Inclusion in Veterinary Medicine
. Purdue University Press.
San Miguel, S.F., Reed, W.M., Davis, K.C. et al. (2014). Human‐centered veterinary medicine.
Journal of the American Veterinary Medical Association
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(4): 374–375.
Burkhard, M.J., Dawkins, S., Knoblaugh, S.E. et al. (2022). Supporting diversity, equity, inclusion, and belonging to strengthen and position the veterinary profession for service, sustainability, excellence, and impact.
Journal of the American Veterinary Medical Association
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Kornegay, L.M. (2011). A business case for diversity and inclusion: why it is important for veterinarians to embrace our changing communities.
JAVMA
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Lawrence, M. (2022). Celebrating the Second Morrill Act of 1890. USDA (August 30).
https://www.nifa.usda.gov/about‐nifa/blogs/celebrating‐second‐morrill‐act‐1890
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National Agricultural Library USDA (n.d.) Daniel E. Salmon.
https://www.nal.usda.gov/exhibits/speccoll/exhibits/show/parasitic‐diseases‐with‐econom/item/8203
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McMillan, R. (2012). On its 150th anniversary, USDA upholds Abraham Lincoln's vision. USDA (May 15).
https://www.usda.gov/media/blog/2012/05/15/its‐150th‐anniversary‐usda‐upholds‐abraham‐lincolns‐vision
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Nolen, R.S. (2010). Veterinarian's Oath revised to emphasize animal welfare commitment. Prevention of animal suffering is also a key addition.
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Todd, Z. (2017). The surprising history of veterinary medicine for dogs and cats.
Pacific Standard
(June 14):
https://psmag.com/social‐justice/the‐surprising‐history‐of‐veterinary‐medicine‐for‐dogs‐and‐cats
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College of Veterinary Medicine (2019). Veterinary medicine in the US: War drives creation of veterinary schools. Michigan State University (April 12).
https://cvm.msu.edu/vetschool‐tails/veterinary‐medicine‐in‐the‐usa‐war‐drives‐creation‐of‐veterinary‐schools
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Wuest, P. (2019). The history of women in veterinary medicine in the U.S.
Today's Veterinary Practice
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https://todaysveterinarypractice.com/news/the‐history‐of‐women‐in‐veterinary‐medicine‐in‐the‐u‐s/
.
CHAPTER AAccess to Veterinary Care: A Gateway to Family Health and Social Equity
Michael J. Blackwell (he/him)
Assistant Surgeon G, USPHS (Ret.), Director, Program for Pet Health Equity, Center for Behavioral Health Research, University of Tennessee, Knoxville, TN 37996, USA
INTRODUCTION
Understanding access to veterinary care, as discussed in this chapter, requires a broader view: it's about “bonded families” and their integral relationships with pets. Figure A.1, from the Veterinary Care Accessibility Project (VCAP) (Veterinary Care Accessibility Project 2024), shows you one aspect of this topic, the number of veterinary employees per 1000 pets in a given geographic area. Light purple or gray areas have the fewest veterinary care providers; dark purple or gray areas have the highest concentrations of veterinary care providers. Once you finish the chapter, you will see, however, that there are far greater barriers to veterinary care than simply the number of veterinary care providers in a geographic region.
FIGURE A.1
In many households, pets are cherished family members, contributing significantly to the family’s overall health and well‐being. These are bonded families. According to United For Alice, these barriers often reflect the socio‐economic challenges of bonded families, particularly asset‐limited, income‐constrained and employed (ALICE) commonly known as the working poor.
Racial and ethnic disparities in healthcare, as highlighted in the National Healthcare Quality and Disparities Report from the Agency for Healthcare Research and Quality (2022), mirror similar issues in veterinary medicine. These disparities are not just statistics; they represent real struggles for millions of bonded families. These challenges range from financial constraints and geographic inaccessibility of veterinary services to a lack of awareness about available resources. The consequences extend beyond the immediate suffering of the pets. Families face emotional distress, veterinary professionals grapple with ethical dilemmas, and public health risks, such as uncontrolled zoonotic diseases, rise.
This crisis is not just a veterinary issue; it is a societal one deeply rooted in social justice. The veterinary profession must advocate for systemic changes, embracing an inclusive approach to veterinary care that underscores the importance of diversity in serving a diverse society. A One Health response involving collective action and systemic changes is imperative. For more information on this topic, see the “O” chapter of this text. By leading this movement, veterinary professionals can bridge the gap in care, ensuring every pet receives the attention they deserve.
The World Health Organization Constitution defines health as “a state of complete physical, mental, and social well‐being and not merely the absence of disease or infirmity” (WHO 2024). Enjoying the highest attainable health standard is one of every human's fundamental rights without distinction of race, religion, political belief, economic, or social condition. Today's family health is intertwined with the health of their pets, making access to veterinary care a pivotal aspect of overall family wellness.
Healthcare professionals, including those in veterinary medicine, play a critical role in addressing social determinants of health (SDOH), the conditions in which people are born, grow, live, work, and age that shape their health. These factors, detailed by the Healthy People 2030 report (n.d.), significantly influence health outcomes and contribute to health disparities. Tackling SDOH paves the way for health equity, attaining the highest health level for all, irrespective of socioeconomic or demographic differences. Achieving health equity involves several fundamental principles:
Equal health opportunities for all, eliminating barriers like poverty and discrimination.
Inclusive participation in health decision‐making across all societal levels.
Addressing the root causes of health outcome disparities.
Culturally competent healthcare professionals who respect and integrate diverse community values and needs. (For more information on this topic, see the “C” chapter of this text.)
Community engagement in health problem‐solving.
Systemic changes across healthcare, education, and economic systems, including policy reforms for equitable resource distribution. (Additional information on systemic issues is found in the “S” chapter of this text.)
Health equity goes beyond equal healthcare access; it's about fostering a society where everyone has the resources and opportunities to reach their fullest health potential. Ensuring equal opportunity requires a collective effort across healthcare, education, economics, community involvement, and more. Health equity for families cannot be achieved without the health equity of their pets.
ACCESS TO VETERINARY CARE: A FAMILY AND COMMUNITY AFFAIR
Access to veterinary care is innately a diversity, equity, and inclusion (DEI) matter that starts with acceptance that all who wish to receive veterinary care for their animals should be able to do so – that is, inclusion. To ensure inclusion, we must understand why inclusion is important: to achieve health equity – that is, fair and just access to essential services. To achieve health equity, we must use diverse care delivery methods in sync with the diverse society we serve. We must understand that the barriers to veterinary care are primarily associated with human realities. Therefore, solutions need to be heavily weighted toward meeting the needs of humans.
As veterinary professionals, we understand that access to veterinary care is more than a service; it is a lifeline connecting families to their beloved pets' health and well‐being. Imagine a scenario where a family's cherished dog, Max, begins to show signs of illness. Without access to veterinary care, the family is left to watch, helpless and anxious, as Max's condition worsens, the joy and laughter he once brought to their home diminishing by the day. Max's health is impacted, and this deteriorating situation casts a shadow of distress and worry over the entire family.
Contrast this with a family who has ready access to veterinary services. When Max shows the first sign of illness, the family can consult their trusted veterinarian. Prompt medical attention not only puts Max on the path to recovery but also reassures the family, preserving harmony and happiness in their home. In this context, access to veterinary care transcends its primary function, becoming a crucial component in safeguarding the emotional and physical well‐being of the entire family unit. It is a testament to our profession's profound impact on the lives of those we serve, emphasizing the need for accessible, compassionate, and comprehensive veterinary care for every bonded family.
According to the Agency for Healthcare Research and Quality (2023), access to healthcare consists of seven key components:
Availability:
Having a local vet is like having a reliable friend in the neighborhood. Just as you'd want a doctor nearby for your family, the same goes for veterinary services for our nonhuman family members.
Affordability:
Imagine if every family could provide for their pet's health without breaking the bank. Veterinary care should not be a luxury but a reachable goal for all, regardless of their wallet size.
Accessibility:
This is about bridging the gap – ensuring that no matter where a family lives, they can reach veterinary care without a hassle.
Acceptability:
Just as every family is unique, so are their needs. Veterinary care should respect and adapt to different families' diverse beliefs and values.
Accommodation:
No family should feel left out. Inclusive care means considering the unique needs of all families, especially those who might otherwise slip through the cracks.
Awareness:
Knowledge is power. Families empowered with information about pet care can make better decisions for their companions.
Health information systems:
Think of this as the backbone that supports everything else, ensuring every decision for a pet's health is informed and timely.
Improving access to veterinary care requires a systems approach. An ideal healthcare system in the context of veterinary medicine is distinct in several ways from human healthcare but still has four essential features:
Coverage:
Unlike human healthcare, where insurance plays a significant role, pet health insurance is only used in about 3% of transactions at veterinary service providers according to the North American Pet Health Insurance Association (
2024
). This stark difference means most families rely on limited or no financial assistance for their pet's healthcare costs. This reality underscores the importance of veterinary professionals being aware of and sensitive to many pet families' financial constraints.
Services:
Veterinary services span a broad spectrum, from wellness and preventive care to acute, injury, and emergency critical care. This spectrum requires a flexible approach, especially when dealing with families that may be unable or unwilling to pay for all medically recommended treatments. Here, an incremental care approach becomes vital, allowing for the management of patients based on what the family can afford while still providing the best possible care.
Incremental Veterinary Care
(IVC) is a compassionate, pragmatic strategy that aligns veterinary care with the economic realities of the patient's family. Treatment options that are staged and flexible reduce the instances of economic euthanasia, ensuring that pets receive the necessary care while respecting the financial limitations of their family. This approach saves lives and upholds bonded families' dignity and emotional well‐being, reinforcing the human–animal bond at the heart of veterinary practice.
Timeliness:
A structured system of identified service providers and partners helps achieve timeliness in veterinary care. This system uses technology to reduce wait times for veterinary consultations and treatments. It's about ensuring that pets get the care they need when needed, without unnecessary delays that can worsen their condition or cause additional stress to the family.
Workforce:
A comprehensive One Health system extends beyond the traditional veterinary care team. It includes professionals like social workers who attend to the human needs that veterinary service providers may encounter. Recognizing that families struggling to afford veterinary care often face other challenges, such as food and housing insecurity, the system aims to support families holistically. This approach requires policies and procedures that reflect the ecosystem in which these families exist, ensuring that both the pet's and the family's needs are addressed in a coordinated manner.
In this One Health system, the veterinary professional's role is not just about treating the patient but also about understanding and responding to the broader context of the family's situation. It's a shift from a purely medical model to a more integrated approach, where the pet's health is considered part of the family's overall well‐being. This paradigm shift is crucial for veterinary professionals to embrace as we strive to provide comprehensive, compassionate, and accessible care.
The Access to Veterinary Care Coalition's (AVCC) 2018 national study found that more than one in four (28%) US families did not receive veterinary care during the previous two years, primarily because they could not afford it. The United States Department of Agriculture (USDA) preliminary reports state that in September 2023, 22,183,757 households participated in the Supplemental Nutrition Assistance Program (SNAP) (USDA 2024). Using the national average of 66% of households, having an average of 1.6 dogs or cats per household, it is estimated that there may be 23,426,047 dogs and cats living in SNAP households (American Pet Products Association 2023; and American Veterinary Medical Association 2022). The lack of access to veterinary care is the greatest threat to the health and well‐being of pets with loving families. The AVCC made five recommendations to address access to veterinary care (AVCC 2018):
Improve veterinary care delivery systems to serve all socioeconomic groups.
Provide IVC to avoid nontreatment.
Improve the availability of valid and reliable information to educate families with pets.
Develop public policies that improve access to veterinary care and pet retention.
Continue researching how to improve access to veterinary care.
Some suggest that a pet is a luxury, and those who cannot afford veterinary care should not have one. However, families often refer to their pets using terms of endearment, not luxury. There is an emotional bond. The costs of veterinary services are beyond what most low‐income families can pay out of pocket, and they face limited availability of loans or credit. Many middle‐class families also struggle to access veterinary care. Data from the Pew Research Center shows that only 47% of middle‐income adults in the United States report having enough savings to support them for at least three months (Parker et al. 2020). Most of us depend on assistance to receive healthcare through private or public insurance and other financial assistance programs. As the costs of veterinary care continue to increase, more families need financial assistance. Consequently, improving access to veterinary care for all bonded families requires new public policies that address the primary barrier families face, which is economic.
SOCIAL RESPONSIBILITY OF HEALTHCARE PROFESSIONS
Veterinary professionals are driven by a deep sense of compassion and a commitment to the well‐being of their patients. Yet, the realities of veterinary practice often narrow the focus to immediate patient care, leaving little room to contemplate the broader societal impact of their work. The AVMA Veterinarian's Oath (n.d.) has a pledge to “use my scientific knowledge and skills for the benefit of society,” which speaks to the care of animals and a larger societal responsibility. This oath does not discriminate; it encompasses all segments of society, privileged and underprivileged alike. It calls on veterinary professionals to see beyond their clinics' walls and consider their work's broader implications. As stewards of animal health and welfare, veterinarians are uniquely positioned to influence and improve the lives of animals and the people and communities connected to them. This broader context is essential in understanding the full scope of the social responsibility that rests on the shoulders of those in veterinary practice.
Historically, a strong correlation existed between employment and financial stability. Employment was often synonymous with a guaranteed ability to afford basic living expenses, including healthcare and other essential services. Post–World War II, the booming economy, the growth of the middle class, and the establishment of social safety nets reflected this correlation. Economic growth generally translated into improved living standards for most employed individuals. However, several changes are leading to the current rise of the ALICE population:
Wage stagnation:
Over the past few decades, wages for middle and lower‐income earners have largely stagnated when adjusted for inflation. Wages have not kept pace with the rising cost of living, making it difficult for many employed individuals to afford basic necessities.
Job market:
There has been a shift in the job market with a growth in service‐oriented and part‐time jobs, which often pay lower wages and offer fewer benefits compared to the full‐time, benefit‐rich jobs that were more prevalent in the mid‐twentieth century.
Cost of living:
The cost of living, including housing, education, healthcare, and other essential services, has risen significantly. This increase has outpaced income growth for many workers, placing a strain on their financial resources.
Family dynamics:
Changes in family structures, such as an increase in single‐parent households, have also contributed to financial strain, as single‐income families may struggle to cover all expenses.
Economic shocks:
Events such as the 2008 financial crisis and the more recent economic impacts of the COVID‐19 pandemic have disproportionately affected lower‐income earners, exacerbating financial instability for many families.
These societal changes have significantly impacted the landscape of veterinary medicine, highlighting disparities in health access and shifting attitudes toward pets. The rise of the ALICE population is a significant socioeconomic trend with profound implications for the veterinary medicine industry. In the United States, most of the underserved are not indigent, although this is an important subgroup. Most underserved families are ALICE. They are members of the essential workforce, including cashiers, servers, registered nurses, customer service representatives, and childcare providers, among others. These essential workers might earn just above the Federal Poverty Level but less than what it costs to make ends meet. There are several implications for veterinary medicine:
As the ALICE population grows, there is an increased demand for affordable care.
Veterinary practices may need to adapt their service models to meet the needs of the ALICE population, for example, by offering a range of options from basic to comprehensive care, sliding scale fees, or alternative payment plans to make veterinary services more accessible.
There is a potential shift toward preventive and incremental care models. Preventive care can be more cost‐effective in the long run, and incremental care allows for treatment plans that align with what the family can afford without compromising the pet's health.
Veterinary professionals might spend more time in community education and outreach, helping bonded families understand the importance of preventive care and how to care for their pets on limited budgets.
Partnerships and collaborations with animal welfare organizations, nonprofits, and other community resources could become more critical. These collaborations can help provide subsidized care or direct families to resources to assist with pet care expenses.
The rise in the ALICE population may also impact the mental health of veterinary professionals. Veterinary care teams often face emotional stress from treating pets whose families cannot afford care, leading to difficult decisions like economic euthanasia.
There may be an increased need for advocacy for policies that support affordable veterinary care, such as public funding, subsidies, or insurance options tailored for the ALICE population.
The rise of the ALICE population presents challenges and opportunities for the veterinary medicine industry. This shift necessitates a reevaluation of how veterinary services are structured and delivered. It calls for reevaluating traditional service models and an increased focus on accessibility and affordability. Veterinarians are increasingly required to balance the ethical aspects of patient care with the economic realities of their clients, adapting their practices to meet the needs of a more economically diverse clientele. By adapting to these changing socioeconomic realities, veterinary professionals can continue to provide essential care to a broader population segment, ensuring that the bond between pets and their families is nurtured regardless of economic status.
The Racial and Ethnic Diversity Index (REDI) from the US Census Bureau (2021) is a measure used to assess the diversity of a population based on race and ethnicity. It indicates how likely it is that two people chosen randomly from a given area will be of different races or ethnicities. The REDI increased to 61.1% in 2020, reflecting a more diverse population. In the context of the veterinary profession, which is more than 90% White according to the US Bureau of Labor Statistics (2024), the rising diversity in society, particularly the increase in Black, Indigenous, and People of Color (BIPOC) populations, presents both challenges and opportunities. Challenges for a predominantly White veterinary profession include:
Cultural competency:
One of the primary challenges is ensuring cultural competency among veterinary professionals. Cultural competency involves understanding and respecting the diverse cultural perspectives and practices of BIPOC bonded families, which can influence their decisions regarding pet care. For more information on this topic, see the “C” chapter of this text.
Communication barriers:
Effective communication that respects cultural nuances is crucial. Misunderstandings or miscommunications can arise from cultural norms, beliefs, or language differences, potentially impacting the quality of care.
Trust and relatability:
Building trust can be more challenging if bonded families feel their cultural background is not understood or respected. Relatability is vital in establishing a comfortable environment for BIPOC clients.
Economic disparities:
Considering that BIPOC populations are disproportionately poor compared to White families, veterinary professionals need to be mindful of the financial challenges faced by these clients when it comes to accessing veterinary care.
The increasing racial and ethnic diversity in society, as reflected by the REDI, poses unique challenges to the predominantly White veterinary profession, particularly in terms of cultural competency, communication, and addressing economic disparities. The profession must adapt and evolve, embracing diversity within its ranks and working toward more inclusive and accessible care models to provide effective and equitable care. This adaptation is a professional imperative and a societal responsibility, aligning with healthcare's broader goals of equity and justice.
Our healthcare landscape is characterized by a notable fragmentation, where veterinary medicine stands mostly disconnected from the broader human healthcare system. This separation represents a missed opportunity for a more integrated approach to health and poses a significant barrier to achieving a truly healthy society. The lack of interconnectedness means that pets' health, so crucial to their human families' emotional and physical well‐being, often goes unaddressed in the larger family health discourse. This oversight undermines the holistic understanding of health, which recognizes the profound One Health interplay between human, animal, and environmental well‐being. Living with pets saves the US healthcare system $22.7 billion annually, according to a 2023 report commissioned by the Human Animal Bond Research Institute (HABRI). By failing to integrate veterinary medicine into the overall healthcare framework, we miss critical insights and opportunities for preventive health, early detection of zoonotic diseases, and fostering a comprehensive, One Health approach essential for a truly healthy society.
In the realm of family healthcare, we need a holistic, inclusive approach that sees the health of each family member, including pets, as interconnected. This approach brings a new dimension to healthcare, one where veterinary medicine is integrated into the broader family healthcare system. The emerging field of Veterinary Social Work (VSW) is rapidly becoming indispensable in comprehensive healthcare, bridging the gap between animal welfare, human health, and broader societal factors. This integration is a response to increasingly recognizing the complex interplay between these domains.
VSW specializes in addressing the human elements within veterinary medicine to consider the emotional, psychological, and social impacts of animals on humans and vice versa. This field is crucial in several key areas:
Grief and loss support:
VSW provides support to individuals and families dealing with the grief of losing a pet, recognizing this as a significant emotional event akin to the loss of a human family member.
Animal‐assisted interventions:
VSW professionals are involved in therapeutic interventions where animals play a central role, acknowledging the profound impact that animals can have on human mental health and well‐being.
Human–animal bond:
VSW helps understand and nurture the human–animal bond, which is crucial for bonded families' mental and emotional health and plays a role in treatment plans for humans and animals.
Crisis intervention and conflict resolution:
VSW is essential in crises involving animals, such as cases of animal abuse, where human social issues intersect with animal welfare.
Educational and advocacy roles:
VSW professionals educate communities about the importance of animal welfare and advocate for policies that benefit human and animal health, reflecting a One Health perspective.
Addressing socioeconomic barriers:
VSW also addresses the socioeconomic barriers families face in accessing veterinary care, working to find solutions sensitive to their financial constraints.
As we move toward a more integrated understanding of health, the role of VSW is becoming increasingly vital. VSW professionals are enhancing how we care for animals and enriching our understanding of the human condition, leading to a more compassionate and comprehensive approach to health and well‐being in our society.
ACTION STEPS: BUILDING A ONE HEALTH INTERPROFESSIONAL SYSTEM
Building on our understanding of the diverse needs and challenges faced by today's society, including the rise of the ALICE population and the increasing racial and ethnic diversity, it's clear that action is imperative in the veterinary field. The responsibility to adapt and evolve in response to these socioeconomic and demographic shifts falls not just on the industry but on each veterinary service provider and care team member. This section is designed to turn insight into action, offering practical, immediately implementable steps to make a real difference in providing equitable, compassionate care. These steps are more than just guidelines; they are the building blocks for a more inclusive and responsive veterinary practice where every team member can play a part in bridging gaps, enhancing understanding, and ensuring that all members of our society, regardless of their economic status or cultural background, have access to the veterinary care they need and deserve. Let’s embrace these actions with positivity and commitment, recognizing that each small step contributes to a larger, more impactful journey toward a genuinely inclusive veterinary practice.
Actionable steps that veterinary service providers and individual care team members can take to address the challenges discussed:
Sliding scale fees:
Implement a system of sliding scale fees based on income, making veterinary care more affordable for families in the ALICE population.
Community partnerships:
Form partnerships with local animal welfare organizations, nonprofits, and community groups to provide subsidized care or direct families to resources for financial assistance.
Cultural competency training:
Regularly participate in cultural competency training to better understand and effectively communicate with clients from diverse racial and ethnic backgrounds.
Flexible payment options:
Offer flexible payment options such as installment plans, which can help make veterinary care more accessible to families facing financial constraints.
Telehealth services:
