HealthDay News -- With the vast majority of the nation's attention being centered on the election of Barack Obama as the 44th U.S. President Nov. 4, some important statewide ballot referendums might not have received the attention they merited -- especially in terms of what they eventually might mean for practices and procedures beyond state boundaries.

Such was the case in Nebraska and Colorado, both of which had ballot initiatives on what role affirmative action should play in government hiring.

Voters in Nebraska approved a ballot initiative that banned the state's public agencies from considering race, sex, color, ethnicity or national origin when recruiting students or hiring workers. Colorado voters rejected a similar referendum.

The Nebraska outcome troubles health leaders who believe affirmative action is an important tool in achieving diversity in the healthcare workforce.

The Nebraska vote is "an indication of the need for our country to have more meaningful conversations about the implications of our history and the implications of our growing diversity," said Dr. Gail C. Christopher, vice president for health programs at the W. K. Kellogg Foundation in Battle Creek, Mich.

"Clearly, we are dealing with continued, less-than-adequate levels of people of color in the health professions, and the situation is not improving," she said.

By a vote of 52 to 48 percent, Nebraska joined California, Washington and Michigan, which previously banned affirmative action policies. However, a similar ballot initiative in Colorado this November was voted down, 51 to 49 percent.

Despite the changing complexion of America, blacks and Hispanics remain vastly underrepresented in the U.S. health professions workforce, and that lack of diversity among health professionals bodes ill for the health of the population, says Health Professions for Diversity, a broad-based health coalition whose members include the American College of Physicians.

Numerous studies have revealed shocking disparities in the quality of care that minorities receive compared with whites, even after controlling for other factors, such as insurance status and income. Increasing workforce diversity would not only access to care for underserved patients but enhance the quality of education of all health professionals, the coalition said.

Race-conscious admissions to public institutions first came under attack in the mid-1990s. California voters approved a ballot initiative in 1996 that scrapped affirmative action by the state's public institutions. Washington followed in 1998, then Michigan in 2006.

The effect of these actions on medical school diversity is difficult to determine, according to the Association of American Medical Colleges (AAMC). But in a recent analysis, the AAMC cites some troubling statistics.

From 1997 to 2007, an average of 171 minority applicants were offered acceptance to state medical schools. That's down 62 minority acceptances from the peak in 1993.

Meantime, minority group Californians studying at state medical schools account for a declining percentage of all med students in the state.

"This may be especially detrimental to efforts to diversify California's workforce, where in 2008 only 5 percent of physicians are Latino and 3 percent are African American," the AAMC noted.

The need to address racial disparities in medicine got a nod this past summer when the American Medical Association issued a formal apology for discriminatory practices that excluded black doctors from participating in the group. But the medical profession can do more, Christopher said.

"We do that by, certainly, encouraging a pipeline that brings more qualified people into the profession who reflect the diversity of the nation" and by providing continuing education that equips health professionals to overcome stereotypical perceptions, she said.